Talk:Puberty blocker/Archive 7

In the Gender Disporia section it says "Puberty blockers are associated with such positive outcomes as decreased suicidality, improved affect and psychological functioning, and improved social life."

But in the Long Term Side Effects secction it says "There is limited high-quality research on puberty suppression among adolescents experiencing gender dysphoria or incongruence. No conclusions on impact on gender dysphoria, mental health and cognitive development could be drawn."

These things cant both be true at the same time. 73.38.245.197 (talk) 03:35, 20 April 2025 (UTC)

So, which is it? 73.38.245.197 (talk) 17:26, 10 May 2025 (UTC)

I can't edit this article but someone should. 73.38.245.197 (talk) 20:24, 11 July 2025 (UTC)

Thanks for pointing this out. There was a discrepancy, and we were using primary sourced single studies to make the point. This is contrary to WP:MEDRS. I expect there will be more to say on this when more systematic reviews are completed, but whatever we say should be sourced to such reviews, so I have removed some of the statements. Sirfurboy🏄 (talk) 12:01, 22 July 2025 (UTC)

The article extensively uses systemic and narrative reviews to make the point about improved outcome, it just happens to also cite primary sources to repeat some of that information Snokalok (talk) 12:51, 22 July 2025 (UTC)

But it doesn't cite any WP:MEDRS secondary sources for the claims regarding that sentence. Edit warring them back in does not resolve this. Finding a review that meets WP:MEDRS would. There should not be statements in the lead that contradict the main text, based on single studies. That is bad writing. Also, per ONUS, you should have discussed this and gained consensus before restoring the disputed information (twice!). Sirfurboy🏄 (talk) 13:04, 22 July 2025 (UTC)

Per ONUS, blanking text that is the product of consensus requires seeking a new consensus, that puts the onus on you, sir. And again, it's a sentence in the lead. It doesn't need citations period, so long as it accurately follows the body. Just because someone added a primary source citation, does not suddenly invalidate that; and also it does not contradict the main text, the main text has systematic reviews backing up its statements on the efficacy of puberty blockers. Snokalok (talk) 13:18, 22 July 2025 (UTC)

Where is this consensus to have contradictory information in the lead sourced to primary single studies please? You have provided no evidence any such consensus exists, neither here nor in your edit summaries. Sirfurboy🏄 (talk) 13:23, 22 July 2025 (UTC)

Well, let's start with the fact that for over four years, on one of the most hotly fought over pages in one of the most hotly fought over topics, the fact that puberty blockers reduce suicidality and lead to more positive mental health outcomes longterm has been cited to reviews of the research and remained in the article as a fact without molestation (ctrl+F suicidality). Per WP:EDITCON, most consensus is editorially implicit, and I do not think you can find a more textbook example of implicit consensus than the fact that on, as said above, one of the most hotly fought over pages on the entire wiki, this has remained a constant. Likewise, in the modern article, it's the same - reviews cited in the body saying these are positive outcomes. Just because we don't know the effects on a decades long scale, does not contradict that. Snokalok (talk) 13:41, 22 July 2025 (UTC)

That it has not been removed yet is not a consensus (what would be the point of ONUS, if all edits are said to have consensus simply by virtue of being previously unchallenged?) In any case, I have requested help at Wikipedia_talk:WikiProject_Medicine#Puberty_blocker. Sirfurboy🏄 (talk) 13:48, 22 July 2025 (UTC)

They are not contradictory. A new or relatively recent addition to the article has to justify its inclusion if disputed, but if ONUS made everything fight for inclusion, any IP could come along and blank the page, before saying it couldn't be unblanked without consensus on talk. But of course, the page being not blank is the product of longterm implicit consensus, and thus the IP needs to achieve a new consensus to blank it. What would be the point of AfD otherwise? Snokalok (talk) 14:10, 22 July 2025 (UTC)

Also, I'm going to request wikiproject LGBT since they also have interest in the article and thus should be invited to weigh in if we're inviting one wikiproject Snokalok (talk) 14:11, 22 July 2025 (UTC)

That would appear to be forum shopping. The question was about MEDRS. Now then, you have replaced the primary sources with:

1. Pink News which is a summary of the SaxInstitute review but not itself a MEDRS. That one can come out. We need one good source, and let's avoid WP:OVERCITE.
2. Evidence for effective interventions for children and young people with gender dysphoria—update - This is a good one. The full report, which is a review, says in its conclusion,

   Psychosocial therapies: This Evidence Check added considerably to the evidence base from the original review. Newly identified studies reported a range of benefits across suicidal ideation, depression and anxiety. Furthermore, most studies reported that interventions are both acceptable and safe, with no risks or potential harms reported. Although we identified one RCT, it was not specific to gender dysphoria. Furthermore, the considerable variation in the psychological therapies and delivery modes evaluated should be borne in mind when interpreting findings of studies of psychological interventions.

   The sentence could be rewritten along those lines, but also we should include their caveats. Whether that can be done in one sentence the lead is unclear. I expect a form of words is possible though.
3. Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature - this one does not directly address suicidality, although it notes the higher rates among transgender individuals. It concludes:

   Despite a recent increase in the number of TGD youth seeking healthcare services for their gender dysphoria, there exists a relatively small amount of research regarding the positive and negative short- and long-term effects of using GnRHa drugs to suppress puberty and to allow more time for gender identity exploration. The need for additional well-designed longitudinal and mixed methods studies is critical to support and even improve cur-rent practice for this very vulnerable population

   Which does not support our statement in the lead at all. Indeed, that one would be a strong argument that the statement is not leadworthy. It says we cannot make that determination without further study. It is dated 2020, whereas the Sax Institute source is dated 2024. It is misleading to include this one and it should come back out. Sirfurboy🏄 (talk) 14:29, 22 July 2025 (UTC)

Counterpoint, it says the evidence can be better and more thorough, but that's different from saying that there is no evidence or that the current evidence is invalid - just that it could be improved. So it's, perhaps a justification for saying "Though many say that greater longitudinal research is needed" Snokalok (talk) 14:32, 22 July 2025 (UTC)

As to your allegation of forum shopping, not at all. I simply believe that, if we're notifying one wikiproject containing expertise on the subject matter, we should notify others. I would've added pharmocology as well, but I imagine everyone in pharma is also in medicine so, moot point - whereas there are, to my belief, many voices in wikiproject lgbt well apprised on the research status of puberty blockers but whom do not engage in the wider wikiproject medicine. Snokalok (talk) 14:34, 22 July 2025 (UTC)

Which seems to suggest a belief that the question is about some kind of LGBT battleground topic, whereas the issue I raised was clearly and specifically that we had statements being made sourced to single studies that contradict statements we make sourced to systematic reviews. Your decision to revert in those sources twice when I had clearly flagged MEDRS issues necessitated a referral to those working with MEDRS sources. Now about the above, would you agree that the Pink News source is unnecessary and Rew et al (2020). does not support that statement as it stands? Sirfurboy🏄 (talk) 17:01, 22 July 2025 (UTC)

Which seems to suggest a belief that the question is about some kind of LGBT battleground topic

I don't know what to tell you, I'm sorry that people interested in LGBT topics are well informed on LGBT topics?

