The reckoning over puberty blockers has arrived

Across the United States, thousands of parents have consented to having their children’s puberty stopped with a class of drugs called gonadotropin-releasing hormone agonists. Known colloquially as “puberty blockers,” these drugs overstimulate the pituitary gland to the point of preventing it from sending signals to the ovaries or testes to start producing the hormones responsible for puberty.

Parents who have consented to these drugs for their children love their kids dearly, but they’ve consented under entirely false pretenses. The doctors who’ve advised them say that puberty blockers are known to improve mental health — that they are even life-saving — and that they are fully reversible and just give kids “time to think.” None of this is true.

Major American medical associations say that “gender-affirming care” for kids is “medically necessary” and “life-saving.” Health authorities in Finland, Sweden, Norway, Denmark and the U.K. disagree. Last month, the National Health Service of England decommissioned puberty blockers as a treatment of adolescent gender dysphoria. “We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time,” the NHSE explained.

Imagine if American doctors told parents the following truths. The mental health benefits of puberty blockers are highly uncertain, according to multiple systematic reviews of the evidence, the bedrock of evidence-based medicine. The World Health Organization says the evidence is “limited and variable.” There is no research into long-term harms, but some evidence suggests decreased IQ and brittle bones. Permanent sterility is guaranteed for minors who go through full hormonal “transition.” Sexual dysfunction appears to be extremely common as well. Over 93 percent of kids who take these drugs go on to cross-sex hormones, which lead to permanent physical changes including excruciating genital growth, vaginal atrophy and tearing and much higher risk for cancer and cardiovascular disease.

There is no credible evidence that puberty blockers function as suicide-prevention measures. Finland’s top gender clinician has called the suicide narrative “purposeful disinformation” and “dangerous.” For all these reasons, health authorities in a growing number of countries, including some of the most LGBT-friendly, are now prioritizing talk therapy.

How many parents would consent to puberty blockers under these circumstances? Very few, if any.

It is common for drugs to enter pediatric use after evidence of their success in adult medicine. The opposite happened in gender medicine. It was the failure of “sex reassignment” in adult men to achieve satisfactory cosmetic outcomes and improve life functioning that led a group of clinicians in the Netherlands to propose starting the “reassignment” process in childhood.

Their hypothesis was as technologically appealing as it was ethically dubious: since males could not reverse the effects of testosterone-fueled puberty to pass as women, it would be beneficial to these men to have their puberty bypassed altogether.

The Dutch recognized the dilemma but thought they found a way around it. Relying on their experience using puberty blockers to treat a condition known as central precocious puberty (CPP), they argued that blockers were fully reversible and thus part of the diagnostic process. If it turned out that the kid wasn’t “truly trans,” the drugs would be discontinued and puberty allowed to resume.

Their argument was dubious from the get-go. First, CPP has an objective diagnosis, based on a blood sample, whereas gender transition is based on the adolescent’s feelings and experiences, which are subject to change. In a political climate such as ours, in which mere exploration of the reasons for rejecting one’s body can be labeled “conversion therapy,” differential diagnosis becomes impossible.

As Dr. Jason Rafferty, author of the American Academy of Pediatrics’ current policy statement on “gender-affirming care,” has put it, “the child’s sense of reality and feeling of who they are is the navigational beacon to sort of orient treatment around.” The AAP statement has been witheringly critiqued, and Rafferty and the AAP are now defendants in lawsuits by former patients.

Second, in CPP puberty suppression is by definition temporary; the goal is to delay puberty to its appropriate developmental window. In gender dysphoria, a “successful” prescription is where puberty is bypassed altogether. The assumption about reversibility, never tested and highly questionable from the start, proved to be the ethical foundation for the entire Dutch experiment, and it quickly crumbled. Over 93 percent of adolescents who are put on puberty blockers for gender issues continue down the medical pathway to cross-sex hormones. Some go on to surgeries.

Gender clinicians do not see this suspiciously high figure as a reason to rethink their approach. They see no possibility of iatrogenesis — a medical intervention that unintentionally induces harm, in this case by causing gender distress or confusion to persist artificially. On the contrary, they regard the high persistence rate as proof of their own remarkable diagnostic abilities.

More modest and scientifically-minded clinicians and researchers see things very differently. “Blocking puberty,” writes Sallie Baxendale, a professor of neuropsychology and author of an important new study on puberty blockers, “prevents the critical rewiring in the brain that underpins the ability make complex decisions. Puberty blockers may give children time to think but they simultaneously rob them of their developing capacity to do so.”

What is likely happening is that an ongoing youth mental health crisis whose origins predate and have little to do with gender is being misdiagnosed and mistreated with harmful and experimental drugs. Puberty blockers are the definition of a “quick fix” solution.

Researchers incorrectly refer to what the Dutch did as an experiment. In an experiment, falsifiable hypotheses are proposed, alternative interventions are tested, outcomes are monitored and competing explanations for observed results are thoughtfully ruled out.

The Dutch did nothing of the sort, according to a comprehensive scholarly examination of their study. Further, the only attempt to replicate that study, which was done in the U.K., failed. The researchers had to be forced to disclose their disappointing findings. Any scientific-minded person willing to put in the effort and read the literature will come to the same conclusion: Pediatric gender medicine is an industry built on fraud.

During the 2000s and 2010s, the Dutch pseudo-experiment with puberty blockers “escaped the lab” and became entangled in a fast-growing international social movement for transgender recognition. In the U.S., the drugs are being prescribed at numbers far exceeding anything the Dutch could possibly have imagined. Most adolescents referred to pediatric gender clinics are teen girls who have no history of dysphoria in childhood but who do have other mental health challenges that predate their distress with their bodies.

American medicine is no stranger to scandal — lobotomy, “recovered memory” and OxyContin are just a few examples. What makes pediatric gender transition unique is that it has been framed as a nonnegotiable civil right and defended by powerful civil rights groups, the Democratic Party and their ideological allies in the mainstream media.

A key reason for the divergence between U.S. and European medical authorities, as I’ve explained in a previous essay, is the latter’s greater willingness to follow principles of evidence-based medicine, including reliance on systematic reviews. Jack Turban, a prominent American gender clinician, revealed in a deposition that he seems not to know what a systematic review of evidence is.

Another reason is that in the U.S., doctors who practice child “transition” demand and often receive deference as the experts on the evidence for their practices; abroad, such clinicians are seen as having conflicts of interest. When the National Health Service of England appointed the highly respected Dr. Hilary Cass to lead its review of its youth gender service, it did so precisely because she was “a senior clinician with no prior involvement or fixed views in this area.” Sweden and Finland delegated the evaluation of evidence to experts with no personal involvement or stake in pediatric gender medicine.

Parents should never have been put in the position of having to decide whether to “allow” their kids to go through puberty. Those who would put the onus on parents are letting charlatans in the medical profession off the hook. Puberty is difficult for all teens, and it is not a disease. Puberty blockers offer teens in distress — especially girls with history of sexual abuse, autistic kids and gay kids — false hope by casting puberty as optional.

Puberty is a rite of passage from childhood into adulthood, responsible for the development of the body’s major organs and systems and not just its external sexual features. Puberty blockers rob children of their right to an open future.

Leor Sapir is a fellow at the Manhattan Institute.