Puberty blockers

[MuttleyLaugh]

I have seen some pretty scary stuff on here about Lupron. Is it used to block male as well as female puberty, and if not, is there any information about the risks of drugs that are used for ‘transgirls’?

As far as I understand it, GnRH analogues (of which Lupron is an example) are prescribed as off-label puberty blockers to both transgirls and transboys, although there is even less evidence relating to the long-term impact on males than females.

www.transgendertrend.com/puberty-blockers/

TRAs will tell you that Lupron is not used as a PB in the UK, which is true, but the UK equivalent works in exactly the same way.

These drugs were actually developed to treat hormone-related cancers. Later they were used to delay puberty in children with precocious (early) puberty, though their use is controversial: precocious puberty does cause physical and emotional health issues, but it is controversial whether this justifies the potential side-effects of giving PBs.

Either way, there is no data on the safety of using PBs to delay puberty indefinitely. Puberty changes the entire body, not just the sex organs, and is important to intellectual development. We may well be creating many long-term health and cognitive issues for children given them, on top of the obvious ones like infertility.

I think this is the drug normally used in the UK
www.macmillan.org.uk/information-and-support/treating/hormonal-therapies/individual-hormonal-therapies/triptorelin.html

Is anyone following the fortunes of the drug companies who sell these types of drugs and the ones that people would have to take for life to transition? I assume this is a holy grail for drug companies, a lifetime medication

Triptorelin has been found to reduce IQ in children treated for precocious puberty.

Sex hormones have important roles in the brain, and it's likely that suppressing them causes untold damage.

I posted on a thread a while back about an FDA investigation which is happening in the USA, for young adults who were prescribed Lupron to deal with precocious puberty symptoms, and who have been left with life-altering side effects including bone thinning and degeneration to the extent that they have needed hip replacements in their mid-20s.

As PP have pointed out, to be technically correct Lupron is not prescribed as a puberty blocker in the UK. However it is a GnRH agonist and this class of drugs works in the same way. Meaning that the side effects of Lupron are highly likely to be found in the same class of drugs prescribed here in the UK for puberty blocking.

Here is a link to the manufacturer's own website, showing the possible side effects and contraindications for each patient group.

It's worth noting the specific warning that Lupron should not be prescribed to children with mental health issues.

Here are some of the other possible side effects in adults - have a think about how much more fragile a child's body and immune system is:

• Thinning of the bones which may not be reversible
• Convulsions
• Increased risk of heart attack, strokes and diabetes
• Impotence

The last side effect is an important one. We hear a lot about children needing a 'pause button' so that they can decide what they want to do, and that these drugs are completely reversible. Not true. If puberty is halted then sexual maturation isn't reached. If at a later date a child wants to come off puberty blockers then they are left with adolescent genitalia and sexual immaturity unless medical intervention is sought - and that's before you look at bone thinning and heart problems.

If a child decides that they do want to transition, then the current proposals of fertility banking (of sperm and ova) are virtually impossible as they've not been through puberty so their gametes aren't mature or viable - unless they go through the puberty that they've been desperately delaying.

Puberty blockers are condemning these children into being lifelong medical patients and are categorically not the harmless panacea that they are held up as. At best they leave a child having to go through puberty years after their peer group. At worst they leave a child permanently neutered and sterile with lifelong physical complications.

When you look at it in these terms, it's hard to understand why anyone would want to push this agenda so keenly. Why indeed?

To be clear, it should be noted that GnRH agonists (aka 'puberty blockers') are being prescribed 'off label'. This means that the drug is being used to treat a condition, or symptoms, that the manufacturer's license does not cover.

In broad terms, this means there have been no tests, no monitoring and no long-term studies completed for the situation/condition/symptoms you are treating. You are therefore prescribing a drug with no idea of the long-term consequences to the patient in that particular scenario.

"We hear a lot about children needing a 'pause button' so that they can decide what they want to do, and that these drugs are completely reversible. Not true."

Yeah this is a lie.

pediatrics.aappublications.org/content/134/4/696

"Participants included 55 young adults of the first cohort of 70 adolescents who had GD who were prescribed puberty suppression"
" The young adults were invited between 2008 and 2012, when they were at least 1 year past their GRS (vaginoplasty for transwomen, mastectomy and hysterectomy with ovariectomy for transmen; many transmen chose not to undergo a phalloplasty or were on a long waiting list)"

The 15 who dropped out:

• 1 transfemale died after her vaginoplasty owing to a postsurgical necrotizing fasciitis.
• 6 were less than a year post-surgery
• 3 were medically ineligible (diabetes or morbid obesity)
• 1 dropped out of care
• 4 did not respond

So to be clear, what these children were being signed up to was NOT puberty blocking, but puberty blocking followed by mastectomy, hysterectomy & ovariectomy and vaginaoplasty.

This was the medical pathway they were all sent merrily down (and killed by, in at least one case).

So there is no 'pause button', rather there is a clinical pathway starting with chemical castration and culminating in permanent sterilization at the earliest possible opportunity (the transchild who died of necrotizing fascitis died at the age of 18).

