At 4zzz, we acknowledge the traditional owners.

Of the land on which we broadcast. We pay our respects to the elders.

Past, present and emerging of the Turbul and Jagera people.

We acknowledge that their sovereignty over this land was never ceded. And we stand in solidarity with.

Transmission on 4zzz, amplifying the trans and gender diverse community of Meanjin, Brisbane and beyond. Yeah, yeah, yeah. You're listening to transmission on 4zzz. My name is Ez, I use he, him, pronouns.

I'm, bet, I use she, they, pronouns.

And special thanks to culture vultures. Jimmy, you're fantastic as always. Just love your broadcast. So jealous you're at Woodford. I was not there. I was lying down. I was resting through the new year period and BET and I had a couple of drinks on New Year's, you know.

Well, actually I didn't drink anything, but I was there. I drank water.

I was like, I swear I saw you with glass.

But it was, it was a glass of water.

There you go. Yeah, stay hydrated for 20, 26.

That's right.

Stay sharp, stay sharp. Yes. If you don't BET will.

Someone's gonna do it.

And yeah, we're gonna cover up on just a couple of pieces of news and events and then this entire episode will be dedicated to the vine review which came out on 28 November. Was it 20?

No, it wasn't November. It must have been December because it was two weeks ago on Friday. And remember that because it was the first day of my.

Oh no, it was the 19th of December.

Yeah, it was the first day of my holidays.

Yes, yes. So called holidays that were. Maybe it was strategic, maybe probably politicians. Boo. Okay, so yeah, we'll just cover on a couple of things. So some news. A new petition urging the Northern Territory government to reverse its recent ban on publicly funded puberty blockers and gender affirming care for trans and gender diverse young people. A policy that follows similar restrictions elsewhere and has been criticised as harmful, unjust and out of step with evidence based health care and human rights principles. Advocates argue the ban increases distress and the risk of vulnerable young people by denying access to internationally recognised clinician led care. And call on community members to add their voices to demand that access to safe, timely and appropriate health care be restored for all trans young territorians. If you agree with that statement, please head to the Transmission Socials rans Radio Trans with a Z. There is a petition there that you can sign to reverse this decision. Yeah, so head over there. Also in the week coming events we've got Board game night by transjoymeengine at Meeple and Mug which is 633 Hargrave Road and West End. Friday 9th of January from about 6pm it's completely free. We're kicking off 2026 with another board game night. Join us for an evening of board games with trans and gender diverse people and our loving allies. Meeple and Mug is a board game cafe with a library of board games ready for us to play together. Friday nights are LGBTQIA nights where gameplay is free and they have a menu of great food and drinks which you can view on their website. They have a table booked right at the door as you enter, so keep an eye out as you walk in. Meeple and Mug has two levels with the board game library and front counter on street level and wheelchair accessible. Unfortunately, the gender neutral bathrooms are down a relatively steep flight of stairs in the bottom level of the venue. Board game night this Friday 9th of January. Cheque it out and bet. So I guess we are now talking about the vine review. So do you want to give listeners a bit of a rundown of like what we're doing, what, what's covering off on?

Well, look, I'm gonna. I'll give a quick summary at the start and then we'll have some positives and some negatives. We'll take a little trip to Finland because that's one of the big negatives about this review, is many mentions of Finland and anyone who's heard me speak about the CAS review might remember what I think about Finland. And then at the end, what do we have? We have. I'll put in some observations from other folks that may not be my observ but probably worth noting. And then at the end why it's not the CastReview 2.0. This is something that I've heard said around the traps. I think it's understandable that interpretation, but I really don't agree with it and I'll say why there's positives and negatives about it. It's a grab bag.

Yeah.

All right, we'll grab into it.

We're gonna stick our hand in the bag of the vine review and pull out bits and have a look and.

That'S all you can really do with it. Right. It's very chaotic, divine, 500 plus pages.

So it's pretty substantial.

Yeah. Now a lot of that is the systematic review at the end, the JBI review that was commissioned so that has more of a very data focused bunch of tables and you know it's incredibly dry reading, and I'll admit that I've skimmed that part of it. The other part I've done. I've done a close reading, like the main body of it. I've done a couple of other less close readings based on other people's notes, and I've discussed it with some clever people and some professionals with relevant experience. So I'm not an expert on the JBI review. That would take someone probably with a psychology degree or something like that, or a medical doctor, and I'll look out for other interpretations of the JBI Review, and I'll no doubt be looking at it more closely, but I do think I've got a good handle on the main body of the Barn review.

Fantastic. Before we dive in, we'll listen to a track and when we come back, we'll start with the overview.

Oh, yes.

All right. How many genders are there? I don't know. I just got here. You're listening to transmission on 4 triple Z. My name is Ez, I use he, him, pronouns.

My name is Bet, I use she, they, pronouns.

And we're talking. The vine review. We're gonna go over some things now about the general overview of the Vibe. What is the Vibe?

The Vibe.

What's Roots? Vibe?

Look, the Vibe is, as I said, it's a bit confused. It doesn't really come down strongly on any side. And that's deliberate because it was very limited by its very narrow terms of reference, which made it clear, firstly, that it wasn't able to make recommendations, and secondly, that it was not designed to resolve differences of views. So it's kind of not about coming to any conclusions. And the result is an inevitable exercise in both sidesism. And I think that's what we can take away from the Vine Review is that it very much comes down on both sides of the debate. But as I said, I think that that makes it unlike the CAS review, because the CAS review is ruthlessly focused on one outcome, which is discrediting gender, affirming medical treatment for young people, in my opinion.

Yeah.

