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You're right; I'm not sure what I was thinking. I guess you'd enter adolescents with gender dysphoria into a study, and either give them puberty blockers or a placebo, would be hard to keep secret from the patients. But I'm reminded of AIDS patients desperately trying to beat the blinding system in the AZT trials. ("There were also stories of patients from the 12 centers where the study was conducted pooling their pills, to better the chances that they would get at least some of the drug rather than just placebos.") And a story I can't find right now about a teenager who stole HRT from their mother back in the sixties or seventies.
My concern is less that people are ignoring the evidence we have (as you point out, the best we have is an uncontrolled retrospective study), and more that the people fighting the use of puberty blockers in teenagers have no interest in answering these questions. I see this in the pre-emptive excuse-making; if we did do an RCT and puberty blockers saved lives, maybe the whole thing is still social contagion?
And here we're back to the beginning. If you say, "a massive uncontrolled retrospective study found that kids who present with the symptoms your kid is presenting with were less likely to commit suicide when given this treatment", are you "scaring the parents into allowing blockers for their kids"?
Right, and I'm reminded of lobotomies and psychosurgery, where people were told to trust the experts sticking electrodes in their brains supposedly for their own good.
It's not that they're not interested in answering the question, it's that they don't think society should bend itself around the latest idea coming out of academia.
Like I said, there's place for experimental medicine, and I'm ok with blockers being used in that context. Once we gather enough data, and it's blindingly obvious blockers do more good then harm we can move towards mainstream usage.
What we shouldn't do is prescribe blockers to every kid with dysphoria, just because the latest hottest RCT came out. What would you think of a doctor that started prescribing Ivermectin for COVID because a positive study just came out (and those were actual RCTs by the way)? Should they be allowed to say "people who don't take it have a much higher chance of dying" as they prescribe it?
If you're hiding the base rate of risk, and neglecting to inform them the study has no way of determining the direction of the causality, then obviously yes.
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