Puberty Blockers - impact on the brain

My deleted comment was suggesting there are many instances of non-puberty-blocked (or even non-cross-sex-hormone) trans people who seem quite happy adults. Whereas I'm not seeing lots of happy puberty-blocked youth blossoming into adulthood yet. Are we sure this is working?

(No names this time)

You'd hope any significant treatment would have clear benefits to the untrained eye, and that the trials would be just making sure it wasn't confirmation bias or a placebo effect.

But instead it feels like we're struggling to find statistical evidence of a benefit that we can't see.

But the salesmen assure us it's a miracle tonic for this condition that almost no children were suffering from 20 years ago.

Thanks, slug, yes, that would be the human study I've seen referenced. Not super conclusive though - exactly one subject. But it is consistent with wider Hough et al sheep trial.

A Global IQ reduction is observed. At the end of 28 months of treatment, speed processing and memory remain lower than before GnRHa treatment.

Wasn't there some research that concluded puberty blockers led to a drop in IQ? www.ncbi.nlm.nih.gov/pmc/articles/PMC5694455/

I’ve always found it depressing that the adult transwomen who have and still do enjoy the benefits of what male puberty brings aren’t helping protect children from missing out on that. Why aren’t they advocating that these children can be happy with their bodies? Their silence is....interesting.

How is a trans girl old enough to decide to go through a testosterone puberty that will give her a broken voice, beard and masculine body shape and stature? Given that these are things that will likely cause her lifelong dysphoria, and that may need extensive surgery even to partially correct.

Children don't need surgery to 'correct' them turning into adults. Don't be silly.

Yeah. The focus on genitals and boobs and bums isn’t coming from those fighting to retain women’s and children’s rights and safeguarding. .....,

@Shizuku, what you say makes no sense. You might as well say how does a child give consent to be born. Puberty is not optional. It's not something we decide whether we want to go through. It's a natural and essential part of the human life cycle.

Add me to the list of those who find your weird comments about full or fat bottoms really inappropriate and creepy.

I'm a bit creeped out at Shixuku's repeated mentions of 'transgirls' full bottoms'.

How is a trans girl old enough to decide to go through a testosterone puberty that will give her a broken voice, beard and masculine body shape and stature? Given that these are things that will likely cause her lifelong dysphoria, and that may need extensive surgery even to partially correct.

Did you now know that estrogen causes fat to build up in the buttocks?

Flippity - I don't really have many references, so hopefully someone else can give you more info.

But in mind that, especially if you're talking about a 4-year-old, the treatment in that case is accomplishing a specific aim to reduce the potential risks from undergoing the precocious puberty. There would be risks from not having the treatment, so don't get too alarmed about the potential negative effects.

The reason we're so concerned for the "gender correction" is that we're unclear that the treatment is helping anything - it seems like there's only potential downside.

The gender activists make all sorts of claims about puberty blockers being "life-saving" somehow, but it seems like pure emotion. It's not doing anything physically useful, unlike the precocious puberty treatment, so all you're left with is mental health effects, and studies are often coming up blank or negative.

I had never realised that PB for children who are going through PP are such a risk: DN has been on them since he was about 4, is the risk the same in boys as well as girls? I know my brother hasn't been told about them. Sorry for derailing I'm just a bit worried.

It's a mystery to me how it ever came to be allowed in the first place. I can see the arguments for delaying puberty in cases of precocious puberty. It's horrific to think of a primary-aged girl becoming pregnant, and I know there are other serious risks there.

Here, though, the long-term effects on health are so huge that I just can't understand anyone ever thinking this was a good idea as a treatment for children.

I have seen interviews with adults who transitioned well into adult life, often after having children, and they sometimes say wistfully that they wish they'd been able to transition in childhood as going through puberty made it impossible for them ever to truly pass as the opposite sex.

What I'd like to see a journalist ask them is if they've said this to the children they would have been unable to have.

Also, talk them through all the health consequences of transitioning in childhood - would they really have wanted those for life?

Very true.

As seen on twitter by a detrans woman:

"There’s plenty of detransitioners that transitioned as adults. If that’s the case with adults- why the hell would anyone think a child knows what’s right for them?"

This may well already have been stated, but I believe it bears repetition.

A child put on puberty blockers is having normal brain development frozen at the point before they started the blockers, i.e. kept in a childlike state.

That child is then being asked to make a decision whether to move on to taking cross-hormones. In the UK the child must be at least 16 if the cross-hormones are going to come from the NHS. (Gender GP seems to think it's fine to prescribe them to younger children, and we know this happens in other countries too, but let's stick with the NHS for now.)

Most of us at the age of 16 are well on the way through puberty, but we know that the brain is still far from fully mature at that age. Some studies estimate that the brain isn't fully adult until we're in our mid 20s. Hence some of the risky and foolish decisions that teenagers and young people make.

However, a 16yo who has been on puberty blockers for several years still has a child's brain and decision-making capacity. As the child has been kept in a state of arrested development, there should have been no sexual relationships and the child presumably has virtually no idea of what a sexual response might be like.