Now about the above, would you agree that the Pink News source is unnecessary and Rew et al (2020). does not support that statement as it stands? If you refer to the pinknews source referring to NSW, yes for the lead, no for the body. It helps establish notability for certain points and thereby avert potential concerns of OR. I do not agree with you on Rew, I think it's perfectly reasonable to say that the evidence as it stands supports the benefits of puberty blockers but that the evidence could always be stronger. Snokalok (talk) 17:34, 22 July 2025 (UTC)

I'll take it Pink News out of the lead. As for Rew et al. in the lead, if we keep that there, then the sentence needs to change. The sentence reads "They have been shown to reduce depression and suicidality in transgender and nonbinary youth." The paper does not say that. The closest thing it has to that is Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. There are caveats too (not least the contents of the very next sentence, which we don't seem to summarise in our lead), but I note that the observation on suicidality specifically refers to adults, not youth. Sirfurboy🏄 (talk) 18:34, 22 July 2025 (UTC)

It refers to adults who took puberty blockers as youth (because obviously you don't take puberty blockers as an adult). We could perhaps change it to "transgender and nonbinary patients who receive them as youth" or we can combine it with NSW to say "in transgender and nonbinary patients both as youth and later into adulthood" Snokalok (talk) 18:45, 22 July 2025 (UTC)

If it stays, it needs to be placed in context that this was an early review, and later ones have not corroborated that finding. Void if removed (talk) 19:59, 22 July 2025 (UTC)

That's not true. The review by Taylor et al (2024) partially corroborates the sentence, at least regarding depression, as pointed out by Nosferattus above. According to Taylor et al there is moderate quality evidence for "reduction in depressive symptoms". Twiggy1977 (talk) 06:25, 23 July 2025 (UTC)

So why cite Rew et al? If we're sticking to what Taylor et al says, Rew adds nothing - and if we cite Rew on suicidality we have to say other, later reviews don't support that. Void if removed (talk) 09:05, 23 July 2025 (UTC)

Rew was also added to the Gender dysphoria text in the main yesterday. I have amended it in this edit owing to close paraphrasing, and to ensure we capture a more neutral summary rather than one that only listed the positives. This would be the place to add any work from following reviews too. I don't think what we have in the lead is a good summary of anything, and that must be amended or deleted, but we might want to get the main text correct before doing so. Sirfurboy🏄 (talk) 10:48, 23 July 2025 (UTC)

The content of the lede is supported by the WPATH SOC-8 guidelines S-126, found here:

https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

"Turban, King et al. (2020) found a decrease in the odds

of lifetime suicidal ideation in adolescents who

required pubertal suppression and had access to

this treatment compared with those with a similar

desire with no such access (Turban, King et al.,

2020). A recent systematic review found pubertal

suppression in TGD adolescents was associated

with an improved social life, decreased suicidality

in adulthood, improved psychological functioning

and quality of life (Rew et al., 2020) "

Perhaps it should explicitly cite SOC-8. HenrikHolen (talk) 19:50, 22 July 2025 (UTC)

That chapter presents only a narrative review. So, no. Void if removed (talk) 19:57, 22 July 2025 (UTC)

The algorithm just pushed this article from a month ago in front of me. I missed it back then. From the Atlantic: "When Justice Samuel Alito challenged the ACLU lawyer Chase Strangio on such claims during oral arguments, Strangio made a startling admission. He conceded that there is no evidence to support the idea that medical transition reduces adolescent suicide rates." Here is the link: https://www.theatlantic.com/ideas/archive/2025/06/transgender-youth-skrmetti/683350/— Preceding unsigned comment added by 73.38.245.197 (talk)

This was published under "Ideas", meaning that it is opinion not News reporting. Lewis is not an impartial commentator and the highly polemic title, "The Liberal Misinformation Bubble About Youth Gender Medicine. How the left ended up disbelieving the science", shows that she very much has a horse in this race and she is not trying to pretend otherwise.

The claim is exceptional enough to require a much better source than an opinion piece. To be honest, I doubt it this is a correct characterisation of what was presented. It sounds like Strangio might have been addressing some specific set of studies, not the entire body of studies, but without any additional context it is impossible to know what, if anything, any of this really means. If such a broad admission really had been made then I'm pretty sure that this would not have eluded you, or many of us, for a month before an algorithm pushed it at you seemingly at random. It would have been seized on and shouted from the rooftops. By all means dig into this to see if you can find a better source covering it as News but I don't think that this alone is even close to being good enough to use, even with attribution. We don't want to have double hearsay where we write something like "Lewis said that Strangio said that...". Quite apart from the BLP issue that it would be putting words in Strangio's mouth, that would just make everybody involved sound ridiculous. --DanielRigal (talk) 22:52, 22 July 2025 (UTC)

Several other sources confirm what The Atlantic said. All have their biases, so I am only including liberal outlets. For what its worth, I really don't have a dog in this fight. I just couldn't square the two competing statements in this article that contradicted each other.

Washington Post: https://www.washingtonpost.com/politics/2024/12/04/supreme-court-transgender-rights-case/#link-3EYAPZOXVZGCVAW3PLPDIJUW3I

New Republic: https://newrepublic.com/article/189040/supreme-court-rule-transgender-rights

Harvard Journal of Law & Public Policy: https://journals.law.harvard.edu/jlpp/suicide-suicidality-and-pediatric-medical-transition-in-united-states-v-skrmetti-and-beyond/ 73.38.245.197 (talk) 03:40, 23 July 2025 (UTC)

This article isn't about medical transition, it's about puberty blockers. Twiggy1977 (talk) 04:33, 23 July 2025 (UTC)

The problem with what we had was that it was based on single studies and not systematic reviews and contradicts main text in the lead. Neither of these issues will be improved by using a bunch of newspaper reporting. The single studies are gone now. The text still needs rewriting, but as DanielRigal says, please follow up the news reporting and look for better sourcing. But for a medical claim (which this is) we need WP:MEDRS sources. Although, in the lead, we wouldn't need any sources if the lead text clearly summarised sourced text in the main. (It doesn't right now). Sirfurboy🏄 (talk) 08:04, 23 July 2025 (UTC)

