I’m thrilled that my second book, Teenagers: The Evidence Base, will be published by
@_SwiftPress
on 30 January.
You can pre-order it (which apparently matters for later sales) here:
You can also buy Evidence-Based Parenting here:
A 🧵 on unintended consequences of mental health interventions, and why some school and workplace schemes may be contributing to the problem they were designed to solve. 1/10
A short🧵on the implications of the
#CassReview
for research. One extraordinary finding among many: it was not possible to assess long-term outcomes of treatment pathways because NHS gender clinics would not co-operate. 1/7
I have two papers out today for
@SexMattersOrg
. The first is a technical paper on the placebo effect. The (limited) data shows that puberty blockers and hormone treatment have no more effect on teenagers’ mental health than taking a placebo pill 🧵 [1/16]
TLDR:
1. Interventions aiming to boost mental health aren’t necessarily positive or even neutral, and need careful planning to avoid negative impacts.
2. Doing nothing is sometimes better than doing something.
/Ends
#edutwitter
New research is published today by
@SexMattersOrg
, written by me and
@stellaomalley3
. It’s the first of a 3-part series for parents looking at the research on gender identity in teenagers.🧵 1/12
.
@drlucyfoulkes
&
@drjackandrews
have a well-argued theory: bringing attention to mental health makes some people think normal feelings of distress are actually mental health problems. This increases their symptoms, exacerbating the issue. 2/10
The new draft of the Brighton & Hove Trans Inclusion Schools Toolkit has just been published by
@BrightonHoveCC
. It doesn’t yet seem to have considered recent legal advice or evidence reviews, including Monaghan and Cass.
Quick 🧵1/9
The final part of my series for
@SexMattersOrg
is published today. This part looks at practical suggestions for parents and carers of gender-distressed teenagers who want to follow a supportive waiting model. It’s based on expert interviews… [1/13]
What is the impact of ongoing tensions over sex and gender on the women’s sector – on rape crisis centres, refuges and women’s prisons, among others? My research with
@SexMattersOrg
, published today, investigates this question through interviews with sector leaders. 1/11
This CAMHS doc is available to teenagers with mental health conditions in Hampshire; there’s a hard-copy Sussex version too. It’s a general mental health guide, but contains (of course) a section on gender, listing how it might feel to struggle with your gender identity. (1/8)
Schools and workplaces may mistakenly assume that taking action on mental health is always positive. Recent research in this area doesn’t seem to have filtered through yet to many of those commissioning and running activities/interventions. 9/10
Some studies of universal mental health interventions in schools show worse mental health in the intervention arm than in the control arm – e.g. teenagers in ‘WISE Teens’ programme had worse MH & worse relationships with parents after taking part. 3/10
Here,
@HarrietHarman
describes working through the implications of the GRA & EqA with the women’s sector to find consensus, “and it worked”. But whatever happened in 2010, it’s not working now for many women – as this
@SexMattersOrg
research makes clear.