The child has watched his/her peers go through their growth spurts and other bodily changes while s/he still has a childlike body. The blocked child still has a child's interests and outlook on life while their peers are moving on. This in itself must be really hard.

This, however, is the point when this child is asked to decide whether s/he wants to move onto cross-hormones which will bring about some superficial changes in the body but will destroy fertility.

How can this child possibly understand the magnitude of what they're being asked to do to their body, what they're going to lose?

I've seen this question sidestepped by saying that the parents are involved too. That isn't a satisfactory answer. It's not the parents' bodies that are going to be changed irreversibly by this hormone treatment. The child has to be involved. But the treatment itself makes it impossible for the child to give informed consent.

Yes, the overall risks of cross-sex hormones, particularly in women, are quite well-known and not really contested. They're just kind of... glossed over, and maybe not fully quantified.

The bone density thing is somewhat uncertain - we'd expect a negative effect as loss oestrogen is not good for bones, but adding testosterone may offset that somewhat, as that study suggests. But again - medication for life probably required.

Increased cancer risk is one thing, but the most direct is that hysterectomies are likely inevitable if you're going to stick with cross-sex hormones. Atrophy is a severe health risk. .

Rene Jax talks about a lot of health issues after a life time on cross sex hormones.

It's not the brain but certainly causes her mental distress.

belle

@Shizuku

I am infertile and I definitely went through puberty.

Infertility is not about not having a working reproductive system. Many infertile couple have unexplained infertility, everything technically works okay but there is still no viable pregnancy.

I have had four miscarriages and now can’t get pregnant again.

But thanks for using me as a prop to beat other women with.

Not a paper but a good article

www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/

They also noted this:

The unexpected finding of lower heart rate that was associated with longer duration of the treatment should be further explored by methods appropriate for assessment of cardiac health.

Onto this paper of Shizuku's: www.frontiersin.org/articles/10.3389/fpsyg.2016.01053/full

I still can't decide if Shizuku actually reads and understands this stuff or is just spitting them out using a keyword search. Shizuku is quite good at finding things which say "no effect", the problem is they're almost always not what we're talking about.

Maybe this works with people who don't click on links or say things like "Trust The Science"?

Anyway, that paper was studying girls who underwent treatment for precocious puberty. NOT girls having their normal development blocked for "gender correction".

What we're primarily worried about here is interfering with the normal development that happens leading up to adulthood. Any such problem would be a lot harder to spot in a precious puberty treatment. I'm not even sure we'd know what we're looking for at that point. One issue the authors note:

Since a [randomized control trial] cannot be conducted due to ethical reasons ... [but we can give them to people for gender correction without having done any such trials!!!!] ... ...comparison of treated CPP children and controls matched for either chronological or biological age. [...] Furthermore, the question remains if matching should be done by chronological or biological age.

They went with chronological, which is the most likely to find no effect, but what if what you've just done is blocked a year of their normal development because it's "early"? What if these precocious puberty children should be gaining brain function now - this is their time - and won't catch up everything later? Could be a problem if they still end puberty early despite the blockers.

Anyway, we know there's been quite a lot of studies on younger children having shorter-term regimes. What we're looking for is cognitive studies of children having their puberty totally blocked all the way up to a cross-sex hormone regime (which that bone density study did manage to do). That's a totally different ball-game to a short period of blocking precocious puberty at 9.

Doing my own cherry-picking now (if Shizuku can do it on this thread, only fair to do it back) - there was one potential negative finding in that precocious puberty study:

Only in the Trail Making Test—Number Sequencing, assessing processing speed, the CPP group showed significantly poorer performance (Table 2). This finding is difficult to explain since neither the very similar Trail Making Test—Letter Sequencing, nor any other of the processing speed tests showed significant differences between the groups. Taking into account that the p-values were not corrected for multiple testing, it is possible that this finding is accidental. In line with this, the CPP girls' parents did not report any problems with regard to executive functioning as measured by the BRIEF questionnaire.

Just to add a bit to the above explaining without quoting chunks, and to maximise charity to Shizuku - the bone density paper did find no effect of cross-sex hormones on bone density for women. And a paper showing no effect is indeed worth noting.

Get a set of them, and few or none showing an effect and that's heading for evidence.

But Shizuku picked that part of the paper out as it's the only firm "no effect" finding in there - specifically for cross-sex hormones in females. The paper does discuss the loss of bone density due to puberty blockers, and that it's not made up when the cross-sex hormones starts.

Do you think we are lacking in intelligence and ability to read or something?

Just adding

So. To reiterate.

they did not fully make up their bone loss as Z-scores at age 22 were still lower than baseline

So, not only has there been not enough study done when transitioning as an adult.

But the study also showed that the lack of density due to puberty blockers is NOT made fully up with cross-sex hormones.

Several posters told you this study was not fully supporting your statement.

Anyway, thanks for posting it. We now have another study to add to our list of increased health risks for female transitioners. Well apart from the stories from the detransitioners with health issues caused by transition, and the already known group action building against the makers of one of the puberty blockers from people who were prescribed it 15+ years ago for precocious puberty. Who then went through normal puberty and STILL have significant debilitating health issues.

This study you keep posting, just supports those cases.