Your characterization of review articles and medical guidelines as "single studies" and "primary sources" in your recent edits is misleading. WP:MEDRS doesn't require systematic reviews for every medical statement, and some of those statements aren't even medical statements, but statements about studies or medical practice. Nosferattus (talk) 17:22, 24 July 2025 (UTC)

I do agree, however, that we could use better sourcing for some of the claims in this article, and better explanation for why there are disagreements. Nosferattus (talk) 17:44, 24 July 2025 (UTC)

Now the question of whether a source is primary or secondary is not always black and white, and depends on the question asked, but you'll note from my edsum that my real concern there was the use of three sources to verify "Studies examining the effects of puberty blockers for gender non-conforming and transgender adolescents have generally indicated that these treatments are reasonably safe" is WP:SYNTH. By presenting three sources that make the point that they are reasonably safe, and inviting the reader to suppose that this verifies that studies generally find this is, indeed, SYNTH. And yes, the studies then become primary sources for the claim being verified: that studies generally find this. All it takes is to find one suitable review that shows this to be the case generally, and you can cite that. But no, you can't cite three sources and invite that conclusion. One study with the conclusion is a secondary source for the claim. I tweaked the wording to get around the issue. Sirfurboy🏄 (talk) 17:59, 24 July 2025 (UTC)

Fair enough. Also, I noticed that our statements about puberty blockers negatively affecting fertility and libido in the long-term have no citations and are not supported by the other references in that section. (Some of the other sources do mention negative affects from HRT, but not puberty blockers specifically.) If we're going to require strenuous sourcing, we should apply the standard across the board and not just for positive statements. Nosferattus (talk) 19:33, 24 July 2025 (UTC)

Yes indeed, and thanks for your edits today. Sirfurboy🏄 (talk) 21:12, 24 July 2025 (UTC)

Our single citation about penile inversion vaginoplasty describes itself as a "short essay", and just mentions the procedure in a single sentence. Do you think that citation is appropriate and adequate for the text? Nosferattus (talk) 20:24, 24 July 2025 (UTC)

That reference has been inserted twice and is a duplicate in the reflist. Which text are you asking about? From the question, perhaps the section Fertility and sexual function? Sirfurboy🏄 (talk) 21:17, 24 July 2025 (UTC)

And indeed, now I read that section and the source, I see what you mean. Something else would be better, but I'm not sure that the claim is controversial, or contested is it? But this is why I asked for help on WikiProject medicine. I'll defer to others on that one. Sirfurboy🏄 (talk) 21:25, 24 July 2025 (UTC)

This edit request has been answered. Set the |answered= parameter to no to reactivate your request.

Replace this:

       "Transgender healthcare guidelines published by the Association of the Scientific Medical Societies in Germany recommend immediate access to puberty blockers and other gender-affirming medical treatments as quickly as possible for patients in which the progression of puberty would lead to irreversible bodily changes.[144]"

With this:

      "Puberty blockers are recommended only under specific conditions: The adolescent must be at least in Tanner stage 2 of puberty, have a persisting gender incongruence diagnosis (ICD-11), and be psychosocially stable without untreated mental disorders or severe obesity. The decision requires interdisciplinary evaluation by experienced psychiatric-psychotherapeutic and endocrinological professionals. Treatment should be time-limited, as prolonged use may affect bone density, hormonal balance, and fertility, with increasing caution beyond age 15.[144]" 

Also add this to the Austrian section as both countries follow the same guideline.

The AWMF S2k guidelines, in German "AWMF-Leitlinie – Geschlechtsinkongruenz und Geschlechtsdysphorie im Kindes- und Jugendalter – Diagnostik und Behandlung (S2k) AWMF-Register-Nr. 028 – 014", do not recommend immediate access to puberty blockers and other gender-affirming treatments as quickly as possible. Instead, they outline specific preconditions and a careful, interdisciplinary evaluation process before starting puberty blockers. I would recommend to put in the first statement for clarity in both the German and Austrian section as both countries worked together on this guideline. — Preceding unsigned comment added by Hunig Brocc (talk • contribs) 10:14, 18 March 2025 (UTC)

 Not done: please provide reliable sources that support the change you want to be made.

SMYTI (tk|CNTBTN)

21:46, 29 March 2025 (UTC)

On Prerequisite (Persistent GI & Post-Pubertal Distress):

       "Voraussetzung für die Indikation einer Pubertätsblockade soll das Vorliegen einer stabilen/persistierenden Geschlechtsinkongruenz (GI, nach den diagnostischen Kriterien der GI im Jugendalter/ ICD-11 HA60) mit nach Pubertätseintritt entstandenem oder verstärktem geschlechtsdysphorischen Leidensdruck sein." (Page 189, Recommendation VII.K3)
       (Translation: Prerequisite for the indication of puberty blockade should be the presence of a stable/persistent gender incongruence (GI, according to the diagnostic criteria of GI in adolescence/ ICD-11 HA60) with gender dysphoric distress that arose or intensified after the onset of puberty.)

On Minimum Pubertal Stage:

       "Die Indikation für eine Pubertätsblockade bei Jugendlichen mit Geschlechtsinkongruenz bzw. Geschlechtsdysphorie soll nicht vor dem Tanner-Stadium 2 gestellt werden." (Page 194, Recommendation VII.K6)
       (Translation: The indication for puberty blockade in adolescents with gender incongruence or gender dysphoria should not be made before Tanner Stage 2.)

On Informed Consent Capacity:

       "Die Indikationsstellung für eine Pubertätsblockade soll die Prüfung der Einwilligungsfähigkeit (D) / Urteilsfähigkeit (CH) / Entscheidungsfähigkeit (A) der behandlungssuchenden minderjährigen Person durch eine kinder- und jugendpsychiatrische bzw. psychotherapeutische Fachperson beinhalten." (Page 200, Recommendation VII.K9)
       (Translation: The indication for puberty blockade should include the assessment of the capacity for informed consent (D)/ decisional capacity (CH)/ decision-making ability (A) of the minor seeking treatment by a child and adolescent psychiatric or psychotherapeutic specialist.)

On Risk-Benefit Assessment:

       "Die Begründung für die Indikation einer Pubertätsblockade soll eine ethisch reflektierte auf den Einzelfall bezogene Nutzen-Risiko-Abwägung enthalten, sowohl der vorgesehenen Behandlung, als auch des Nicht-Einleitens dieser Behandlung bzw. eines Abwartens bis zu einem späteren Zeitpunkt." (Page 189, Recommendation VII.K3a)
       (Translation: The rationale for the indication of puberty blockade should contain an ethically reflected, case-specific benefit-risk assessment, concerning both the planned treatment and the non-initiation of this treatment or waiting until a later point in time.)

