Netherlands Puberty Blocker Review Comes to Opposite Conclusion, Dismisses Cass Review

It's not having it both ways. Even if all children on puberty blockers went on to cross-sex hormones, it wouldn't follow that the exploration step should be skipped. It's reasonable to see this as an important safeguard — time for a child to reach an informed decision. I haven't argued how valuable that safeguard is or how long it should last, only described its purpose: it's part of a cautious treatment model, and it's only ever supposed to be temporary.

The cancer comparison was just an analogy, not a claim about actual chemo-to-surgery rates. The point was that some conditions require multiple, sequential treatments — and a high rate of moving from one to the next doesn't mean the first treatment caused the need for the second. It's because both treatments track the natural progression of the same underlying condition. Another random example - could be any number: patients who start using a mobility aid for a progressive neuromuscular disease very reliably go on to need a wheelchair. That's not because the mobility aid weakened their muscles — both are downstream markers of the same disease progressing on its own timeline.

But in England CSH will not be available till aged 18 (with a further review planned for safety in age 18-25) so how does it help to have puberty blocked between 11-13 with all the problems already listed by PP?

Not a podcast but an article written by him:

I have isolated hypogonadotropic hypogonadism (IHH), a condition in which the brain never sends the signal to start puberty. Without medical help I would have stayed forever pre-pubescent. My story is not just my personal history; it is a warning.

In the 1980s, my classmates shot up in height, their voices broke and they started dating and becoming independent. I did not. My legs grew long but the rest of me stayed childlike. I looked like a stretched-out little boy. I still played with He-Man figures in secret because emotionally and mentally I felt years younger than my peers. The social gap widened every year. I spent my whole school career in special education; reading is still, decades later, brutally hard for me.

At fifteen I remained at Tanner Stage 1, with no secondary sexual characteristics at all. After months of scans and tests at UCSF, the diagnosis was clear: my brain was not producing the hormones needed to trigger puberty. This was not “delayed” puberty that would eventually arrive; it was absent puberty. Without intervention, I would have had a child’s body for life. I would have had brittle bones and no sexual function, as well as the emotional maturity of someone much younger.

Doctors finally gave me testosterone in a bottle. My peers had crossed that bridge gradually years earlier. I sprinted across it as a teenager, clutching prescriptions, trying to catch a train that had already left.

What I’ve learned since is that when the adolescent brain is starved of sex hormones during the critical window, the damage is permanent. Autism is five times more common in people like me, ADHD several times higher, and severe intellectual disability nearly eighteen times more likely. A quarter of us never become sexually active, and three-quarters of us never have children. Executive function, attention, and processing speed are all measurably lower. I live with ADHD and learning disabilities that no amount of therapy will ever fix.

That same biochemical state—profound suppression of the hormonal axis—is now deliberately created in healthy children with drugs like Lupron. The Dutch protocol, on which the entire gender-affirming model rests, induces exactly what my body did naturally.

genspect.org/frozen-in-time-when-puberty-doesnt-happen/

I thought that there were 14 year olds expected in the trial (wasn't the starting age 14 at one point and then they changed it? Or am I misremembering?) and that the first cohort is for 2 years? Is this not right?

If said child then took CSH, you are saying that this would resolve the issues of having had puberty blocked until 16 years of age? So a boy who is a late developer has PB from age 14 to 16 then has CSH but this would be developmentally fine?

You are trying to have it both ways. You say both that PBs are a chance for reflection and exploration, but also that actually there really is no need for that reflection and exploration as the identification of the 'right children' is so accurate that it explains why 98% progress on to hormone treatment. Your explanation suggests that any supposed 'exploration' is really just for show.

The parallel with cancer doesn't work for many reasons, not least because it isn't a pathway of one leading chronologically to the other. But as you seemed curious, roughly 15% of patients in the UK, according to government figures, also have surgery in addition to chemotherapy (some of those will also have radiotherapy). It would seem that truly is an example of individualised clinical judgements leading to different models of treatment for different patients.

I actually don't think it's good at all to stay on PBs until 16 and wait that late for cross sex hormones. Thats rarely the desire of the young person either. It was imposed because clinicians in the UK were so cautious of giving children cross sex hormones, rather than for any medical reason. The focus on PBs is in many ways a red herring. It's something that is required as part of a cautionary approach to treatment, not an interventionist one.

This is evidence that PBs are , in practice, usually given to children who really need them, and are really experiencing gender dysphoria- thus the decision to progress to CSH.

It's like saying why do x% of patients on chemotherapy also have surgery to remove a tumour. It's not because chemotherapy causes surgery, it's that both treatments are necessary to resolve the underlying problem.

