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

When somoene approaches a mental/ health professional for counselling, they shouldn't really have a firm desitination or prescription in mind. Other than to feel better or to get well.

You seem to be suggesting that people with gender distress will always be seeking to transition to some degree or other, as they have already concluded that this is what will relieve their distress.

I don't understand what you mean.

The claim was that a child must go through endogenous puberty in order to mature into an adult and develop an understanding of their identity. But there is no evidence for this claim.
Indeed there are many groups of children who don't because of a range of different medical conditions (one example being children with POI). There is no evidence that these children don't grow up into mature adults with a sense of identity.

Actually a lot of people describe an experience of feeling like they are "lying" in just the way you have, or sometimes they describe it as a pretence. So the description of personal experience of gender dysphoria is often very consistent/ similar.

what's often very different is the ways that people conceptualise sex/ gender / being a man/ woman , and the use of different terminologies. That's not surprising really- that there would be a range of different views .

One thing I do agree with you on, and I think a lot of other people would as well, is that there should be more research in psychological support to give people the necessary space to decide how far they want to take their transition, and what goals they want to reach.

"It's gender related distress" isn't the diagnosis sunnibee, it's the symptom. Saying it's gender related distress doesn't rule out it being related to stereotypes, or puberty distress, or anxiety, or autism.

Now say it slowly in your head and try to consider the difference between that and what you’re advocating. Then you can go back, read the whole blog you posted, watch the video hosted by the expert who wrote the blog you cited and consider why you’re so keen on setting children on a lifelong pathway of medication.

From that blog.

James thought he was a trans woman for several years and started transition before pausing. Through trauma-focused therapy he came to understand that his hatred of his body was rooted in childhood sexual abuse he had never spoken about. I wish a therapist had screened for what happened to me before affirming what I thought it meant, he says. I needed to do the trauma work first.

estrogen replacement therapy

That's not quite right — it's more complicated than that.
PBs work by initially causing a brief surge of GnRH hormones. But after a few weeks of steady use, the pituitary gland stops responding to GnRH signals — it basically stops listening. The hypothalamus is still making GnRH the whole time. The drug doesn't touch GnRH production at all — it just makes the pituitary deaf to it.
Now compare that to a condition called Congenital Hypogonadotropic Hypogonadism (CHH). In this condition, kids are actually missing the GnRH signal itself — the neurons that are supposed to make GnRH never developed properly.
So if the theory that "no GnRH = damaged brain development" were true, these kids should have the worst outcomes there. But the clinical worry in CHH isn't about GnRH per se; it's about the downstream absence of sex hormones and the solution is to supply those hormones exogenously.

There are lots of groups of children who do not go through endogenous puberty and instead receive HRT to induce hormonal changes. What evidence do you have that these children do not mature into adults with a mature adult identity?

These include children with:

• primary ovarian insufficiency
• primary testicular failure
• hypogonadtropic hypogonadism
• CAIS
• children who have had their ovaries or testes removed because of cancer or other medical conditions.

That's not quite right — it's more complicated than that.
PBs work by initially causing a brief surge of GnRH hormones. But after a few weeks of steady use, the pituitary gland stops responding to GnRH signals — it basically stops listening. The hypothalamus is still making GnRH the whole time. The drug doesn't touch GnRH production at all — it just makes the pituitary deaf to it.
Now compare that to a condition called Congenital Hypogonadotropic Hypogonadism (CHH). In this condition, kids are actually missing the GnRH signal itself — the neurons that are supposed to make GnRH never developed properly.
So if the theory that "no GnRH = damaged brain development" were true, these kids should have the worst outcomes there. But the clinical worry in CHH isn't about GnRH per se; it's about the downstream absence of sex hormones and the solution is to supply those hormones exogenously.

Can you tell us what the treatment is for prepubescent children diagnosed with POI?

A quick Google tells you that

Puberty starts when a part of the brain called the hypothalamus releases gonadotropin-releasing hormone (GnRH). This chemical messenger signals the pituitary gland to release more hormones, which then tell the body's sex organs to make estrogen or testosterone.

In the conditions you listed the puberty signal is given but there is a problem with the oestrogen or testosterone. Puberty blockers stop the signal

There are lots of groups of children who do not go through endogenous puberty and instead receive HRT to induce hormonal changes. What evidence do you have that these children do not mature into adults with a mature adult identity?

These include children with:

• primary ovarian insufficiency
• primary testicular failure
• hypogonadtropic hypogonadism
• CAIS
• children who have had their ovaries or testes removed because of cancer or other medical conditions.