On Purpose (Temporary Measure):

       "Eine Pubertätsblockade [...] dient vorrangig dazu, vorübergehend zu verhindern, dass die Ausbildung sekundärer Geschlechtsmerkmale [...] irreversibel fortschreitet. [...] kann ein bestehender geschlechtsdysphorischer Leidensdruck vorübergehend entaktualisiert werden [...] Dies lässt die Möglichkeit einer Desistenz der Geschlechtsinkongruenz noch offen..." (Page 177 & 179)
       (Translation: A puberty blockade [...] serves primarily to temporarily prevent the irreversible progression of the development of secondary sex characteristics. [...] An existing gender dysphoric distress can thereby be temporarily de-actualized [...] This leaves the possibility of desistence of gender incongruence open...)  

— Preceding unsigned comment added by 2001:871:22B:EA36:77D2:7371:491:C19D (talk) 21:03, 30 March 2025 (UTC)

So why is this not being updated. I find it very telling that false information that serves a certain agenda is quickly published but the correction of said information is ignored for months. I thought we are here for the facts. 2001:871:22B:EA36:91C5:C37F:4101:C3FE (talk) 12:28, 5 June 2025 (UTC)

@Hunig Brocc: The new text you added seems to be at odds with English-language interpretation of the AWMF S2k guidelines. For example, states: "According to the draft guidelines, the only requirement for medical gender transition of youth is the provision of the adolescent diagnosis of "Gender Incongruence." The previously required "distress" criterion has been re-interpreted merely as "anticipatory anxiety" over developing secondary sexual characteristics and a desire to avoid future pubertal changes. Further, the current draft states that requiring psychotherapy as a prerequisite for gender-transitioning of minors is not ethical, and allows for the prescription of puberty blockers "provisionally" before a comprehensive evaluation takes place." And : "If, in individual cases, the progressive pubertal maturation development creates a time pressure in which health damage would be expected due to longer waiting times to avert irreversible bodily changes (e.g. male voice change), access to child and adolescent psychiatric or psychotherapeutic clarification and medical treatment options should be granted as quickly as possible."

I took a look at the section quoted above in the AWMF S2k guidelines regarding distress and it does indeed state that "[distress] can manifest as an anticipatory fear of the progression of feminization or virilization of physical appearance without the occurrence of pathological psychosocial impairments", which is a very low bar. So your wording about requiring "significant gender-related distress" seems a bit over-blown.

Also, your sentence, "An evaluation of the minor's ability to provide informed consent by a specialist in child and adolescent psychiatry or psychotherapy is mandatory." doesn't seem to align with the guidelines quoted above, which state that the indications "should include" such an evaluation. "Should include" and "is mandatory" are very different statements. Same for the section on the ethical evaluation. The guidelines say "should contain", but your wording says "must include".

Finally, I was wondering if you could comment on the claim that the guidelines allow for provisional prescription before a comprehensive evaluation takes place, as that would certainly warrant mention if true. Nosferattus (talk) 01:15, 6 June 2025 (UTC)

Please help me understand how we can engage in a constructive discussion when you have to rely exclusively on English websites run by gender‑affirming activists advancing a particular narrative, while I have read the original German study myself. There is currently no English translation of the study (at least not under your provided links - I also could not find one). You are setting my translations, my understanding, against those of these activists. As the gatekeeper of this article’s content, why would you accept my version over theirs? Would I not be wasting my time? Hunig Brocc (talk) 17:03, 2 July 2025 (UTC)

Regardless of the English language secondary sources, the original German-language guidelines (which I translated via Google Translate) do not seem to support your specific wording (as I already mentioned above). I wrote four paragraphs in reply above. Only the first paragraph mentions English language coverage. It doesn't really matter though as there is no need for us to debate the minutiae of the guidelines. I've reworded the content to just state the uncontested facts of the guidelines with no emphasis on how strict or lenient they are. Just presenting the basic facts in a neutral manner is probably the best approach. That section doesn't need to go into great detail about the specific guidelines (especially since they are likely to keep changing). Nosferattus (talk) 20:21, 2 July 2025 (UTC)

I hope you realise that I was trying to not be confrontational because it did not come accross at all that you where trying to be neutral by relying on biased websites and some understanding of the German language without knowing the language ... which you have now disclosed as being "Google Translate".

I think I do not need to address your bias sources and the quotes you are getting from there but I will address the "should" versus "must" argument. It is a guideline. The word "guide" makes it clear that it is not a law. But ... it is standard practice. Which has legal implications if the health professional ignores it without good cause. So in this case it is more of a must than a should if it will be implemented 99% of the time.

I support your approach of just presenting basic facts in simple terms. I took the liberty of making some changes so the normal user understands what CD-11 HA60 means. I hope it finds your approval. Hunig Brocc (talk) 07:58, 4 July 2025 (UTC)

Thanks. I think the current wording is probably fine. By the way, your characterization of SEGM as "run by gender‑affirming activists" is very incorrect. SEGM strongly opposes gender-affirming care for transgender youth, so your argument that I am relying exclusively on English websites "advancing a particular narrative" is unwarranted. Please assume good faith. I'm just relying on the sources I have access to. Regardless, I think it is best to stick to the uncontested facts without trying to put a particular spin on it. Nosferattus (talk) 14:39, 7 July 2025 (UTC)

Haven't dug into the full content dispute here yet but want to make 2 quick notes:

• 1) I'd be vary wary of using SEGM's translation because I wouldn't put it past them to mistranslate (not saying it happened here or impugning you for using an accessible translation, just given their track record)
• 2) The AWMF released an official English version of their guides late June! Found that last week consulting the source for something else so want to drop it here

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:08, 7 July 2025 (UTC)

@Your Friendly Neighborhood Sociologist: Thank you for the links. Those are very helpful. I think the only aspect that is unresolved is do the guidelines allow for provisional prescription of puberty blockers before a comprehensive evaluation takes place? The English-language sources mentioned previously suggest that they do, but as you mentioned SEGM is probably not a reliable source and The Advocate article just says "as quickly as possible" without going into detail. Nosferattus (talk) 14:44, 8 July 2025 (UTC)

No problem! Double checking now, the relevant info seems to be page 177: 6.2.2 Special case: Initiation of a puberty suppression with a high degree of urgency In care practice, particularly in cases of gender incongruence and high gender dysphoric distress in the early stages of pubertal development, there can be a great deal of time pressure for those affected, which creates a correspondingly increased pressure to act. After the onset of puberty, the progression of irreversible body changes can be associated with lifelong effects on body dysphoria and quality of life (e.g. male voice change, female breast growth), so that prompt intervention is often recommended. In these cases, long waiting times (e.g. more than 6 months) for an appointment for a child and adolescent mental health assessment would not be medically justifiable. In these situations, prompt access to mental health assessment and support as well as the necessary clarification with regard to medical treatment, sometimes by passing the waiting lists, is important. This avoids the additional damage to health that would be caused by long waiting times for child and adolescent psychiatric assessments. which is paired with the recommendation If, in individual cases, time pressure arises as a result of progressive pubertal maturation, in which irreversible physical changes (e.g. male voice change) could be expected to cause damage to health as a result of longer waiting times, access to child and adolescent mental health assessment and medical treatment options should be granted as soon as possible.

