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Puberty Blockers and Gender Dysphoria: 5 Facts Every Parent Should Know

Despite popular reception by LGBT advocacy groups, the efficacy of puberty blocking drugs in treating gender dysphoria is questionable at best, and outright dangerous at worst. Before conceding to the hype, take a look at five important facts about transition-affirming hormone therapies:

1.) There is no medical consensus on transition-affirming treatments for gender dysphoria.

The term “gender dysphoria” replaced the term “gender identity disorder” in 2013. This change represented a seismic shift in how we think and talk about gender. “Gender identity disorder” indicates a deviation from the norm where one’s mental state is incongruous with reality, whereas “gender dysphoria” suggests that gender has nothing to do with biological norms or physical realities.

Since then, the new phenomenon of transition-affirming therapies for children have gained popularity, as gender clinics dedicated to the practice jumped from 24 in 2014 to 40 in 2017. Now there are 215 pediatric residency programs teaching these new methods.

Yet there remains little scientific understanding of gender in the first place. As Dr. Lawrence S. Mayer and Dr. Paul R. McHugh wrote in a recent study for The New Atlantis:

In reviewing the scientific literature, we find that almost nothing is well understood when we seek biological explanations for what causes some individuals to state that their gender does not match their biological sex. The findings that do exist often have sample-selection problems, and they lack longitudinal perspective and explanatory power. . . . Yet despite the scientific uncertainty, drastic interventions are prescribed and delivered to patients identifying, or identified, as transgender. This is especially troubling when the patients receiving these interventions are children. . . . Moreover, there is a lack of reliable studies on the long-term effects of these interventions. We strongly urge caution in this regard.

Given this lack of research, a number of notable medical associations do not recommend transition-affirming therapies for children, including: the American College of Pediatricians, the Alliance for Therapeutic Choice, the Association of American Physicians and Surgeons, the Christian Medical & Dental Associations, the Catholic Medical Association, and the LGBT-affirming Youth Gender Professionals.

Given the lack of studies behind these emerging procedures, the debate over puberty blockers is far from over.

2.) The majority of children diagnosed with gender dysphoria come to identify with their biological sex after puberty.

In fact, the overwhelming majority of children no longer experience gender dysphoria after puberty: 80 to 95 percent.

Meanwhile, all of the children that used puberty blockers at an experimental 1998 Dutch gender clinic continued to identify as transgender.

Dr. Paul W. Hruz, Dr. Lawrence S. Mayer, and Dr. Paul R. McHugh wrote in another recent study published in The New Atlantis: “[T]he medical treatments provided for children with apparent symptoms of gender dysphoria, including affirmation of gender expression from the earliest evidence of cross-gender behaviors, may drive some children to persist in identifying as transgender when they might otherwise have, as they grow older, found their gender to be aligned with their sex.”

In other words, interventional treatment may prevent children from coming to identify with their biological sex upon experiencing the natural “sexual awakening” of puberty, instead causing them to persist in gender dysphoria.

As Drs. Hruz, Mayer, and McHugh point out, “If the increasing use of gender-affirming care does cause children to persist with their identification as the opposite sex, then many children who would otherwise not need ongoing medical treatment would be exposed to hormonal and surgical interventions.” That means more expenses and medical risks for children who may have otherwise not needed drastic treatment plans.

3.) The drugs used to disrupt puberty in gender dysphoric children are not FDA approved for that purpose and must be prescribed off-label.

The FDA has not approved any drug specifically for the purpose of transition-affirming treatment for children with gender dysphoria. Hence physicians must prescribe the drugs “off-label,” i.e. not for the purpose specified by the label. The practice is legal and relatively common. However, prescribing drugs for purposes besides those approved by the FDA does not come without risks.

An international consortium issued a warning against prescribing off-label hormone treatments for precocious puberty in 2009. They concluded that there was not sufficient research to support utilizing the drug for precocious puberty.

Note that this warning did not even consider the practice of attempting to suspend puberty altogether and prevent the development of secondary sex characteristics, as occurs in transition-affirming hormone therapy.

4.) The side effects of puberty blockers are severe.

Drugs like Lupron, one of the most commonly used for transition-affirming therapy, have severe side effects and can be incredibly risky, even when taken for their intended purpose.

For example, Lupron was initially approved to treat prostate cancer. Now it is prescribed for precocious puberty and to prepare women for in vitro fertilization, although the FDA does not recommend it for women considering pregnancy.

In addition to the adverse effects experienced by adults, PBS reports: “More than 20,000 adverse-event reports have been filed with the FDA in the last decade [concerning Lupron]. . . . About 900 reports cite side effects that children below age 13 have suffered, mostly within months of taking Lupron. Those reports frequently note injection-site pain but also include dozens of cases of bone problems, such as pain or disorders, and the inability to walk.”

Moreover, a 2003 study published by The New England Journal of Medicine found that some children who took hormonal drugs like Lupron to help with growth during puberty suffered from a significant loss of bone density over the course of three years of treatment. Researchers concluded that the loss ultimately could not justify the therapy.

Furthermore, in the “Growing Pains” study published by The New Atlantis, Drs. Hruz, Mayer, and McHugh list the numerous potential side effects of hormone therapy: “…disfiguring acne, high blood pressure, weight gain, abnormal glucose tolerance, breast cancer, liver disease, thrombosis, and cardiovascular disease.”

And last but not least, long-term hormone therapy ultimately leads to sterility.

5.) Puberty blocking is not a “fully reversible” treatment.

Since the hormonal effects induced by puberty blocking drugs stop once a child stops receiving injections, proponents of these therapies present these treatments as fully reversible.

However, as Drs. Hruz, Mayer, and McHugh write: “If a child does not develop certain characteristics at age 12 because of a medical intervention, then his or her developing those characteristics at age 18 is not a ‘reversal,’ since the sequence of development has already been disrupted.”

So even if a child decided to “transition back” to an identity consistent with their biological gender, there would still be physical, psychological, and social consequences since they would undergo these biological changes outside of their normal, natural context.

Moreover, unlike the majority of children who naturally underwent puberty and came to identify with their biological sex, all of the children from the Dutch clinic that first developed puberty blocking therapy persisted in gender dysphoria. Hence there is no evidence to substantiate the claim that the treatment can effectively be reversed. There are simply no studies that show this to be the case.

Puberty blockers thus have serious implications for the long-term well-being of children with gender dysphoria. Many children who may have otherwise come to develop a healthy sexual identity consistent with their biological sex are now likely to undergo costly, drastic, and risky treatments. They may face serious long-term health issues as a result.

The medical community, government regulators, and parents alike ought to challenge the legitimacy of puberty blocking treatments. These treatments lack sufficient scientific backing to justify widespread use. The common portrayal of these drugs do not disclose their serious side effects. Therefore, citizens should demand to know the full truth about puberty blockers — beginning with the five facts above.

Monica Burke

Monica Burke is a researcher for APP's Religious Freedom Program.

  • Thank you for this thoughtful article am very concerned that the FDA hasn’t approved they should not approve what is the process and is there a public comment. Thank you