Puberty Blockers are NOT Reversible
New Data Emerges
by Sue Greenwald MD and Jenna Derr MD
Puberty Blockers are being heralded by transgender activists and many medical associations as a harmless “pause” in puberty, which allows a child to choose their gender without interference from nature. If only everything were as simple as it’s marketing.
First lets address the medical associations. They are wholly owned by the big pharma. Every portion of the medical-industrial complex is making bank on transitioning kids and gleefully turning them into life-long patients. Those financial incentives are discussed Here.
Puberty Blockers, a common term for the off-label use of Gonadotropin Releasing Hormone Agonists, suppresses the release of the sex hormones testosterone and estrogen. From Reuters:
“The U.S. Food and drug administration has approved the drugs to treat prostate cancer, endometriosis and precocious puberty, but not gender dysphoria. Their off-label use in gender-affirming care, while legal, lacks the support of clinical trials to establish their safety for such treatment.”
The article goes on: “After suppressing puberty, a child may pursue hormone treatments to initiate a puberty that aligns with their gender identity. Those for whom the opportunity to block puberty has already passed or who declined the option may also pursue hormone therapy. Hormone treatment may leave an adolescent infertile, especially if the child also took puberty blockers at an early age. That and other potential side effects are not well-studied, experts say.”
For years the Tavistock Centre in London had a respected transgender clinic funded by the National Health Service. In August of 2022 it was shut down. The main reason was a successful lawsuit brought by a patient named Kiera Bell who claimed permanent injury from puberty blockers. From the UK Daily Mail:
“Dr Hilary Cass told NHS England there is no way of knowing if the medication may 'disrupt' the process of children deciding on their gender identity, rather than 'buying time' for them. She also raised concerns that the drugs could interrupt the process of the brain maturing, affecting children's ability to exercise judgment.”
“Barrister Simon Myerson QC predicted that the scandal could even lead to a criminal investigation.”
'We're in the extraordinary position that drugs prescribed to children as safe and reversible appear not to have yet been subject to clinical trials in respect of the purpose for which those children received them. There is thus unlikely to be informed consent to taking them.'
Information learned through the legal process indicated that children started on puberty blockers went on to take cross-sex hormones 98 % of the time. While historic statistics have shown that children allowed to let nature take it’s course will de-sist (return to being comfortable with their gender) 75% to 90% of the time. Therefore, a judge concluded, an adolescent starting on puberty blocking drugs is actually consenting to a long term treatment plan of cross-sex hormones, and they can not possibly comprehend the ramifications at that age.
A longitudinal study from the Tavistock Centre was concluded the day after the court decision. It found that the children on puberty blockers stunted their growth and bone density. The fact that all but one of the children went on to use cross-sex hormones put them at further risk for side effects such as sterility, heart disease, breast and uterine cancers, and mood problems including psychosis. They also found that 35% of those who were transitioned as youths were on the autism spectrum.
Interestingly, the UK NHS has updated it’s web site and they no longer say that puberty blockers are “ fully reversible”. They now have disclaimers about possible side effects and say that “little is known about the long term side effects”.
All the hoopla about using puberty blockers in pre-adolescents and adolescents began with a “Dutch Protocol” which was widely adopted after a pair of studies from the Netherlands extolled the virtues. Dr. Derr’s testimony at the Nebraska Legislature, (in favor of LB 574 which would limit transgender hormones and procedures to people past the age of majority), enumerated the many ways that the Dutch Protocol has been discredited:
My name is Jenna Derr, and I am a Nebraska physician. I speak on behalf of myself today and I support LB574. When I became a physician I took an oath to first do no harm and today I choose to speak publicly because children in our state must be protected. There are other physicians who would like to be here today, but are not, because they are fearful of professional repercussions.
Today, you will hear testimony in opposition to this bill, and the opposition may reference and quote commonly depended upon research to support their position. I would like to quickly review two of these foundational studies.
A pair of Dutch studies, published in 2011 and 2014, are routinely cited and used to support gender affirmation care in the US. These studies have significant flaws.