It does get a little complicated per page 178, the original draft (which some organizations preferred and left a dissenting note in support of) said In individual cases, the progressive development of pubertal maturity can lead to time pressure. In these cases, the paediatric endocrinological specialist may initiate puberty suppression promptly due to its urgency with a provisional recommendation in order to prevent irreversible bodily changes (e.g. male voice change, female breast growth), if the implementation of an appropriate mental health assessment for a recommendation would mean an unacceptable delay. In such a justified case, diagnostic consultation by a child and adolescent mental health specialist to confirm the recommendation should be carried out promptly after the beginning of treatment

So the TLDR is the document originally allowed for provisionary PBs (which was to be very shortly followed by mental health assessment), and later updated to address the root cause which is long waiting lists in the first place, recommending they be seen/intaken as quickly as possible and focusing on long waiting lists being unethical. SEGM is talking about the original draft with provisional perscriptions, but the Advocate's comments seem to reflect the actually published recommendation to have youth be seen/recieve appropriate treatment ASAP.

Regarding the original proposed change by Hunig Brocc, it's problematic:

• 1) The AWMF doesn't actually say half of that - it's on page 397 and a summary of the Swedish guidelines
• 2) How exactly puberty blockers are used (which all CPGs say is after Tanner Stage 2, time-limited, until about 15-16) is not mutually exclusive with the note that delays can be harmful and intake should be speedy

My 2c is the proposed change isn't justified and a key note in the article's Germany section should be the risks they point out about delays and the need for a speedy intake. Sometime this week I plan to update the article to draw some basic points of agreement from CPGs/reviews about how/when PBs are used to supplant some of the weaker sources we use for that. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:23, 8 July 2025 (UTC)

I find it fundamentally misleading to focus on Section 6.2.2 as if it represents the standard procedure in the AWMF guideline. The document explicitly labels this section as a 'Sonderfall' – a special or exceptional case. To try to present this exception as the norm is to turn the entire guideline on its head.

The Legal and Professional Weight of AWMF Guidelines: While the guideline is not a law, in the German healthcare system a high-level (S2k or S3) AWMF guideline defines the recognized medical standard of care ('Facharztstandard'). A doctor who deviates from this guideline bears a significant burden of proof. In a legal dispute, they would have to meticulously document and scientifically justify why their deviation was medically necessary and not negligent. Simply 'ignoring' it is not a viable professional option. This also means that any doctor invoking 6.2.2 would need to rigorously document exactly why the case was so urgent that the standard, more measured timeline could not be followed. In practical terms, the doctor has no more or less legal leeway than if the clause did not exist at all. Hunig Brocc (talk) 13:54, 28 July 2025 (UTC)

Following a discussion at Wikipedia_talk:WikiProject_Medicine#Puberty_blocker the question was raised whether there is sufficient consensus in the published literature, or to that point even support from the cited sources - one of which covers suicidality in adults: that suicidality decreases. I quote from there:

A couple of thoughts, numbered for clarity:

The "depression and suicidality" line in the lead is presently cited to a webpage that leads to a 191-page-long PDF (the intended target?) and a summary. Could someone add a page number or quotation? I see that it says Psychological effects of PS [puberty suppression] on conditions such as depression and anxiety appear modest in comparison with GAHT [gender-affirmed hormone therapy], with the primary impact being reduction of distress associated with unwanted secondary sexual characteristics, but this is not exactly a ringing endorsement puberty blockers, and it is inappropriate to describe "modest" effects as shown to reduce depression and suicidality. The section describing this also says with the qualification that the strength of the evidence remains poor. This is more of a "suggests it may" situation, or a "small effect size" situation, rather than a "shown to work" situation.

The second (Rew) citation for that line in the lead says decreased suicidality in adulthood. The lead says suicidality in transgender and nonbinary youth, which {{fails verification}} with this source, because "in youth" is not the same as "in adulthood".

Given the sloganeering aspect of "safe, effective, and reversible", it might be better to spell it out: It's safe given the medical severity of the situation (cytotoxic chemotherapy, which occasionally kills people, is also considered "safe"); it's effective at delaying puberty progression (not magically ending all gender dysphoria), and it is reversible in the sense that when you stop taking the drugs, puberty proceeds (but, if memory serves, bone repair doesn't fully recover).

WhatamIdoing (talk) 01:54, 23 July 2025 (UTC)

The point further arrises about how WP:DUE this is to include in the lede of the article in the face of multiple contradictory reviews. Perhaps WhatamIdoing could shed some light who seems knowledgeable - before we start digging deeper? CFCF (talk) 09:08, 28 July 2025 (UTC)

Agreed. I continue to believe that this sentence should not be in the lead at all. It is not necessary to say anything about suicidality in the lead, the references do not support this one sentence summary without caveat, and multiple editors have now expressed concern (I count 4) against the one editor repeatedly reverting. I think it can come out. Sirfurboy🏄 (talk) 09:26, 28 July 2025 (UTC)

I count three and three. Myself, @Twiggy1977, and @HenrikHolen on one side, you, CFCF, and @Void if removed on the other. That is not consensus. Snokalok (talk) 10:44, 28 July 2025 (UTC)

How are you getting consensus for suicidality from comments like The review by Taylor et al (2024) partially corroborates the sentence, at least regarding depression, referencing Rew et al? Void if removed (talk) 12:10, 28 July 2025 (UTC)

Look at Sirfur’s talk page. Twiggy very clearly advocates for keeping the current text until a new is decided Snokalok (talk) 15:26, 28 July 2025 (UTC)

No, the latter source says trans youth issued these meds in adolescence have better outcomes in adultgood. The former source, the Sax Review, fully just says youth who receive them have reduced suicidality and such as youth. Snokalok (talk) 10:29, 28 July 2025 (UTC)

The Sax Institute source repeatedly says that newly identified studies report a range of benefits across suicide ideation, but stops short of presenting a systematic synthesis that would find that suicidality is reduced. Specifically, they say

Suicide risk:

One Level I study, one Level III-3 study and six Level IV studies reported reductions in suicidality following GAHT. However, one Level IV study reported no change in suicidality and a further Level IV study reported that 11 of 315 participants had suicidal ideation and a further 2 died by suicide.