Yeah. I don't think the vine review is like that. I think it has bits of that in there. And I'll get into why I think it might have turned out this way. But it doesn't strongly put forth any argument, really. Now. It does because the terms of reference made it clear that it wasn't. It wasn't about making recommendations. It could give advice, but it couldn't make recommendations to the government. And so I think Ruth vine and the other People on the panel did a sort of a workaround, they kind of hacked it and they, they did, they made three options, what they called options and these have been spoken about a lot, so I won't really go into them. Most of the media has picked up on these three options. I think what most people have done is they've read the executive summary which includes the three options that the committee recommend and they've. It's pretty clear that Ruth vine and her colleagues are in favour of the third option. Briefly, the first option that they suggest is a continuation of the ban. They outline why that's dangerous and it seems clear that they don't really endorse that. And when you read the body of the review it's pretty clear they don't endorse that. I think the second option is a return to what we had before, before the ban was initiated. Now that would be my preference. And the third option is kind of a return to what we had before but. But with more policing and more research.

So for strict oversight and review further.

Strict oversight, yeah. So what I think the best thing we can really take away from the review is the best reading that I have is that it's conservative and it basically is suggesting a continuation of care, but with greater oversight, more in depth assessment process, which I think is worrying. I think that one's very worrying. And more research which I'm fine with so long as people consent to it.

And. And the outcome of these three options, which seems to me like. So the first option, which is the option that the. That Tim Nicholls has. Has opted for is the one that has got the least, is that has been advised against the least to say that this is dangerous, this has legal ramifications, this is human rights ramifications.

Yeah. They also make clear that it will lead to inequities among rich and poor families so that only families with money will be able to access care. And they also mentioned that people will go the DIY route.

Yeah. Which is another concern.

Yeah. So I think everyone agrees, everyone who's done a good faith reading of the review and this includes even like the Heralds and the Brisbane Times. I think they all seem to agree that Ruth vine and the panel are not supporting option one. They're really coming down for either option two or three. But most people agree it's option three and it seems clear that the Health Minister and the Christopher Lee government are ignoring their own review. And I think that that's fantastic for us. I mean like when the continuation of the ban was announced My response, after looking at the review and being honestly pleasantly surprised that it wasn't, in my opinion, the CAS review 2.0, because it so easily could have been. But my first response was, well, you know, maybe we haven't actually lost anything here because it was clear that the government was going to do everything they could to keep the ban in place. Now they've announced their intention to keep the ban in place till 2031. That's just their intention, I would say.

That doesn't mean that it will be in place in 2031 either.

No, I mean, they may not even be in power in 2021.

Exactly, exactly. And that's something for general public to be aware of, is that just because the government say something to give a date doesn't mean. How often do they follow through on a lot of their dates anyway?

Yeah, totally. Having said that, I mean, they may try their darndest to keep the ban and we may really struggle to overturn it, but my feeling is they were going to do that anyway and now at least we have some ammunition in their own review, which I'm sure they were hoping was going to be a Cast Review 2.0, I'm sure, too. Yeah. So we. There are positives and I'll go into them in a minute.

They held onto it for a long time when it came out before releasing it because. Because of. I think because of this particular outcome.

Yeah. And there's a theory which I'm sure you're aware of and you probably agree with, which is that they saw an opportunity to release it with the Bondi shooting, which was dominating the media and Christmas on the way, and government shutting down, they were like, oh, this is the perfect time to release it. And suddenly it was out.

Yeah. While you were looking over here. Yeah, yeah.

So what I did want to mention, though, is, so the vine review had a consultation process. You'll remember there was an online form, a submissions form that people could fill out, and they invited people to come in and speak to them one on one. Now, I think the outcome of this consultation process, in the way it is presented, the results of it are presented in the vine review, is very problematic. And one of the worst parts of the vine review in that, I mean, look, I should. I should say the vine review was very rushed. So I spoke to someone who has been involved in reviews like this before, who has helped to write them, and nine months for a review of this scope appropriate, apparently, is incredibly rushed. So for context, the CAS review took four years, and so it's not really surprising that when they consulted all these people and they got a lot of submissions and they spoke to a lot of people irl, but they didn't do anything meaningful with that data. They just cherry picked it to show both sides of the argument, which is exactly what the cast review did. And I think it's incredibly poor, a poor way to approach that. But having said that, I've spoken to a few people who were directly involved in the consultation process and my impression is that it really made a difference on the panel of the VINE review. So I spoke to someone who went in there right at the start of the consultation process and they had an experience where they felt like the panel were just kind of like a brick wall and they weren't listening to what they were saying and they were just flying focused on finding evidence for the theoretical negative outcomes for this treatment. And that's definitely what the submission form looked like. It was so focused on, you know, do you think bone or what do you think the risks of this treatment are? Blah, blah, blah. It didn't really give you any space to say what the positives of the.

Treatment, what do you think the benefits are? There was less on that.

Yeah. But then I spoke to some people who went in later in the consultation process and one of them said they went in directly after the panel had met a bunch of young people, of trans young people and families. And they said that in their opinion, the panel was visibly moved, having met these young people and their families, and that the panel was very willing to listen. And they mentioned an endocrinologist who was on the, on the panel who admitted that they had no experience, direct experience in trans care. But they said that they were here to learn and they wanted to learn from this physician who'd gone in there for the consultation process. And so another person who'd gone in late in the, in the consultation process told me that they felt that this was like a victory of people power that had helped the VINE review to not be a nightmare, which is what we all expected, that it would be a complete nightmare based on the terms of reference, based on the submissions form and the type of questions that were asked. Now this person was saying they felt that there'd been like a victory of people in the consultation which had swayed the panel to give a more reasonable overview of the treatment. Let me see. Yes. Okay. I'll just sum that up by saying, look, the outcome of all that, in my opinion, you've got narrow and restrictive terms of reference, it's rushed. You have no expertise among the panel members. Deliberately no expertise in trans care because the government didn't want to, quote, unquote, bias the review by putting people who actually knew what they were talking about in the panel. Now obviously that's incredibly problematic. No trans people in the panel. Incredibly problematic. Could have been a complete disaster. But I think what the result actually is, is this is the best reading I can give it, is that this is a well meaning but ignorant attempt to summarise the evidence which has resulted in excessive conservatism and excessive both sidesing of the debate. But that's essentially. I'm gonna. I'm gonna probably. There was disagreement among the panel members. Maybe, you know, sometimes you get the feeling that someone slipped in a couple of transphobic lines here and there, maybe without the oversight of someone else on the panel. And then other times you get the feeling that maybe someone who really supports this carer slipped in a few lines without Ruth vine noticing. I don't know. It is confused in that way. But I think the best reading I can give it is that the panel is trying to summarise the evidence, but they're basically inherently conservative and worried because they've taken on some of the scaremongering narrative coming from disinformation they've listened to. You know, they had Jen Spect in there, they had Jillian Spencer in there. They may have consulted someone from Segum for all I know. And you can see the results of that. You can see the results of them, I think, being ignorant about the care, learning as they went and taking on a bit.

