Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty

[Bespin]

here is a study about the long term effects of pubity blockers on young people I know people are concerned about that. would be interested in peoples veiws about the findings.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4342775/

I'm not really sure what relevance this study has to the issue at hand - namely, children who present as transgender being prescribed puberty-blocking drugs at the onset of puberty (early teens).

The Korean study is of children who are given GnRHa drugs to treat precocious puberty, with the main focus seemingly on achieving a desired adult height. The study talks about the optimum age for girls starting treatment as being

So this is a study where blockers were used but then stopped? So, not followed by a lifetime of cross sex hormones and surgery.

What point regarding women and girls rights are you making Bespin?

Here's another report from the USA:

pro-transgender advocates do not want to know, said McHugh, that studies show between 70% and 80% of children who express transgender feelings “spontaneously lose those feelings” over time.

Also, for those who had sexual reassignment surgery, most said they were “satisfied” with the operation “but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery.”

“And so at Hopkins we stopped doing sex-reassignment surgery, since producing a ‘satisfied’ but still troubled patient seemed an inadequate reason for surgically amputating normal organs,” said Dr. McHugh.

The former Johns Hopkins chief of psychiatry also warned against enabling or encouraging certain subgroups of the transgendered, such as young people “susceptible to suggestion from ‘everything is normal’ sex education,” and the schools’ “diversity counselors” who, like “cult leaders,” may “encourage these young people to distance themselves from their families and offer advice on rebutting arguments against having transgender surgery.”

Dr. McHugh also reported that there are “misguided doctors” who, working with very young children who seem to imitate the opposite sex, will administer “puberty-delaying hormones to render later sex-change surgeries less onerous – even though the drugs stunt the children’s growth and risk causing sterility.”

Such action comes “close to child abuse,” said Dr. McHugh, given that close to 80% of those kids will “abandon their confusion and grow naturally into adult life if untreated ….”

This is the indication for which the drugs are licenced.

They are not licenced for gender questioning behaviour.

They are actively contraindicated in ANY patient with co existing mental illness and the FDA is investigating their usage in that context.

What are your thoughts on these drugs being used off label in a perfectly physically healthy population with no clinical rationale to use them AND with an active contraindication, bespin?

These drugs are not harmless. They are not a harmless pause button. What’s being done to children questioning gender is going to be he medical scandal of our time.

What are your thoughts on these drugs being used off label in a perfectly physically healthy population with no clinical rationale to use them AND with an active contraindication

As I work in the field of mental health and use medication almost daily that is not licenced for the exact purpose it was tested for I'm ok with that. Licencing of medication is to show positive. outcomes and side effects in a perticular patient group in larger clinical studies. that does not mean using a medication is completely untested for that use just that it as not achieved that certification. yet due to lack of appropriate larger. scale studies. GP will very rarely us unlicensed medication that consultants will routinely use as they do not have that specialist knowledge or be aware of the outcome side effect ratio of that medication. A simular think for contraindications which when prescribing people should be aware of, close monitoring psychologically would need to be in place. which it is when these are prescribed to counter this counterindion. these no not. in themselves mean that a medication can not be used but that monitoring needs to be in place.

again I am happy to talk all day aroud the use of medication in the treatment of mental health. when I was training when you looked in a BNF the final side effect of a lot of psychotropic medication was always the opersite of what you were treating someone for or death.

What is your opinion on taking medication that is actively contraindicated for something most of the patients suffer from?

These drugs should not be used in anyone with any coexisting mental health issue.

Bowlofbabelfish

as gender dysphoria is not a mental illness in that sence then I would be fine. there are a lot of checks in place to trwat young peoples other mental health issues before prescribing blockers. I agree that young people can be trans and also suffer mental health issues and that the levels of monitoring need to be clearly set on a case by case basis. but you appear to misunderstand what action is needed if a medication as a potential active contraindication again it is a risk assessment of outcome and if levels of monitoring can be put in place that minimise risk.

if you also work in this area I would hope you would be aware of the dynamic nature of. treating active mental health issues.

If the underlying cause of GD is CSA that needs treating as a priority.

We are told that 90% plus of these children are suffering co morbid anxiety and depression

Those are contraindications. I understand perfectly what the risk/balance issues are thank you - I work with it daily. That’s why the suicide stats are faked, because the only way that risk/benefit calculation is positive is if the alternative is death.

What’s your interest in medicalising young children?
What’s your view on demedicalisation for adults and medicalisation for children? Why two opposite pushes?

These children are physically healthy. Giving them harmful puberty blockers for a condition 80% will not even be experiencing in a few years is unethical

As I work in the field of mental health and use medication almost daily that is not licenced for the exact purpose it was tested for I'm ok with that

Huh?

I've said it before but after working for a Paediatric Endocrinologist and seeing how tightly regulated this treatment was and the emphasis put on the benefits of a normal puberty it just seems bizarre the way it is being given to developmentally normal children and teenagers.

I’ve taken medication for things off label. Ondansetron for HG for example.

The key differences being:

1. There is a body of data suggesting safety and efficacy for the off label usage
2. There are no active contraindications for the off label usage.

You can’t compare such a thing to off label usage for GnRH analogs.

Why the push to medicalise children, and remove gender dysphoria as a medical condition in adult ? Why are the two groups getting such different treatment focuses? Why the push to give young children harmful drugs?