First, they were funded by a personal grant from the Netherlands Organization for Health Research and Development. This for-profit company was founded in 2001. They do not have to disclose where their funding comes from, and this is concerning, because you cannot determine if there are financial incentives related to the funding of these studies.1
Additional flaws include the following: small sample size, lack of long-term followup, and lack of a control group. In the initial study, 70 participants were assessed with a variety of different surveys and scales at T0 (mean age 13.6 years), which corresponds to initial attendance at the gender identity clinic and at T1 (mean age of 16.7 years), shortly before the start of cross-sex hormone treatment.2 Subsequently, of these 70, only 55 completed the final phase of gender reassignment surgery in the second study.3 They were assessed at T2, at least 1 year after their surgical intervention (mean age of 20.7). All participants in both studies received an intervention, thus no comparison is available as a control. Additionally, psychotherapy was required of all subjects.2 This support allowed for psychological or social issues to be addressed in a timely manner. It’s unclear what role this played in achieving the results of either study, and it would be difficult if not impossible to determine.2
In the first study, after review of all surveyed data, the findings supported the psychological functioning of adolescents diagnosed with gender identity disorder had improved, whereas there were no significant changes in gender dysphoria or body image scores.2 In the second study, after review of all surveyed data, they found that “not only was gender dysphoria resolved, but well-being was in many respects comparable to peers”.3
The latter finding is frequently relied upon to support gender affirmation care. However, this conclusion is based upon faulty measurements, secondary to the inappropriate use of the Utrecht Gender Dysphoria Scale. This scale was developed for the Dutch studies and later analyzed to provide validation of its use.4 In this validation study, the study population included clinically referred transgender individuals, a group of disorder of sex development patients, and heterosexual, homosexual, and bisexual control participants.4 There are two different versions of this scale, “male to female” and “female to male”, and each are scored differently.4 In the validation study, the version was given according to their sex at birth and in those with disorder of sex development patients, it was given according to their gender of rearing.4 Now, back to the Dutch Studies. At T0 and T1, which correlates with prior to initiation of puberty blockade and and prior to cross sex hormone treatment, the versions of the scale given were consistent with their sex at birth.2 However, at T2, which correlates to the period of time after gender reassignment surgery, the opposite version was given.3 Initially, as you can imagine, the scores were quite high at T0 and T1, indicating the level of gender dysphoria significantly affected the individuals, however, when the opposite version was provided at T2, the score dramatically dropped. The UGDS scale was never validated for use after gender reassignment surgery or when the version was not congruent with biological sex, subsequently nullifying the results of this widely referenced and depended upon research.
Additionally the Dutch approach to adolescents is different from the US, so conclusions are difficult to generalize. The Amsterdam gender identity clinic does not provide physical medical interventions before puberty, and parents are advised in watchful waiting.5 The treatment of children with gender identity disorder is primarily focused on emotional, behavioral, and family problems, as they may or may not be affecting their presentation of gender dysphoria.5 Adolescents are only considered eligible for puberty suppression when they are diagnosed with gender identity disorder, live in a supportive environment, and have no serious psychosocial problems interfering with the diagnosis or treatment protocol.5 If there are problems identified which may interfere with the physical medical intervention, treatment is postponed.5
In summary, considering these two studies to be foundational and reliable is concerning at best. There are multiple reasons to be cautious in extrapolating this data to our current patient population.
“Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-up Study”. De Vries MD, Annelou, et. al. Journal of Sex Medicine. 2011; 8:2276-2283.
“Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment”. De Vries MD, Annelou, et. al. Pediatrics. 2014; 134(4):696-704.
Chapter 3 The Utrecht Gender Dysphoria Scale: A Validation Study. Archives of Sexual Behavior. Steensman, Thomas D., et. al.
“Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach”. De Vries MD, Annelou, et. al. Journal of Homosexuality. 2012; 59:301-320.
For those not accustomed to medical research, let me translate. This pair of Dutch studies are quoted often to justify the use of puberty blockers in minors, but it is a mirage. During COVID you probably heard that “randomized and controlled” studies were the gold standard for research. These studies were neither randomized (no one knows who is being medically treated and who is not), nor controlled (some get treated and some don’t). In fact, patients with complications were dropped from the study. Without a group of people who received an alternate treatment plan, it is impossible to know if the plan being studied is better.
Note that the primary method in treating minors in this study is counseling of the youth and their family. Puberty suppression was only considered after counseling determined that good family support systems were in place. These interventions were also done in the years 2000-2008, when gender dysphoria was a rare (1 per 10,000 persons) medical condition and not a common (1.5 per 100 youth in 2020) social contagion as it is today.
Scientific funding is important to determine, as often times there are constituencies seeking a pre-conceived conclusion. The funding of these studies is a headscratcher:
This study was supported by a personal grant awarded to the first author by the Netherlands Organization for Health Research and Development.
This Organisation for Health and Research Development appears to be an private NGO that does appear to receive funds from government agencies. Any private funding to this group is not disclosed. A “personal grant” means that the funding source can not be scrutinized, and therefore is suspicious.
One of the main criticisms of this longitudinal study is that they measured gender dysphoria using an opposite scale at the follow up. For example if you are a trans-male, the early study asked you how you felt about being female and the later study asked you how you felt about being male. Of course, if you had transitioned in the interim, your gender dysphoria would be presumed to be less pronounced as a male. Therefore, before and after comparisons could not be made.
Their conclusion was cautiously optimistic. However, recall that any patient that did not have the ideal family support and counseling did not remain in the studies.
Gender dysphoria did not resolve as a result of puberty suppression. Psychological functioning, however, improved in various respects. We cautiously conclude that puberty suppression may be a valuable element in clinical management of adolescent gender dysphoria.
This is not the raving endorsement that the international activists have made it out to be. Yet many children and their families have been told that puberty blockers are “fully reversible” based on this flawed data.
In closing, I would like to share this article that I found from an Australian doctor who reached the same conclusions. Here.
Dr Sue Greenwald is a retired Pediatrician, Dr. Jenna Derr is a practicing Family Physician. Both reside in Kearney, Nebraska