It's basically like political ideology versus lived experience and evidence based research and at the same time time kind of conflicting.

Yeah. Summarised by some CIS folks with no experience in the field.

Yeah. Well, that's what happens when you hire those people to do these reviews.

Exactly.

We're going to chat about more of the positives and some of the negatives.

I just realised I. Or we didn't really summarise what the vine review is. Maybe, I guess there's some listeners who. What the heck is freak right now? Totally. So firstly, the vine review is just slang, really. It's not called divine review in any official capacity. That's just what we all started referring to it as when it was announced that Ruth Vine, a psychiatrist, I think she is, from Melbourne, was going to be leading this review. The review is a review into the evidence base around puberty blockers and gender. Gender affirming hormone treatment.

Read out the literal title if you like.

Yeah, you might as well or might want to google it or duck. Duck, go it.

Yeah, yeah. It's independent review advice, report advice and evidence base regarding policy options for the use of puberty suppression stage one and gender affirming stage two hormones for children and adolescents with gender dysphoria. In Queensland's public hospital system we have been calling it the Vine Review as a good reason.

Try saying that with a mouth full of pickles.

A mouthful of feminine's. Yeah, so that's the review.

Yeah. Anyway, so I was gonna say what the Vine Review gets right or what's good about it and I already ran this down. We did a post in the Transmission socials and I did a quick list. So look, I'll just go through that, I'll add a couple of things. It says that puberty blockers are reversible important. It says that regret rates, quote unquote, appear to be very low. So that's regret rates for both of these treatments for beauty blockers and hrt. It says that none of the trans people that Divine Review consulted regretted their care. This is a big one and I was very impressed that it said it. It says that paediatric medicine is often grounded in so called low quality or better, better put, low certainty research. Now this is a point that I've made over and over again and that a lot of people on our side make over and over again. Now unfortunately, the vine review, like every review of this, not every review, I shouldn't say that like a lot of reviews of this treatment recently, not the German one and not the Utah review, those two were different. The others have mostly emphasised that there is only so called low quality research or evidence to support gender affirming medical treatment for young people. But that is the case in, in most paediatric medical treatments that there is only so called low quality or low certainty evidence to report them to. Sorry, support them. Divine Review says there is increasing evidence suggesting positive psychosocial outcomes of this treatment, quote, unquote. It does not find any evidence of widespread serious harms. It outlines the risks of continuing the ban on treatment and it seems to clearly favour an end to the ban. And that's all through the review, not just the options that it outlines. I've written here, I've quoted from it. The research design standard of a double blind random controlled trial is inappropriate in these circumstances as drug related physical changes are self evident, making blinding of participants impossible. So in other words, it's saying what we say over and over and over again, which is, is that you can't have a random controlled trial for puberty blockers or gender affirming hormone treatment because it would be immediately obvious to the participants whether they were in the control group or whether they had been given a placebo or whether they'd been given the actual treatment. So the fact that it says that is fantastic. And that goes totally against what the government has done, which is to pause treatment until 2031 so that they can find out the results of a random controlled trial being done in the UK into puberty blockers, which is called the Pathways trial. Now that RCT has been designed to fail, many commentators think it's not likely to come up with any meaningful evidence, and that is because you can't have an effective random controlled trial for this treatment. Would have been good if the Vine Review had made the point of how unethical it would be to do an RCT on this treatment too. Now, it does pay lip service to child's rights as well. The Vine Review does, unfortunately. So it says that child's rights are integral to modern healthcare. And another section, it runs down what child's rights in modern healthcare entail. But unfortunately, I don't think it follows through on that. So when the Vine Review first came out, as I said, that was two Fridays ago, I was thinking I was about to have a holiday. Suddenly my phone lights up with all these people, people telling me the vine review's out, telling me that the band's been extended, journalists getting in touch, et cetera. So I sat down to look at it in a very heightened state, with a deadline of about two hours before I was supposed to speak to the abc, which ended up not happening because I found someone else to do it instead. In that time, I noticed that some other people who were reading the Vine Review at that point, they went straight to the executive side. But what I did was I went straight to the evidence about puberty blockers and gender affirming hormone treatment. And I think that when you. I think when you read the actual sections that go more deeply into those two topics, you get a more positive reading than if you look at the executive summary. Because in those two sections is where they say a lot of these truths. So for instance, it says there. So there were things that, that I was really glad to see just because they showed that someone there understands puberty blockers, which I don't think the cast review did. Either they didn't understand what the purpose of puberty blockers is, or they did understand it, but they deliberately ignored those facts. So they made the point that it's not expected that puberty blockers alone will reduce distress related to gender dysphoria. And so the inference there is that the studies that looked for reduced in distress related to gender dysphoria and couldn't find much evidence for that are not relevant. Right, yeah. Which is good. It says that in those who had persistent gender dysphoria from an early age, the onset of puberty is very stressful. And knowing that puberty has been suppressed and delayed is likely to bring relief to the young person in itself. And this is something I've said repeatedly that it's not actually that puberty, Puberty blockers are directly necessarily treating distress. It's the relief that the young person has managed to get puberty blockers. And if you didn't let the young person get distressed in the first place about that topic, if you just assured them that they were going to get the help they needed, then their distress would be radically lessened in many cases.

