Puberty blockers: Can a drug trial solve one of medicine's most controversial debates?

[IwantToRetire]

It is among the most delicate and controversial challenges in modern medicine - how to determine whether the benefits of puberty blockers (or drugs that delay puberty) outweigh the potential harms.

This question came to the fore in June 2023 when NHS England proposed that in the future, these drugs would only be prescribed to children questioning their gender as part of clinical research.
Since then, a new government has arrived in Westminster and Health Secretary Wes Streeting has said he is committed to "setting up a clinical trial" to establish the evidence on puberty blockers. The National Institute for Health and Care Research is expected to confirm soon that funding is in place for a trial.

The dilemma that remains is, how will such a trial work?

Eighteen months since the announcement there is still a lack of consensus around how the trial should be conducted. It will also need to be approved by a committee of experts who have to decide, among other things, whether what's being tested might cause undue physical or psychological harm.

But there is a second unanswered question that some, but by no means all, scientists have that is more pressing than the first: is it right to perform this particular trial on children and young people at all?

Article by Deborah Cohen continues at https://www.bbc.co.uk/news/articles/clyd2qe5kkjo

-A. Feeling that your body is wrong (incongruence) can make you sad (dysphoria)

I'm sure most of us dislike some part of our bodies. The solution is to accept that is the body you have and learn to accept the parts you dislike. Or do you believe that you can literally be "born in the wrong body"?

-D. Feeling that your body is wrong AND knowing that treatment exists which can ease the feeling of incongruence

I don't think a child could possibly know this.

But this bit makes me think you're talking about stereotypes:

people are defining your existence using a surface-level impression of the parts that are making you sad

Surely you're not suggesting that children should be medicated for not conforming to stereotypes?

Point D is hanging my happiness on the actions or inactions of strangers. Point A would be my problem to deal with.

Thankyou for engaging.

1. Your child remains your child. They were your child prior to your discovery of their genotype and your adjustment to that. They remain your child after it.
2. It's very reasonable to feel a sense of loss over what can be a profound change in dynamic with your child. I'm sorry - it's not easy.
3. Your child is trying to tell you who they are.
4. Yes. If you discovered your child had a DSD that meant they had XX chromosomes, would this change your perspective at all?
5. Your child still exists. The past still exists. Your child is not asking you to pretend she doesn't exist; only that this is who she is and would prefer to be treated as.
6. I can only see the direct reflection of what my own parents went through. The grief; the uncertainty; the guilt; the fear. It's hard. I'm sorry.
7. This is a very reasonable and understandable fear and I can see why you would want to be cautious. Your child will inevitably make some bad choices in life - there is a small chance that this will turn out to be one of them. Nobody has perfect hindsight nor insight into their own mind and I understand your desire to protect them from making one they may regret.

I would say that if you have reached the point where this is enough of a consistent point of contention for enough years that you are a regular poster on this board, there is clearly something going on here that is worthy of serious investigation - children don't just spontaneously express gender dysphoria for years for no reason. Perfect happiness and perfect health are, by definition, impossible things to achieve - but decisions that can impact them don't want to be rushed into. The difficult balancing act comes from the devastating impact of waiting for the clock to run out just in case - withholding treatment is not a neutral act in this situation. It is taking a massive gamble upon the idea that your child has been consistently lying to you (and clinicians? not that they can meaningfully do anything now) for years about their own experiences and feelings and will, at some blissful point in the future, desist and go on to have genetically related children with a partner.

That is an awful lot to gamble your child's future over, especially when they are trying to tell you who they are and presumably have been doing so for years.

I don't know your personal situation; I'm sorry if I'm making assumptions here. Based upon my own experiences of being there as a child desperate for this treatment at an extremely precarious age where all of this was very novel and uncharted, not a day goes by when I do not thank my parents for listening to me and believing me even when it was confusing or frightening or difficult.

Your child is trying to tell you who they are.

Nobody is the opposite sex to that which they actually are. A boy who says he's a girl or a girl who says she's a boy is mistaken or lying.

I look like the version of me who was spared the majority of pubertal development under endogenous testosterone and was allowed to commence exogenous oestrogen at 18. I was able to identify this was the right path at a young age, helped along by some genetic quirks that ended up proving quite useful in the long run.

That is me. I'm very happy that my body largely matches my perception of it, especially since I lived just long enough in a state where it didn't to be able to understand the difference!

I live a life where I generally experience gender congruence. It's really hard to overstate how much of a difference that makes. I got a very lucky break, all told. Most people in that situation, especially back then, never get a chance to 'jump the rails' in so complete and drastic a fashion.

