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

[ForZingyCat]

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

Oh my, that is so sad. And it could have been avoided if the lack of puberty had been diagnosed in time.

Heartbreaking to think that ideologically driven medicalists are deliberately promoting this to vulnerable children.

Yes, I think it's a terrible idea to withhold cross-sex hormones until 18 — and it lends more weight to PP's concerns on this thread than the historical approach or the approach taking in other jurisdictions. Skepticism about medical interventions for gender dysphoric children, and the poor quality of the Cass review (because it was not carried out by people with any subject or clinical expertise/ experience) is what has driven this change and imv it will very certainly have detrimental effects on children's health and wellbeing.

If the concern is the welfare of young people, I don't think the solution is to deny access to puberty blockers altogether. The solution is to ensure that young people who are appropriately assessed and for whom treatment is indicated can progress to cross-sex hormones at a developmentally appropriate age, rather than remaining on blockers for an extended period because of policy restrictions.

Yes I mean the PB trial.

So (trying to understand) the plan is to prevent puberty to have a time to think (about changing sex, which is impossible) and then have puberty later than all of that child's peers so they miss out on all the normal teenage stuff, which they can never get back.

And then they won't have access to CSH (and given how many usually go on to these that's not going to be easy for them to accept). So they just have puberty later than everyone else, so without peer support and probably feeling like a complete oddity.

It seems cruel to me tbh.

Again @Sunnibee it's your view that if a child had CSH after PB, they would go through puberty and likely be a fertile adult?

Gender dysphoria is by its very definition a mental health condition not a physical health condition - unlike cancer. This is a dis-ease of the mind. And it is the mind that requires treatment. As long as the mind is ill at ease it will never cease to create some degree of dysphoria - only the object of its focus will just keep shifting.

Encouraging this pathway and validating this framework in children is condemining them to a life time of shifting dysphoria and extreme cognitive dissonance - totally dependent on the response or validation of others to feel whole. And quite often with undesired physical side effects which can be life limiting or otherwise problematical.

https://post-trans.com

A boy who has taken CSH is still a boy even if he then has loads of cosmetic surgey. He will always be a boy. He has no right to demand anyone pretend otherwise or impose himself on female spaces. So what exactly is being achieved?

Yes, I think the proposed trial is unlikely to answer the most clinically relevant question and, given the timelines involved, may expose participants to unnecessary harms.

Puberty blockers are intended to be initiated at around Tanner stage 2. If treatment does not begin until age 14, many young people—particularly natal females—will already have undergone a substantial proportion of endogenous puberty, limiting one of the principal purposes of the intervention. Starting blockers at that stage or later also means suppressing an already established pubertal process, with its own physiological consequences (it can introduce very challenging side effects akin to a sort of menopause).

Equally concerning is the proposal to keep young people on blockers until age 18. Four years of pubertal suppression during adolescence would be challenging both physically and socially.

If the aim is to protect young people's welfare, I don't think the answer is to eliminate hormonal treatment for those with persistent gender dysphoria. Rather, it is to ensure that appropriately assessed young people receive treatment on a medically and developmentally appropriate timeline, as occurs in a number of other healthcare systems, rather than one determined primarily by policy / political compromises.

As for your final question: no, of course children wouldn't develop fertility if they don't have the relevant reproductive organs. Nor would they be left in a permanent prepubertal state, unable to grow into a mature adult with a sense of self, and permanently affected by brain damage. As I've explained, there are many groups of children for whom puberty is induced through exogenous hormones; regardless of chromosomes, hormone receptors respond to these hormones which drive systemic pubertal changes (including those associated with bone health and brain development) even if they can't grow new reproductive organs.

@Sunnibee

PBs are not a safeguard but a figleaf. The side effects (and those of any hormone blockade) are severe. Given that most progress to CSHs anyway, it would be considerably less medically dangerous to subject boys to gonadectomy and start œstrogen at 11.

They don't do it because it would make it obvious that he is being committed at an early age to sterility and vitiated sexual function (lack of genital development makes vaginoplasty more difficult). PBs are a simulacrum of caution.

CAIS is an inapt comparison because they have normal female external genitalia from birth and, interestingly, will develop female secondary sex characteristics spontaneously at puberty (due to aromatisation of endogenous testosterone), although they do need œstrogen thereafter to preserve bone health.

It's pointless transitioning girls early. Testosterone is so powerful it can do a bang up job when they're thirty.

Hmmm. Deleted. Someone was super fast not wanting those observations to stand!

I wonder if it was because I pointed out the poster dominating this thread clearly came here with their mind already made up and has made no effort whatsoever to understand any other perspective or concerns, just rolled fluff around them and rolled past them.

Or maybe because of the second word of a common phrase that starts "cargo..." that very well describes how Genderists appear to ascribe some quite unscientific powers to PBs and cross sex hormones. I know by itself it is not a word that can be said, at least not one Genderists allow to stand when said against them. Didn'texpect it to be verboten as part of a well known and specific colloquial phrase mraning something quite different though.

CAIS is an inapt comparison because they have normal female external genitalia from birth and, interestingly, will develop female secondary sex characteristics spontaneously at puberty (due to aromatisation of endogenous testosterone), although they do need œstrogen thereafter to preserve bone health.