Would be good to also be focusing on the. How can we make this young person feel happy and euphoric instead of focusing on all these negative outcomes that we seem to keep gearing everyone towards.

Exactly. And that is a problem here. They do mention gender euphoria at least once in the, in the. When they. So they have these little sections where it says the panel heard and it says what they heard in the consultation process. And so they mentioned gender euphoria there, but it's really, it's just like blink and you miss it.

Right.

So, yeah, I agree. Look, there were other things they said. I, I feel like I'll run out of time if I go too far in the weeds about this. They did point out that suppressing puberty comes at the cost of increasing discrepancy between the stalled physical maturity of the person with gender dysphoria and the advancing puberty of their peers. Now, I thought this was a good thing that they pointed this out because basically it's an argument for getting kids on HRT earlier.

Right.

And that is what the physicians that I'm aware of in this field are trying to do is get kids onto HRT earlier. And that is because there is some small risk of bone density negative outcomes. And so it's better if kids don't stay on the treatment too long. And because of this, this is anecdotally, I've heard this from a few parents now that their children did feel this way. Now, interestingly, I saw that another trans person online had complained about this obstacle Observation because they thought that it was downplaying, I guess, the, the physical distress that a young person might feel. But I don't think so. I think it's just pointing out there's another source of.

And also that's a side effect of puberty blockers, you know, which is that your peers will have puberty before you do because you're suppressing puberty.

Yeah.

And it's just, it's a social comment. It's just what's happening.

Yeah. And you know, and then they said that puberty blockers and gender affirming hormone treatment that there is evidence that suggests psychosocial benefit. And they made this point, which I was really glad that they made, which is that psychosocial outcomes reported in the studies on puberty blockers and gender affirming hormone treatment include. And this was the first thing they listed, non exacerbation of gender dysphoria. Now, I don't know, I think most people. People would probably have read over that and not have noticed it. For me, that's a big thing that they're recognising that. The point here is that the CAST review spoke about these treatments as if there wasn't enough evidence to support them because they don't consistently reduce gender dysphoria. Well, especially puberty blockers. But that is, I mean, as I've said, if you don't let the young person get too far into the, the distress of their endogenous puberty, then you may be able to avoid a lot of their dysphoria. So you get a non exacerbation of gender dysphoria. So again, I thought that was great because it shows that they actually understand the purpose of these treatments, especially puberty blockers, which are often misunderstood. And I would have hoped that this would have led to them weighing up the evidence with these things in mind. Unfortunately, I don't think it totally did.

And that's also the downside of having a review that is rushed.

Yeah.

As rushed as this was.

Totally. And I should also qualify. So these were my first impressions that I was just talking about. My first impression was it was positive because I had such low expectations because I'd seen the submissions form I'd heard about at that stage. I'd only heard one person tell me how their experience had gone in the consultation. Consultation process and it was negative. And I was really expecting that this was just going to be another piece of propaganda all the way through, but I don't think it is. But I think as I looked more deeply into it. And I noticed things like the number of times they mentioned Finland, I started to get a bit more worried about it. So on closer reading, some things that I noticed. So as I've said that the sections which are called the panel herd. So, so the panel heard this from this person. These are cherry picked quotes which, like I say, try to show both sides of the issue, even where it's pretty clear that there were probably only a couple of people in the consultation process who said a thing and then there was like 98% of people who said something else. I'm guessing in some cases, and they treat those two things as equal. I think that's a huge problem. The data from that, what could have been qualitative data was not meaningfully collated or categorised, so you get no idea of who said what. So for instance, not that I expect them to name who said what, but they could have categorised the responses they got much more carefully. So, for instance, there's a pie chart, I think there's a couple of pie charts near the end of the review that show the different groups that they consulted with. And it breaks down physicians, but it doesn't break them down in terms of whether or not they have any experience in gender affirming medical treatment or with.

Young or even with children.

Exactly. It doesn't tell you what their specialisations are. So to me that's incredibly problematic because then when it says something like that, the physicians just couldn't agree on what constitutes an affirmative approach to gender care for young people. Well, is that because you had a handful of experts who all agreed on what gender affirming medical care is, and then you had a few anti trans campaigners with no experience, like Jillian Spencer, who disagreed? Sounds like it to me. And it would have appreciated hearing. Oh, okay, so we consult, you know, 70% of the people the physicians we consulted with agreed on the basic precepts of gender affirming medical care. And they happen to be the ones with experience in the field. That would have really helped me to hear that.

Right, yeah. And just further clarification on who these people are and what exactly they know and why they're involved with such a, you know, hot political potato here. And, and, and having. No. Like, are you even an expert on any of this?

Yeah, well, I mean, and that relates to the fact that the way they define stakeholders is very bizarre. Like, how is Gillian Spencer a stakeholder in this care? She's not. She, she doesn't offer gender affirming medical treatment. She presumably has treated some trans patients the same way as maybe any psychologist has, but she clearly hasn't gotten along with them or had good outcomes. Why is she someone to consult? And then they had Genspect in there. Genspect, a very well known anti trans org. Now, as far as I know, most, or maybe just many of the members of Genspect, they're not physicians, they're. I don't know why they were there. And there is. I mean, just the fact that Finland is referred to so often and that they actually consulted. It says in there. There's one line where you read that the panel consulted with physicians from Finland, from the Finnish Gender service, whatever that's called about this type of care. Now, they didn't. They don't mention consulting with anyone from any other countries. I'm not exactly sure where they got the idea to consult with Finland from, but I feel certain it was from Genspect or some anti trans or girl from Gillian Spencer, because I don't think they would have just thought of that. They wouldn't have just pulled that out of the air. Let's talk to Finland about this care. Yes, why would they?

