Study: Effects of puberty-blockers can last a lifetime

Proponents of putting gender-confused children on puberty-blocking drugs have long said there’s no harm in pressing pause on their physical development while they take time to consider their identity. “It’s completely reversible,” said Stephen Rosenthal, a pediatric endocrinologist at the University of California, San Francisco, in a 2016 cover story for UCSF magazine. “You take them off it, and they resume puberty.”

But a long-term study by the United Kingdom’s leading facility for treating gender-dysphoric children found otherwise. Contrary to common beliefs about puberty-blocking drugs, the majority of children who take them do not resume puberty.

In a Dec. 2 preprint of the study from the Tavistock and Portman National Health Service Foundation Trust, all but one child treated for gender dysphoria with puberty-blocking drugs went on to take cross-sex hormones to alter their sex characteristics permanently. The study also showed that children’s bone density and normal growth flatlined with puberty blockers as compared to their peers, and participants reported no improvement in their psychological well-being. The findings support a growing body of evidence showing the harm and irreparable damage of experimental medical treatments for children with gender dysphoria.

The U.K. High Court issued a landmark ruling on Dec. 1 requiring doctors to seek a court order before administering puberty-blocking drugs to children under 16. The plaintiff, Keira Bell, 23, argued the Tavistock Center did not adequately warn her as a teenager of the irreversible damages of such hormone treatment. The judges said doctors failed to provide adequate scientific basis for the treatment or explain their long-term effects on children. They also chastised the center for its lack of record-keeping, including tracking the proportion of children who go on to take cross-sex hormones.

The Tavistock Center published its study the day after the High Court’s ruling. The study began in 2011 and followed 44 children ages 12 to 15 for three years. Youth participants were urged to store their gametes before taking blockers, and female participants reported they did not menstruate while taking the drugs, indicating the practitioners anticipated and observed effects on the patients’ reproductive development.

Endocrinologist Michael Laidlaw from Rocklin, Calif., noted that children in the study who took puberty blockers exhibited significantly less bone density than their peers. That causes stunted height and puts them at greater risk for osteoporosis and fractures in adulthood, he said.

Given the study’s findings that nearly all children who take puberty blockers end up on cross-sex hormones, it is clear that the drugs do more than give children time to pause to consider their gender identity.

Cross-sex hormones carry side effects including sterility, increased risk of cardiovascular disease, and increased risk of breast and uterus cancers, and other harmful psychoactive effects of high-dose hormones such as mood swings and even psychosis, Laidlaw said.

“Kids are not able to understand the long-term implications of this radical treatment to the human body,” he said. “They cannot provide meaningful informed consent.”

Puberty blockers were first used to treat gender dysphoria at a Dutch gender clinic in the 1990s. The so-called “Dutch protocol,” published in the European Journal of Endocrinology in 2006, tracked 55 young people with gender dysphoria who were treated with puberty blockers, put on cross-sex hormones at age 16, and underwent sex-change surgeries after they turned 18. The study had no control group to compare the results with. Still, it concluded that the treatments succeeded based on psychological functioning at least one year after surgery.

At UCSF, Rosenthal began prescribing puberty blockers to gender-dysphoric youth in 2009 based on the Dutch protocol, which also informed the Endocrine Society’s clinical guidelines for treating transgender youth.

On Dec. 15, the Endocrine Society posted a position statement on transgender health. It said medical intervention for gender-dysphoric youth, including puberty blockers, cross-sex hormones, and “medically indicated surgery,” was “effective, relatively safe (when appropriately monitored) … and has been established as the standard care.”

Laidlaw has called the Endocrine Society’s position “highly deceptive.” Most gender-dysphoric children experience other psychological or familial problems or pre-existing trauma or autism, he said. “These kids, given time and compassionate care, should be able to become comfortable in their bodies without the harmful interventions of hormones and surgeries.”