Talk:Puberty blocker

This page is out of date and has numerous glaring inaccuracies

I have been making small steps to improve this page the last few days -and in the process have realised the page is a much bigger problem than I first realised.

The Cass Review page has benefited from many editors reviewing the latest state of play around gender dysphoria: and not least about puberty blockers.

The latest Cass page states that in the last 6 months the state of art has changed radically re blockers:

• the UK has banned them for both state health care and private health care
• "the evidence base,...had already been shown to be weak... continues to be a lack of high-quality evidence"
• "the lack of evidence means no conclusions can be made regarding the impact on gender dysphoria and mental health, but did find evidence of bone health being compromised during treatment"
• "The review disagreed with the idea of puberty blockers providing youth patients with "time to think""
• most international guideines "were said to lack editorial independence and developmental rigour, and were nearly all influenced by the 2009 Endocrine Society guideline and the 2012 WPATH guideline, which were themselves closely linked. The Cass review questioned the guidelines' reliability"

And debate on the Cass page agreed that the Review's view that the evidence as weak was not due to the lack of RCTs (randomized controlled trials )

And yet this page has much content that contradicts the above:

• "The use of puberty blockers for gender-affirming care has attracted some criticism, due primarily to the lack of randomized controlled trials within the research base" -
• "Puberty blockers are intended to allow patients more time to solidify their gender identity...the medication can be stopped, allowing puberty to proceed."
• "The statement was made that the treatment was fully reversible, "
• "the studies that have been conducted generally indicate that these treatments are reasonably safe, are reversible, and can improve psychological well-being in these individuals."
• "Puberty blockers are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.
• "Puberty blockers have clearly beneficial, lifesaving impacts on a scale of up to six years,
• "WPATH... declared puberty-blocking medication to be medically necessary ... because longitudinal data shows improved outcomes for transgender patients who receive them"
• "In the short term, they are generally considered safe and well-tolerated by most individuals."

In addition the page contains:

• unscientific evidence: from 2010 of just one person (The longest follow-up study followed a transgender man...)
• As I flagged up above - a whole paragraph given to a mere activist: Cal Horton.

Weasel words

• "National Institute for Health and Care Excellence ....evidence for puberty blocker outcomes... was of very low .. but that it was plausible that the outcomes would have been worse without treatment"

Poor sources:

• URLS that no longer exist, and the body that publish them no longer has any page at all about PBs (St Louis hospital)
• WebMD - a non-authoritatve source, whose page paints a rosy-eyed view of PBs
• "A 2019 study found that a "multidisciplinary approach" is necessary" - but the source includes now discredited claims 'a physically reversible option to suspend sex hormone production, reduce the anxiety of ongoing physical development and allow further space for psychotherapeutic intervention and exploration." https://adc.bmj.com/content/103/7/631

What is the best way ahead -

1. delete 80%, and copy back the Cass Review content that is much higher quality
2. incremental changes?
3. any other approach?

Peckedagain (talk) 14:42, 17 August 2024 (UTC)

@Peckedagain I'm a bit confused here about what issues you have with this page. It wouldn't make sense to ignore a large proportion of research in favour of the Cass Review. Also this page is about puberty blockers, not the Cass review. It might be helpful for you to add cleanup tags to the areas you believe need work instead of trying to fix the page all by yourself, this way you can discuss with other editors what actions should be taken. CursedWithTheAbilityToDoTheMath (talk) 00:26, 18 August 2024 (UTC)

HI @CursedWithTheAbilityToDoTheMath

> "I'm a bit confused here about what issues you have with this page"

Well , I listed them. I'm not advocating "to ignore a large proportion of research in favour of the Cass Review." The Cass review page is more recent than much on this page, and has had alot of editor discussion to come up with an agreed authoritative view on issues, not least puberty blockers. So much of this page here has been superceded by the Cass page content. Yet this page remains unchanged -and therefore wrong.

I can't see any reason why this page should be left as a 'fossil' when other wiki pages (Cass page) contain more accurate and uptodate content that this page directly contradicts? But maybe you can think of a reason? Peckedagain (talk) 01:11, 18 August 2024 (UTC)

And that is the core of where you are not quite right.

The government of one nation has issued a review for use of policies in that country. That is the purpose of the Cass Review, not more, not less. The worldwide consensus is not in line with the UK's conclusion (as has been shown by the worldwide response by various national and international health organizations to the Cass Review, criticizing it) and we represent the global worldview on Wikipedia, not that of one country. So the swathing editing of global articles to one country's narrow view is generally not WP:DUE. Raladic (talk) 01:20, 18 August 2024 (UTC)

@Peckedagain I highly suggest you check out Wikipedia:Recentism. Just because information is newer does not mean it trumps other information. Again, I think you're getting the scope of this article confused. This article is not about the Cass review; it's about puberty blockers. These two topics are not the same and therefore do not deserve to have content that is nearly the same. An agreed upon consensus for the Cass review page does not automatically transfer over to other pages. I also think it's important to consider WP:DUE here. The UK does not represent the whole world, and therefore we should not be generalizing one country's findings to apply to the rest of the world. CursedWithTheAbilityToDoTheMath (talk) 01:26, 18 August 2024 (UTC)

I agree with Raladic and CWTATDTM. The Cass Review is only one study, and a fairly controversial one at that. We should not overhaul this page over the result of one study. Loki (talk) 02:04, 18 August 2024 (UTC)

The Cass Review is just one of numerous systematic reviews of puberty blockers. Why would it trump all the others? Plus most of the points you mention are already discussed in the article, although I have no idea what this one means: "The review disagreed with the idea of puberty blockers providing youth patients with "time to think"". Perhaps you could elaborate. Nosferattus (talk) 02:03, 19 August 2024 (UTC)

As I replied to you a month ago, linking an earlier discussion from May with citations, Taylor et al found no singular rationale, ie that we cannot simply say they provide "time to think" as that is neither clearly what they do, nor clearly why they are given.

The Cass Review does not "trump all the others" - it concurs with them. The York review into puberty blockers simply confirmed what every other systematic review has found, with AFAICT the sole exception of Baker et al (2021), which the York reviews suggest found differently because it included low-quality evidence, which all the other reviews filtered out. Void if removed (talk) 08:22, 19 August 2024 (UTC)

You're also forgetting about Rew et al. which found "good" and "excellent" quality positive benefits. It seems at least some of the reviews, e.g. Taylor et al., exclude "moderate quality" evidence, for example, of puberty blockers' effect on depression, not just low quality evidence, so it's a bit more complicated. I don't understand your argument about puberty blockers not providing time. That is clearly the rationale for treating transgender children with puberty blockers, and we cite MEDRS sources that say that (and could cite more). Do you have a citation that contradicts this? If so, what does it say specifically? Nosferattus (talk) 13:37, 19 August 2024 (UTC)

some of the reviews, e.g. Taylor et al., exclude "moderate quality" evidence

This is false, Taylor et al included moderate evidence.

Do you have a citation that contradicts this?