And we'll go more into a bit more about Finland and their gender affair. I'll get there. Or gender not affirming care.

Yeah, it's my axe to grind. So anyway, I'll try to hurry up here. Here. The review cites disinformation. It repeats anti trans talking points. Again, my impression is that those talking points and that disinformation are less convincing and cited with less certainty on the whole than some of the actual facts. But they're still there and they shouldn't be there. The JBI review, the systematic review that is attached to the Vine Review, I only noticed this last night. It includes the Gender Exploratory Therapy association guidelines. So it, it assesses. The JBI review, assesses a number of international guidelines and one of them is the guidelines of the Gender Exploratory Therapy association, which has now been rebranded to Therapy First. And we've talked about them before.

Yeah, I was like, this rings a bell.

And I have no idea, again, I've got no idea how those guidelines are relevant because these are not people with any proven track record of treating trans kids. Like this is. It's an anti trans organisation pushing what we would. What many people would think of as conversion.

I was going to say arguably conversion therapy.

Yeah, yeah. So that's incredibly worrying. Yeah. So it uncritically repeats the claim of limited evidence it uses that term limited evidence. It talks about about a paucity of evidence for the treatment. Well, no, it's not that there's limited evidence. It's that that evidence is of quote unquote low certainty. And we can get back to that excessive focus on fertility. Even though the panel heard that while some young people have changed their minds about having children later in life, not one of them regretted accessing gender affirming medical treatment and most young people were happy to consider adoption. It cites Trump's the Trump administration's HHS review, which was entirely authored by anti trans campaigners. It doesn't give any qualification to that. It just acts like it's just as legitimate a review as anything else. That's about as problematic as the gender exploratory therapy review. And it does not adequately consider child's rights.

Peter Sterling the only man in the.

World who's given birth to a child.

Someone might say you're a bit of a queer and they'd be right. You're listening to Transmission on 4zzz. My name is EZ, I use he.

Him pronouns, hi, I'm bet, I use she they pronouns.

And we're chatting. The Vine Review about the overview of the the review, we've been talking a bit about the positives and negatives overall. Currently where it stands, what we're caught up to is it's a very fence sitting report that lends itself to one side really quickly and then left and doesn't seem to really understand itself too much. But there are lots of positives and there are also negatives. So we've been covering off on those things.

On my second, I guess I had three readings but the first two were were very like I didn't read the whole thing the first two times with more skim readings. On my third, very close reading, I noticed what I'm going to call some very granular concern. There are many of them, but I just want to mention a few just so that people get an idea of what sort of little nuggets of nonsense you can find in there.

Nuggets of nonsense.

One thing which really blew my mind is that they say that in the JBI review that looks closely at the various studies on this topic that the average age of commencement of puberty blockers in the systematic reviews they looked at was 14.5 to 16.9 years. So that's the average age that young people in these studies started. Puberty blockers. That really blows my mind because that means there were some young people that didn't Start them until about 17, which is really light. That's ridiculous. And all I can think is that these systematic reviews covered some of the studies from the UK which I've spoken about. And in the UK they had this ridiculous rule that any person under 18 who wanted to go on HRT had to go on puberty blockers for a year first, even if they'd already been through puberty. But those studies should not be included. I can't believe that they even took those studies into account. And elsewhere in the Vine Review it says it is expected that puberty blockers will commence at Tanner Stage 2. Now, how many young people, people are going through Tanner stage two at 16.9 years old? I doubt there's any. Maybe.

Yeah.

So, yeah, incredibly concerning other, other little things, the Vine Review talks about, quote, unquote confounding factors when assessing gender affirming hormone treatment. So they're saying that the evidence for HRT has these confounding factors in it that undermines the quality of the evidence. And two that they mention are use of puberty blockers and co occurring psychiatric support. So what they're saying is that you can't adequately isolate the effects of HRT if a young person has been on puberty blockers or is going to a psychiatrist. And I'm like, well, that probably counts out a huge number of young people that they're saying that the evidence has too many confounding factors. I find that strange. The JBI Review found that across the whole evidence base that they looked at, there was no indication of patient or stakeholder involvement in study design, conduct or interpretation. This is a good observation. Right, look, that we need. There weren't any trans folks involved in designing the studies that they looked at. And the Vine Review criticises this. But the thing is the, that both the vine review and the JBI review are examples of it. Neither of them included any stakeholder or stakeholders or trans folks in the study design. Right, so what's this one? And that's very long. I don't know if I can go in.

Oh, more things about us without us.

Exactly, yeah. Now actually this is a big one and this was pointed out by someone online. They talk about the implementation of a youth model that would go up to 25 years and it might alleviate the problem of adolescents at age 17 years ageing out of child gender services because there's a transition problem apparently between child gender services and adult gender services. Then elsewhere they repeat the disinformation claim that the brain isn't quote Unquote, fully developed until age 25. So the implication that you could draw from these two points is that they want to do what the CAS reviews are suggests and kind of rigorously police access to this care up to the age of 25. They don't spell that out. And I'm not even clear if they know that that's what they're saying. I get the feeling that someone on the panel might know that's what they're saying. And that's very problematic, obviously, elsewhere, little things that the panel heard. So the panel heard that the ongoing harms of social transition are not fully understood. I'm guessing maybe you said that, Gillian, or someone from genspect. I mean, what are the ongoing harms of social transition anyway? Why are we even talking about that? Completely ridiculous. This one's probably. This is absolutely terrible. And someone pointed this out to me. Number 408 in the review section. 408. The panel heard about social media and online grooming of trans young people. Meaning by this I think they meant that queer people often, or trans people often, quote, unquote, groom young people into being trans. Now, obviously this was something that was said in the consultation process by someone, God knows who. It's. It shouldn't be in there. It shouldn't. If it's mentioned, it should definitely be qualified by saying one nut job said this rather than giving it any air whatsoever.