Bowlofbabelfish I'm. sorry but you state

I understand perfectly what the risk/balance issues are thank you

and willfully misunderstand the purpose of licencing medication and the role contraindications play in looking out the potential. use of medication to treat mental health issues, yes there is a very high coleration with anxiety and depression and not all. of that is linked to being trans and yes that needs to be treated hopefully with access to talking therapies. I am a massive advocate for talking therapies and close monitoring of young people with mental health conditions there is a massive lack of funding for.thay in this country. I do not want young people medicalised unless it is shown that is what they need following prolonged assessment I'm at odd with mermaids over this approach. like you keep saying and I agree 75 % don't require treatment but 25% maybe do what do you want them to do? I also agree suicide statistic is floored for the simple fact that suicidal isolation is not suicide and may not lead to it but is an indication of potential risk along with a number of other factors.

sorry isolation = ideation

TellsEveryoneRealFacts sorry that was a flipent comment around how medication is infact licenced and used. that other conditions can be treated with medication that it was not specifically designed for and is used routinely like this, wider testing of Mediction is done on this feedback eg reporting to BNF noted side effects and other contraindications. for licensing studies have to be undertaken and in that field and these are not often done for a number of years. this does not mean that medication is unsafe to use but it is still being actively monitored.

For goodness sake, you cannot treat children with these drugs when:

• the majority desist
• they are physically harmful

-they are mentally harmful

• the are being used off label in a way that has no clinical rationale or ethical justification, or any long term safety follow up, or monitoring
• they are actively contraindicated in any young person with depression, anxiety etc.
• they place the child on an irreversible pathway

How can this be justified? It cannot be. Not medically. Not ethically,

Watch and wAit and supportive exploratory therapy for ALL children. no one can change sex - affirmative therapy is often conversion therapy for children who will turn out to be gay
When they’re adults, they can make different treatment decisions but to put a child onto a medical path that will leave them damaged in body, mind and in future sexuality is unconscionable. It cannot be justified.

Why the push to medicalise children when adults are pushing to demedicalise?

I’m well aware of drug safety data and post marketing licensing, pharmacovigilance etc.

I’m a scientist who now works in clinical trials. I know how drug safety works at a very detailed level. I know how the drugs work because I’ve got twenty years in academic primary research in human development and genetics behind me.

This is going to be a major scandal. It is not ok.

Sanchez Manning article for Mail on Sunday April 2018:

'NHS sex change drugs are putting hundreds of children at risk each year warns top doctor who says medication could lead them infertile or cause sexual dysfunction'
(extract)
The health of hundreds of children is being put at risk by sex-change drugs doled out on the NHS, a leading doctor warns today.

Dr Lucy Griffin, a consultant psychiatrist at Bristol Royal Infirmary, says she is ‘extremely worried’ about the long-term effects the medication is having on adolescents.

She is the first NHS doctor to publicly voice fears about the damage being done by the huge increase in young people receiving irreversible medical treatments after declaring themselves transgender.

In an interview with The Mail on Sunday, Dr Griffin reveals that:

Patients are being given drugs to change sex after claiming they are transgender, despite having serious psychiatric conditions;
The NHS is ‘running scared’ of challenging requests for transgender treatments in case it is accused of bigotry.
Medicines being given to teenagers to help them change gender can render them infertile, cause osteoporosis and result in sexual dysfunction, Dr Griffin warns.

Two treatments are causing the most concern. One is ‘puberty blockers’ which are not classified as sex change drugs, but instead halt the onset of adulthood.

Their effects are completely reversible when patients cease taking them.

The other treatment involves the administration of ‘cross sex hormones’, that do start the physical process of changing sex.

Last year this newspaper revealed that 800 children in England who were unhappy being the sex they were born were being given puberty blocking injections.

Some of the children were as young as ten years old.

But Dr Griffin said that such medication was never designed to treat patients who are confused about their gender.

She explained that it was developed to halt ‘precocious puberty’ – a rare condition which causes children under eight or nine to begin going through puberty. ‘Puberty blockers are not designed for the blockage of puberty in healthy adolescents,’ she said.

‘Now they’re being used for something that’s a psychological presentation without a body of scientific study behind it.’ (continues)

www.dailymail.co.uk/news/article-5642577/NHS-sex-change-drugs-putting-hundreds-children-risk-year.html

thread discussing the article:
www.mumsnet.com/Talk/womens_rights/3228447-Transing-children

I agree 75 % don't require treatment but 25% maybe do what do you want them to do?

First do no harm.
You don't medicate with off label drugs when 75% dont need any drugs, and 25% maybe do, or if 80% would desist without drugs.

.

One in three women get breast cancer. That’s a higher figure than your 25%

We aren’t all given tamoxifen or any other chemo drug from birth. Because that would be utterly unethical, and clinically indefensible wouldn’t it?

Also a 10 year old has no idea what adult life as the opposite sex is like so how can they seriously consent to this?

It’s a good point that the only reason a loving parent could have to consent to this is the belief that if you don’t the child will suffer serious and life threatening mental health consequences

Yet the drugs are contraindicated when there are MH problems

Thanks for that it will be useful in real life conversations

Yes I am concerned about it - because I spent two years on GnrH analogues in my mid 20s. That medication utterly destroyed my health and most areas of my life, which continues almost a decade after I stopped them.

The use was “off label” in the sense that they’re only licensed for six months usage in adults with endometriosis and I was on it for two years. Now I understand why that limit is in place. Why on Earth anyone would consider giving this to children is utterly beyond me. The answer seems to be the risk of suicidality, but forcing someone into terrible health and destroying their career, marriage and life generally isn’t exactly great for one’s mental health either.

I can’t imagine many people who consent to them being given to their children have ever taken them themselves.

But I’m sure you’ll ignore this OP, like all pro- Lupron posters do when I bring it up.

tammy

Funny how your experience of this is dismissed isn't it? Well not funny. Fucking infuriating