Females taking testosterone are more likely than other women to have heart attacks (ref 1). They have higher cholesterol and worse bone health (ref 2). They frequently experience painful vaginal atrophy (ref 3) and other symptoms. 🧵
NEW: NHS England has announced that new youth gender services will provide masculinising and feminising hormones to children from ‘around their 16th birthday.’ This goes further than GIDS ever did: YPs cld only access hormones at 16 if they’d been on puberty blockers for 1 year🧵
This study on a mindfulness intervention with 13- to 21-year-olds shows increased depression and physical symptoms in the younger adolescents (though not in older ones) who took part. 4/10
Prompted by the invitation here, a thread. Two provisos: 1) I’m not a lawyer, clearly (though I research education policy, among other things). 2) The thread starts off about Robin White’s analysis, but is mainly about something else. 1/28
There’s also evidence of possible harm from group interventions to help teenagers with behaviour problems – some behave worse, drink more & take more drugs at the end of intervention than at the start of it (poss due to being w. similar peers). 5/10
Preferring to be by yourself; feeling alone; disliking puberty/having periods; feeling anxious about PE and having to get changed in front of others - these are normal parts of being a teenager, not signs something is deeply wrong. (3/8)
There’s increasing evidence, too, that workplace interventions on mental health are failing to achieve their ambitions, with a common thread being a lack of evidence for popular activities. 6/10
But one that found positive effects cautioned that this was only for clinician-led interventions – there were no positive effects for mental health programmes delivered by teachers. 8/10
Most of this list is common to the mental health conditions for which these teenagers will have been referred - e.g. low self-esteem, feeling hopeless, feeling alone - or else are experienced by pretty much everyone who goes through puberty. (2/8)
Data on long-term outcomes from a large cohort is a key area of missing evidence. Blocking it doesn’t seem helpful, whatever your views on transition – data is for wider benefit, and especially future cohorts of gender-questioning children. 3/7
This is an NHS service arguably playing a role in making children believe they are experiencing gender distress - being part of the problem when it needs to be part of the solution. Children referred to CAMHS are among the most vulnerable there are. (7/8)
Conclusion: the limited data we have indicates that gender medications, in the form of puberty blockers and hormone treatment, are no better than taking a placebo in improving teenagers’ mental health.
[Ends]
Will intervention or public pressure bring about this co-operation in future? It was an opportunity to understand long-term outcomes of social and medical transition (and, data allowing, watchful waiting). Government even passed a statutory instrument to help this to happen. 2/7
TLDR. The Toolkit is some distance from “excellent”. As to the original question: “Would you care to suggest why my analysis is wrong in law?” – promoting and attributing excellence to a document that’s legally incorrect, and in multiple ways, provides an answer. /Ends
Back to schools, reviews of studies have found mixed findings on effectiveness of universal mental health interventions. 7/10
No evidence of effectiveness:
Evidence of effectiveness:
Another🧵on the research that
@stellaomalley3
and I have done for
@SexMattersOrg
on gender identity and teenagers, this time looking at the state of the evidence base. 1/15
🧵looking at
@WPATH
’s new Standards of Care from perspective of research on gender-questioning teenagers (something I’ve been investigating). TLDR: astonishing cherry-picking of research to fit a narrative given its promotion of “evidence-based care”. 1/16
2. Cass calls for clinical research linked to unified research strategy to fill evidence gaps (my view: get hold of missing data before clinical trials. Without new evidence saying otherwise, there’s enough existing evidence of harm to make puberty blocker trials unethical.) 5/7
AFAIK, on the one occasion on which a Toolkit has come before the courts, the council in question decided to withdraw it rather than have to defend it before a judge. We might infer that their lawyers did not consider it to be “excellent”. 26/28
In this clip, Green Party co-leader talks about her party’s policy to make misogyny a hate crime. But what would this policy actually mean? (Hint: this is why ‘What is a woman?’ is an important policy question.) 1/9
The ongoing abuse of women and girls is unacceptable. The Green Party will focus on ending domestic violence, training police properly, and make misogyny a hate crime.
#C4LeaderDebate
#C4News
#VoteGreen
1. Children have got a roughly 25-40% chance* of seeing their gender distress persist if they don’t socially transition. If they socially transition, their chance of seeing it persist is 97.5%. That’s almost everyone. Social transition bakes in gender dysphoria.
This paper was published yesterday, looking at mental health in gender-questioning teenagers after 2 years of hormone treatment: . A quick 🧵on its approach/conclusions. (1/11)
First issue.
@BrightonHoveCC
doesn’t “promote the removal of single sex spaces” but does promote the admission of people of the opposite sex into those spaces – at which point, those spaces are no longer single sex. So single-sex spaces ARE removed (reminder: “excellent”-RW) 6/28
CAMHS is reflecting back to its vulnerable teenage service users their current symptoms and implying they have yet another thing to deal with - a struggle with gender identity. (5/8)
This 2nd thread summarising research on sex, gender & the women’s sector – with
@SexMattersOrg
and out today – focuses on the words of the women I interviewed. Please use these, repost them, quote them. It is their voices that will bring change.