And this and the section 408 that they, they're referencing here around social media. What I'm reading is that it's to do with the parents being confused about what's true and what isn't, spending time in Reddit forums or on YouTube. This led to some parents feeling marginalised, powerless and very concerned about their child's well being. So this is about misinformation and this is about probably random men with podcasts instead of psychologists and women. Yeah, well, they're out there too, doing the same thing. But this is, you know, some parents describe, describe feeling risk of being framed as transphobic and unsupportive if they appear to disagree or want more information independent of what was online.

Yeah. Now this is another case where I'm like, okay, so how many. What was the percentage of parents that said that? I'm guessing it's under 10. I mean, like, I don't know. I have no idea actually. So why don't you tell me, Ruth Vine. But that sort of stuff comes up so often in the panel heard section. So I've got here another one that they say is the panel heard perceptions that a coercive environment is created when unquestioning gender affirmation was expressly linked to reduced suicidality. For young people experiencing gender related distress, even that term gender related distress is a massive red flag. That's a cast review type saying so that's terrible, this consistent platforming of transphobic parents views. But one thing I will point out is that in the whole of the cast review, they did not mention the word trans child once. I don't think they made it a point to call them gender distressed children. Gender confused children talk about gender related distress. So this is something good about the vine review as compared to the cast review, that it does at least acknowledge the existence of trans young people, which you would think would be the baseline for something like this. But on the other hand, it does platform these voices. So I wanted to get to probably one of my biggest concerns though, and it was always going to be this way. But the vine review explicitly prioritises gender dysphoria over gender incongruence. And this is common too. A lot of writing on this topic. But it goes against what Wpath's trying to do, what Ospath's trying to do. Gender dysphoria requires distress. Gender incongruence doesn't require distress. Gender incongruence is just that you feel that your gender presumed at birth does not align with your gender identity. Gender dysphoria, it's the same thing, but it's the distress associated with that. And so what Divine Review is saying is that no young person in Queensland should be given treatment unless they are experiencing distress. But this means that there will be young people who can't. I mean, if this is rigorously policed. Because this, this has kind of been the unofficial policy for a while, I think, but I think doctors have also been able to work around it. If they can see that a young person is trans and has gender incongruence, then they don't necessarily have to wait for them to experience clinically significant distress before they can treat them. But if Divine Review is taken seriously, and if these things are policed, then they will have to. And that's presuming that we even have a reinstatement of care through the public system that is incredibly concerning to me. But the other thing is that while saying that they're only talking about dysphoria and they do acknowledge that incongruence is a thing and that it's a valid thing, and that you don't need dysphoria to be trans, but they Say, but that's outside the scope of the review. We're only talking about dysphoria here. But then the JBI review conflates the two, so it includes studies that only looked at gender incongruence. So again, in my opinion, this is probably going to lead to inconsistent results, which is another reason why the evidence base isn't as certain as we might hope. Because if you look at incongruence and you and a young person is not experiencing clinically significant distress, then they're not necessarily going to have an improvement in mental health through accessing these treatments. And many of the studies that they looked at were about whether or not young people have improvements in mental health. So that's a big problem for me. So another huge problem, maybe the biggest problem. And I think it's something that we all just have to accept. I think this is true of pretty much, I don't know, any system gender view of this topic that we've seen. Again, I'm not the German review, not the Utah review. Most reviews into this hold gender affirming medical treatment to a higher standard than other treatments. And I think we just have to accept that they do. Now, as I mentioned earlier, most of them emphasise low quality evidence or lack of evidence. The actual term is low low certainty evidence. And I've been getting that wrong for a while. I was corrected in in a meeting that I did with some professionals recently on this topic. But also I'd started to notice that Gordon Guy, at the inventor of the grade system and evidence based medicine, which is what they're using in these reviews to assess this treatment, uses the term low certainty evidence. Now somewhere he says that I think it was 80% of healthcare has a similar low certainty level of evidence. But I can't find that quote. So instead I've got an article from Mother Jones that we can put in the show notes in the podcast episode. It cites two studies that find that roughly only 10% of treatment recommendations were supported by so called high certainty evidence. And that's the type of evidence that like the cast review wants. And that's why they're doing a random controlled trial that's designed to fail because they're claiming that the reason why is that they need high certainty evidence. Well, only 10% of treatments, according to Gordon Guyot, have that level of evidence. Right. Also, the vine review makes the point a few times that evidence based medicine, and this is a direct quote from them. There's some better quotes, but I couldn't find them. And my annotated PDF version broke down. Anyway, evidence based medicine incorporates individual clinical expertise and the person's preferences and values, as well as the best available evidence. So there's three prongs to evidence based medicine. There's clinical expertise, which we have plenty of, saying that this treatment is safe and effective. There's the person's preferences and values. We have plenty of young people who want the treatment. And there's the best available evidence, which in this case is usually rated as low certainty. But as Gordon Guyt has said, and as the grade system explicitly says, you can have strong recommendations for a treatment that arise from low certainty evidence.

And this would have all been pretty clear if any of these people who worked on this report were at Ozpath conference.

Well, none of them would have been.

But you know, if you're looking for, for evidence and you're looking to actually find out what, what is relevant to the community from a healthcare perspective, you'd go to the annual health conference for trans people, wouldn't you think?

