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Honestly, this is one of the situations where I say "fuck it"; the amount of trans surgeries from doing the RCT, assuming it finds that they're bad, will be lower than the amount from not doing it (in contrast to the usual case), so I'm not seeing the "do no harm" issue.
The bigger issue is that trans activists will attempt to defy you and transition the control group anyway. I don't see a way to get around that that isn't either "deploy the counterterrorism apparatus in full to prevent such attempts" or "ban transition as a whole in order to saturate the trans movement's covert-ops resources and draw them away from the trial". These are both pretty drastic actions, with significant PR costs even if you personally aren't bothered by using that level of force.
Yeah, I haven't settled on an opinion, but I feel you. There is currently some brouhaha about an NHS puberty blocker trial, with the anti-trans side arguing that it shouldn't be done because we already have the evidence (they also have other criticisms, but that tends to be the opener). A part of me feels like the political capital would be better spent saying "Oh, you want a trial? Fine, we'll do a trial, but we're doing this one properly", but I've been wrong on political tactics before (I was against blanket bans, until Alabama and Tennessee did them, and ACLU in their infinite wisdom decided to sue them, which allowed WPATH's internal docs to go into discovery).
When I was reading the papers on chemical castration, I think one of them said you can detect non-compliance with a blood test (though it may have been about taking counter-measures, instead of unauthorized taking of chemical castration / puberty blockers).
Oh, it's easy enough to tell if somebody's been taking hormones against your instructions. That just doesn't solve the problem.
If you count defiant transitioners as part of your control group, it biases your study in favour of transition, because defiant transitioners amount to "transition with a bunch of extra annoyance" and as such are near-guaranteed to do worse than the transition group regardless of how good or bad transition is.
If you kick defiant transitioners out of the control group, it biases your study against transition, because desisters will stop trying to defy you at some point, and as such success stories will make up a larger chunk of your control group than they would have if you'd successfully prevented the defiant transitioners from transitioning.
If the trans activists manage to subvert enough of your control group (which is pretty likely without the extreme measures I mentioned), these two effects will destroy the study's value; it will give the "do transitions!" answer with one set of rules and the "don't do transitions!" answer with the other. Whoops, looks like the clear liquid you poured on that fire was petrol instead of water.
Oh, and this is assuming that you picked outcome measures that don't allow for easy lying; it's not like people can't go on Twitter and yell "hey everybody, put down that you're ecstatic if you were in the transition group and suicidal if in the control group; it's for the sake of all the other transfolk". As Scott said, "sometimes people might just be actively working to corrupt your data".
Your overall point is correct, but:
That's not necessarily true: suppose transition, even with transition-with-extra-annoyance, always leads to strictly better outcomes. The control group will then have better outcomes if the defiant transitioners are counted than if they aren't, possibly on par with transitioners within margins of error depending on how many there are and how much the extra annoyance impacts outcomes.
This point aside, I also think any study of this sort would need extremely careful design to separate the effects of social transition vs the actual puberty blockers. I think you'd need two control groups: one where the kids socially transition but don't take puberty blockers, and one where they don't transition either way. And while it's very easy to tell if somebody's been taking unsanctioned hormones, it's rather harder to tell if they switched pronouns among friends, so you really couldn't run a study like that with participants who don't play fair.
By "biases in favour of transition" I mean "makes it more likely to put transition ahead". This cannot flip the study from "transition good" to "transition bad", but it can flip it from "transition bad" to "transition good".
I was arguing that it could conceivably flip it from "transition has better outcomes" to "transition and non-transition have equally good outcomes within margins of error" (if there are a lot of defiant-transitioners, all defiant-transitioners get outcomes as good as overt transitioners, and outcomes between the two groups weren't far apart anyway).
Yes, I know, but that's just a "this reduces your study's power" issue; this is trivially fixable assuming you have enough funding (and you should).
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