This is now the third time I've responded to this request. Please see the link I have already provided, which will lead you to the relevant quote and citation from Taylor et al. Void if removed (talk) 14:23, 19 August 2024 (UTC)

In the Taylor et al. results it says that the de Vries study showed "moderate" quality evidence for "reduction in depressive symptoms", yet the entirety of their Conclusions section is "There are no high-quality studies using an appropriate study design that assess outcomes of puberty suppression in adolescents experiencing gender dysphoria/incongruence. No conclusions can be drawn about the effect on gender-related outcomes, psychological and psychosocial health, cognitive development or fertility. Bone health and height may be compromised during treatment. High-quality research and agreement on the core outcomes of puberty suppression are needed." Depression is certainly an aspect of psychological and psychosocial health, so it seems they excluded it from their conclusions because it is only "moderate" quality. Should our article discuss their results in detail or only their final conclusion? Nosferattus (talk) 16:09, 19 August 2024 (UTC)

The quote you cite definitely doesn't contradict "the idea of puberty blockers providing youth patients with 'time to think'". It just claims there is disagreement about what the primary aims of puberty blockers are. There is nothing there negating 'time to think' as an aim of treatment. In fact, your own quote says that the Dutch protocol gives "allow time for gender exploration" as a rationale. Personally, though, I think 'time to think' is a bit overblown, as the vast majority of children that take puberty blockers for gender dysphoria go on to hormone therapy later. I think the real purpose of puberty blockers is to simply block puberty (and thus keep gender dysphoria from getting worse as discussed in the NICE Review) and to delay hormone therapy. Nosferattus (talk) 16:06, 19 August 2024 (UTC)

Here's what the lede says:

Puberty blockers are used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity.

That is a strong and singular claim of purpose: blockers are given for time to explore.

What does taylor et al say?

Rationales for puberty suppression in the Dutch treatment protocol, which has informed practice internationally, were to alleviate worsening gender dysphoria, allow time for gender exploration, and pause development of secondary sex characteristics to make passing in the desired gender role easier. Practice guidelines propose other indications for puberty suppression, including allowing time and/or capacity for decision-making about masculinising or feminising hormone interventions, and improving quality of life.

That's 4 or 5 different reasons there, from improved mental health to better cosmetic outcomes. Do you think the statement in the lede is a wholly accurate rendition of this MEDRS? I don't. I think there are multiple reasons, not just simply "time to think/explore", and according to Taylor et al this is partly why the evidence base is so poor - there's no clearly agreed reason, therefore no clearly agreed measure of success. Void if removed (talk) 09:15, 20 August 2024 (UTC)

It is not a matter of ignoring the majority of the research - it is about assessing what the highest quality MEDRS say - and the systematic reviews commissioned by Cass are highest quality MEDRS, and they concur with other systematic reviews. What we should not be doing is highlighting individual papers or findings to present an overly-confident picture, when higher quality MEDRS in the form of systematic reviews do not do so. These are the best quality synthesis of the available data, and WP:RECENTISM doesn't really apply here. York et al came out in April. Zepf et al was February this year. This is not breaking news, this is the most recent, most thorough, best-quality MEDRS superceding what came before.

Amazingly, we give less space to the NICE review, Zepf et al and Taylor et al than we do to one activist/researcher's opinions on the NICE review. This is severely imbalanced. Void if removed (talk) 09:08, 19 August 2024 (UTC)

So would you support removing the part in the current article about puberty blockers' effect on IQ? It is only mentioned in a single review and is based on a single study that was described as poor quality evidence by the review. Nosferattus (talk) 13:44, 19 August 2024 (UTC)

I would phrase it in line with Taylor et al, ie:

No conclusions can be drawn about the effect on gender-related outcomes, psychological and psychosocial health, cognitive development or fertility. Bone health and height may be compromised during treatment. High-quality research and agreement on the core outcomes of puberty suppression are needed.

And I think this level of summary should be in the lede. Void if removed (talk) 14:27, 19 August 2024 (UTC)

I'm glad we agree that poor quality evidence should be excluded from the article. What about "moderate" or "good" quality evidence (according to review evaluations)? Nosferattus (talk) 16:19, 19 August 2024 (UTC)

I ask you to revert your last change, as your edit comment completely misrepresents this discussion. Void if removed (talk) 17:02, 19 August 2024 (UTC)

I'm sorry if I misunderstood your response to my question. Just to clarify, do you think the "Neurological effects" section should include the "poor quality" evidence about effects on IQ, or do you think it should only include the statement from Taylor et al that "No conclusions can be drawn about the effect on ... cognitive development", as it does now? I thought your response above meant you just wanted the Taylor et al conclusion in that section, as you said "I would phrase it in line with Taylor et al". Nosferattus (talk) 19:26, 19 August 2024 (UTC)

What you've done is remove a link to a different systematic review that incorporates animal studies and finds cognitive impacts. I think that review should stay, but worded better, to clarify that it is a systematic review of animal studies (significantly, the only one). I think that the prior wording is misleading - "poor" is being taken out of context, and the focus on "IQ" misses that the IQ studies were a minority of those considered. The complexity and sex-specificity of the impact and lack of reversibility are all notable, and removing this systematic review entirely is unjustified. I would suggest reinstating and rephrasing as:

A 2024 systematic review which incorporated animal studies found some evidence of sex-specific impact on cognitive function in mammals, and no evidence that cognitive effects were fully reversible. Void if removed (talk) 09:26, 20 August 2024 (UTC)

It's not a great review. Published in 2024 in an open source journal, and using animal studies seems like a bit poor usage.

Could possibly still be WP:PRIMARY and be removed based on that. Bluethricecreamman (talk) 23:20, 21 August 2024 (UTC)

I've put this content back in now, with the wording above. Void if removed (talk) 09:36, 21 August 2024 (UTC)

I'm not implying that there isn't issues with this current page, I haven't looked at it enough to say there isn't. My main point is that this page isn't solely about the Cass review. I'm not educated enough on the topic to say much about the Cass review itself. CursedWithTheAbilityToDoTheMath (talk) 22:36, 19 August 2024 (UTC)

Hi @CursedWithTheAbilityToDoTheMath

You're quite right - I think every editor here would agree that 'this page isn't solely about the Cass review.'.

So I guess we also would agree that where the Cass Review page has been thrashed out by editors of all persuasions and reached it's current state -that this PB page, which has had a lot less editing attention, would benefit from using the same editors-have-agreed-upon content from the cass page where that page covers blockers - and would be better than leaving this page containing content that on consensus was actually removed from Cass page. Peckedagain (talk) 23:07, 19 August 2024 (UTC)

I might not be understanding what you are trying to say here but again just because a consensus was reached at the Cass review talk page doesn't mean that translates over to this page. CursedWithTheAbilityToDoTheMath (talk) 00:56, 20 August 2024 (UTC)

I think doing WP:TNT like this would be horrible without broader discussion... If you are going to restart this page or large portions of it, it would warrant doing an AfD.