I actually don't think it's good at all to stay on PBs until 16 and wait that late for cross sex hormones. Thats rarely the desire of the young person either. It was imposed because clinicians in the UK were so cautious of giving children cross sex hormones, rather than for any medical reason. The focus on PBs is in many ways a red herring. It's something that is required as part of a cautionary approach to treatment, not an interventionist one.

This is evidence that PBs are , in practice, usually given to children who really need them, and are really experiencing gender dysphoria- thus the decision to progress to CSH.

You're not a scientist, are you? This is not evidence. There are other reasons why this might be the case, the most obvious one linked to the fact that the majority of children with gender dysphoria grow out of it after puberty. Since these children haven't gone through puberty, they haven't had the opportunity to grow out of it naturally, so continue to suffer from gender dysphoria and end up on opposite sex hormones.

So it is, in fact, quite likely that the use of puberty blockers actually causes the persistence of gender dysphoria resulting in the progression to opposite sex hormones.

Not a podcast but an article written by him:

I have isolated hypogonadotropic hypogonadism (IHH), a condition in which the brain never sends the signal to start puberty. Without medical help I would have stayed forever pre-pubescent. My story is not just my personal history; it is a warning.

In the 1980s, my classmates shot up in height, their voices broke and they started dating and becoming independent. I did not. My legs grew long but the rest of me stayed childlike. I looked like a stretched-out little boy. I still played with He-Man figures in secret because emotionally and mentally I felt years younger than my peers. The social gap widened every year. I spent my whole school career in special education; reading is still, decades later, brutally hard for me.

At fifteen I remained at Tanner Stage 1, with no secondary sexual characteristics at all. After months of scans and tests at UCSF, the diagnosis was clear: my brain was not producing the hormones needed to trigger puberty. This was not “delayed” puberty that would eventually arrive; it was absent puberty. Without intervention, I would have had a child’s body for life. I would have had brittle bones and no sexual function, as well as the emotional maturity of someone much younger.

Doctors finally gave me testosterone in a bottle. My peers had crossed that bridge gradually years earlier. I sprinted across it as a teenager, clutching prescriptions, trying to catch a train that had already left.

What I’ve learned since is that when the adolescent brain is starved of sex hormones during the critical window, the damage is permanent. Autism is five times more common in people like me, ADHD several times higher, and severe intellectual disability nearly eighteen times more likely. A quarter of us never become sexually active, and three-quarters of us never have children. Executive function, attention, and processing speed are all measurably lower. I live with ADHD and learning disabilities that no amount of therapy will ever fix.

That same biochemical state—profound suppression of the hormonal axis—is now deliberately created in healthy children with drugs like Lupron. The Dutch protocol, on which the entire gender-affirming model rests, induces exactly what my body did naturally.

genspect.org/frozen-in-time-when-puberty-doesnt-happen/

I listened to a podcast a while ago with a man who had a DSD, which was not identified until he was 16 and hadn't yet started puberty. He talked about the effect on his brain function and his interactions with peers (still playing with toys at 16, not having or understanding normal teenage interactions).

He also talked about the impact on adult relationships (the vast majority of of his peers with the same DSD remained single throughout their lives).

He went through a chemically induced puberty late, but explained how this does not replace a normal puberty at the right time.

Sorry, I've tried to find it but can't! Can anyone assist? It is a very interesting first-hand account from someone who has actually been through this.

I listened to a podcast a while ago with a man who had a DSD, which was not identified until he was 16 and hadn't yet started puberty. He talked about the effect on his brain function and his interactions with peers (still playing with toys at 16, not having or understanding normal teenage interactions).

He also talked about the impact on adult relationships (the vast majority of of his peers with the same DSD remained single throughout their lives).

He went through a chemically induced puberty late, but explained how this does not replace a normal puberty at the right time.

Sorry, I've tried to find it but can't! Can anyone assist? It is a very interesting first-hand account from someone who has actually been through this.

Puberty blockers at their very superficial isolates you from your peers by stopping you having the same experiences as them. Suddenly not only do you not ‘feel like’ others of your sex because of vague preferences for socially imposed stereotypes, you are no longer like your peers (of either sex) because you have been medically separated from them. Your peers are developing, growing, brains maturing, sexuality developing etc whereas you have been stunted by drugs. So of course you no longer identify with others of your sex, just like you don’t identify with your grandparents. They are having a group experience that has been denied you. The big lie of course is being told that this feeling of difference is because you must have an identity of the opposite sex rather than because you are drugged,

This is evidence that PBs are , in practice, usually given to children who really need them, and are really experiencing gender dysphoria- thus the decision to progress to CSH.

