Hacker News Reader

Comment by ttpphd | Hacker News Reader

Puberty blockers did not lead to mental health improvements, she said, most likely because the children were already doing well when the study began. “They’re in really good shape when they come in, and they’re in really good shape after two years,” said Dr. Olson-Kennedy, who runs the country’s largest youth gender clinic at the Children’s Hospital of Los Angeles.

Ok so there was no "improvement" because they were doing fine already. What's the problem here?

View on HN

If they were doing fine before then why was a significant medical intervention with possibly irreversible effects warranted? I can't make sense of the premise.

Puberty blockers are not irreversible. Children who experience precocious puberty have been going on puberty blockers for decades. They take them for a few years and then get off them to start puberty at a more appropriate age.

Puberty blockers are intended to be reversible. Their purpose is to defer puberty until the point that it would be more appropriate. They are commonly used with children who begin puberty too early, like single digit years. The child is then take off of the blocker and things proceed as normal. This has decades of study and use.

In trans kids the purpose is to buy time in a way that is reversible. Reversibility is the point. If a child says “I might want to medically transition” they can defer their normal puberty think on if they want to make an irreversible decision and then if they don’t the blockers are ceased and they continue life as normal.

Edit: I missed the point about the premise as well. We do this for the same reason we encourage self expression in all children. Expressing yourself and playing with that expression is an incredibly important part of childhood. Puberty blockers enable a child, an incredibly small number of them who’ve already shown a lot of interest in it, to explore a side of themselves that is potentially going to be erased without much risk at all.

For puberty blockers, "reversible" just means that discontinuing the blockers will unsuppress the hormones that the blockers suppress, allowing them to gradually reach normal baseline levels. It doesn't mean that the downstream effects of doing this are reversible.

There is a developmental window that opens during puberty that cannot be returned to later on once closed. That is, the blocked part of this pubertal window is not deferred: it's forfeited.

If a child is on puberty blockers for a significant period of time during this, they risk lifelong infertility and anorgasmia, underdeveloped sexual organs, undermineralized bones leading to osteopenia and osteoporosis, and potential brain developmental defects.

None of which is reversible in adulthood.

As an analogy, hypothermia is "reversible" up to the point you're about to die of it. This means that you can raise a hypothermic person's body temperature back to its normal setpoint. However, this does not mean that if you get gangrene from hypothermia, the dead tissue can be resuscitated and brought back to normal function. This is not reversible.

I had initially included the phrase "largely reversible." You're not wrong that if used for too long, or outside of specific windows there are effects that cannot be reversed. But that's not how they are used in this context. They are used in the context of providing time to decide if you want to make the irreversible decision.

No reasonable health provider is going to leave a child on blockers so long that they end up functionally a eunuch. Is it possible for problems to occur? Of course. Is that the intent and the way they are usually used? No. Has it happened to a non/0 number of people? Maybe? Being technically correct here doesn't help anyone.

We're not talking about the difference between "almost dead" and "dead" we're talking much more about something like a tattoo or an ear gauge. Ear gauges are reversible up to a point. You experiment with them and if you enjoy having the ability to adorn yourself that way you do so. If you don't you stop increasing the size before you have to spend the rest of your life with a giant hole in your ear.

> They are used in the context of providing time to decide if you want to make the irreversible decision.

That is the claim made by proponents of this treatment, but the evidence base for this is remarkably weak.

Recently, the Cass Review examined the available research and concluded that "the most significant knowledge gaps are in relation to treatment with puberty blockers, and the lack of clarity about whether the rationale for prescription is as an initial part of a transition pathway or as a 'pause' to allow more time for decision making."

Even more concerning, they make the point that there is "no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process."

The Review further explains that there are indications that brain maturation may be disrupted by puberty blockers, meaning this could be a significant factor in reducing the ability of the individual to reach such a decision, due to the potential of causing neurocognitive deficits.

Because of all this, puberty blockers are actually banned in the UK now for this purpose, except when being offered under a strictly controlled research protocol.

There are ways to fix the underdeveloped sexual organs thing by applying the needed hormone on them. This is quite documented.

As for anorgasmia, I was able to have one long before puberty so idk, I feel like it's not true.

Really?

I think maybe this is because you don't understand how someone can be gender non-conforming and also happy. Maybe you are having a hard time with the asymmetrical and temporal aspects (child is happy, child chooses their puberty path, child is happy during and after puberty). Isn't that a good path for care?

If that's true, why not publish the study?

Because people struggle with reading comprehension and are willing to twist anything and everything to take autonomy and liberty from gender diverse people.

Reply on news.ycombinator.com