If you are going to do edits in a way that evolves this page, we can work through that much easier.

I am not quite certain if there is a significant failing of the PB page here tbh. Bluethricecreamman (talk) 21:11, 20 August 2024 (UTC)

A valid question was raised - PB should not be rewritten based on a single country's review content

Radalic on my Talk page wrote:

• "Also note that the re-write of the article based on a single country's review content as you tried to summarize is not WP:DUE"

The question was helpful, and for anyone else thinking the same, my answer was:

• But that is not what was being done. The Cass page , after consensus of editors on many sides, makes some statements that are universal and not limited to one country. Not least regards the lack of good evidence about the effectiveness of puberty blockers for those with gender dysphoria. The Cass review included all worldwide evidence: so that can't be minimised as 'just 1 country stuff'.
• The Blockers page contains some claims of universal truth that are contradicted in the cass page. Which had more Talk-page detailed discussion too.
• So it is only logical, to review the PB page: because the 2 pages do 100% contradict themselves in some of the claims of universal truth.
• Yes it is also true that where Cass is talking about specific 1-country stuff (eg what went wrong at UK clinics.... UK whisteblowers) that is not relevant to the PB page. We would both agree 100% on that, I guess. Peckedagain (talk) 00:00, 20 August 2024 (UTC)

There are at least eight systematic reviews about treatment with puberty blockers: Zepf et al, Ludvigsson et al, Taylor et al, Baker et al, Rew et al, Soliman et al, the Nice Review, and the Cass Review. Most of these are from the last 5 years and overlap in their primary source coverage. They have very different methodologies, however, and come to different conclusions. So yes, treating one of those reviews as the gospel is WP:UNDUE, especially when it is the review that has been the most heavily criticized and politicized. What we need is to distill the actual results from these various reviews, not just replace this page with content from the Cass Review page. Nosferattus (talk) 00:21, 20 August 2024 (UTC)

I haven't communicated my opinions very effectively on this topic in some of my previous replies but this was the point I was trying to make. CursedWithTheAbilityToDoTheMath (talk) 00:58, 20 August 2024 (UTC)

Also, people seem to keep forgetting that this article is about puberty blockers in general, not just puberty blockers for gender dysphoria. If anything needs to be added to the lead, it is discussion of treatment of precocious puberty with puberty blockers (which has been practiced since the 1950s). Right now this is just briefly mentioned in a single sentence. Nosferattus (talk) 01:23, 20 August 2024 (UTC)

@Nosferattus

• "What we need is to distill the actual results from these various reviews,"

But the Cass page did this already, why do it again? The Cass review itself included all worldwide evidence: and according to the Cass page is the newest, most thorough review of all the evidence.

• "especially when it is the review that has been the most heavily criticized and politicized.

It is entirely to be expected that the longest, deepest review would create the most criticism: because

A) it's global in it's review of the evidence and therefore it's findings are global: statements of universal truth (eg about puberty blockers) that are not just UK truths

B) it's findings were a shock to those how had followed the widespread opinion that there was (for example) good evidence that puberty blockers have proven mental health benefits for those with GD. The Cass page makes it clear - there is no such good evidence.

Alot of good faith work was done by many editors since the Cass came out in April. The task on this PB page is to 'build on the shoulders of giants' and bring it up to date: so that it no longer includes claims that contradict the Cass page and were specifically deleted from there because they are not founded: and the Talk page shows you the reasoning behind that editors concensus.

But of course, if something incorrect is spotted in the Cass page, take it to that page. But the Talk page shows that all of the page was laboured over: so there are unlikely to be criticisms of it , that have not already been responded to. Peckedagain (talk) 21:03, 20 August 2024 (UTC)

In fact: thinking further of (B): we must as editors be kind to our readers -and not feed contradictory statements on the two pages. we need to be kind to the many parents of GD children who have for years taken advise from the medical profession and whose children have used PBs and some had surgery. Because it is the biggest shock for them to read that there is no good evidence of mental heath benefit for the very invasive treatments their children had. Some of those children will have life long health complications: and out of empathy to those parents: that is the most heart breaking revelation. That they somehow cooperated in causing that lifelong harm to their own child. Many will find it hard to forgive themselves, for what they allowed to happen - even though in reality they could have done nothing different than take the advise of the medical experts they had.

So for those parents sake - let's not leave contradictory statements of fact about the evidence in the two pages. Peckedagain (talk) 21:14, 20 August 2024 (UTC)

Please read WP:SOAPBOX and WP:NPOV. CursedWithTheAbilityToDoTheMath (talk) 21:57, 20 August 2024 (UTC)

Your statements are transphobic and offensive. And what "life long health complications" are you talking about? Even the Cass Review doesn't make such ignorant unfounded claims. I hope you will take off your self-imposed blinders and take a look at some of the other sources. The Cass Review certainly doesn't "include all worldwide evidence" and is not "statements of universal truth". For starters, it only evaluated studies related to transgender children, and excluded all studies related to precocious puberty. So just like all the other reviews, it had a specific scope and that scope is not the same as the scope of this article. Nosferattus (talk) 22:11, 20 August 2024 (UTC)

I would also like to add that no research article contains "statements of universal truth", the medical field is constantly evolving and research is only ever a reflection of what evidence we have today. CursedWithTheAbilityToDoTheMath (talk) 22:27, 20 August 2024 (UTC)

@CursedWithTheAbilityToDoTheMath you are 100% correct: 'statements of universal truth' was shorthand for

• things that apply universally - ie to all countries not just the home country of the review
• things that true to the best of our knowledge - but we may change them in the future when new evidence comes along.

Peckedagain (talk) 22:42, 20 August 2024 (UTC)

@Nosferattus

So what worldwide evidence did the Cass Review not include? There is nothing on the Cass page about missing evidence, or have I missed something there?

If you read the Talk page this has all been covered a couple months back: with the input of highly experienced MEDRS wiki editors. The Cass page says: "The review concluded that the lack of evidence means no conclusions can be made regarding the impact on gender dysphoria and mental health, but did find evidence of bone health being compromised during treatment." - that is not a UK-specific statement but a universal one, isn't it?

> Your statements are transphobic and offensive.

That was 100% not my intention, I apologize if my words hurt your feelings. Please point out where I did that, so I can understand your perspective and avoid doing it again.