Anyway, just again, I dare say you would. So the other big, big concern for me is I think the VINE Review basically supports increased gatekeeping. I'm sure it does. So they talk a lot about multidisciplinary disciplinary biopsychosocial assessments. We heard about how that language can be kind of weaponized from Cal Horton when we were at the Ozpath conference. So while these are theoretically standard already at the Queensland Children's Gender Service, I think the strong inference is that the VINE Review wants doctors to be surveilled more and young people to be surveilled more and assessments to become more extensive, more arduous, more invasive. Now, I will also link to a study in the show notes by Florence Ashley that concluded. Actually it's not a study, sorry, it's a paper by Florence Ashley at et al 2024. It concluded there is no evidence that gender assessments can reliably predict or prevent regret better than self reported gender identity and embodiment goals. And lastly, the VINE Review supports treatment, but again, I'm quoting only after any other causes or contributors to the young person's distress have been considered and resolved to the extent possible. Now, as I might have mentioned, last week I conducted an online meeting with a number of very smart people, including a couple of professionals in this care, some psychologists, psychology student, a few trans folks. Included among these some parents, some counsellors. The general feeling among professionals in the field seemed to be that that kind of comment is not that worrying and that they've seen that before and that they do that already. They consider the other sources of distress. The wording worries me that the distress should have been been resolved to the extent possible. The physicians weren't at all worried about this. I will say they didn't seem worried about enough about some things to me. I think as a trans person, obviously we're jumping at shadows right now, but just because you're paranoid don't mean they're not after you, as the great Kurt Cobain said.

So you hear that everyone remain paranoid.

Yeah, couldn't hurt. And I'll link this to Finland because if you take into account the number of times they bring up Finland and the amount of respect they accord to Finland, then this statement becomes very worrying. Yeah, so it's mostly in the JBI review is where Finland gets mentioned the most. And as I said, I hadn't looked all that closely at that, so I had. It took me a while to really catch on to the extent to which Finland is upheld as a, as a example. So going back through the review I noticed they reference Rita Kertu Kaltiala a couple of times. I've mentioned her before they. So they. There's. There's not all that many references in the review. A lot of the review will reference the JBI review or it will reference other reviews. They don't always reference primary sources, but they prioritise Kaltiala and she is. So she's collaborated with Sagan. She has to her credit unlike most anti trans campaign, has actually done original research in the field and actually does lead a gender clinic in Finland. So she does have experience but she's not saying the things that we would hope that someone in her position would say. She's upheld by the CAST review as a, as a brilliant example that she actually helped author the CAST review. We found out no thanks to the CAST review who did not reveal who. Who co authored it. So they, they referenced two of her articles. One of them is the very problematic study on suicide which claims that there's no heightened risk of suicide for trans young people by doing some clever manipulation of the data. As I said. They also say that the panel met with key clinicians from Finland who described their model of care. Relevant components to note include respecting diverse identities while ensuring a neutral comprehensive assessment. Now elsewhere they uphold Finland as the most neutral in terms of their approach to gender affirming medical treatment. And I'll get back to that when I get to that quote. They also say that Finland requires persistent gender incongruence since before puberty. Now I Presume what they mean here is that, that Finland requires parental report of persistent gender incongruence since before puberty. Because I think that most trans young people who, I mean, I don't, I don't know, I'm not a physician and I don't have stats for this, but I think that at very least many trans young people are able to articulate gender incongruence going back before puberty, even if they only came out.

Absolutely.

When puberty started or afterwards. Right, yeah.

We think about times for ourselves when we were like five years old.

Yeah, exactly. Yeah. They, they say that psychosocial support is, quote unquote, the mainstay of treatment in the States, United UK and Finland. There is no evidence that psychosocial support helps gender dysphoria at all. It can deal with associated distress like other things that are going on, like minority stress and whatever else, but it can't actually address gender dysphoria. Here it is. The panel notes that the approach in Finland appears representative of a truly neutral approach regarding matters like you use of pronouns, name or attire. Now here's something interesting. In Finland they don't have gendered pronouns. So yeah, no shit, they have a neutral approach to pronouns. We can't repeat that in English unless everyone wants to use they pronouns. I guess we could do that, but I don't think that most trans young people would be okay with that anyway. And it's not going to happen. The JBI review, it says at the start that it synthesises guidance from Australia, Finland, the United Kingdom and key international or multi regional organisations such as WPARTH and the Endocrine Society. Hear how it puts Finland second after Australia in that list? So we've got Australia, Finland, the UK and then after that, key regional or multi regional. Sorry, international or multi regional organisations. So. So it's prioritising Finland and the uk, who are two of the most regressive, harmful constituencies in the world for trans kids. Eligibility for those under 18 in Finland requires severe and persistent gender dysphoria that began before puberty and intensified with its onset alongside the absence of contraindications. Now, I don't know, I may be ignorant, but what, what's a contraindication for gender affirming medical treatment? I'm not really sure. The Finnish guidance establishes one of the most restrictive frameworks identified in this review. This is a direct quote with particular emphasis on ruling out co occurring mental health conditions. Only after this process can eligibility for medical treatment be considered, reflecting a prioritisation of psychiatric stabilisation over early pharmacological pathways. Now, for those who don't know, I've been through this before. Finland basically subscribes to the gender exploratory therapy approach. There are reports coming out of Finland from trans young people of being interrogated in the most horrific, sexual disturbing ways that I've ever heard of. I don't have any direct quotes from them right now. That was in the. In the cast. Actually, I never did use direct quotes because I considered it too disturbing and I don't want to trigger people that much. But in Finland, young people are aggressively questioned about their sexuality, their porn usage, how they feel about their genitals, how they masturbate, have they ever been sexually abused, so on and so on and so on in order to rule out porn users or distress resulting, or trauma resulting from sexual abuse as causes of their trans identity.

It's extremely invasive and unnecessary.

Yeah.

And this is not a framework that we want to be drawing upon at all at any point.

And it's not neutral. This really gets me that Divine Review has given a platform to people who think that. That if you just use a young person's pronouns and use their preferred name, that you are somehow like, gaming the system and diagnosing them with something and medicalizing them before they've even had a chance to, quote, unquote, explore their identity with a physician. No, just respect the young person. Use their freaking pronouns and their freaking name. It shouldn't even be a conversation.