#SectorSilenced
#Women
#SexMatters
Only 3 out of the 14 items (arguably 2) relate to gender dysphoria, not referred conditions or teenage reality. Imagine being a 14 year-old who ticks off most of the other items on the list. Would it give you comfort or make you think you have another pending diagnosis? (4/8)
Once gender clinics have been persuaded not to block the acquisition of data, it would seem sensible to look at what it implies for childhood social transition, too, before experimenting further with it (cf links into a medical pathway, with known negative side effects). 6/7
The placebo effect can be strong. This excellent paper, recently published by psychiatrist Dr Alison Clayton, shows why puberty blockers & hormone treatment present the “perfect storm environment” for the placebo effect [2/16]
Now onto the rights of girls.
@BrightonHoveCC
“has seen no evidence” that male pupils who identify as trans present more threat to girls in single-sex spaces than other girls do. But we know that having mixed-sex spaces puts girls at risk of assault. 7/28
3. Cass wants more in the way of systematic review; system learning; & provisions to prevent ‘incremental creep of practice in the absence of evidence’. This is positive - especially if gender services can be stopped from blocking development of a collective knowledge base. /Ends
There is much more in there, but it is astonishing that Brighton & Hove Council is publishing something so contrary to expert legal advice and mounting counter-evidence in the summer of 2024.
8/9
This new paper therefore does nothing to change the conclusion that gender medication - and in this case, hormone treatment - is no better than placebo when it comes to teenagers’ mental health. (Ends)
This thread on social transition of children was doing the rounds yesterday. As it purports to be “evidence-based”, let’s see what the evidence actually says. It’s poor quality across the board, by the way.
This is happening tomorrow!
@HJoyceGender
, Michael Biggs and I will be talking about medication for gender-distressed children. What does the evidence show when it comes to physical and mental health effects, and what does it mean?
@SexMattersOrg
"The philosopher Karl Popper argued that scientific beliefs must be falsifiable: there must be some experiment you can perform that puts your beliefs to the test. A belief which cannot be criticised cannot be falsified, and so cannot be science."
The Cass Review shows that the academic community has failed gender-questioning children. I explain how the erosion of academic freedom allowed this medical scandal to happen. 👇
2.
@BrightonHoveCC
: Makes no definitive requirement of Brighton’s schools that they provide 11+ children with single-sex facilities when it comes to changing rooms.
@k21fem
: ‘This is incorrect as a matter of law’.
4/9
And it starts with a massive thank you to Allsorts. They’re name-checked 40 times. How many times does it mention organisations who believe gender-questioning children aren’t best served by an affirmative model?
Trick question. It’s zero. *Balance*
11/28
Some final thoughts. In more than 20 years distilling research on issues affecting children and young people, I haven’t seen such a shaky evidence base affecting lives so irreversibly before, in this case through “gender-affirming care”. 10/12
On a quick review, some examples of where the new version of the Toolkit falls down (I’ll do more on this anon w. a bit more time).
1.
@BrightonHoveCC
: Single-sex toilets can be used by both sexes ‘on a case-by-case basis’.
@k21fem
: ‘This is incorrect as a matter of law.’
3/9
So what does Allsorts think? Balanced?
-Sex is “assigned at birth” (News to me. My children’s sex was observed at 20 week scan.)
-Use chosen pronouns, always.
-Children should identify into single-sex spaces.
-Supports transitioning, despite Cass.
13/28
On p.7, RW declines to offer alternative guidance, saying that the government’s guidance on gender-questioning children in schools is “shot through with anti-trans hatred”. This is a serious and specific charge from a barrister. No examples of this hatred are given. 3/28
Other points on data/evidence/research from Cass: 1. Services to feed into a national dataset, information from which will contribute to an ‘active learning environment’. Presumably this means that treatment paradigms will be updated as new evidence emerges. 4/7
"...avoid treating anxiety as if it is a permanent personality trait. And where possible, treat adjustments and avoidance as temporary measures, in the service of gradually helping young people tolerate and face their fears." Advice from
@lfoulkesy
3.