> life long health complications

The Cass page says under 'Recommendations': "NHS England should ensure there are proper detransitioning services available'. I understand that for those people, there can be complications. Cass says for hormone therapy: "found insufficient and inconsistent evidence regarding physical risks". A quick google found this paper, I don't know if its a strong one or not: "Current limited evidence from non-randomized studies suggests that transgender women taking GAHT have increased risks of myocardial infarction, ischemic stroke and VTE. The current evidence does not indicate increased cardiovascular risk in transgender men receiving GAHT." Peckedagain (talk) 22:36, 20 August 2024 (UTC)

Again the talk page for the Cass review does not translate over to all of Wikipedia. You made claims not backed in evidence. "I apologize if my words hurt your feelings" is not taking accountability. The user never claimed you hurt their feelings so I'm not sure where you are getting that. CursedWithTheAbilityToDoTheMath (talk) 22:41, 20 August 2024 (UTC)

@CursedWithTheAbilityToDoTheMath

I intended to invite Nosferatu to show me how I had been 'transphobic and offensive'. But I invite you too, to help clarify that: if you wish, whilst your online now. It's your choice, either way. Peckedagain (talk) 22:46, 20 August 2024 (UTC)

@CursedWithTheAbilityToDoTheMath

Also, could you expand on: "the Cass review does not translate over to all of Wikipedia." thx Peckedagain (talk) 22:47, 20 August 2024 (UTC)

Just because a consensus is reached on the talk page of one article doesn’t mean that said consensus should be applied to the rest of Wikipedia. Things that are relevant for one page may not be relevant on another. CursedWithTheAbilityToDoTheMath (talk) 22:57, 20 August 2024 (UTC)

@CursedWithTheAbilityToDoTheMath Again, I agree with you 100%. It is a truism. But in the specific context here: I had compared the two pages, and listed 10-20 places where they make contradictory statements of universal truth about the very same thing. That is bad for our readers isn't it? And relatively easy to work on: as the heavy-lifting to-n-froing debate in Cass talk can be referred to as the reason why Cass page has it's content: and compare the Talk on this page. If the Talk evidence here is superceded by or weaker than in the Cass page: then we can change this page to match Cass. Or vice versa.

Maybe there is a good reason not to do that process, but to leave up the glaring contradiction, but i can't think of one right no, can you? Peckedagain (talk) 23:24, 20 August 2024 (UTC)

Please read WP:NPOV and WP:TRUTH. Nosferattus (talk) 23:49, 20 August 2024 (UTC)

Hi @Nosferattus, I have read them -which specific part of them should I take note of: and regards to which words I wrote?

If your mean the Truth page is relevant because I used the phrase 'universal truth' - then yes i agree; the word truth was just common parlance and can be swapped, eg to

• 'scientific findings that have scientific applicability in all countries -until better findings, on better evidence, come long'

Regards NPOV - please do spell out my exact words you're thinking of. This is my second time of asking. Peckedagain (talk) 00:43, 21 August 2024 (UTC)

I can see that when I wrote:

• there is no good evidence of mental heath benefit for the very invasive treatments their children had

It would have been more neutral to have written:

• there is no good evidence of mental heath benefit for the Puberty Blockers their children had

Which is what the Cass page does say.

And regards

• life long health complications

The Cass page says that there is no good evidence to say Puberty Blockers do not have side effects. we all know that any medical intervention introduces new risk: it is never zero, but for some interventions can approach zero.

So would it be scientific to believe that a non-trivial intervention like PB, will mean that 100% of those using it will have no long term side effects for the rest of their lives? There is no evidence available today to support that claim.

Maybe you have a different view? But either way: stating these two things is not transphobic, is it? Isn't it just stating the data we have? It would be wonderful if the Cass page said that there was strong evidence of no side effects - due to the findings of the cass review. But it doesn't. Peckedagain (talk) 01:02, 21 August 2024 (UTC)

And as a precaution - if I suddenly go silent on this page and don't respond any more, it is because there is an arbitration against me, and a friendly editor has told me that I may get a 6 month ban. (I've only been on wiki a little over 6 months so far) Peckedagain (talk) 01:10, 21 August 2024 (UTC)

@Peckedagain: First, the Cass Review is not the most recent review. The evidence review phase of the Cass Review was conducted in 2020. The work between then and the final report focused on interviews with practitioners and evaluation of the UK's practices related to gender-affirming care for young people. Taylor et al., Zepf et al., and Ludvigsson et al. are all more recent as far as systematic reviews go, and include studies not considered by the Cass Review. (Taylor is about PBs, Ludvigsson is about PBs and hormone therapy, and Zepf is also about both.) As far as what evidence was excluded from Cass, the Cass Review's evaluation of puberty blockers did not include results that spanned both puberty blockers and hormone therapy (which is a valid choice, but one that was critisized by WPATH). It also didn't include any studies about treatment of precocious puberty with puberty blockers, as that was outside its scope (but is within the scope of this article). Nosferattus (talk) 23:30, 20 August 2024 (UTC)

@Nosferattus You are making claims that were made and discounted in the Cass page. Such as "The evidence review phase of the Cass Review was conducted in 2020" whereas Cass Review also included later studies than 2020. It would be helpful, to avoid all of us editors sitting through the same debate again: if for each concern you raise there, you could look in Cass Talk for the consensus there: and share that summary here: to explain why you think it is not sufficient. But actually, now I think about it - it sounds like you are talking here on PB but really it is the Cass page you think should be changed? Have I read that right?

Either way; it would be most helpful if you'd pull from Cass Talk and share here the summary of it, regards each of your issues below: as background to explaining why you think the reasoning there needs to be over-turned:

1. Cass Review is not the most recent review 'it was back in 2020'
2. "did not include studies that spanned both puberty blockers and hormone treatment (which is a valid choice, but one that was critisized by WPATH).
3. "excluded studies about treatment of precocious puberty with puberty blockers, as that was outside its scope"

Sorry if I sound impatient - but on the Cass page talk there was alot of circular debates where the same issues would come up, be shown to be unfounded and not wiki enough to be included: and then weeks later the same all over again, and again weeks later. Sometimes the same editor again. I'm sure you don't wish for that style of Talk, either. Peckedagain (talk) 23:53, 20 August 2024 (UTC)

OK, you're right, the evidence review, although conducted in 2020, was updated in April 2022 (according to the final report). But Taylor et al. is from 2024, Ludvigsson et al. is from 2023, and Zepf et al. is from 2023. So it still isn't the most up to date. Points #2 and #3 are not "issues", they are just examples of methodology and scope differences between Cass and other reviews. This is why reviews that seem to be analyzing the same topic can come to different conclusions. From Wikipedia's point of view, there is no "universal truth", there is only what reliable sources report. To quote WP:NPOV, Wikipedia must "fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in those sources." Nosferattus (talk) 01:15, 21 August 2024 (UTC)

Thanks for agreeing. Yes, I agree with you that my shorthand 'universal truth' meant 'reliable sources that report something scientific that is valid to all countries not just UK (because some editors kept suggesting that Cass findings on the effectiveness/safety of Puberty blockers only had relevance to the UK. which is obviously not a supportable stance, I'm sure you'd agree)

I will stay out of your mention of Taylor / Ludvigsson etc: as it seems you are in ongoing disagreement with another editor on that -and they have supplied helpful sources, so hopefully you two'll reach consensus shortly. Peckedagain (talk) 01:38, 21 August 2024 (UTC)

The Cass Review is not, itself, a systematic review. The Taylor et al 2024 review of puberty blockers is one of the systematic reviews commissioned by the Cass Review, and the one that informs the Cass Review's findings on puberty blockers. This: Taylor et al., Zepf et al., and Ludvigsson et al. are all more recent as far as systematic reviews go, and include studies not considered by the Cass Review. is completely wrong.