It is now no longer possible for trans kids - especially trans girls for whom this treatment really does define a life trajectory - to decisively fix their gender incongruence in this way in the UK. That road is closed - potentially forever - or at least until compassion and sense allow us to revisit the topic once the neoreaction movement has burned itself out.

I hope you can understand how horrifying it is to hear the despair of desperate teenagers who can see the path I was allowed to walk and the life it has enabled, and know that there is now nothing that can be done to spare them from the needless suffering that lies ahead.

They've tried being themselves in the bodies they have. They try, desperately, every day.

I've never really got over Opal Fruits being renamed Starburst 😟

Thank you also for engaging.

1. Rapid's son remains his son. It's not about discovering a "genotype". It's about his son discovering a belief that we all have a gender identity. Some people believe this to their core, some people don't think it's true at all. Rapid's son's belief in gender identity sounds genuine from everything I've read on other threads. But that doesn't mean Rapid has to share it, nor that you should force him to do so.
2. Losing someone to their belief is indeed a loss. It's grief. I can also believe it works the other way: if someone genuinely believes that they have a gender identity but it's not something their parents share, they've now "lost" their parents and are grieving. There will be parents grieving their children and children grieving their parents. It's a heartbreaking situation 😢
3. Yes. And Rapid is clearly trying to tell his son who he is: his son's dad.
4. What on earth have DSDs got to do with this?!
5. Yes, Rapid's child still exists. I imagine that most people reading this thread will recognise that he knows this.
6. To be fair, this bit sounds genuine. But.. that doesn't change anything.
7. No. That's just a guilt trip. Everyone who is a parent knows that at some point, their child will do things they regret. But the general idea in this acceptance is that it's not something that has a permanent, irreversible effect. If any parent sees their child doing something that has this much risk, they'll be faced with a decision: act to prevent it, actively go with it or watch and wait for the moment where they are needed. Depending on their child's age, acting to prevent something that's likely to be harmful may no longer be an option.

I would say that if you have reached the point where this is enough of a consistent point of contention for enough years that you are a regular poster on this board, there is clearly something going on here that is worthy of serious investigation - children don't just spontaneously express gender dysphoria for years for no reason.

?!?!

not a day goes by when I do not thank my parents for listening to me and believing me even when it was confusing or frightening or difficult.

It's great that you have a strong bond with your parents and that they support you. There are different ways that parents can listen to their child. From everything I've read on other threads, Rapid has listened lots.

Edited to sort formatting re numbers

I went through a period of eating little as a 15-16 year old (pretending I'd eaten, throwing food away, passing out) as I was convinced I was fat. If there was a trial to keep weight off I'd have taken it. It wasn't natural and I was wrong. If the people around me told me I was right, I would have damaged myself.

It’s body dysmorphia. There is no gender incongruence.

I would question what gender dysphoria even is. I think for kids in particular it tends to be an iatrogenic condition, in the sense that we have created a medical landscape where people interpret their other issues through that lens and it causes symptoms and worries based on that.

I don't see how treatments can be assessed without a better definition of the disease.

My child is indeed my child (though he is adult). He remains my son, from my perspective. He cannot be my daughter to me unless that makes sense to me. It doesn't . Far more of his relatives see him as a man than as a woman, even if some are prepared to pretend. They have known him, factually and perceptually, for many years as male. Does he have the ability unilaterally to change his identity, or is his identity formed in community? Is this the reason people "go no contact", because their identity in community cannot stand up if it is not totally affirmed? Is this healthy?

He is not "she" unless one believes that third person pronouns now refer to the social construct "gender" and not to sex. Gender is societal expectations and roles; one can only measure gender against adherence to stereotypes. Even then, I know no-one who is totally "feminine" or totally "masculine".

He, by his own admission, did not experience "gender dysphoria" until after he came to the conclusion he is transgender. I do not know what "transgender" means to him; he has been unable or unwilling to articulate this. At first, he was relaxed about "chosen" name and pronouns, but he has hardened to a position of demanding compliance. I believe that this has come about because of the societal pressure from those around him, self-described trans allies who are, to put it bluntly, loading on to him their expectations of how a trans person has to behave.

