Myths and false concerns about puberty blockers
Gender dysphoria is the intense, painful feeling that the physical sex of one’s body is ‘wrong’, resulting in the strong desire to become the opposite sex. A transgender person is someone who suffers from gender dysphoria, often from a very young age.
Puberty blockers, or hormone blockers, are used to suppress puberty in gender dysphoric children at the onset of puberty. They temporarily prevent the development of (secondary) sex characteristics, many of which are irreversible. This buys them extra time and allows them to make a decision about their body at an age where they’re better able to handle the responsibility.
“Children shouldn’t medically transition!”
A useless argument, because children do not medically transition to begin with. Cross-sex hormone therapy is not started before the age of 16-18 years old. For children, ‘transition’ usually consists of things like name and pronoun changes, clothing changes, hair style changes, changes in their social lives, and if eligible, temporary puberty suppression. These are all non-permanent changes.
“Children can’t make such a decision yet!”
Hormone blockers are not a permanent decision, it is the delay of one. Hormone blockers simply put puberty on hold. When the child stops taking them, puberty commences as normal. They are fully reversible. It allows them time until they can make the decision. This ensures it becomes their choice, not that of the parents or strangers on the internet.
Hormone blockers have been deemed (relatively) safe by the medical professionals using and studying them. [1]
The choice for hormone blockers is about risk reduction. No medication is 100% safe. But in the case of a genuinely dysphoric teenager, who is at risk for, or already suffering from: major depression, self-harm, eating disorders, trauma/PTSD, permanent physical alterations that may result in unsuccessful transition and life-long gender dysphoria, and at worst, suicide – then hormone blockers preventing and reducing all these symptoms are by far the safer option. [2] [3] [4]
“Hormone blockers lead to a loss of bone mass, which will lead to osteoporosis.”
An unfounded claim, one countered by a study that followed 127 patients receiving hormone blockers, which concluded that the blockers had minimal effect on the bone mineral density, and upon receiving cross-sex hormone therapy was able to fully catch up to normal or near-normal levels. [5]
“Hormone blockers prevent the male genitals from reaching adult size, which makes bottom surgery impossible!”
This affects MtF patients only. It cannot be used as an argument to deny FtM patients hormone blockers.
It’s also false. Hormone blockers delay puberty. The patient can always choose to stop them and let natural puberty commence, should they consider that worth it. Secondly, this is not the only possibility for MtF bottom surgery. There are options that don’t rely on the enlargement of the male genitalia (or on its presence at all, if the genitalia have been fully removed). [6] [7]
“Hormone blockers might halt brain development.”
There is no evidence for this claim. However, there is evidence that hormone blockers have no significant effect on executive functioning (basic cognitive processes that help you memorize, organize and complete tasks). [8]
An fMRI-study in adolescents with gender dysphoria determined whether the performance on the Tower of London task, a commonly used executive functioning task, was altered in adolescents on hormone blockers. The study found no significant effect of hormone blockers on performance scores (reaction times and accuracy) when comparing treated gender dysphoric patients with untreated patients. [9]
“We don’t fully understand all the long-term consequences of hormone blockers.”
We probably don’t fully understand all the consequences of what administering chemotherapy to children might do in the long term either, and the late effects we do know of can be quite serious, but surely you wouldn’t advocate we let young cancer patients die instead.
When self-harm and suicide become realistic risks in a young gender dysphoric patient, hormone blockers are still the safer path.
“They’re not gonna die without them. It’s unnecessary.”
Puberty suppression leads to an improved global psychosocial functioning in gender dysphoric adolescents. [10] [11]
Generally people interpret “life-threatening” as “the body will physically die if we do nothing,” while suicide is seen as a deliberate choice. But the healthy don’t commonly choose to commit suicide, and if we took a moment to stop treating the long-term depressed as whiners, fakers or people who just need to do some yoga and cheer up, we could view suicide as the possible outcome of an untreated, ill brain the way death is the possible outcome of an untreated cancer.
