Following the BBC Newsnight report about the Tavistock and Portman clinic’s prescribing of puberty blockers to young transgender people, we thought it would be a good idea to collate some ‘Top Puberty Blockers Facts’ to debunk the myths surrounding puberty blockers for trans kids.
MYTH 1: Puberty blockers are harmful to bone growth.
THE FACTS: The Endocrine Society found that Medical intervention in transgender adolescents appears to be safe and effective and that hormone treatment to halt puberty in adolescents with gender identity disorder does not cause lasting harm to their bones.
“Hormonal interventions to block the pubertal development of children with gender dysphoria are effective and sufficiently safe to alleviate the stress of gender dysphoria,”
Henriette Delemarre-van de Waal, MD, PhD, a professor of pediatric endocrinology at Leiden University Medical Center, Leiden, The Netherlands.
MYTH 2: Young people wouldn’t want to take puberty blockers if they knew the risks
THE FACTS: The few negative effects of puberty blockers do not change children’s minds and most adolescents stated that the lack of long-term data did not and would not stop them from wanting puberty suppression. They said that being happy in life was more important for them than any possible negative long-term consequence of puberty suppression:
“The possible long-term consequences are incomparable with the unhappy feeling that you have and will keep having if you don’t receive treatment with puberty suppression.”
Trans boy; age: 18;3
“I would rather live 10 years shorter but live a very happy life being myself, than live 10 years longer and be unhappy my whole life.”
Trans boy; age: 17;7
“It isn’t a choice, even though a lot of people think that. Well, actually it is a choice: living a happy life or living an unhappy life.”
Trans girl; age: 14;5
MYTH 3: Puberty blockers aren’t reversible
THE FACTS: The suppression of puberty using GnRHa puberty blockers is a reversible phase of treatment. This treatment is a very helpful diagnostic aid, as it allows the psychologist and the patient to discuss problems that possibly underlie the cross-gender identity or clarify potential gender confusion under less time pressure. It can be considered as ‘buying time’ to allow for an open exploration of a young person’s gender identity. [As reporte by Cohen-Kettenis PT & van Goozen SH. Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. European Child and Adolescent Psychiatry 19987246–248.]
This is supported in the guidelines of both the Royal College of Psychiatrists and the World Professional Association for Transgender Health [WPATH]
MYTH 4: Puberty blockers are a new thing being prescribed to children
THE FACTS: Puberty blockers have been used for years to treat precocious puberty in children, with recommendation that they can be prescribed from the age of 6 years old, as detailed by Carel, J.-C., & Léger, J. (2008). Precocious Puberty. New England Journal of Medicine, 358(22), 2366–2377. doi:10.1056/nejmcp0800459
The study also noted that:
“Pubertal manifestations generally reappear within months after GnRH-agonist treatment has been stopped, with a mean time to menarche of 16 months. Long-term fertility has not been fully evaluated, but preliminary observations are reassuring.”
Heger S, Muller M, Ranke M, et al. Long-term GnRH agonist treatment for female central precocious puberty does not impair reproductive function. Mol Cell Endocrinol 2006;254-255:217-20.
MYTH 5: Puberty blockers will give trans kids osteoporosis and make them sterile
THE FACTS: Research has found that long term puberty blocker treatment of precocious puberty girls preserved genetic height potential and improved FH significantly combined with normal body proportions. No negative effect on bone mineral density and reproductive function was seen. As reported by Sabine Heger, Carl-Joachim Partsch, Wolfgang G. Sippell in The Journal of Clinical Endocrinology & Metabolism, Volume 84, Issue 12, 1 December 1999, Pages 4583–4590
MYTH 6: Taking puberty blockers makes your mental health worse
THE FACTS: A study of young people taking puberty blockers over a two year period found that although the patients had been very concerned about physical differences from their peers, they recovered slightly from loneliness and behaviour disorders during treatment. While this study was in relation to people taking puberty blockers for precocious puberty, it can be surmised that the same alleviation of stress levels surrounding puberty with peers would occur with transgender children.
It was additionally commented that:
“The patient’s self-perceived body image, rather than physical improvement after puberty blocking treatment, may play a more significant psychological role, and therefore psychological support should be provided during GnRHa treatment.”
Eun Young Kim, MD, PhD, Korean J Pediatr. 2015 Jan; 58(1): 1–7.
MYTH 7: It is not ethical to give puberty blockers to transgender children
THE FACTS: Aside from the fact that puberty blockers are, by their very nature, designed to block puberty, which only occurs in children on the cusp of adulthood, the question “Should we suspend the puberty of children with gender identity disorder?” was researched by S Giordano in the Journal of Medical Ethics 2008;34;580-584
The conclusion was conclusive; that not prescribing puberty blockers for children with gender dysphoria was the much more unethical action to take:
“If allowing puberty to progress appears likely to harm the child, puberty should be suspended. There is nothing unethical with interfering with spontaneous development, when spontaneous development causes great harm to the child. Indeed, it is unethical to let children suffer, when their suffering can be alleviated.
This is not responding with medicine to a problem that is social in nature. This is responding with medicine to a serious medical problem that causes enormous distress to the sufferers and makes them prefer unqualified help, street life and even death, to life with GID.
Whether or not the administration of puberty suppressant drugs is ethical depends not only on the net balance of clinical risks and benefits of treatment, but also on what is likely to happen to the child if s/he is not treated at the early stages of puberty. On balance, healthcare providers should include future physical risks (invasiveness of future surgery), and the psychological and relational/social risks (disgust for the self; social integration; risk of suicide).
Healthcare providers are ethically (and to some extent legally) responsible for what is likely to happen to the applicant as a consequence of the fact that treatment has been withheld.32 Thus a decision on SP should involve a judgment on the overall quality of life and welfare of the child.”
S Giordano in the Journal of Medical Ethics
MYTH 8: Children are too young to know they are trans and are pushed to take blockers by parents / social media / peer pressure
THE FACTS: There are multiple accounts by parents and older trans people who observe that they / their child knew that they were transgender from a young age – Here is one such account and another article explaining how transgender kids aren’t rushed into transitioning
Aside from the numerous peer reviewed research and personal testimony’s from both parents and transgender people, the most important thing to remember is this…
Trans kids exist. They need support. Puberty blockers are well evaluated in this situation. Doing nothing causes major harm. Doing nothing is not a neutral option. Every programme like the one by Newsnight causes untold damage. FACT.