And yes, you have made a number of assumptions, which is fully understandable. I appreciate the opportunity to see what those assumptions are, and to have my assumptions challenged. It is refreshing to see some recognition that other people's stories (parents' for example) are valid, not just trans people's stories in isolation from those who love them. My wife and other close relatives are also severely impacted, and I believe my son is being damaged by the pressure he is under to see his family as bigoted. Deep down he knows we love him, but he is being drip fed a narrative of "anything other than complete agreement is unacceptable and means lack of acceptance of you". He knows he does not have to agree with us to be loved. Does he still know that we do not have to agree with him to love him? Does he still know that he can still love us if he disagrees with us? Does he know that we would drop everything if he was in trouble and called for help?

If he wants us to accept him as the image of himself he is presenting, he has to allow us to spend time with him. It's not possible to get used to the new behaviour of someone we are no longer permitted to see and to relate to. It is utterly unreasonable to expect an instant realignment of our perception of him. And it is only possible to relate to anyone based on the reality of our own perception of them - not on their perception of themselves. This is the fundamental flaw in the trans worldview I keep coming across - the idea that a person has the right to dictate how everyone else sees them.

@ButterflyHatched
I live a life where I generally experience gender congruence.

Can you explain what this means?

This is the fundamental flaw in the trans worldview I keep coming across - the idea that a person has the right to dictate how everyone else sees them.

This is so true - the narcissism, the sheer chutzpah of the trans movement is encapsulated in that issue. No one gets to dictate how others perceive them, nor how they are referred to in their absence.

I can't be taller, younger or a super athlete like Simone Biles by wanting others to see me that way. I'm tethered to reality. I can't change sex and have DH be pregnant next time (because I've definitely done my fair share of that) no matter how much I might wish it so.

We can't bend reality to our preferences. We also can't bend other people's perceptions to suit ourselves.

Sure.

I look in the mirror and don't want to cry.

I walk down the street and don't get transphobic abuse.

I board an aircraft and staff say 'good afternoon madam' without hesitation, awkwardness or uncertainty.

I walk into a toilet desperate for a pee and don't inspire nervous or hostile looks.

I share knowing glances with other women to silently communicate a situation has bad vibes.

I can easily find clothes that fit me. I can walk into a shop to buy them and not feel awkward or unwelcome.

I talk on the phone and people reflexively address me correctly.

I can see photos of myself without feeling a crushing pang of sadness.

I get cast in acting roles as female characters. I do not have to automatically be portraying a trans person.

I don't hate how my body looks or feels.

I feel comfortable in my own skin.

Turns out there is this amazing hack which lets you jump developmental rails so all of this stuff never becomes an issue, but it only works for a brief window during your youth and Wes Streeting is about to ban it for good.

So 'gender congruence' means convincingly masquerading as the opposite sex?

It means not having to strive to be correctly perceived in a way most people take for granted.

It means there is no 'masquerade'. There is nothing you need nor want to change; you are comfortable in your own skin and at peace.

No one is changing sex, just as I am not getting younger.

Often, sex or age are irrelevant. But sometimes they really, really matter. Gender? Not so much.

I look like the version of me who was spared the majority of pubertal development under endogenous testosterone and was allowed to commence exogenous oestrogen at 18. I was able to identify this was the right path at a young age, helped along by some genetic quirks that ended up proving quite useful in the long run.

From your previous posts, you either got puberty blockers late, or had a medical condition that delayed puberty, depending on which version is true this week. Either way you were 17/18.

Puberty blockers are now given at Tanner stage 2. Which is 10-12 for some children. It’s not remotely the same. And you know this, because this is just a rinse and repeat of every single thread you join.

There is no study that can be ethically done to determine which children retain their body dysmorphia, is acceptable in the harm it will cause, and can be fully consented to.

This initiative is to help stop the puberty blocker trial genspect.org/call-to-action-help-genspect-uk-stop-the-nhs-puberty-blocker-study/

Correctly perceived? People perceiving someone as a woman when they are actually a man is not correctly perceiving them.

I'm sorry if people lied to you as a child by telling you that you could change sex. You can't and you didn’t.

I would sincerely hope the Ethics Committee they take this to will be very hawkish. Ethics typically are incredibly picky on tiny points - and if there was any suggestion that the committee were too lenient I would be complaining to the regulators - the process here is very strict and they must follow Good Clinical Practice. The system of ethical approval is set up to avoid scandals like experiments on prisoners (obviously happened in WW2, but also in the USA plus the Tuskegee Syphilis Study). The obvious first step is to do a retrospective study of people who have already been through UK youth gender clinics - given that doing a double blind controlled trial is impossible, looking at retrospective data from medically treated vs untreated groups is a valid proxy. There is no justification for a new trial without using existing NHS records for a retrospective study first.