This is not nothing, but neither is it support for the unequivocal (and downright contradictory to main text) sentence we are presenting in the lead. Please again review the comments by other editors. We may feel it stands to reason that suicidality would be reduced, but we can't say it unequivocally in the lead unless systematic reviews have determined equally unequivocally that this is so. It is just a matter of following sources. And, again, we don't need to say this in the lead. We are not saying the opposite either. It is not necessary to present, as fact, in the lead, something that the reader may well suspect to be likely, but that does not (yet) have unequivocal evidence to support it. Sirfurboy🏄 (talk) 11:45, 28 July 2025 (UTC)

I’d like to note that the last level 4 study there does not contradict the others. Reduction does not mean elimination. A person can have reduced suicidality and still kill themselves. All this is, is six level 4 studies say yes, one says mmph, one doesn’t comment. Then let’s look at the higher studies - One top tier study said yes. One mid tier study said yes. In addition to six meh studies. That’s a low level of evidence; but the level of evidence being low is a different axis from what the evidence actually says. That is, the evidence still says yes, there’s just not as much of it as there could be Snokalok (talk) 15:24, 28 July 2025 (UTC)

Yes that source suggests there may be benefits across suicide ideation. But it doesn't settle the matter. I think for the lead that we need a strong level of evidence to support a sentence that says this is a benefit of the intervention. Is there any strong reason for mentioning suicidality in the lead in the absence of the high level of evidence though? Might this be a case of just hanging on until the matter is settled? As always, Wikipedia is a lagging indicator of notability of something. Sirfurboy🏄 (talk) 18:19, 28 July 2025 (UTC)

I mean, it's not an absence of high level evidence, there's a level one study there, it's just a dearth of it. But there's no evidence that I've seen that says the opposite. My proposed wording is "They have been shown to reduce depression and suicidality in transgender and nonbinary youth, although the evidence thus far has been found to be of low certainty." Snokalok (talk) 18:31, 28 July 2025 (UTC)

The level 1 study the Sax report refers to there is Rew et al. Have to be careful not to double count the same review. Void if removed (talk) 18:39, 28 July 2025 (UTC)

Fair fair. The point remains, I'm not saying there are a lot of high quality studies - but what I am saying is that the amount of evidence we have mapped out that says yes is infinity more than that which we have that says no Snokalok (talk) 18:51, 28 July 2025 (UTC)

Here's an overview of some of the sources:
Rew at al 2020:

Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life...

The advantages of using puberty suppression in children and adolescents with gender dysphoria have been identified as improving some psychological functioning such as decreased depression and improved global functioning...

Importantly, when compared to youth who did not receive pubertal suppression, those who did showed lower lifetime rates of suicidal ideation (Turban et al., 2020).

NICE 2020:

The study by de Vries et al. 2011 in 70 adolescents with gender dysphoria found that treatment with GnRH analogues before starting gender-affirming hormones may reduce depression (measured using the Beck Depression Inventory-II [BDI-II]). The mean BDI score was statistically significantly lower (improved) from baseline compared with follow-up (n=41, 8.31 versus 4.95, p=0.004)...

The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE.

Sax Institute 2024:

The review undertaken by the National Institute for Health and Care Excellence (NICE) (2020) reported that GnRHa had positive effects on psychosocial functioning and may reduce depression; Rew (2021) reported improvements in affect and social life and decreases in depressive symptoms, emotional and behavioural problems and suicidal ideation. Ramos (2021) reported improved mental health. Additionally, two Level IV studies reported lower odds of lifetime suicidal ideation (Turban 2020); and reduced emotional and behavioural problems (van der Miesen 2020)...

Psychological effects of PS on conditions such as depression and anxiety appear modest in comparison with GAHT, with the primary impact being reduction of distress associated with unwanted secondary sexual characteristics; two Level IV studies reflected positive impacts on gender dysphoria.

Taylor 2024:

No conclusions can be drawn about the effect on gender-related outcomes, psychological and psychosocial health, cognitive development or fertility.

As I mentioned before, Taylor 2024 is interesting because it has an extremely high bar for conclusions (which is what generated a lot of the controversy around the Cass Review which commissioned it). It assesses 1 study regarding depression, ranking it as "moderate" quality evidence of "Reduction in depressive symptoms". It assesses 3 studies regarding suicidality, ranking 1 as "high" quality evidence of "Less self-harm/suicidality in those treated" and the other 2 as "moderate" quality evidence showing "No change over time." It also mentions another study published after its literature cut-off date, which it says showed "fewer symptoms of depression, anxiety, stress and suicidal thoughts compared with those who had not received puberty suppression." However, this study was not included in the analysis.

So basically, everyone agrees that there is evidence that puberty blockers may decrease depression and suicidality. The disagreement is in whether this evidence is enough to make any conclusions. My suggestion would be to create some sections in the body where these issues can be hashed out in better detail. We have sections discussing adverse effects in great detail, but no equivalent for positive effects. Nosferattus (talk) 20:30, 28 July 2025 (UTC)

To be frank, for systematic reviews, the only one of those to fully apply somewhat standard criteria (modified GRADE) to deem quality of evidence and certainty of conclusions is the NICE 2020. They authors of Taylor 2024 directly state that they used narrative synthesis due to the inherent heterogeneity of included studies, and the authors of Rew simply state the the data derived is used to answer the research questions. That isn't saying any of these methods are inherently wrong, but Taylor actually uses a low bar compared to the standard method in systematic reviews. (The Cochrane Handbook: Chapter 14 gives an overview if anyone is interested.)

To this end, I propose that what makes sense is to qualify the totality of the evidence as either "very low quality and low certainty", or "low quality and very low certainty" depending on which systematic review we consider most authoritative.

To me this implies that we need to either be even more careful in the lede, stating in full in the lede that:

"Evidence of any benefit for suicidal ideation or suicidality in adolescents is of very low quality and low certainty."