When hormone blockers are the only treatment to successfully alleviate the depression and suicidal urges, we can say hormone blockers are necessary and life-saving.
“The body shouldn’t go too long without sex hormones.”
The Dutch model for transgender care, recommended by the World Professional Association for Transgender Health as standard procedure, recommends a maximum of 4 years on hormone blockers, giving patients until the age of 16-18 to make a permanent decision. Patients begin puberty suppression on average around the age of 14, and continue for about three years. [12, page 45] [13]
You wouldn’t make this argument to deny child cancer patients chemotherapy.
“Children can’t know they’re transgender.”
Studies support the theory that brains are sexually dimorphic and there is a neurological basis for the feeling of being male or female. This helps explain why a person may feel male/female while their physical body is the opposite. The fact that gender dysphoria exists all over the world and can even be traced back in history, no matter the drastic differences in societies, shows that it cannot have a purely social cause, and current theories strongly suggest that, much like sexuality, people are born with a ‘brain sex’. [14] [15]
This is also reflected in the story of David Reimer, a biological boy who was raised as a girl after a botched circumcision. Psychologist John Money set out to prove that gender identity was taught, not innate. However, David never identified with his reassigned gender, and upon finally learning the truth, underwent reconstructive surgeries to become physically male again. David attempted suicide several times during his teenage years. [16] [17]
Children may be incapable of fully understanding the concepts of gender, sex and the medical transition process, but because of the biological nature of the condition, this is not required to suffer from gender dysphoria. Children are not incapable of feeling (emotional) pain or when something is ‘wrong’ with their body. Little boys found with sharp objects to cut off their genitalia due to the severe distress they cause them are not just stories, these children really exist. Hormone blockers provide them relief and enough time to allow them to make a decision.
“Children don’t even understand sex and what sexual purpose their genitals have!”
Neither gender dysphoria nor genitalia are inherently about sex. Genitals are a natural part of the human body. Transgender people can be completely asexual and still suffer from genital dysphoria. Genital dysphoria is not about the desire to have sex, it’s about correcting the feeling that the body is 'wrong’.
“Children are stupid. One day they want to be a girl, the next day they’re a cat!”
This is a gross misinterpretation of the serious and long-term nature of gender dysphoria, and the pain and grief it causes a child suffering from it.
When treated right, gender dysphoric children are closely monitored for an ongoing time. If there were such drastic changes, that would exclude them from the diagnosis.
“If children are too young for tattoos, they are too young for this!”
Tattoos are not a necessity, medication where the benefits outweigh the risk is. The transition process for transgender people is not cosmetic or a fashion statement, it is an often live-saving medical need.
And while tattoos are permanent, puberty suppression through hormone blockers is not.
Child abuse is ignoring the needs of a child suffering from sincere, long-term emotional pain and knowingly putting them at risk for major depression, self-harm, eating disorders, trauma/PTSD, permanent physical alterations that may result in unsuccessful transition and life-long gender dysphoria, and at worst, suicide.
“Children will grow out of it.”
Your data on how many children may grow out of it will differ incredibly based on the area you research. For example, the model used in the Netherlands
follows teenagers on hormone blockers through the years and ultimately saw every single one of them transition to the opposite sex, with none of them regretting it. Another article discussing the Dutch model states “I’ve yet to see one change their mind [..] because we’re using the psychological testing methods the Dutch have perfected, and they’ve yet to see one person change their mind. And they’ve run 100 kids through the treatment.” [18]
Gender Dysphoria may exist in childhood, but in only a minority of prepubertal children GD does it persist into adolescence. The percentage of “persisters” appears to be between 10% and 27%.
Children who are still experiencing GD when entering puberty almost invariably go on to become gender dysphoric adults. [19]
A difference must be made between prepubescent children and adolescent children. The number that shows the majority of children will grow out of it affects prepubescent children only. Once gender dysphoria has persisted into adolescence, a child will “almost invariably” continue to suffer from it into adulthood. Growing out of it is no longer a common occurrence by this age, the age at which puberty suppressing medication first becomes an option.