It's like saying why do x% of patients on chemotherapy also have surgery to remove a tumour. It's not because chemotherapy causes surgery, it's that both treatments are necessary to resolve the underlying problem.

This is evidence that PBs are , in practice, usually given to children who really need them, and are really experiencing gender dysphoria- thus the decision to progress to CSH.

It's like saying why do x% of patients on chemotherapy also have surgery to remove a tumour. It's not because chemotherapy causes surgery, it's that both treatments are necessary to resolve the underlying problem.

you appear to believe it's cruel not to do this. I believe it's cruel to do it. I agree that it's a good idea to leave it there, as neither of us looks likely to concede to the other's viewpoint.

Agreed. Just to quickly clarify my position - it's not that I think it's cruel to do it or not to do it. I don’t think there are simple absolutes in terms of what is or is not “cruel” in these situations.

Whether a particular pathway is preferable depends on the individual child, their circumstances, the evidence available, and a careful assessment of the potential risks and benefits of different options. That is why these decisions require individualised clinical judgement rather than assuming that one approach is inherently compassionate or harmful in every case.

Thanks for sharing the youtube clip, its really interesting.
I think there are some important points to note:

• this evidence comes from 11 animal studies. Of these, 8 were done in the same single flock of sheep . 2 were in monkeys and one was in mice
• Only one of the studies - on sheep - had any length of follow up (around 40-55 weeks follow up). The rest looked at immediate outcomes with no follow up at all. I don't think anyone has any doubt that suspending puberty has strong physiological effects while on the drug, the question is do these effects reverse after ceasing or are there long term effects.
• The presenter concludes herself - particularly given that there isn't any evidence of follow up - that the point is that we simply don't know, rather than long term cognitive impairment has been proven.

Finally, it's important to recognise that this is one expert's interpretation of a complex and contested area of medicine. It is entirely reasonable to discuss possible long term risks of puberty suppression, including questions about neurodevelopment. However, there is a very important distinction between “this is an area requiring further research” and “this intervention is known to cause brain damage”. The latter requires a level of evidence that currently has not been establised.

Ok have to get back to the day job :)

If the purpose is to pause in order for decisions to be made on whether to continue endogenous puberty, why do you believe only 2% of patients continue with that puberty? What reflection and exploration do you think takes place?

This is simply wrong on the biology and medicine.

Puberty is just the physical changes — bone growth, the growth spurt, secondary sex characteristics, brain maturation — that estrogen or testosterone cause in a developing body. It doesn't matter where the hormone comes from. A body given estrogen builds bone density, stops growing, and develops secondary sex characteristics through the exact same pathways it would if that estrogen came from ovaries instead of a pill. The hormone doesn't check chromosomes or birth certificate before it binds :) :) :).

Your claim that it's "impossible to go through the puberty of the opposite sex" is doing political work, not describing biology. Take the case of people with CAIS, born with XY chromosomes and testes who have them removed before puberty (once routine, due to cancer risk) and are then given estrogen externally. They go through a normal female puberty as a result — breast development, fat redistribution, bone changes, the full range of typical female pubertal hormonal effects. Of course there are still differences - they never menstruate, since CAIS also means no uterus, but otherwise it's real puberty by any physiological measure.

No one claims these women are stuck in a permanent pre-pubescent state, failed to mature into adulthood, or suffered brain damage from having their puberty driven by external rather than gonadal hormones.

This is simply wrong on the biology and medicine.

Puberty is just the physical changes — bone growth, the growth spurt, secondary sex characteristics, brain maturation — that estrogen or testosterone cause in a developing body. It doesn't matter where the hormone comes from. A body given estrogen builds bone density, stops growing, and develops secondary sex characteristics through the exact same pathways it would if that estrogen came from ovaries instead of a pill. The hormone doesn't check chromosomes or birth certificate before it binds :) :) :).

Your claim that it's "impossible to go through the puberty of the opposite sex" is doing political work, not describing biology. Take the case of people with CAIS, born with XY chromosomes and testes who have them removed before puberty (once routine, due to cancer risk) and are then given estrogen externally. They go through a normal female puberty as a result — breast development, fat redistribution, bone changes, the full range of typical female pubertal hormonal effects. Of course there are still differences - they never menstruate, since CAIS also means no uterus, but otherwise it's real puberty by any physiological measure.

No one claims these women are stuck in a permanent pre-pubescent state, failed to mature into adulthood, or suffered brain damage from having their puberty driven by external rather than gonadal hormones.