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nora @norajsp_

3 days ago

important read !!!!

Shattubatu

@Shattubatu

4 days ago

So much misinformation in Rowling's tweet, in the QRT, in the article, and in the study itself! This BS has been floating around since April, so I paid for twitter premium so I could write a post long enough to go through and methodically tear every single misleading fact, baseless generalisation and bald-faced lie to shreds. 🧵 tl;dr: The study Rowling is citing doesn't look at suicide at all, and its methods are rigged in ways that make treatment look bad. The same authors' actual suicide study, on the exact same 2,083 people, found treated trans youth statistically no different from cis controls, and untreated trans youth at 3.2 times the risk. Let's go: The study claims that patients who undergo gender affirming care end up having a significantly higher rate of usage of psychiatric services than they did before. (see image #1) However, this study makes some HUGE methodological mistakes. The largest of which is that it defines psychiatric morbidity after treatment by checking if a patient has had a psychiatric appointment 2 or more years after their first contact seeking gender affirming care. The process for getting gender affirming care in Finland requires psychiatric appointments every few months for around 2 years before a patient can be prescribed hormones. (Which is a disgustingly unjust system, by the way!) Patients can have to wait longer than 2 years from their first appointment until they receive their first dose of HRT. If that (mandatory!) process generates a psychiatric referral or monitoring appointment more than 2 years after their first contact, even before they have started treatment, it is counted as "psychiatric morbidity after treatment". The Ruuska study counts the psychiatric contacts the pathway itself generates as "proof" that the treatment causes psychiatric morbidity! It's hard to convey how absurd and circular this is. Imagine a bank that only gives you a mortgage after two years of meetings with a financial adviser, and only if the adviser certifies you've had no money worries for at least a year. Then a study starts counting at the two-year mark and announces: "Mortgage holders see financial advisers far more often than renters do. Suspicious! Mortgages must cause money problems!" The paper does exclude the gender-assessment appointments themselves. But the assessment runs inside an adolescent psychiatry department, generates psychiatric referrals and monitoring as a matter of routine, and the study has no way to tell a routine pathway referral from a crisis. Kaltiala's own reply admits the data has "A limitation of this study is that more detailed information on patients' reasons for using the psychiatric services could not be analysed.". So any psychiatric contact after the 2-year mark, even before treatment starts, is counted as "morbidity after treatment". It never checks actual rates of mental illness in the populations, or for what reason patients are getting psychiatric appointments. They didn't even factor in how many psychiatric appointments the patients had, even though the authors had that data (frequency of appointment) available, they chose to collapse it into a binary "Did they have at least one appointment" measure! Notice what's not measured: gender dysphoria, body congruence, quality of life, depression symptoms, anxiety symptoms. You know, the things the treatment is for? The study has no measure of any of them! The treated group started at 9.8% (trans fem)-21.6% (trans masc) needing psychiatric care, this is because Finland only treats people who've been psychiatrically stable for a year. This skews the "starting percentage" of patients low. There's a selection bias towards trans people who haven't had a psychiatric appointment before their first contact with the gender service being more likely to receive treatment. This is part of what makes the "increase" so dramatic. They're selecting for people who haven't needed psychiatric care, and then counting the appointments created as part of their gender pathway. And even if you do look at their numbers, the claim that hormones are harmful still doesn't hold up! Two-plus years on, every trans group sits at 55-67%, treated or not, and the treated trans-masc group ends LOWER than the untreated one. If hormones were harmful, that's the opposite of what you'd see! This study's own data (shamelessly biased as it is) shows no sign of harm: even on their own broken measure, the treated group ends no worse than the untreated one when compared to an appropriate control (ie. trans people not receiving treatment!) The logic is so circular and so obviously wrong that I can't believe it was published! Neither can the 43 clinicians and researchers who wrote to the journal saying the same thing, or the eight US academics who called for the data to be reanalysed, or the Italian paediatric team whose letter is literally titled "Psychiatric Contacts Are Not Outcomes"!