Yep, right there with you.

And the reason why they're calling Finland neutral is because. Because gender exploratory therapy positions this as a neutral approach where they say that when the young person comes in, you make a make up, a nickname so as not to use their dead name, but not to use their. Their chosen name either. And you refuse to use their pronouns. You. You kind of weasel your way out of that somehow. And this is somehow neutral. That's.

That's the kind of dehumanising. Really.

Yeah, it's disrespectful. So we're running out of time. So I did want to end on a slightly positive note because I'm conscious that I've spent a long time here just ripping the poo out of this. I did want to say why it's not the cast review, because it really worries me that people are panicking so much that they think that this is the equivalent of the cast review. Now, I don't want to boast, but I know a lot about the cast review. I've read it very closely I've looked very closely at its sources. I know about something, at least about the way it was written and who collaborated on it. I know as much as is probably possible to know. Unless there's someone out there with more information, please tell me this is the first thing. The cast review was not transparent. We still don't know all the people who were on the panel of the cast review and the cast review tried to keep them hidden. And the only three people we do know of two were members of Segum who you can find on the Segum website. Society for Evidence Based Gender Medicine, the most dangerous anti trans org in the world for trans young people at the moment. And the other one was Dr. Ritiker to Kaltiala who has is affiliated with SEG and has spoken at their conferences. And they quote her all the time. She's an anti trans campaigner. I would consider her that. So that is very unlike the vine review panel. No one on the vine review panel is a non anti trans campaigner. As I said earlier, the castreview wouldn't even say trans young person. Cass was either ignorant of or deliberately avoided many of the facts that I cited earlier. For instance, blockers are reversible, that regret rates are very low. The paediatric medicine is often based on low certainty evidence. Etc Etc. CAS review deliberately avoided all of those facts. The vine review does not spend several pages citing spurious possible causes of transness like porn usage. It briefly gestures at some of them. Social contagion. So the vine review does, in the panel heard sections. It does pay some lip service to social contagion. But it doesn't make a whole section out of it. It doesn't go deeply into the theory. It doesn't cite the 80% desistance myth. Whereas the cast review spends tens of pages on this complete bullshit in order to try and make a of sense think that you know that transness is a social contagion and it's caused by porn usage. The vine review does not excessively focus on detransition. In fact it glosses over it. It has a tiny section in it which concludes that regret rates are very low. It really doesn't focus on it much at all. That may be because they were aware or someone in the panel was aware that if they focus too much on it they would bring to light the fact that the negative narratives around it are nonsense. But I don't know. It could also be that they just don't think that it's a huge risk.

Yeah.

So in short, the Cast review is conscious disinformation. It's been made to be disinformation. Divine review, I don't think is that. I think it's ignorant, it's conservative, it both sides the debate and it does platform disinformation. But I, I don't think that it does all of that deliberately. Or if so, maybe there's someone in the panel doing it deliberately, but there are other people in the panel working against them. So, in short, the vine review is not what trans kids need. It is going to make the situation worse, presuming that the government even follows it, because it will lead to more invasive assessment processes.

Well, I disagree. I mean, I think it will. It could, it could. There's a potential. Potential, because you've got these three options that they're choosing and the options that they've chosen to continue the ban. But ultimately, if they were to look at the advice overall, and it is its fancy, you can kind of pick, cherry pick what you like from it. It's really, I think, leaning into whatever your idea is on transness. You can just use the review to support whatever theory you want, which is neither here nor there. Would that not make it a neutral review?

Well, they would like to think so, but I think the problem is because it platforms disinformation to the degree that it does, you know, as I've said before, all the other side has to do is generate doubt and it does generate some doubt. And so the outcome is going to be a more conservative approach than what we had before, presuming that the government takes Divine Review seriously. In my opinion, if they were to look at the vine review properly and try to assess what it's really saying, I think they would say, well, it's saying that we should keep treatment going, but we should be wary because maybe there's some side effects that we're not. That we're not catching here. And you know, maybe this, maybe that Lady La de la, like, it's still feeding into the kind of.

Into the doubt. Yeah.

Into the panicky, you know, into the, the moral panic kind of thing. So. But it's way better than what it could have been. Yeah, like way way better than what it could have been. It's way better than the cast review, I think. Now, I know that might be controversial and someone's probably going to take me to task for it on the Internet today, but that's my opinion, having taken a pretty close look at it.

And also, dear listener, if you are a trans person or a young trans person listening Regardless of whether you have access to this care or not, your transness and your existence is still real. It is still valid. You still deserve to be here. And it doesn't matter what any government, any adult, any medical professional, practitioner says. You are real. You are here. And there are so many people out there who are fighting back. And we're gonna do everything we can to keep you updated on all those things. And I wanted to just give you a special nod, bet on air because the amount of work, laborious work that you do, the time that you have given to reading this, to updating community, to your unrelenting activism, I thank you so much.

Thanks.

Yeah. And we're gonna keep, we're gonna keep you updated with everything and yeah, thanks.

So much Bet to all the trans young people out there. I love the shit out of you. As my friend would say, you're great. Keep on doing what you're doing.

Yeah. Thank you so much for tuning in. Catch us next Monday from 10 till till 12. You can also listen to our podcasts special shout out as well to Greg for subscribing during transmission. Greg from Willowin, thank you so much. You are keeping 4Z alive and you can do that too. If you are not subscribed to 4zzz, head to 4triplez.org AU support. You can subscribe they're annual subscriptions. You've got a variety that you can choose from. Whether you're a band, a business, a household or just a very passionate zed person. You can get yourself a tote and a tee bunch of stuff. So head over there. Love you all and see you all next week. Bye. Thanks for listening to Transmission. Catch us every Monday live on 4zzz from 10am or listen to our podcast on the community radio plus. Sam.