That actually supports the point rather than undermining it. CAIS is a clean demonstration that puberty — in the sense of secondary sex characteristics and presumably the associated brain maturation — is fully dissociable from both reproductive status and chromosomal sex. These are XY individuals who go through a complete female puberty, driven by hormone receptors responding to circulating sex hormone, while never having female chromosomes, ovaries or a uterus and never being able to reproduce. That's exactly the separation between "puberty," chromosomes, and reproductive maturation I was pointing to.

The fact that in CAIS this happens via aromatization of endogenous testosterone (for those who haven't had their testes removed pre puberty) rather than exogenous hormone administration doesn't change that conclusion — it just shows a different route to the same outcome. What matters for the underlying argument isn't the source of the hormone, or the chromosomes behind it, it's that hormone receptors drive pubertal changes independent of gonadal/reproductive status and independent of karyotype.

So they would be infertile. Not good at all. The other things you describe also sound like very bad outcomes for already distressed children.

Yes, sometimes children get distressed. It's not great. But, honestly, it's also not the end of the world. Distress can be worked with. Most people have experienced distress and have come out of the other side. Being infertile is awful and nothing can be done.

Lying to children about reality and putting them on harmful drugs and making them infertile to somehow alleviate distress (which has been caused by adults imho) is just not proportionate. Or kind, actually, I think.

Other solutions need exploring before this one.

I didn't even see your post before it was deleted. I have no idea what it said, but clearly someone thought it was inappropriate - either MN HQ or another user.

What on earth were you deleted for? All seemed reasonable to me.

It is sad. I think a sad thing is that some/many (?) transpeople are also neurodiverse (read: likely autistic).
This means that A) if they start considering that their sex is what's wrong, they may be more likely than a neurotypical person to focus on that idea.
And B) maybe if society is already a difficult place to be/it's hard to fit in anyway (because you're autistic), maybe it's easier to change who you (physically) are than to mask your autism when you're out and about. That way most people will see a trans person before they see an autistic person.

CAIS individuals missed their initial sexual development in the womb.

This is not the case for a child whose sexed body developed along the normal pathway. For them the bus left before they were born.

It's either extremely poorly informed or extremely bad faith to imply CAIS means any human can have an opposite sex puberty if given the "right" (wrong) hormones.

Yes, yes, and there's even a CAIS lady with persistent Müllerian duct syndrome who had donor egg twins. And children with 5-ARD or PAIS who have successful feminisation treatment (or as successful as it can be with a micropenis and an inguinal sinus). That's not my point.

A normal little boy has a normal little penis, and it's not going to get any bigger, or develop its normal functions, or be capable of being peeled like a banana and turned inside out, unless he goes through male puberty.

You are consistently blurring the line between exogenous puberty induced by the appropriate sex hormones, and whatever it is that happens when a young person is flooded with exogenous hormones in an amount suitable to the opposite sex.

No one can go through “opposite sex”
puberty; they don’t have the body parts to start producing opposite sex gametes.

The two things are not comparable.

Seeing a lot of AI tells now.

That clears up the suddenly very well informed posts (well, presenting as well informed at least. As someone who deals with a lot of AI content at work, treat all "facts" with caution no matter hiw confidently delivered.)

Goes without saying, but anyone who delegates their side of the conversation to AI has no interest in learning or understanding the opposite position, they just want to bulldoze their own views.

An interesting coda to the earlier side track about understanding, learning and the value of taking the journey.

That's fair, and a different claim from the one I was addressing. Penile growth and certain functional/structural changes are androgen-dependent and occur specifically during androgenized male puberty. If blockers are started at Tanner stage 2, that growth doesn't happen, and it's not something estrogen will retroactively produce later — estrogen doesn't drive that tissue's development, testosterone does. This has a real, documented clinical consequence: trans women who blocked puberty early and never had an androgenized puberty often don't have enough penile/scrotal tissue for a standard penile-inversion vaginoplasty, and need alternative techniques (peritoneal or intestinal vaginoplasty) instead. So that's one reason why some clinicians may advice PBs are started later mid puberty around tanner stage 4.

So if the point is specifically "blocking male puberty at Tanner 2 forecloses certain surgical options later, in a way that isn't reversible by giving estrogen afterward" — that's accurate, and it's a legitimate, concrete consideration for informed consent. However, what doesn't make sense it to generalise from that into "therefore blockers + cross-sex hormones don't produce puberty at all" — children are left in pre-pubertal limbo and brain maturation can't happen.

Adults in society tell children that GI is a thing and that humans can magically be born in the wrong body.

Distressed child believes the adults and thinks that this is what has happened to them.

Adults act all surprised and tell child they can solve this by blocking puberty.

Child now very much wants puberty blockers.

Adults point to this as evidence that child is really born in wrong body.

Child goes on puberty blockers. Becomes infertile.

Adults say - well, that was worth it. At least you're no longer distressed!

FIN.

This all sounds like appalling Frankenstein medicine. What on earth are we doing to people? This is not a healthy way to be human.

Ah yeah. The AI was in full force ages ago.

Surely it would be more productive and interesting to join the actual discussion?