Shattubatu's tweet photo. So much misinformation in Rowling's tweet, in the QRT, in the article, and in the study itself! This BS has been floating around since April, so I paid for twitter premium so I could write a post long enough to go through and methodically tear every single misleading fact, baseless generalisation and bald-faced lie to shreds. 🧵

tl;dr: The study Rowling is citing doesn't look at suicide at all, and its methods are rigged in ways that make treatment look bad. The same authors' actual suicide study, on the exact same 2,083 people, found treated trans youth statistically no different from cis controls, and untreated trans youth at 3.2 times the risk.

Let's go:

The study claims that patients who undergo gender affirming care end up having a significantly higher rate of usage of psychiatric services than they did before. (see image #1)

However, this study makes some HUGE methodological mistakes. The largest of which is that it defines psychiatric morbidity after treatment by checking if a patient has had a psychiatric appointment 2 or more years after their first contact seeking gender affirming care.

The process for getting gender affirming care in Finland requires psychiatric appointments every few months for around 2 years before a patient can be prescribed hormones. (Which is a disgustingly unjust system, by the way!) Patients can have to wait longer than 2 years from their first appointment until they receive their first dose of HRT. If that (mandatory!) process generates a psychiatric referral or monitoring appointment more than 2 years after their first contact, even before they have started treatment, it is counted as "psychiatric morbidity after treatment".

The Ruuska study counts the psychiatric contacts the pathway itself generates as "proof" that the treatment causes psychiatric morbidity!

It's hard to convey how absurd and circular this is. Imagine a bank that only gives you a mortgage after two years of meetings with a financial adviser, and only if the adviser certifies you've had no money worries for at least a year. Then a study starts counting at the two-year mark and announces: "Mortgage holders see financial advisers far more often than renters do. Suspicious! Mortgages must cause money problems!"

The paper does exclude the gender-assessment appointments themselves. But the assessment runs inside an adolescent psychiatry department, generates psychiatric referrals and monitoring as a matter of routine, and the study has no way to tell a routine pathway referral from a crisis. Kaltiala's own reply admits the data has "A limitation of this study is that more detailed information on patients' reasons for using the psychiatric services could not be analysed.". So any psychiatric contact after the 2-year mark, even before treatment starts, is counted as "morbidity after treatment".

It never checks actual rates of mental illness in the populations, or for what reason patients are getting psychiatric appointments. They didn't even factor in how many psychiatric appointments the patients had, even though the authors had that data (frequency of appointment) available, they chose to collapse it into a binary "Did they have at least one appointment" measure!

Notice what's not measured: gender dysphoria, body congruence, quality of life, depression symptoms, anxiety symptoms. You know, the things the treatment is for? The study has no measure of any of them!

The treated group started at 9.8% (trans fem)-21.6% (trans masc) needing psychiatric care, this is because Finland only treats people who've been psychiatrically stable for a year. This skews the "starting percentage" of patients low. There's a selection bias towards trans people who haven't had a psychiatric appointment before their first contact with the gender service being more likely to receive treatment. This is part of what makes the "increase" so dramatic. They're selecting for people who haven't needed psychiatric care, and then counting the appointments created as part of their gender pathway.

And even if you do look at their numbers, the claim that hormones are harmful still doesn't hold up! Two-plus years on, every trans group sits at 55-67%, treated or not, and the treated trans-masc group ends LOWER than the untreated one. If hormones were harmful, that's the opposite of what you'd see! This study's own data (shamelessly biased as it is) shows no sign of harm: even on their own broken measure, the treated group ends no worse than the untreated one when compared to an appropriate control (ie. trans people not receiving treatment!)

The logic is so circular and so obviously wrong that I can't believe it was published!
Neither can the 43 clinicians and researchers who wrote to the journal saying the same thing, or the eight US academics who called for the data to be reanalysed, or the Italian paediatric team whose letter is literally titled "Psychiatric Contacts Are Not Outcomes"!

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nora @norajsp_

about 2 hours ago

@szpela @heyyKayyRL whatever it's your call

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nora @norajsp_

about 7 hours ago

ce matin en pause on parlait de feminisme avec des collègues femmes, et un moment une d'entre elles mentionne les femmes trans (positivement) et elle m'a expliqué ce qu'est une femme ttans