The relevant MEDRS for this page is Taylor et al 2024. Void if removed (talk) 09:42, 21 August 2024 (UTC)

For the interested, the full series of systematic reviews commissioned by Cass, which provide the peer-reviewed evidence that the Cass Review is based on, is here. The scope of Cass is far greater than simply blockers. While the discussions on the Cass Review page are interesting, and some aspects of Cass and its fallout in the medical community (especially in Europe) could be relevant here, consensus on one page does not translate to consensus on another.

IMO the biggest problem Cass raises for this page - which I raised on talk months ago - is how to weight WPATH and APA guidance after the York systematic reviews found their guidelines to be poor? Systematic reviews and medical body guidance are supposed to be in accord and equivalent MEDRS - but we have a disconnect, with equivalent MEDRS criticising each other. I don't see any of this reflected in the article. Instead we simply say eg. Puberty blockers have clearly beneficial, lifesaving impacts on a scale of up to six year and The World Professional Association for Transgender Health's Standards of Care 8, published in 2022, declared puberty-blocking medication to be medically necessary and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, because longitudinal data shows improved outcomes for transgender patients who receive them which I think is a significant misrepresentation of the difference of opinion in MEDRS. Void if removed (talk) 09:58, 21 August 2024 (UTC)

Yes, that describes succinctly biggest elephant in the room: WPATH / Cass being in contradiction to each other on PB and yet our PB page is silent on that. Peckedagain (talk) 10:28, 21 August 2024 (UTC)

Also, while I'm on here - Rew et al is given far too much importance. It comes to stronger conclusions than more recent reviews, despite being based on fewer papers and weaker evidence (and arguably employing weaker methodology). We derive the following very bold wikivoice claim directly from there: Puberty blockers have clearly beneficial, lifesaving impacts

No subsequent systematic review comes anywhere close to this, and this claim in Rew et al is derived from one paper - Turban 2020 - which is an analysis of self-reported survey data and so I cannot fathom how they arrived at the quality score they did. This is, IMO, seriously overstating the evidence. There's no way we should be stating this in wikivoice, and definitely not without at least counterbalancing it with the more recent, more comprehensive evidence stating no clear benefits. Void if removed (talk) 10:33, 21 August 2024 (UTC)

I agree that the article needs to address the differing conclusions from the different systematic reviews. This needs to be addressed in the article body first before we start making sweeping changes to the lead which just cause the article to be more self-contradictory. And we need to provide balance per WP:NPOV, not simply gut everything in the current article and replace it with conclusions from the Cass Review. It's also difficult to discuss these issues in good faith while editors are pushing transphobic tropes about puberty blockers being "invasive treatments" that cause "lifelong harm", etc. On a final note, I find it ironic that you criticize the methodology and quality scores from Rew et al. (which is original research), but then turn around and insert results into the article based on animal studies, which as WP:MEDRS warns, do not translate consistently into clinical effects in human beings. Nosferattus (talk) 01:11, 22 August 2024 (UTC)

while editors are pushing transphobic tropes about puberty blockers being "invasive treatments" that cause "lifelong harm", etc

In general, any wikipedia article uncritically pushing that without major asterisks is extremely transphobic and uninformative, and pushing to completely destroy this article with that in mind is WP:POVPUSHING in its most naked form.

The addition of a lit review making highly ungeneralizable claims based on animal studies seems especially problematic. Bluethricecreamman (talk) 01:46, 22 August 2024 (UTC)

Check the talk history - the balance issues have been discussed for months, at least since the release of Zepf et al. There are more recent, better reviews than Rew, and there's no good reason for the current imbalance. Nor is there a reason to give so much space to low quality negative opinion of the NICE review. The release of the York review in April simply adds weight to the existing argument for a rebalance towards less certainty. That's all.

The Baxendale systematic review included human and animal studies, this is not just a case of eg. chucking a single mouse study into an article about cancer and claiming some wonderdrug is a cure. This source is absolutely fine, and nowhere near overemphasised.

Also OR is allowed on talk pages, and the editor I believe you're complaining about has already been topic banned so there should be no difficulty discussing these issues now. Void if removed (talk) 07:53, 22 August 2024 (UTC)

If we're doing our own research on the soundness of these studies, the Baxendale paper is absymal, IMO. Since you can't give animals IQ tests, all of the animal research she evaluated assessed behaviors correlated to cognitive development, which she divided into 3 categories: "positive interactions with the environment" (including social interactions), "responses to stress", and "performance on cognitive tasks (maze tasks)". No consideration is given to whether confounding variables like changes in physical size, speed, strength, or hormone levels (which are all associated with puberty) might be biasing those results, as they are all based on physical or social activities (rather than strictly cognitive activities). And the one human study that she gives any credence to was an IQ study of 2 dozen southeast Asian girls that had precocious puberty and were all adopted into Dutch families. In that study the author explains that adopted children tend to have lower verbal and math IQ scores as well as behavioural and emotional problems, and that the decline in IQ scores "could be explained by the adoption status of the children" rather than the puberty blockers as he had no control group. (And why he chose such a confounding group as his study group is beyond me.) Baxendale makes absolutely no mention of this in her review, but remarks "it is noteworthy that at least one patient in this study experienced a significant loss of 15 [IQ] points". So Baxendale doesn't mention the unique confounding factor highlighted by the author, but does highlight a single outlier as "noteworthy". At best this is bad science, at worst, dishonest. She then goes on to discuss in detail another human IQ study that she admits had no baseline data and showed no statistically significant results. And regarding reversibility, Baxendale admits that only a single study on male sheep even addresses this topic. So yes, this is just as bad as declaring a cancer cure based on a mouse study, in my opinion. It's also remarkable how frank Baxendale is in her lengthy introduction about how this review was conducted in order to prove her preexisting hypotheses, which is normal in clinical studies, but strange for a systematic review. Nosferattus (talk) 19:39, 26 August 2024 (UTC)

And taking all that into account "Another 2024 systematic review, using both human and animal studies found some evidence of sex-specific impact on cognitive function in mammals, and no evidence that cognitive effects were fully reversible" is a fair, one-line and attributed assessment of this review, that does not give undue prominence to its results.

Whereas "Puberty blockers have clearly beneficial, lifesaving impacts on a scale of up to six years" is a strong, definitive wikivoice claim based on Rew et al. This latter is untenable IMO. Void if removed (talk) 08:41, 27 August 2024 (UTC)

Puberty blockers banned in the UK?