@BrightonHoveCC
: Trans-identified children can share bedrooms with children of opposite sex on a case-by-case basis.
@k21fem
: ‘A school is likely to be acting unlawfully.’ Cites effects of violating dignity/creating an intimidating, hostile, degrading etc environment.
5/9
The Toolkit suggests schools teach that “most, rather than all boys have a penis and testicles and most, rather than all girls have a vulva and vagina”. This seems to me to be the promotion of a partisan view, even with the caveat that genitals relate to sex. 10/28
The barrister
@moira_robin
has published commentary via Translucent on the Government’s RSE Draft Schools Guidance. Astonishingly, it’s not always based in material reality. Let’s start with this statement about stereotypes. 1/10
From
@moira_robin
regarding RSE Draft School Guidance. Please note
@GillianKeegan
"I cannot remember reading four short paragraphs and 282 words from the government that contained such misinformation, muddle, and sheer madness so tightly".
One reading of the
#WPATHFiles
is that being deeply invested in a conclusion makes contradictory information unlikely to change it, no matter the weight or consequence.
“I feel the best time for surgery in the U.S. is the summer before their last year of high school.”
Despite the widespread and growing expression of concern within the WPATH Files over the negative side effects of gender medicine, WPATH members urge that irreversible surgeries
5.
@BrightonHoveCC
: misgendering, including refusal to use neo-pronouns, requires challenge and possible action.
@k21fem
: would represent indirect belief discrimination under the EqA.
7/9
The Cass Review, in its final form, will hopefully go further to change things positively for teenagers in England. In the meantime, why is the Scottish Govt not trying to learn from this? 11/12
A women’s sector leader on a sector partner stating it was exclusionary to discuss women’s issues within a support-group setting
#SectorSilenced
#Women
#SexMatters
Again, I’m not a lawyer - but I’m a researcher, Brighton resident and former school governor, and spend a lot of my time analysing education policy. I know a bit about the city’s Trans Inclusion Schools Toolkit. Understated TLDR: it needs some work. 5/28
4.
@BrightonHoveCC
: Social transition happens when children feel they are ready.
@k21fem
: There is no ‘recognition or understanding of the best interests and welfare of the child who may be psychologically impacted by social transition’.
6/9
This graphic shows the headline results. In no cases was the effect of gender medication on mental health higher than the placebo effect (in fact, it was smaller in 3 out of 4 measures, but we can’t rule out this difference being due to chance). [8/16]
It links on these pages to the Proud Trust, which tells children they usually know their gender from the age of 3 or 4; that children are never to young to “be yourself” and change pronouns; and talks about medical transition as part of “becoming who we are”. (6/8)
But competitive sport has its own provisions under the Equality Act (section 195). Competitive sport may be segregated according to sex, regardless of gender identity, where it’s fairer or safer to do so. This is not what the Toolkit says. 22/28
I’ll be at the University of Kent tomorrow discussing my research for
@SexMattersOrg
on gender identity in teenagers, along with implications for parents/parenting culture. Free and open to all ⬇️
When services aren’t single sex, impacts on female prisoners and survivors of male violence include rekindled trauma, actual or perceived lack of safety, less ability to speak openly about experiences & poorer quality support. Some women self exclude to avoid being with men. 3/11
Putting children on a transition pathway isn’t a solution to their feelings of distress and may mask other issues. The lack of unambiguously positive mental health effects suggests a need for an urgent reappraisal of the gender-affirming care model. [Ends]
“Gender-affirming care” (social & medical transition) has serious issues. Social transition may make children’s gender dysphoria persist. Medical transition causes physical harm to healthy bodies, & research showing mental health benefit is so flawed as to be meaningless. [2/13]
In short, this is a response to Robin White’s tweet that isn’t really about RW at all. Instead, it’s about
@BrightonHoveCC
Trans Inclusion Schools Toolkit, which formed a cornerstone of RW’s analysis. 27/28
