What to do about puberty blockers

Drugs offered to transgender children need to be used more cautiously

Arising number of girls wish to be boys and boys wish to be girls and a rising number of them are taking drugs to block puberty(青春期). In Britain cases of children being treated for gender dysphoria(烦躁不安) by the National Health Service remain rare, but in the past decade they have climbed at a rate of $5\%$ year on year (see chart). In America the number of gender clinics(诊所) treating children has increased from just one in 2007 to perhaps 50 today.

This has bothered lawmakers. In America several states want to ban giving puberty-blocking drugs to children (see United States section). In Britain the high court is considering the judicial review of a clinic which complainants believe has been handing out puberty blockers too freely (see Britain section).

The use of such drugs raises thorny(多刺的) questions about who decides what can happen to a child’s body and why. Put aside the culture wars, if you can. This debate should be settled in the interests of the child. Yet those can be very hard to discern(识别).

Puberty blockers prevent adolescents from developing secondary sexual characteristics like breasts or a beard. They almost always set off a cascade of interventions that involve “cross-sex” hormones and later may also include gender-reassignment surgery. The main purpose of puberty blockers is to bring comfort to people with gender dysphoria, by sparing(使…免遭) them the experience of, say, becoming more like a woman if they are a girl who wishes to be a boy. They also make most future surgery less severe.

However, the combination of puberty blockers and cross-sex hormones also leads to irreversible changes which, if they start early in puberty, include sterility(不育). About a dozen studies of gender-dysphoric children who did not take puberty blockers have found that most of them, if supported by counselling, are happy with their sex once they emerge from puberty. The share often cited is $85\%$ and many of them turn out to be gay. One sign that something is wrong is that more people are “detransitioning”—re-identifying with their biological sex. Most of them are girls who wanted to be boys when they were in their teens. If they took puberty blockers and then cross-sex hormones early they would be sterile for life, even if they did not have hysterectomies(子宫切除).

As of now, there is no way to distinguish the $15\%$ or so of children who will transition successfully from the $85\%$ who might have been happy with the gender of their birth if they had received counselling(辅导) alone. Some claim that withholding puberty blockers adds to the burden on vulnerable children with gender-dysphoria and may lead to higher rates of suicide.

Choosing whom to treat is a judgment of Solomon. The decision to intervene is made harder by a reckless(鲁莽的) disregard(忽视) for data. The academic studies purporting(声称) to show the higher suicide risk among trans children are unconvincing(令人难以信服的). Clinics do not publish enough studies on the effects of various treatments on their patients. Too little research compares children who have had treatment with those who have not. The field needs a better understanding of the long-term effects of puberty blockers and cross-sex hormones. Every child who is treated should be enrolled in a long-term follow-up study.

This should be with their informed consent. But so should the treatment itself. Today children and parents are not always fully informed about the potentially grave consequences of starting on puberty blockers. Their effects are often described as largely reversible—and the effects of cross-sex hormones that are almost always taken with them are not.

To ban puberty blockers in all circumstances would be unjustified. Not only would it be harsh on some children, but it would also leave the issue permanently obscured for lack of new research. However, today’s rush into treatment smacks(打) of a fad(时尚). Many adolescents feel unhappy with the way they were made. Transitioning will be solace(安慰) for some. But for others it will be a dreadful mistake.

take-home message

• puberty: the stage in people’s lives when they develop from a child into an adult.
• dysphoria: severe unhappiness, especially a person’s feeling of being very uncomfortable in their body or of being in the wrong body.
• thorny: A thorny problem or subject is difficult to deal with. e.g., the thorny issue of taxation.
• discern: to notice or understand something by thinking about it carefully. e.g., Officials were keen to discern how much public support there was.
• spare: to prevent someone from having to experience something unpleasant. e.g., Luckily, I was spared the embarrassment of having to sing in front of everyone.
• counselling: the job or process of listening to someone and giving that person advice about their problems.
• reckless: doing something dangerous and not worrying about the risks and the possible results. e.g., He was found guilty of reckless driving.
• disregard: the fact of showing no care or respect for something. e.h., What amazes me is her complete disregard for anyone else’s opinion.
• purport: to pretend to be or to do something, especially in a way that is not easy to believe. e.g., The study purports to show an increase in the incidence of the disease.
• smack: to hit something hard. e.g., I never smack my children.
• fad: a style, activity, or interest that is very popular for a short period of time. e.g., There was a fad for wearing ripped jeans a few years ago.
• solace: help and comfort when you are feeling sad or worried. e.g., Music was a great solace to me.