Right now both the lead and article body state that prescribing puberty blockers to patients under 18 in the UK is now "banned" except for clinical trials. In both cases this is cited to Wikipedia! According to the actual NHS policy document: "Puberty suppressing hormones (PSH) are not available as a routine commissioning treatment option for treatment of children and young people who have gender incongruence / gender dysphoria… We have concluded that there is not enough evidence to support the safety or clinical effectiveness of PSH to make the treatment routinely available at this time." This is hardly a "ban". According to the BBC, the new policy "will not allow them to be prescribed 'routinely' outside of a research trial, but that individual clinicians can still apply to have the drugs funded for patients on a case-by-case basis."[1] The policy document also doesn't mention anything about whether or not puberty blockers should be prescribed for other conditions such as precocious puberty. If anyone has suggestions for how this can be better worded, please chime in. Nosferattus (talk) 01:43, 20 August 2024 (UTC)

There is this primary one from gov.uk and this article is currently used on the Cass Review page for citing the ban itself, so we could probably add those two as sources for it. The wording by most (all?) sources I've seen definitely uses the term ban. Raladic (talk) 01:53, 20 August 2024 (UTC)

Ah so there is an actual ban, albeit a temporary ban (until September 3) that only covers gender dysphoria or incongruence. Nosferattus (talk) 01:57, 20 August 2024 (UTC)

It won't be temporary, the new goverment that just took over confirmed it will be permanent - article on that here. Raladic (talk) 02:02, 20 August 2024 (UTC)

Thanks for the sources! I'll tweak the wording accordingly and add some of those sources. Nosferattus (talk) 02:11, 20 August 2024 (UTC)

Here's my edit. Hope that looks good. Nosferattus (talk) 02:25, 20 August 2024 (UTC)

Looks good, but I just realized that the first paragraph in Puberty_blocker#United_Kingdom is a bit duplicative to the Puberty_blocker#Ban_on_private_clinic_prescription subsection which also says the same thing (and in more details).

Should we maybe just consolidate it down into the subsection (and probably rename the subsection since the ban is not just on private clinics)? Raladic (talk) 02:29, 20 August 2024 (UTC)

@Nosferattus I know it is not etiquette to criticise other editors, and let make plain that this is not my intent. However it is true that you are stating things here, that a read of the Cass page show to be unfounded. eg

• This is hardly a "ban".

The Cass page makes it very clear that there is a ban! It's not something buried deep in the page.

I am not criticising your talk here - but I am wondering why you don't get up to speed with the Cass page first, in detail, before talking here. It will benefit everyone who reads this page. As per the list I put together above, there are 10 or 20 ways in which this page makes statements that are contradictory to the Cass page: so the discussion here will be more fruitful if it starts with an accurate view of Cass for each, and not be diluted ith misreadings.

this is not a criticism, as I know I too have barged into pages without reading up first: so I am pointing the finger at myself just as much. I hope you'll take this in the positive spirit it is intended. Peckedagain (talk) 21:25, 20 August 2024 (UTC)

I just edited to correct the ban date under 'United Kingdom' and add the date to the lead. Peckedagain (talk) 22:11, 20 August 2024 (UTC)

Slightly off-topic, but what do editors think of devoting a few extra sentences to banning puberty blockers in the lede/body? A handful of American states as well as a few European countries have restricted access to puberty blockers, but the former have decreed a stricter ban out of mostly political reasons, whereas the latter have enforced less strict bans (as reflected in this discussion) mostly for evidential reasons. After all, let's not forget that the UK is not the first European country to implement such restrictions. I therefore propose that we change the current sentence into sth like this: As of 2024, Norway, Finland, Sweden and the UK have restricted access to puberty blockers for patients under 18, solely prescribing them in clinical trials.

The last two paragraphs in the lead definitely need more rewriting than that, but I think this is a good start. Cixous (talk) 09:30, 23 August 2024 (UTC)

The word "ban" is used on the government document. However, the document title uses the word "restriction". A "ban" need not be absolute. Smoking is "banned" inside public buildings in the UK but isn't "banned" entirely. If we merely say something is "banned" then the reader will assume it is entirely banned, which they wouldn't if we said "restricted". I don't mind using the word ban as long as we make very clear the UK has conditions where PBs may be prescribed to under 18s on the NHS. My understanding (correct me if I'm wrong) is that is different to the US position in many states. -- Colin°^Talk 10:32, 24 August 2024 (UTC)

That is true and I think it needs clarifying. As I point out above, it's important to distinguish European restrictions from US bans, because their justification and enforcement differ. Cixous (talk) 18:25, 24 August 2024 (UTC)

I edited the lede myself, unaware of this discussion and coming to similar conclusions to the points mentioned above. The mention of the UK's ban is out of place. The lede really should summarise the following perspectives:

• Medical support for puberty blockers
• Medical caution about puberty blockers (i.e. the view that the evidence is insufficient)
• Political opposition, which should be acknowledged but is more of a 'Society and Culture' issue in a medical article.

Anywikiuser (talk) 22:03, 28 August 2024 (UTC)

That wasn't the conclusion of @Nosferattus - they were asking for clarification on the scope of the ban (as previously, the statement was linked by someone to inside wikipedia instead of a proper external RS) and that's why we had this talk page discussion to clarify on scope and duration as you can see above and after that, they themself expanded on the lead of the UK ban as that section in the lead summarizes the legal use of puberty blockers - it's not a section that discusses efficacy or other politics (that is covered in the summary paragraph below. Raladic (talk) 22:26, 28 August 2024 (UTC)

Lead summary of the support for use of puberty blockers

Per WP:BRD - @Anywikiuser - you tried to change the prose of the summarization of the lead, which summarizes from the article the global view of the support for the use of puberty blockers. You instead introduced a new starting sentence that reframes the wide global support into that of contention with the addition about something totally different. Which in the case of Finnland isn't even part of the Puberty_blocker#Finland section, which states that their guidelines prioritize therapy, but still support the use of puberty blockers, which you changed into something very different that isn't even in the article. The lead section (prior to your change) summarized the legal support for the use of puberty blockers, not discussions of evidence or a discussion of the efficacy of it. It's about whether they support using them at all, which is why the UK was listed as the outlier on a now outright ban. You have also now hit the limit of WP:3RR, so please self-revert your last reversion to avoid running afoul of our rules on edit-warring. Raladic (talk) 21:40, 28 August 2024 (UTC)

I count 2 reverts each there, on a WP:CTOP. I suggest both just stop edit warring and discuss the changes. Void if removed (talk) 21:53, 28 August 2024 (UTC)

The intial change by the @Anywikiuser is a reversion of the status-quo itself that appears to try to reframe the summary very similar to that of another user that was reverted just days ago and that user was tbanned for the very same POV pushing recently, so the initial re-changing it back to the same POV counts as a manual reversion, so that's 3 reversions with the first being manual and the other [2] and [3] being automated reversions, so that's 3.

If the first wasn't so strikingly similar to that of the banned user, then yes, it might be two reversions, but as that first one is so similar, you'll find that most people would agree it looks like a manual reversion of the initial status quo, especially with the total change of the context of what the summary section there summarized, as was also literally just discussed as consensus, with the only thing left potentially is to add the mention on restrictions from Norway, Sweden and Finland (after those restrictions actually are in the article sections, since the WP:LEADFOLLOWSBODY) as Cixous pointed out, but also seeing the sections on Norway, Sweden and Finland, neither of those countries actually banned the use, just changed some recommendations.