Again, it’s about balance, this time between the needs of different protected characteristics. E.g. when males (regardless of gender ID) enter female-only spaces, girls feel less comfortable. Observant Muslim and Orthodox Jewish girls can’t undress in the presence of males. 16/28
The quoted EHRC guidance has been superseded by this, which shows it isn’t discriminatory to maintain single-sex spaces if objectively justified (and surely compliance with the Schools Regs is objective justification to provide single-sex spaces?). 20/28
This 🧵 will quote legal advice on the lawfulness of the previous iteration of the Council’s Trans Inclusion Schools Toolkit by leading human-rights barrister Karen Monaghan KC (
@k21fem
). 2/9
This paper, released yesterday, suggests social contagion isn’t a factor in teenagers questioning their gender. On the evidence provided, I’m not sure it’s right to reject this out of hand. 1/6
🚨We have a new paper out today in
@aap_peds
🚨
We examined 2 hypotheses:
1. That youth identify as
#trans
due to "social contagion" & adolescents assigned female are more susceptible
2. That youth identify as trans to flee LGB-related stigma
Neither was supported by data. 🧵
The Toolkit is governed by s.406 & 407 Education Act 1996, which prevent the promotion of “partisan views” in lessons and require “a balanced presentation of opposing views” in political issues even outside the classroom. 8/28
My study builds on this theoretical base to analyse the effect of gender medication on mental health when compared with the placebo effect in a comparable group of teenagers. [3/16]
None of the links the Toolkit offers to sporting body policies is still valid. There’s since been recognition made by England Rugby and UK Athletics that it’s not safe/fair to include males in female competitive sport. 23/28
We know that discussions about sex and gender are political, as RW implies ⬇️ (sex is arguably factual, but I’ll leave that one for now).
Does the Toolkit comply with
@BrightonHoveCC
legal obligations not to promote partisan views and to secure balanced treatment? No. 9/28
Changing rooms? Same approach. Cite the law and then give reasons not to follow it. The EHRC quote given here is 10 years old and is wrongly presented as bearing the same weight as the Schools Regs. “We would therefore encourage schools to enable this wherever possible.” 19/28
Part 1 looks at reasons why teenagers might question their gender, and whether there’s evidence they do so due to an innate, immutable sense of gender identity (TLDR: there isn’t). 2/12
Such is the influence of Allsorts that they’re cited as the Toolkit’s co-author alongside
@BrightonHoveCC
on the Gendered Intelligence resource list. 12/28
Can children understand what it means to consent to treatment that means they will probably be unable to have children and to have full sexual function as adults? Are parents able to consent to such treatment on their behalf? My analysis suggests not. [9/13]
'It’s the behaviour of people who are... certainly not prioritising the emotional well-being of kids. The overall message is not “you are loved”. It is “you are hated. But don’t worry! I love you!”' Some devastating analysis by
@glosswitch
.
Most GQ teenagers are same-sex attracted (perhaps 80%, according to GIDS data). Google Trends data here shows an interesting correlation/pattern-switch in recent years. 4/12
The Toolkit does similar on sport. “Single-sex sport? Well, if you must, but we’d really rather you didn’t. Gender identity, please. Even for competitive sport.” 21/28
See, in particular, the need to “advance equality” and “foster good relations” between persons who share a protected characteristic and those who don’t, and that gender reassignment is only one of the characteristics, which include “sex”. 15/28
Rather than provide alternative guidance, RW cites
@BrightonHoveCC
's Trans Inclusion Schools Toolkit as “excellent”. The Toolkit will be the focus of the rest of the thread. 4/28
The Green Party is therefore actively advocating against women’s rights under the guise of fighting misogyny. People in Bristol Central and Brighton Pavilion might want to take note. 8/9
The existence of detransitioners lends weight to the argument that we shouldn’t be making such complex decisions, with permanent effects, on behalf of children who may later change their minds. [8/13]
There are no studies that compare gender medication and placebo treatment directly. I therefore compared mental health (MH) outcomes from gender med studies with placebo arm from randomised controlled trials (RCTs) testing drugs for MH conditions in teenagers. [4/16]