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

[ForZingyCat]

https://www.gezondheidsraad.nl/adviesonderwerpen/behandeling-en-begeleiding/transgenderzorg-voor-jonger

the potential need to initiate them earlier for physiological and other reasons

There is never a "need" to give opposite sex hormones to a child.

That is why these decisions require individualised clinical judgement rather than assuming that one approach is inherently compassionate or harmful in every case.

I find it difficult to believe that the application of individualised clinical judgments just happens to result in the same outcome in 98% of cases tbh.

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.

Got to say watching this from the sidelines, there's a very definite set of double standards at play. And also a lot of quite detailed knowledge about the incumbent ideas of "trans" children from someone who initially didn't seem.to know much about it. Hmmmm.

It's also very noticeable how the conversation has been kept incredibly trammelled into the subjective experience of these so called "trans" children.

They "might" feel a certain way so we must treat them as if this is a known fact.

Whether what they feel has anything to do with the actual lived reality of the opposite sex is irrelevant but nevertheless we must treat them as if we believe it does and therefore the appropriate treatment is medical intervention to disrupt the natural development of their actual sex body, leading almost inevitably to further medicalisation in an attempt to visually mimic the opposite sex.

Whether what they feel has anything to do with the actual lived reality of the opposite sex is irrelevant and need not be examined but nevertheless the depth of their distress requires that we must treat them as if we believe it does and therefore the inclusion of people of one sex in the social category of the other must be acceptable as a necessary provision to relieve their subjective distress.

While the objective reality that they are not of that sex and that whatever they feel has in reality no especial commonality with the opposite sex is being paid lip service to, the impact of society appearing to condone the belief that what makes one a man or a woman is what is in ones head rather than ones body, and of the impact on women of opening up supposedly woman-only resources or legal identities to the opppsite sex is firmly out of bounds for discussion.

The experiences and statistics about detransitioners are out of date so should be ignored, but we must nevertheless proceed with damaging treatments based on anecdotal evidence that those who want them believe they will reduce distress.

What does it all add up to? While focusing on anything other than the distress of the trans person "isn't what we are talking about", the case is nevertheless being built for doing things that have far wider impacts than just the trans person. Women who try to engage are finding their focus tramelled into only one small area, and this creates the impression that this small focus is the core, most significant or only relevant concern of those women rather than being the only area in which they believe their points have any hope of being heard. So they keep trying to frame the bigger picture within the very small area of allowed topics, and as a result even their own expression of the bigger picture gets smaller and smaller, and the real spread of consequences is accidentally edited out in the hope o getting any recognition of bigger consequences at all.

It's fascinating to watch. I wonder if it's being done consciously or simply the consequence of having an incredibly narrow minded, individual focus view of trans issues rather than a societal or feminist one.

As I said in an earlier post on this thread, it's not that I haven't thought about the whys and whats and hows of trans identities' cause and development, it's that after homestly engaging with this type of thread many times trying to get a poster to place their passionate support of trans people in the wider social context and consider its impact on others as well, I realised it was really just a distraction technique.

Because whatever the reason a trans person feels as they do, the answer to supporting their distress is never to accept, or even pretend to accept, bending everyone else's sense of self and how one relates to ones own sex and the sex of others tp accomodate a distorted body image or projected ideas of what feelings belong in what body.

I'm glad you watched it. Despite our viewpoints being at odds on the fundamental question about PBs (with or without CSH) vs only psychological support, I do appreciate you engaging with information being shared.

Yes, the studies were on animals. But a large amount being explained in that video is about human brain development and the critical windows within which key milestones need to happen.... or they never can.

However, there is a very important distinction between “this is an area requiring further research” and “this intervention is known to cause brain damage”.

At no point did I say that"this intervention is known to cause brain damage". I said it was likely to cause brain damage. Frankly, I'm amazed that anyone who watches that video could conclude otherwise.

The latter requires a level of evidence that currently has not been establised.

Agreed. And we're now right back at the point that we'll never agree on: whether or not it's ethical to experiment on children to gather this evidence.

Thank you. I appreciate the respectful engagement as well :).

We may disagree about the evidence, the risks and the best way forward, but I think it is important to recognise that disagreement does not necessarily come from bad intentions.
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The chromosomal hard drive determines what the body is geared up to be receptive to. If you put incompatible 'software' in it will not function effectively and may even show signs of damage.

Your claim that it's "impossible to go through the puberty of the opposite sex" is doing political work, not describing biology.

I'm afraid saying that you can go through puberty of the opposite sex is the statement doing the political work here. You go through something but you do not end up as biologically the opposite sex. You will probably be infertile - and your fertility, if it still exists (depending on if you stop hormones usually), will be the fertility of your sex at birth. You can go through a "puberty" but you will not become a fertile member of the opposite sex.

You don't seem to understand what puberty is. It is the process by which a child's body becomes a sexually mature adult body capable of reproduction.

The other things you mention such as bone growth, the growth spurt, secondary sex characteristics and brain maturation also happen during puberty, but these are not what puberty is.

If the administration of opposite sex hormones changed immature male sex organs into mature female ones (or vice versa), then you would be correct in saying that it was possible to go through an opposite sex puberty. They don't, so it isn't.

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.

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.

So in order to discover whether there is cognitive impairment from this treatment, we could either do some better experiments on animals, or we could just experiment on children and hope for the best.

Which of those two options do you think is better?

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.

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.

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,

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 hadn't read your post before posting mine, but that was exactly the man in the podcast's point. He had no idea what his teenaged peers were on about. He became isolated because of it.

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 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.

Btw Tanner stage 1 is before the stage a child would be given PBs so not directly comparable.

Of course it's evidence. It's not the only explanation of the pattern ofc, but it's certainly the simplest and most obvious one, rather than coming up with unsubstantiated theories about how one treatment might lead to the other as you do here.

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?

The problem here is 'gender'. Administering even more, or different, gender is not the solution. To resolve 'gender issues' you need to be able to step outside of 'gender' altogether, or you certainly need to unpack it.

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?

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.

Do you mean the PB trial?