Feeling that your body is wrong AND that people are defining your existence using a surface-level impression of the parts that are making you sad can also make you (even more) sad.

I'm just trying to tease out what this means, butterfly. It isn't intended to be hostile. I just wonder about the rather dramatic way in which you speak of others' perception.
What does it mean to 'define someone's existence'? Do you mean 'recognise you as male'? Maleness isn't a destiny. You can still be anything you want, including a transwoman. Most people, including most GC feminists (certainly me) would absolutely endorse your right to live as a transwoman, to define yourself as such and to present in whatever way seemed to you to express your sense of being female. So in what sense do we 'define your existence' if we simply accurately perceive something about you that makes you sad?

Use of the term 'defining your existence' presents a simple and involuntary moment of perception as if it were an authoritarian and aggressive act.

Sometimes the trans movement (I certainly don't mean you, butterfly - I have only read one or two of your posts and haven't a clue how you feel about what I am going to say next) reminds me of a strand within the incel movement. Incels often seem to present women as being hugely powerful, just in virtue of the fact that men need women's bodies and women are allowed to withhold them. Just having sovereignty over ourselves (our bodies, our perceptions) is perceived as a form of control over men, because it presents an obstacle impeding the gratification of a need.

I hope you can understand, butterfly, how commonly women experience a man approaching them in some way and requiring compliance to their needs. Not just in the extreme way of rape, sexual assault, flashing, lewd comments, but in a million smaller ways. Unwanted approaches, superficially friendly comments, that we have to respond to smilingly, endorsing the man's ego, as if flattered, in order to forestall their angry perception of us as (to use some of the comments typically thrown as woman) cockteasers, frigid whores, stuck up slut, etc.

This is the context in which we are presented with an additional requirement -- to fully perceive a transwoman as female (not just to use preferred pronouns etc but to go further than that in order to avoid being seen as 'grudgingly humouring' as butterfly puts it).

This requirement comes on top of a huge pile of life experience in which we have been required to second-guess ourselves, defensively misrepresent our reaction to male people.This is order to keep ourselves safe from overt or seething anger from those who 'define our existence' as if we were simply the means to (or the obstacle to) the gratification of a desire.

I don't think I ever comment, Rapid, on your posts. But I read all of them with great compassion.

I always find the profound difficulty of your experience, and your deeply thoughtful articulation of it so affecting- and this post, for me, in particular.

The sheer pain of trying to enact what loving your child really means. The deep and complex struggle that comes with the understanding that love is an action/effort, not a passive feeling/ease- and a willingness to tolerate your own discomfort for the ultimate wellbeing of your son shines through.

This scenario, for parents like you, has always brought to mind The Judgement of Solomon story (I'm not a Christian, but some biblical stories, like this one, have stuck in my consciousness since childhood)

It actually hurts my heart.

And I hope so much, that one day, your son is able to clearly see the depth and strength of love he is held with.

There are so many people in the world, for myriad reasons, who will never have been loved like this; so when it is there, the hope is that it is recognised for the gift it is.

Great post.

And yes, this describes how I feel too:

Most people, including most GC feminists (certainly me) would absolutely endorse your right to live as a transwoman, to define yourself as such and to present in whatever way seemed to you to express your sense of being female.

Where I draw the line is autogynophilia. But not every transwoman is an autogynophile.

Sadly, there is no objective way of knowing a) which TW are (unless they explicitly say so, like Debbie Hayton does) or b) how the behaviour of someone's autogynophilia will develop over time.

So on a societal basis, the only viable way to accommodate the difference between sex (fact) and gender identity (belief) is to base laws on what we know. We know from data that biological males are statistically a threat to biological females in certain situations e.g. in changing rooms, where people are getting undressed. We know from FOIs that TW in prison, who have been convicted of sexual offences, are disproportionately high compared to both the standard male population and the standard female population.

It's not about one individual TW, it's about a societal level of risk management.

I'm happy to use my own instinct in any given situation. I've met TW who seem perfectly lovely, I've met TW who give me other vibes. In a personal situation, I'm comfortable managing my own personal risk, just as I have done the whole of my life. I'm also aware that I was an idiot when I was younger e.g. the day I had an argument with my boyfriend and decided to walk across the city from his student house to mine, at 2am, going down residential roads, often in shadows. Regardless of my own risk management skills, society needs laws that do this at scale. Lovely or not (and obviously there will be non-lovely TW who present a lovely facade, as with any other nefarious person),TW are not women. TW don't belong in women's sports, spaces or services.