The phenomenon of the speed of time seeming to change with our age is well-noted, and in one study it was noted that puberty blockers interfere with this "resulting in a marked distortion in the young person's relationship to time”

It is also noted that the normal adolescent process of developing an age-appropriate sexual identity is disrupted by blockers, in that the child is pre-pubescent while those around him are experiencing their developing sexuality, so lacks the essential understanding to consent to any treatment even upon reaching majority at 18.

Does anyone here have a trans child and had any experience of being offered puberty blockers? How easy were they to get?

A couple of good threads on the side effects here:

www.mumsnet.com/Talk/womens_rights/3288846-Article-on-the-side-effects-of-Lupron

www.mumsnet.com/Talk/am_i_being_unreasonable/2862870-Transing-a-4-year-old

Including contributions from scientists, at least one paediatrician and a woman who has taken the drugs for I think endometriosis and suffered pretty severe side effects. Oddly enough the TRAs who tell us that these drugs are harmless never seem to have much to say to Tammy ...

This truly concerns me-have just watched the new series on ITV "Butterfly" and they said exactly this-that puberty blockers just allowed a pause for thought!😡

The BBC also has a page with a similar claim. I complained as did several others

This is what the Tavi GIDS publishes on its evidence base page which you can find here:
gids.nhs.uk/evidence-base

There are different options available around physical interventions. Some young people may decide not to access any form of physical intervention. For those who do, few people will choose to access the full range of physical treatments. Figures from the Scottish Trans Alliance Survey (2008) show that 24% (17/71) of the transgender respondents have not transitioned on a permanent basis from female-to-male or from male-to-female, but are either still living partly or fully as the gender they were labelled at birth or alternatively are living in a non-binary gender expression which is not clearly male or female.

Hormone treatment
Although hormone blockers and cross-sex hormone treatment are recommended in young people with GD and widely used across the board, it should be noted that the research evidence for the effectiveness of any particular treatment offered is still limited.
A Dutch research programme indicates that a treatment protocol including puberty suppression followed by cross-sex hormones and gender reassignment surgery, leads to improved psychological functioning in a selected group of transgender adolescents, who had persistent GD from childhood, lived in a supportive environment and had no serious co-morbidities. If the young people did not show persistent GD from childhood, live in a supportive environment or if they had serious co-morbidities, assessment was prolonged (de Vries et al 2014). The hormone blocker alone does not seem to alleviate feelings of GD, however, it does have a positive impact on adolescents’ psychological well-being by putting their pubertal development on hold (de Vries et al 2010). The Dutch authors conclude: ‘Clinicians should realize that it is not only early medical intervention that determines this success, but also a comprehensive multidisciplinary approach that attends to the adolescents’ GD as well as their further well-being and a supportive environment’ (de Vries et al 2014). Additionally, having good peer relationships and engaging in social interaction with other transgender people have both been shown to help build resilience and improve psychological well-being (Testa, Jimenez & Rankin, 2014; De Vries et. al., 2015).
Safety concerns
Safety concerns remain regarding the impact of physical interventions. Although puberty suppression, cross-sex hormones and gender reassignment are generally considered safe treatments in the short term, the long-term effects regarding bone health and cardiovascular risks are still unknown (Cohen-Kettenis & Klink, 2015; Klink et al., 2015,).

As with a lot of the literature around trans kids - there is a subset of teenagers who have been convinced they were "born in the wrong body" from a very young age. This group is allowed to go through Tanner stage 1, and if the GD persists can be considered for puberty blockers. The evidence cited above is for this group "persistent GD from childhood".

I have no doubt that the Tavi doesn't treat kids lightly, and I expect come under huge pressure to do it more. I am certain they don't treat an 11 year old who has only a few months before revealed his GD to his parents.

Just for clarity the last 2 paragraphs are my comments, not part of the evidence base!

I have no doubt that the Tavi doesn't treat kids lightly, and I expect come under huge pressure to do it more

I agree. But if the proposed GRA changes go through* then expect any attempt to gatekeep to be decried as transphobic and causing unnecessary distress.

*I say 'proposed changes' but the Govt has very cleverly left the whole thing wide open by saying they don't know what they want to change yet - hence no impact statement. Therefore leaving us in a situation where if changes are made the impact statement will be post-consultation. But there's nothing to worry about - move along!

Transgender Trend have put this blog post out today. After reading it how could any parent not question the wisdom of giving their child puberty blockers? It is a shocking piece:
www.transgendertrend.com/puberty-blockers-safe/

New article on TT, which I think has both clarity and compassion:

www.transgendertrend.com/puberty-blockers-safe/

Whoops. Sorry, Housework, missed your post there.

I don’t know much about puberty blockers but I can tell you that DH was on the same ones as a cancer treatment. They didn’t make him feel great, his sleep went to pot, his emotions were all over the place and he lost all sexual function. 4 months later, although he feels better he still has no sex drive or function. This is a man in his 40’s. I dread to think what they would do to a child. For him, the side effects were worth it as it controlled his cancer for a while but for a child, no way