It is hard to believe that there is no deleterious effect on neuro or brain function as a result of blockers. The effects of puberty are still not even fully understood - puberty is an essential part of human development. When the wheels really start coming off the bus, it is going to be very interesting to see. Tragic indeed.
Yes, it's very worrying. I think unexamined mind/body dualism may help explain this -- "We're just pausing the body, mind will carry on as usual." Similar to the idea of a "female brain" imprisoned in a "male body".
Why only puberty blockers? I don't understand why just them.
The UK NICE evidence review found:
"The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE."
for *both* puberty blockers and hormones in the treatment of gender dysphoria. The evidence behind *both* of them is lacking. These treatments are not shown to have benefit outweigh the risk for any age, although there are anecdotes of both benefit and of harm.
"Some ask: Why are these experimental interventions, with inherent risks and scarce, low-quality evidence for benefits, being implemented outside HREC regulated clinical trial settings?"
Anyone who claims to want to help those with gender dysphoria--why are they not clamoring to get studies to show it? Apparently these drugs are so necessary, "medically necesary"--it should be easy to demonstrate?
Yes, I’ve wondered about that. Maybe it’s because cross-sex hormones are given closer to adulthood (although there is a push to give them under 16) & there is more literature on hormones in adults than there is on blockers in kids.
The evidence for adults is also low quality--these drugs are not US FDA approved for this use for adults or for minors. Presumably adults can consent, too, rather than assent, so the reasons to not do a proper study are even less strong.
This "argument" you pointed out--why has anyone taken it seriously?
"that a national inquiry into youth gender medicine “would further harm vulnerable patients and their families through increased media and public attention.” It gave no evidence for this claim."
For adults, the Swedish record study by Branstrom and Pachankis, once corrected, showed no advantage in any of the indicators they measured for either hormones or surgery. It's all low quality. I don't understand how the judicial review request for 18-25 and vulnerable adults in the NHS works but am really hoping that it goes forward. They are flying blind for all of these people with gender dysphoria.
Yes, I’ve wondered about that. Maybe it’s because cross-sex hormones are given closer to adulthood (although there is a push to give them under 16) & there is more literature on hormones in adults than there is on blockers in kids.
Australia’s Royal Children’s Hospital in Melbourne launched a study on puberty blockers and the brain last year. In a newsletter to patients and parents, the clinic acknowledged that the effects of these drugs on the brain are unknown.
That same clinic’s website, under the heading of ‘Puberty Suppression’, currently states:
“Puberty blockers suppress the development of secondary sex characteristics and are used for adolescents in the early stages of pubertal development. As they are reversible in their effects, should an adolescent wish to stop taking them at any time, their biological puberty will resume”.
It is relevant to note that the RCH Gender service has been operating for some twenty years, having received a single referral in 2003. A twenty-some year lapse between commencing an ‘off-label’ therapy (i.e. one that is not approved by the TGA for that purpose) and then acknowledging that its “effects on the brain are unknown” is a worrying reality.
For the past twenty years the Royal Children’s Hospital in Melbourne has been providing care and treatment to persons with gender dysphoria aged 3 to 17 years.
In 2003 the facility received their first such patient. In 2020 this number had skyrocketed to 473.
Now, near 20 years later, the facility has advised parents and patients that the effects of puberty blockers (one of the key components in the management of the condition) may have unknown effects on brain development and now, near 20 years later a study has been launched to investigate this possibility.
It is hard to believe that there is no deleterious effect on neuro or brain function as a result of blockers. The effects of puberty are still not even fully understood - puberty is an essential part of human development. When the wheels really start coming off the bus, it is going to be very interesting to see. Tragic indeed.
Yes, it's very worrying. I think unexamined mind/body dualism may help explain this -- "We're just pausing the body, mind will carry on as usual." Similar to the idea of a "female brain" imprisoned in a "male body".
Exactly.
Why only puberty blockers? I don't understand why just them.
The UK NICE evidence review found:
"The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE."
for *both* puberty blockers and hormones in the treatment of gender dysphoria. The evidence behind *both* of them is lacking. These treatments are not shown to have benefit outweigh the risk for any age, although there are anecdotes of both benefit and of harm.
For both of them, for all of these treatments, as Clayton has said in https://link.springer.com/article/10.1007/s10508-021-02232-0
"Some ask: Why are these experimental interventions, with inherent risks and scarce, low-quality evidence for benefits, being implemented outside HREC regulated clinical trial settings?"
Anyone who claims to want to help those with gender dysphoria--why are they not clamoring to get studies to show it? Apparently these drugs are so necessary, "medically necesary"--it should be easy to demonstrate?
Yes, I’ve wondered about that. Maybe it’s because cross-sex hormones are given closer to adulthood (although there is a push to give them under 16) & there is more literature on hormones in adults than there is on blockers in kids.
The evidence for adults is also low quality--these drugs are not US FDA approved for this use for adults or for minors. Presumably adults can consent, too, rather than assent, so the reasons to not do a proper study are even less strong.
This "argument" you pointed out--why has anyone taken it seriously?
"that a national inquiry into youth gender medicine “would further harm vulnerable patients and their families through increased media and public attention.” It gave no evidence for this claim."
For adults, the Swedish record study by Branstrom and Pachankis, once corrected, showed no advantage in any of the indicators they measured for either hormones or surgery. It's all low quality. I don't understand how the judicial review request for 18-25 and vulnerable adults in the NHS works but am really hoping that it goes forward. They are flying blind for all of these people with gender dysphoria.
Thank you so much for all your writing on this!
I agree with you, but there is still a perception that the evidence base for puberty blockers is worse & the consent issue more fraught.
Agree 100%. Thank you (again and again) for your repeated syntheses and explanations!
Yes, I’ve wondered about that. Maybe it’s because cross-sex hormones are given closer to adulthood (although there is a push to give them under 16) & there is more literature on hormones in adults than there is on blockers in kids.
Australia’s Royal Children’s Hospital in Melbourne launched a study on puberty blockers and the brain last year. In a newsletter to patients and parents, the clinic acknowledged that the effects of these drugs on the brain are unknown.
That same clinic’s website, under the heading of ‘Puberty Suppression’, currently states:
“Puberty blockers suppress the development of secondary sex characteristics and are used for adolescents in the early stages of pubertal development. As they are reversible in their effects, should an adolescent wish to stop taking them at any time, their biological puberty will resume”.
It is relevant to note that the RCH Gender service has been operating for some twenty years, having received a single referral in 2003. A twenty-some year lapse between commencing an ‘off-label’ therapy (i.e. one that is not approved by the TGA for that purpose) and then acknowledging that its “effects on the brain are unknown” is a worrying reality.
For the past twenty years the Royal Children’s Hospital in Melbourne has been providing care and treatment to persons with gender dysphoria aged 3 to 17 years.
In 2003 the facility received their first such patient. In 2020 this number had skyrocketed to 473.
Now, near 20 years later, the facility has advised parents and patients that the effects of puberty blockers (one of the key components in the management of the condition) may have unknown effects on brain development and now, near 20 years later a study has been launched to investigate this possibility.
What, I wonder, is going on inside that hospital’s management & board?
For some time, they have just ignored questions I’ve put to them.
The Age, Herald Sun & ABC Melbourne should be leading coverage of this story.
So far, NZ at least is acknowledging the Euro shift to caution. No sign of that in Australia’s health bureaucracy.