There are a lot of different claims bundled together there. Some are broadly correct, some are oversimplified, and some are inaccurate. Regardless none of them provide evidence for the claim that endogenous puberty is required for a person to develop into an adult and have a mature sense of themselves.

I'm not sure what you mean by this? Puberty is driven by hormones. If the concern is that sex hormones are important for brain development, then medically induced puberty through HRT is still exposure to sex hormones.There might be questions about timing and dosage, but why the assumption that to mature into an adult the hormones must come endogenous from the gonads rather than exogenously from prescription.

But they receive the correct hormones for their sexed body in these cases. Each person’s body is set up to work best with the correct sexed hormone balance, and if the body can’t provide it, it can be supplied exogenously.

Cross sex hormones are not healthy; they bring a lot of co-morbidities with them.

A man taking oestrogen at female levels does not go through female puberty. His body cannot respond to oestrogen by having periods or releasing eggs; he doesn’t have ovaries or fallopian tubes or a womb. All it does is increase his risk of stroke, move his fat distribution around a bit and make his breast area put down some fat. He doesn’t develop actual female breast tissue, the milk ducts are blind. It’s just fat.

Giving male levels of testosterone to women causes vaginal atrophy such as is seen in very elderly women.

None of this is healthy.

There are lots of groups of children who do not go through endogenous puberty and instead receive HRT to induce hormonal changes. What evidence do you have that these children do not mature into adults with a mature adult identity?

These include children with:

• primary ovarian insufficiency
• primary testicular failure
• hypogonadtropic hypogonadism
• CAIS
• children who have had their ovaries or testes removed because of cancer or other medical conditions.

Those conditions affect either the production or processing of oestrogen and testosterone which will affect sexual characteristic s but as far as I am aware the other parts of puberty that effect brain development are not affected.

Preventing puberty in total would affect brain development in addition to sexual characteristics

There are lots of groups of children who do not go through endogenous puberty and instead receive HRT to induce hormonal changes. What evidence do you have that these children do not mature into adults with a mature adult identity?

These include children with:

• primary ovarian insufficiency
• primary testicular failure
• hypogonadtropic hypogonadism
• CAIS
• children who have had their ovaries or testes removed because of cancer or other medical conditions.

Why do you think a person who does not go through puberty will mature into an adult?

Why do you believe someone has to experience endogenous puberty to develop a mature adult identity? That’s a very specific claim, but you’ve presented it as though it’s self-evident.

Identity is shaped by a lifetime of biological, psychological and social experiences. Suggesting that one particular developmental process is a prerequisite for a mature sense of self seems an unnecessarily narrow view of how identity develops. What evidence supports that claim?

Why do you believe someone has to experience endogenous puberty to develop a mature adult identity? That’s a very specific claim, but you’ve presented it as though it’s self-evident.

Identity is shaped by a lifetime of biological, psychological and social experiences. Suggesting that one particular developmental process is a prerequisite for a mature sense of self seems an unnecessarily narrow view of how identity develops. What evidence supports that claim?

Yes you are right, my language was really clumsy here. it was late at night and I was starting to ramble 😅.

I've tried to clarify what I've meant more precisely since.

I think the problem is that people understand 'gender'/ social gender categories/ roles as being reducible in a simple way to 'stereotypes'.
The reasoning then becomes: if someone experiences a gender that does not align with their sex, that must be because they have internalised mistaken stereotypes about what it means to be male or female. From that perspective, the solution is to challenge those stereotypes and change society so they no longer exist.

I wanted to acknowledge that there is a certain logic to the idea that, if we lived in a world without socially meaningful categories of male and female, then the experience of being in the "wrong" one might also disappear.

The difficulty is that this strikes me as utopian. We can and should challenge harmful stereotypes and reduce the extent to which people are constrained by gendered expectations. But I don't think we can eliminate the social significance of the categories themselves. They are not only collections of stereotypes; they are rooted in real biological differences that have social consequences. We can reject the idea that women should do the cooking, for example, but it seems much harder to imagine a society in which being male or female carries no social meaning whatsoever.

Indeed, if anything, current developments appear to be moving in the opposite direction. The EHRC guidance, for example, places renewed emphasis on recognising sex-based categories and organising some aspects of society around them.

Categories of male and female therefore remain socially meaningful. So too does the experience, for a minority of people, of profound distress at being somehow in the 'wrong' one - physically and socially. That is the phenomenon referred to as gender dysphoria.