Areas where statistics would show more detransitioners don’t automatically indicate a problem with the concept of hormone blockers, they indicate a problem with the assessment of who should receive them. It doesn’t mean hormone blockers shouldn’t be an option at all. A model that sees no regrets and few (zero may be unrealistic) mistakes is a real possibility, as the Dutch are already applying it. [20]
“I thought I was transgender as a kid, it would have been a mistake to give me hormones!”
The vast majority of these cases are about children who were gender non-conforming, but felt no distress about the physical sex of their body. Gender non-conformity alone, however, is not enough to diagnose gender dysphoria. Distress about the physical sex of the body and a desire to be the opposite sex must be present as well. The Dutch model for transgender care would not have found these patients eligible for hormone blockers. [21] This means these people were misdiagnosed. While that is a problem worth discussing as well, this has nothing to do with children who do suffer from gender dysphoria. You can’t use a wrong diagnosis to deny the rightfully diagnosed patients the treatment they need.
Furthermore, even if these children were given hormone blockers, the reversible nature of hormone blockers would have prevented any permanent damage. They too would have been given the extra time to make a decision, stop the treatment once they realized they weren’t transgender, and experience natural puberty as normal. There would have been nothing to regret because the treatment is reversible.
“Transtrending is a big problem. This one doctor/clinic hands out hormones like candy!”
Proving that there are doctors and/or clinics out there that use a faulty model to diagnose this condition doesn’t mean that the very concept of pausing puberty in the truly gender dysphoric is in itself wrong. The model used in the Netherlands shows that it is in fact possible to successfully diagnose gender dysphoric children and prevent such regrets and mistakes.
“It’s best to do nothing and let them experience puberty.”
You are not “doing nothing” when you deny a gender dysphoric teenager the option of hormone blockers. Forcing a gender dysphoric teen to go through natural puberty is also an irreversible, permanent decision that may have severely damaging and equally permanent consequences.
Puberty is puberty. If you are against parents “pushing” a teenager through cross-sex hormone therapy, you should be against parents forcing a gender dysphoric teenager through natural puberty as well. Hormone blockers are the only option that leave the decision with the person it affects.
Furthermore, understand that the Dutch model recommends that the patient has reached Tanner stage 2 or 3 [22] and be older than 12 years of age:
Some experience with one’s physical puberty is required because the authors assume that experiencing one’s own puberty is diagnostically useful. It is at the onset of puberty that it becomes clear whether the gender dysphoria will desist or persist. Starting around Tanner stages 2 to 3, the very first physical changes are still reversible. [23]
Susan Maasch, director of the Trans Youth Equality Foundation in Portland, Maine, states that:
There’s no way to make the child not feel the way they do. So the goal should be to help them be less afraid… Treating them with a safe, well-known hormone to temporarily prevent puberty has become a standard of care because it buys these children time and a measure of relief. [24]
The only real neutral option here is to delay the decision with fully reversible hormone blockers.
“I’m still undecided on where I stand…”
Good news. You don’t have to decide anything. It’s not your call to make. It’s not up to us to play doctor from behind our screens.
I make no decisions for these children either. All I advocate for is that the option of hormone blockers is available. I advocate for a medical model that takes gender dysphoria in children seriously, while still preventing mistakes and regrets. A model that allows doctors and parents to make the best choice for the individual child’s needs, while leaving any permanent decisions in the hands of the patient.
We don’t have to decide. We simply have to show some empathy and understanding for the pain these children suffer from, and the understanding that there are those that truly need the option of hormone blockers.
Infographic on transsexualism and gender
List of peer-reviewed papers on gender, transgender and intersex conditions
Collection of transgender studies on Tumblr
Quality of life in treated transsexuals
The Dutch model for treatment of adolescents with gender dysphoria (free download for in-depth article)
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