The preferable alternative is to omit it entirely from the lede, and to spell out all the details in the relevant subsection only. CFCF (talk) 21:18, 28 July 2025 (UTC)

(edit conflict) Science is slow, and we already include quite a good portion on the 2025 Guyatt review, which is probably appropriate for that section. The point here is to present the evidence in accordance with what the literature provides. We might disagree, but we need to abide by the science. It is also undue to present this, but not the results of the Guyatt review in the lede. CFCF (talk) 21:18, 28 July 2025 (UTC)

At some point we have to accept there isn't much to be learned by looking at the same couple of dozen low quality papers over and over, no matter what review methodology is used. The underlying evidence base is generally low quality and inconclusive, according to half a dozen different reviews of the same handful of studies. It isn't going to get better until better studies emerge. Void if removed (talk) 21:32, 28 July 2025 (UTC)

I think we shouldn't overstate the lowness of the evidence, though. That is, GRADE requires RCTs, and most others require double blind at the very least - which is impossible for puberty blockers because, one side starts visibly going through puberty. I think saying that researchers consistently wish the evidence was better quality is fair, but that we shouldn't try to entire belay Snokalok (talk) 21:21, 28 July 2025 (UTC)

P.S. I also think you get it the wrong way round, double-blind studies are nearly always a stricter standard of RCTs. There are some exceptions, but they mostly certainly do not apply there. CFCF (talk) 21:34, 28 July 2025 (UTC)

That is actually not true, the link I provided has at the very top among the key points:

GRADE assessments of certainty are determined through consideration of five domains: risk of bias, inconsistency, indirectness, imprecision and publication bias. For evidence from non-randomized studies and rarely randomized studies, assessments can then be upgraded through consideration of three further domains.

CFCF (talk) 21:25, 28 July 2025 (UTC)

Note: The Cochrane Handbook mentions in Chapter 14.2.3 Domains that may lead to increasing the certainty level of a body of evidence (linked above) - but also has an entire dedicated Chapter 24: Including non-randomized studies on intervention effects

In chapter 14.1.2 Selecting outcomes for ‘Summary of findings’ tables it is noted that:

Review authors are encouraged to include non-randomized studies to examine rare or long-term adverse effects that may not adequately be studied in randomized trials.

and

Non-randomized studies can provide important information not only when randomized trials do not report on an outcome or randomized trials suffer from indirectness, but also when the evidence from randomized trials is rated as very low and non-randomized studies provide evidence of higher certainty. Further discussion of these issues appears also in Chapter 24.

CFCF (talk) 21:31, 28 July 2025 (UTC)

Why are you leaving off eg. Zepf et al 2023 (NICE methodology updated with more recent studies) and Miroshnychenko et al 2025 which is GRADE again?

Taylor 2024 doesn't have a high bar - it has a generous one. Void if removed (talk) 21:26, 28 July 2025 (UTC)

I was just covering the sources already mentioned about depression and suicidality. There's also the newest systematic review, Tornese et al 2025, which uses the GRADE approach and includes sources up to 2024:

Results: Of the 51 studies, 22 were rated as moderate to high-quality evidence... Mental health improved significantly, including reduced depression, anxiety, and suicidality—especially when GnRHa was followed by gender-affirming hormone therapy (GAHT)...

Compared to earlier reviews, this study incorporates more recent data, demonstrating significant improvements in global functioning, depression, and anxiety, with studies reporting a reduction in suicidal ideation and self-harm in TGD adolescents also receiving GAHT...

The reduction in depressive symptoms was consistently reported across multiple studies...

While earlier reviews pointed to insufficient data on mental health impacts, this study emphasizes significant improvements in mental health outcomes, quality of life, and reductions in suicidality among adolescents receiving GnRHa treatment...

Suicide ideation: GnRHa treatment has been shown to significantly reduce suicidality in transgender adolescents...

Depression/anxiety: while at referral, 31.3% of transgender adolescents exhibited clinical levels of internalizing problems, including depression and anxiety, with higher rates in AMAB (35.3%) compared to AFAB (28.2%), after initiating GnRHa these rates dropped to 16.3%, bringing them closer to those of cisgender peers. Across multiple studies, both depression and anxiety levels decreased significantly over time with affirmative treatment, with transgender youth showing marked improvements; adolescents receiving GnRHa or GAHT had a 60% lower risk of depression compared to those who did not undergo treatment.

Here's Miroshnychenko et al 2025 (which is a meta-analysis including sources up to 2023):

Results: We included 10 studies. Comparative observational studies (n=3), comparing puberty blockers versus no puberty blockers, provided very low certainty of evidence on the outcomes of global function and depression. Before–after studies (n=7) provided very low certainty of evidence addressing gender dysphoria, global function, depression, and bone mineral density...

Comparative observational studies: Depression: When measured at 12 months with the Centre for Epidemiologic Studies Depression Scale (CESD-R), ranging from 0 to 60 (higher scores=greater depression), a linear regression analysis reported that puberty blockers may not decrease depression scores in female to male participants (r2=0.09, b=−0.02, p=0.95), but may decrease depression in male to female participants (r2=0.52, b=−2.41, p=0.008)...

Before–after studies: Depression: When measured at 23 months with the Beck Depression Inventory, ranging from 0 to 63 (higher scores=greater depression), depression may be lower (MC 3.36 lower (95%CI 3.69 lower to 3.03 lower), n=1 study, very low certainty) after receiving puberty blockers compared with before.

Tornese et al seems to make a pretty strong case. Nosferattus (talk) 23:45, 28 July 2025 (UTC)

I just reinstated Baxendale 2024 and added a further caveat. I'm not sure I understand the objection - the removed text is clear the paper synthesised both human and animal studies, the text says sex-specific cognitive impacts are in "mammals", not humans, and the conclusion in the paper is quite clear that the human studies also showed cognitive impacts, but that the evidence is all very poor quality and robust studies with adequate followup are needed. Void if removed (talk) 09:14, 30 July 2025 (UTC)

So, two points, looking at the abstract here - "No human studies have systematically explored the impact of these treatments on neuropsychological function with an adequate baseline and follow-up. There is some evidence of a detrimental impact of pubertal suppression on IQ in children."

1. "No human studies systematically explore the impact".

In the body it says

"The search strategy identified just five studies that have reported some aspect of neuropsychological function following the administration of medications to suppress puberty in young people. Two studies reported the impact of treatment with a puberty blocker in young people with precocious puberty (CPP) and three reported neuropsychological test performance in people treated for gender dysphoria. One of these studies was a single case study."

But it doesn't go into it anymore. I don't even see where it actually goes over the studies in proper systematic review manner, nor any citations to any such studies. Simply put, she doesn't list any studies, only vaguely says they exist.

2. "IQ"

IQ is an age based metric, as I recall. That's distinctly different from simply saying neurocognitive effects, because they might not be actually changing at all, they're simply getting older while staying exactly the same. Snokalok (talk) 10:16, 30 July 2025 (UTC)

But it doesn't go into it anymore.

