Little understood and much debated: puberty blockers in spotlight

by Matthew Lavietes | @mattlavietes | Thomson Reuters Foundation
Wednesday, 2 December 2020 22:36 GMT

A person receives an injection in Tuebingen, Germany, June 22, 2020. REUTERS/Kai Pfaffenbach

Image Caption and Rights Information

A landmark British court ruling over medical treatment for trans kids has fueled debate over the right age to transition gender.

By Matthew Lavietes

NEW YORK, Dec 2 (Thomson Reuters Foundation) - A landmark British court ruling over medical treatment for transgender children has fueled debate over the right age to transition gender and the risks of blocking puberty with drugs. 

Britain's High Court declared on Tuesday that children under 16 in England and Wales will need court approval to take puberty blockers, saying that minors could not "weigh the long-term risks and consequences" of the medication.

While Tuesday's decision only affects children in England and Wales - and is likely to end in a Supreme Court showdown -courts and lawmakers from Canada to Brazil are tussling over parental powers and the right age to transition.

But the debate has revealed a split over the best route and raised questions about puberty blockers, both what they do and why they are so controversial.


WHAT DO THE BLOCKERS DO?

Puberty blockers are used to delay the onset of puberty or stop a child's body maturing to become sexually reproductive, according to U.S. academic medical center Mayo Clinic.

They act as hormone-obstructing agents, administered by injection or implants, that hinder the signs of puberty, such as the growth of facial hair and testes or breast tissue growth and the onset of menstruation.

WHO USES THEM?

Puberty blockers have been used for decades to treat precocious puberty, a rare condition under which a child's body matures early, usually before they turn eight.

More recently, doctors have prescribed puberty blockers for children who are experiencing gender dysphoria, a discomfort that their gender identity does not match their body, to delay physical changes.

"It's to stop the clock," Dr. Joshua Safer, the executive director of the Mount Sinai Center for Transgender Medicine and Surgery, told the Thomson Reuters Foundation.

"The entire point is to allow the child and the parents and the medical providers time to think about what is most logical for that individual."

The drugs are "safe" and its effects are "fully reversible," Safer added.

WHAT ARE THE BENEFITS?

Puberty blockers help offset the stress of gender dysphoria, according to the World Professional Association for Transgender Health, a global body of doctors specialized in treating trans people.

A study by Boston Children's Gender Multispecialty Service found those who take them are less likely to have a history of suicidal thoughts or suicide attempts by their mid-30s.

The same study found nine in 10 trans adults who were denied access to the medication experienced suicidal thoughts.

WHAT DO THE CRITICS SAY?

Experts say the medication could lead to lower bone density and might hamper bone growth.

Research from the Journal of Endocrine Society, which looked at several dozen children taking puberty blockers for less than two months, concluded that "later pubertal onset" as a result of puberty blockers "leads to lower adult bone mineral content."

The Provincial Health Services Authority, the publicly funded health service provider in the Canadian province of British Columbia, also found that the medication will temporarily delay growth in height and fertility.

Related stories:

UK court rules against trans clinic over treatment for children

Trans teen takes legal action over gender care delay in UK

Who should decide when a child can change gender?

(Reporting by Matthew Lavietes; editing by Lyndsay Griffiths and Hugo Greenhalgh. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)

Our Standards: The Thomson Reuters Trust Principles.