So again, please self-revert your last change per it being otherwise a violation of WP:3RR against current consensus. Raladic (talk) 22:06, 28 August 2024 (UTC)

Any similarities between my edits and the earlier one are most likely a result of parallel thinking. Moreover, the 3 revert rule applies to edits made in a 24-hour window, whereas the earlier edit was made on 17 August.

I don't understand your argument that the lede should not discuss efficacy. (In this case, this would be about whether puberty blockers improve mental health outcomes, as their physical effects are somewhat known.) If anything, that is a more important issue than any 'society and culture' issues. Moreover, I thought the lede was discussing efficacy anyhow. When it says that the use of puberty blockers "is supported by" some medical organisations", doesn't that mean that they not only think they should be legal, but also that they are efficacious?

It is important to remember that doctors stances are more nuanced than a rigid binary of support and opposition. The stance of the Finnish Ministry of Health is an example.

Finally, isn't it self-evident that medical institutions have differing opinions on the matter? Anywikiuser (talk) 23:09, 28 August 2024 (UTC)

Yes, it is self-evident that medical institutions have differing opinions about the matter, but the question is which org is WP:DUE in lede. AMA, APA and AAP are all among the biggest, most-mainstream American medical orgs. Endocrine Society supports it as well as among a gigantic foice.

Meanwhile, specialist orgs, with arguably right-leaning views seem to disagree about them. To suggest that there is significant medical debate when AMA, the BIGGEST of the BIGGEST of medical orgs, endorses their usage is WP:FALSEBALANCE.

I'm reverting it and strongly suggest to stop WP:EDITWAR. Bluethricecreamman (talk) 23:17, 28 August 2024 (UTC)

If this article were dealing with a purely American perspective, this would be tenable, but this article is supposed to deal with a global perspective. As the body notes, in contrast to the lede, some medical institutions in other countries now take a more cautious stance (which does not mean they "oppose" them). Moreover, my edit would have left 18 organisations mentioned to support puberty blockers and 2 that argue that the evidence is uncertain, which is hardly suggesting a 'balance' in those perspectives. Anywikiuser (talk) 08:51, 29 August 2024 (UTC)

To suggest that there is significant medical debate

There is significant medical debate, as documented in WP:RS. To suggest that the AMA has the final word on international medical matters is US-centrism.

Never mind that - as has been raised here before - we have systematic reviews strongly criticising the Endocrine Society, AAP and APA's guidance as circular and lacking developmental rigour. Continuing to argue to keep this out of the lede is untenable. Void if removed (talk) 09:45, 29 August 2024 (UTC)

I'd also like to point out that the European Academy of Paediatrics, the European counterpart of the APA, has a different take on puberty blockers. They essentially point out, among other things, that (i) it is feasible that some European countries may tackle the lack of evidence differently and that (ii) treatment should take into account the rights of a child (though they shy away from being super specific about what this entails). Their point of view is, in summary, more nuanced. They do not recommend puberty blockers but do not dissuade their use either.

Another European organisation, the European Society for Sexual Medicine, does unambiguously support puberty blockers. One cannot simply dismiss one over the other. IMO they should both be included, because the information in the current lede is heavily reliant on American organisations. Cixous (talk) 10:21, 29 August 2024 (UTC)

It's worth noting that the AMA, for example, is not a purely scientific organisation, being a professional organisation with a goal of protecting its members and promoting political positions. What this means for enwiki is laid out in WP:MEDORG: Guidelines do not always correspond to best evidence, but instead of omitting them, reference the scientific literature and explain how it may differ from the guidelines. This is an area where the evidence-based scientific viewpoint is currently discordant with (some of) the consensus-based medical viewpoint(s). These are both significant viewpoints, so per NPOV, we need to cover them both and explain how they differ. The current lead over-weights the consensus-based viewpoint, soft-pedals the scientific viewpoint, and fails to confront the discord head-on. The inclusion of the European Society for Sexual Medicine isn't ideal, because (a) it's not mentioned in the body, and (b) it's a red link, so is it even a notable org? Barnards.tar.gz (talk) 18:41, 29 August 2024 (UTC)

I believe you have a point here. Perhaps it's better to simply summarise that, broadly speaking, there is a clash between consensus-based and evidence-based viewpoints regarding puberty blockers. It'd even make the article more pleasant to read than just simply listing fifteen-thousand organisations. I hope for once that this discrepancy can just be mentioned without the need to argue endlessly back and forth about whether or not it is the proper way to phrase things. Cixous (talk) 19:46, 31 August 2024 (UTC)

Add new reference

A comprehensive study conducted in 2024 by the HealthSense, the UK charity which promotes evidence-based medicine, calls gender dysphoria treatment 'the canary in the coalmine' for its selective evidence base (which it claims is far from unique to this issue) and rejects complaints against randomized controlled trials, pointing out that they are applicable to almost all treatments including surgery. It concludes that where outcomes are not clear or where evidence is controversial it is unfair to patients to adopt interventions except as part of ethically approved and properly conducted research. See original paper at https://www.healthsense-uk.org/publications/background-briefings/10-background-briefings/428-evidence-and-gender-dysphoria.html. Rachelgoodwin (talk) 08:02, 7 September 2024 (UTC)

Japanese translation

@Raladic your reversion here is based on the word "caution" not appearing in Japanese text. I am relying on a translation of the following:

これらのことを踏まえて、今回の改訂では二次性徴抑制療法について注意すべき点を再

I am not a Japanese speaker, so I'm relying on machine translation. Google says:

In light of these points, this revision reiterates the points to be noted regarding secondary puberty suppression therapy.

DeepL says:

In light of these considerations, this revision reiterates the points to be noted with regard to secondary sex characteristic suppression therapy.

GPT4 says:

Based on these considerations, this revision once again addresses the points to be cautious of regarding puberty suppression therapy.

GPT4o says:

In light of these considerations, this revision once again addresses the points that require caution regarding puberty suppression therapy.

ModernMT says:

With these things in mind, this revision revisits the points to be aware of when it comes to secondary feature suppression therapy.

My understanding is that the sense of these guidelines is to reiterate existing points of uncertainty and caution. I also fail to see the point of the quote you have re-added which doesn't actually illuminate anything about the guidelines.

Also, wording like recommend puberty suppression in trans patients doesn't give any indication that (by my reading at least, and again this is machine translated) psychotherapy is still a first-line treatment and they recommend hormonal suppression only if two to three psychiatrists agree, with oversight from a multidisciplinary panel, and they say suppression should be as short as possible and complete within two years, that assessment of gender dysphoria in childhood should account for confounding factors like autism and separation anxiety, and with all kinds of provisos about likely infertility and not intervening too early because of the possibility of dysphoria not persisting after adolescence. Void if removed (talk) 09:42, 1 October 2024 (UTC)

AI hallucinates, so depending on it for translation and then deriving things from it is not a good idea, which is why it should not be used for Wikipedia. More details here - WP:LLM.

