desperate man in silhouette sitting on the bed with hands on head

At Last! Establishment Pushback Against Puberty Blocking

Crossposted at Humanize

In the name of “gender affirmation,” pre-pubescent children and adolescents diagnosed with gender dysphoria are administered substances that impede natural puberty and prevent the normal development of secondary sex characteristics. These hormones and substances were approved for treating pathologies in adolescence, not for preventing normal maturation. Such “off label” uses of these substances is rank experimentation conducted on children.

It is one thing when adults make these life-altering decisions. But impeding natural growth in children should be quite another. Alas, in recent years, the medical establishment has been swept along by the transgender moral panic.

For example, a recent article in the ever-woke New England Journal of Medicine claimed that puberty blocking is “essential treatment” and “evidence based” care, and moreover, that laws interfering with pediatric transgenderism interfere with “lifesaving treatment” because of the supposed reduced risk of suicide that blocking puberty allows.

The American Academy of Pediatrics has similarly supported puberty blocking. But even its position paper admits, “Research on long-term risks, particularly in terms of bone metabolism and fertility, is currently limited and provides varied results.”

But surely, accurately assessing risks is just as important in deciding whether to pursue medical treatment as identifying hoped-for benefits—particularly when the patients are children whose entire lives could be affected by the decisions being made about their healthcare.

Besides, the “science” supporting puberty blocking is hardly “settled—and indeed, growing increasingly fluid. And here’s some proof. Health officials in Europe are pushing back against the intense currents that promote puberty blocking as a first or second resort treatment for pediatric gender dysphoria.

The United Kingdom: The United Kingdom led the way. This is significant because England has witnessed the potential harm that medical moral panics can cause, for example, when the Daily Mail reported that teachers were talking autistic children into believing they were transgender.

Since then, the NHS’s healthcare rationing board—the National Institute of Clinical and Health Excellence (NICE)—issued an advisory opinion that is guaranteed to give zealous transgender activists dyspepsia.

Contrary to the idea that puberty blocking is settled science peddled in the NEJM, NICE found that that there is “very low” evidence that blocking puberty is beneficial for children with gender dysphoria. Moreover, NICE concluded that the studies claiming to support puberty blocking were “subject to bias and confounding.” What a shock!

This is huge news. NICE is as establishment as establishment gets. Whether the NHS heeds the advice and ceases most puberty blocking remains to be seen. But at least the report is an indication that the transgender tide may be finally beginning to turn.

Finland: The medical establishment of Finland has gone beyond making polite suggestions to actively opposing subjecting children to puberty blocking—except in the most severe cases and then, only in a clinical research setting.

Noting that most cases of gender dysphoria resolve naturally by the time the child matures, and echoing concerns about the known and unknown potential physical harms that puberty blocking can cause, the Finnish Health Authority’s official guidelines now state (my emphasis): “the initiation of hormonal interventions that alter sex characteristics may be considered before the person is 18 years of age only if it can be ascertained that their identity as the other sex is of a permanent nature and causes severe dysphoria. In addition, it must be confirmed that the young person is able to understand the significance of irreversible treatments and the benefits and disadvantages associated with lifelong hormone therapy, and that no contraindications are present.”

And this is important too: Because puberty blocking is deemed “experimental,” the guidelines require that “initiation and monitoring of hormonal treatments must be centralized at the research clinics.” In other words, no more freelancing by ideologically driven doctors.

Sweden: Karolinska Hospital, a major Swedish health institution, recently announced that it would no longer use puberty blockers either, noting “a lack of evidence for both the long-term consequences of the treatments, and the reasons for the large influx of patients in recent years.” (Me: See the definition of “moral panic.”)

Even more importantly, the hospital warned, “These treatments are potentially fraught with extensive and irreversible adverse consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis. This makes it challenging to assess the risk/benefit for the individual patient, and even more challenging for the minors and their guardians to be in a position of an informed stance regarding these treatments.” Yikes!

Consequently, the hospital wisely enacted the following policy: “In light of the above, and based on the precautionary principle, which should always be applied, it has been decided that hormonal treatments (i.e., puberty blocking and cross-sex hormones) will not be initiated in gender dysphoric patients under the age of 16.”

Some unlikely pushback has also begun from non-conservative sources in the United States. A recent 60 Minutes segment interviewed formerly gender dysphoric children whose puberties were blocked—and who received mutilating surgeries—but who later “de-transitioned” back to the sex in which they were born. In one truly damning sequence, a young man who was castrated after three months on female hormones bewailed that his life was permanently and adversely affected by adults rushing to let him decide he was really a girl.

Letting children alter their physicality—perhaps permanently—is not compassion. It is weakness that abdicates the responsibility of adults. The courageous revision of medical guidelines in Europe and 60 Minutes’ willingness to cut against the usual pro-transition message pushed in the mainstream media reveal that doubts about the propriety of puberty blockers are growing.

Opponents of puberty blocking can no longer be denigrated as supposed religious fanatics or transphobic haters. Hopefully, the ultimate beneficiaries of this sea change will be the children whose bodies will not now become fodder in the well-meaning but ultimately destructive name of “gender affirmation.”

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.