That's section 3.3 and 3.4 - 2 studies related to central precocious puberty (Mul et al and Wojniusz et al), and 3 in TG youth (Schneider et al, Staphorsius et al, Arnoldussen et al). The key part is no studies had an adequate baseline and follow-up.

they're simply getting older while staying exactly the same

If kids aren't keeping up with their peers, that's a neuropsychological effect. Staying the same when you expect improvement is indicative of an effect - but of course none of the studies are especially good, hence all the caveats. Void if removed (talk) 11:31, 30 July 2025 (UTC)

I think we should specify in the text the role of puberty in neuro-development, and how that contrasts with IQ being indexed by chronological age. It's a difference the source itself stresses in section 1.3, and despite this the source uses age-normalized IQ scales. "Another 2024 systemic review showed marked deviations in the age-normalized IQ scores of patients who received puberty blockers from control subjects, however the review stressed that neurological development typically occurs as a function of pubertal progression rather than chronological age". The scales listed for IQ evaluation are age-normalized, which a trained reader would know already but an untrained one wouldn't. Snokalok (talk) 12:58, 30 July 2025 (UTC)

To be clear, the above quote is my suggested wording Snokalok (talk) 13:43, 30 July 2025 (UTC)

I think it makes sense to include it if properly qualified that there are no human studies with acceptable follow-up. It makes to discuss the current state of the evidence, even if that state is just saying that there is no proper evidence. The gap itself is important, and there is nothing wrong with stating that studies in mammals have been performed if we are clear about it. CFCF (talk) 15:49, 30 July 2025 (UTC)

Oh no I found the human studies he’s talking about, they’re in a separate section (poor formatting), I’m just disputing the wording based on the character of those studies Snokalok (talk) 17:11, 30 July 2025 (UTC)

I would add that Baxendale also stresses that these are poor quality studies (found in the conclusion). Honestly I was surprised to see that Baxendale did no systematic appraisal of evidence (I thought that was necessary for a systematic review) but I'd be very hesitant to add this (especially without mention of the quality) as most reviews only make discussion on /conclusions about moderate quality or above studies, if we were to do this with this review we get what the abstract says

"No human studies have systematically explored the neuropsychological impact of pubertal suppression in transgender adolescents with an adequate baseline and follow-up". LunaHasArrived (talk) 11:39, 31 July 2025 (UTC)

You're correct - I was under the impression this was a systematic review, but I have no idea where that came from, because it is not. Void if removed (talk) 12:02, 31 July 2025 (UTC)

Tornese et al 2025 (which only relies on medium to high quality human studies) says: "Cognitive outcomes, including IQ, were not significantly affected by gender-affirming treatment, and post-treatment educational achievement was largely linked to pre-treatment cognitive scores." So I don't think it's necessary for us to rely on a review that incorporates animal studies, which is both bad science and frowned upon by WP:MEDRS. Nosferattus (talk) 23:01, 30 July 2025 (UTC)

The problem with Tornese et al is that - despite the title - it isn't actually a systematic review of puberty blockers. Unlike the other reviews in this area, they included studies that didn't distinguish between PBs and GAHT. So when they say not significantly affected by gender-affirming treatment that doesn't tell us anything specifically about blockers. Its comparing apples to apple pie. Also, the specific citation for that claim is Arnoldussen et al (2022), which is one of the three human TG studies in the Baxendale review, about which she said:

No conclusions can be drawn from this study with respect to the impact of puberty suppression on the development of cognitive function.

Void if removed (talk) 09:39, 31 July 2025 (UTC)

It is a systemic review of puberty blockers. The difference is that it includes studies in which puberty blockers were followed by GAHT (as is typical). This is certainly a confounding variable, but Baxendale is completely willing to ignore confounding variables elsewhere, such as 100% of study subjects being adopted, or the physical size of animals affecting their social behavior (which Baxendale equates to cognitive ability). You do have a point though. If Tornese is included, it would need to be properly caveated. Nosferattus (talk) 15:18, 31 July 2025 (UTC)

In the lead we claim that puberty blockers have been used to treat transgender children since at the least the 1980s. However, in the body we claim: "The 'Dutch Protocol' is the first known example of the use of puberty blockers to treat gender dysphoria in children. It was developed by Peggy Cohen-Kettenis in the 1990s." These two statements seem contradictory (even if they aren't strictly). The statement in the lead is supported by a citation to a study of a single individual who was given puberty blockers probably in 1989 (although it isn't clear exactly when treatment began). I don't think this single instance is great for establishing when use of the treatment started. My suggestion would be to change the lead to say 1990s and cite it to the same references we use in the body. Otherwise, I think we should reword it to not sound contradictory. Anyone else have an opinion? Nosferattus (talk) 23:25, 6 August 2025 (UTC)

I think change to 1990s per your first suggestion and per WP:LEADFOLLOWSBODY. Thanks. Sirfurboy🏄 (talk) 07:43, 7 August 2025 (UTC)

I went ahead and made the change. Feel free to tweak further or offer other opinions. Nosferattus (talk) 18:52, 7 August 2025 (UTC)

The part of the article which presents criticisms of the Cass report under "Concerns about insufficient evidence for gender dysphoria" only presents the arguments made by Cal Horton. No mention is made of the subsequent paper by Yale or other critiques. I feel like that section could benefit from presenting the arguments as coming from multiple cited sources, or simply inserting an extra phrase or two at the end in order to mention more than the word of Horton. Amateur Truther (talk) 11:12, 29 August 2025 (UTC)

@Sirfurboy In the discussion section of the systematic review I added they explicitly say Given the existence of 22 studies with moderate to high levels of evidence so far, it seems inaccurate to assert that there is still insufficient and/or inconsistent evidence about the effects of puberty suppression in TGD adolescents and then cite the Taylors et al systematic review we cite to say there's a lack of evidence.

Can you tell me if you have any further problem with me re adding the content based on the above quote from the review.LunaHasArrived (talk) 17:16, 7 September 2025 (UTC)

I have a problem with it being re-added with that text, yes. That is taking a sentence out of the description section, with caveated "it seems..." and in a context of a discussion there and applying it into the adjacent, but different context of our article, whilst ignoring or not reporting its actual conclusions. That looks a bit like proof texting. But this source probably should be mentioned, as per the discussion above (See the latter part of section Baxendale / Animal Studies). Void if removed raised a concern, but I think Nosferattus addressed that by saying: You do have a point though. If Tornese is included, it would need to be properly caveated. Nosferattus: could you suggest an appropriately caveated edit? Thanks. Sirfurboy🏄 (talk) 17:49, 7 September 2025 (UTC)

In this case, I think we would need to explain what specifically there is now sufficient evidence for (according to Tornese). My advice would be to create a new paragraph under "Concerns about insufficient evidence for gender dysphoria" and briefly lay out Tornese's specific rebuttal, which mainly concerns mental health outcomes if I remember correctly. It should also clarify that Tornese includes studies based on puberty blockers followed by gender-affirming hormone therapy (which many earlier reviews excluded). Nosferattus (talk) 22:26, 13 September 2025 (UTC)