Using strict translation, whether it be Bing or Google do not hallucinate added word of caution, so they clearly do not exist.

The fact that normal considerations such therapy and oversights in a timely matter, is regular due process.

And in fact on your last point - and not intervening too early because of the possibility of dysphoria not persisting after adolescence. - that is precicely why the quote that I reinstated is relevant, because it is a good common-sense approach that the new updated Japanese guidelines highlight, giving puberty blockers is scientifically evident and they help to prevent otherwise irreversible harm by delaying a puberty onset. If during the course of therapy a teen ends up stopping, then puberty will set in. But if they are affirmed in their transgender identity, then the use of puberty blockers helped prevent harm by stopping the development of irreversible effects of puberty. So, you have effectively proven on why the quote is a very good scientific summary that the Japanese guidelines have produced, they are effectively following the prime adage that each doctor swears in the Hippocratic Oath to prevent harm. Raladic (talk) 14:49, 1 October 2024 (UTC)

WP:LLM says nothing about translations, so I don't know why you bring it up.

do not hallucinate added word of caution, so they clearly do not exist

Points to be cautious of, points of note, points to be aware of, points to pay attention to, all translate as 注意すべき点 in google, translation of any sort is an approximation, machine translation is no different. The point is that your justification that "caution" doesn't appear is arguable without an authoritative English translation, and not really that relevant as a reversion reason since I am not quoting the document but trying to convey the sense of it. I believe it is more conservative than the current wording conveys, since the 5th edition highlights several points of caution, from warning about infertility, to the issues with confounding comorbidities and desistance. Void if removed (talk) 16:37, 1 October 2024 (UTC)

I’m with Raladic here, using AI as the basis for translation is not helpful here, especially with such a contentious topic. Snokalok (talk) 17:02, 2 October 2024 (UTC)

Completely disagree, GPT-4 beats google or bing in translation benchmarks, it is an excellent machine translator, and it is especially good with Japanese. But all machine translations are limited, that's why multiple in parallel is a good idea - the point is that absent an official English translation, the stated reversion reason is hardly justifiable when we're not talking about a direct quote, but the sense in which the guidelines emphasised caution and reiterated points of concern. Void if removed (talk) 19:11, 2 October 2024 (UTC)

Which is why I linked the essay WP:LLM earlier above on why we discourage their use on Wikipedia, as the LLM outputs can have hallucinations. Raladic (talk) 03:20, 4 October 2024 (UTC)

This isn't a response to any of the points I've made.

Your contention is that this:

The guidelines continued to recommend puberty suppression in trans patients, noting that it "is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it". However, they also asked doctors administering such treatment to report more detailed information on it going forward.

Is a better summary of the guidelines than this:

The guidelines continued to use WPATH SOC7 as a basis, and highlighted points of caution for the use of puberty blockers, while retaining requirements for multidisciplinary involvement and psychological assessment prior to any medical intervention. Additionally, they recommended doctors administering such treatment to report more detailed information on outcomes going forward.

And you justify this because your machine translation of a Japanese text doesn't contain the word "caution", and now you're talking about LLM hallucination, even though I've told you a) I'm relying on multiple machine translations of the same document, b) GPT4 is a better translator than google anyway, and c) that I'm not directly quoting a machine translation of any sort, but conveying the sense of the guidelines. If you don't like my choice of word "caution" propose an alternative?

The points I am referring to include noting that autism and separation anxiety can complicate diagnoses, and that blockers should be administered only for a short time, and that they should not be given too young because of the possibility of dysphoria resolving in adolescence. "Recommend" doesn't come close to the limitations they place on usage.

What about just "highlighted important points"?

As for the quote you keep reinstating, I cannot WP:VERIFY this:

"is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it"

Here's what google translate says:

Furthermore, the AMAB considers it medically self-evident that failure to implement secondary sexual characteristic suppression therapy in cases where it is necessary will result in irreversible physical characteristics of the undesired sex, and, although it is difficult to conduct research that provides high-quality evidence in such cases, there are concerns that it may have a negative impact on the patient's mental state after the procedure.

Bing says:

In addition, it is medically self-evident that the undesirable physical characteristics of the sex will be irreversible if secondary sexual characteristic suppression therapy is not provided in necessary cases, and although it is difficult to conduct studies that provide high-quality evidence in such cases, there are concerns that it will have a negative impact on the subsequent mental state.

And here's what GPT4 says:

Additionally, for AMAB (Assigned Male at Birth) individuals, it is medically evident that if puberty suppression therapy is not administered when necessary, the development of unwanted physical characteristics of the assigned gender becomes irreversible. In such cases, although it is difficult to conduct studies that provide high-quality evidence, there are concerns that this could negatively affect the individual's mental state afterward.

None of these match the quote as given, and are in line with your own machine translation here.

But, if I google the exact text you have reinserted as a quotation, I find it here, on the website of the activist group who failed to overturn the ban on puberty blockers in England, who do not give any indication how they obtained that translation. Void if removed (talk) 09:11, 4 October 2024 (UTC)

I don’t know if the quote is an exact translation, but it sounds extremely close to the first parts of the translations you posted above and they’re all basically saying the same thing anyway. Maybe we could just reword the article so it says the same thing but not as a quote? Usr Trj (talk) 01:06, 5 October 2024 (UTC)

Why would we have it here at all? What does it add? This is part of the context, and not really describing the guidelines. Surely we should be trying to summarise what the guidelines actually are, not passing observations about what is "medically self-evident". We have far better sources for this sort of thing, and this sort of observation fits into the context of the Dutch Protocol itself (ie, that was the whole point, intervene early on AMAB individuals to prevent the development of irreversible physical changes in hope of better QoL in adulthood). I simply don't see what it adds here to state the obvious again, and it just takes away space we could be devoting to what's actually noteworthy about the Japanese guidelines. Void if removed (talk) 08:37, 5 October 2024 (UTC)

The quote is noteworthy because it highlights that the Japanese guidelines are summarizing that is it scientifically well-known and safe to administer puberty blockers to give transgender youth time by delaying the onset of puberty and the possible resulting irreversible harm caused from the development of secondary sexual characteristics such as lower voice and hair onset.

It is just a good summary that their new guidelines continue to recommend the use of puberty blockers in light of the worldwide consensus that their safety is well known and that it is medically self-evident of why they should be administered, and they concur with this medical opinion. Raladic (talk) 15:31, 5 October 2024 (UTC)

I agree with @Raladic:. It’s a good summary and also a good example of how the Japanese guidelines contrast with the Cass Review and came to different conclusions/recommendations despite considering the Cass Review. Usr Trj (talk) 23:13, 5 October 2024 (UTC)

Taking your suggestion, aAlternative wording I've proposed over on Cass Review to get round this uncertainty over lengthy translations:

The guidelines note it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in AMAB individuals. Void if removed (talk) 23:02, 12 October 2024 (UTC)

Agree, I think that’s a good compromise for the sentence that conveys the message. Raladic (talk) 23:08, 12 October 2024 (UTC)