The Corner

Health Care

‘Significant Lack of Robust Evidence’ on Safety of Blocking Puberty

Keegan, 8, who identifies as gender creative, looks on after arriving at the Austin International Drag Festival 2018 near Austin, Texas, November 18, 2018. (Amanda Voisard/Reuters)

I have long believed that medically blocking the natural puberty of children diagnosed with gender dysphoria is unethical. I mean, what do we really know about the long-term mental and physical health impact on these children? Not a hell of a lot.

Indeed, that is a worry recently voiced by the U.K.’s Royal College of General Practitioners. From its “Position Statement” on treating transgender patients (my emphasis):

The significant lack of evidence for treatments and interventions which may be offered to people with dysphoria is a major issue facing this area of healthcare. There are also differences in the types and stages of treatment for patients with gender dysphoria depending on their age or stage of life.

Gonadorelin (GnRH) analogues are one of the main types of treatment for young people with gender dysphoria. These have long been used to treat young children who start puberty too early, however less is known about their long-term safety in transgender adolescents. Children who have been on GnRH for a certain period of time and are roughly 16 years of age can be offered cross-sex hormones by the NHS, the effects of which can be irreversible.

There is a significant lack of robust, comprehensive evidence around the outcomes, side effects and unintended consequences of such treatments for people with gender dysphoria, particularly children and young people, which prevents GPs from helping patients and their families in making an informed decision.

Essentially, this means that children — now as young as eleven — are being used as subjects of an experiment, the effects of which could possibly be irreversible, through the “off-label” prescribing of hormones and drugs that were studied and approved for completely different clinical uses.

This could be harmful. For example, blocking puberty can cause immediate health consequences, such as a loss of bone density. Now, potentially adding to the worries, a small study indicates that the intervention could potentially cause increases in suicidal ideation. From the BBC story:

Preliminary data for 30 of the 44 young people on the study was made available to the Tavistock’s board in 2015. It showed that after a year on puberty blockers, there was a significant increase found in those answering the statement “I deliberately try to hurt or kill myself”.

Prof Susan Bewley, who chairs Healthwatch, a charity for science and integrity in healthcare, is one of a number of doctors raising concerns about the lack of evidence in this area of medicine.

She said seeing any change around suicidal thoughts “is very worrying”.“Good medical practice would normally be very reflective about an increase in harms,” she added.

The study is far from conclusive and has been criticized for failures of design and lack of a control group of similar children who did not take the hormones.  On the other hand, any finding that could serve to slow down the transgender stampede would likely be attacked.

All of this illustrates how this most culturally sensitive area of health care seems to have been driven as much by ideological fervor as science, leading to an unacceptable “treat first, study the treatment’s safety and efficacy later,” approach to care. Not to worry, the somnolent medical establishment at the U.K.’s Royal College of Paediatrics and Child Health has decided to assign “experts” to study the ethics of the whole thing.

Good grief. Talk about proverbial escaped horses and open barn doors!

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