US

Opinion on the use of puberty blockers in America is turning

WORRIES ABOUT the use of puberty blockers, which are prescribed to some children to prevent the development of secondary sex characteristics (like breasts and facial hair) have been mounting in much of the rich world. Some countries have scaled back their use. Not America. Doctors who work in transgender clinics routinely claim that prescribing such drugs is conservative, because their effects are largely reversible, and compassionate, because they save children with gender dysphoria (the feeling of being in the wrong body) from enormous distress.

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That may be beginning to change. Last week Abigail Shrier, a writer, published interviews in “Common Sense With Bari Weiss”, a newsletter, with two transgender health-care professionals who suggested that some doctors were irresponsible in the way they treated children. The women, both trans, are on the board of the World Professional Association for Transgender Health (WPATH), which endorses the use of blockers early in puberty in some cases. Though blockers are often described as operating like a pause button, most children prescribed them go on to cross-sex hormones. This combination can have irreversible consequences, including sterility and the inability to orgasm.

This was the chief concern expressed by Marci Bowers, a vaginoplasty surgeon who is due to become the president of WPATH in 2022. Dr Bowers built her career operating on adults, but she has also operated on teens: in 2018 she performed a “penile inversion” on Jazz Jennings, a 17-year-old who had been put on blockers aged 11. But Dr Bowers told Ms Shrier she was “not a fan” of putting children on blockers early in puberty. She worried, she said, “about their reproductive rights later. I worry about their sexual health later and ability to find intimacy.”

In 2018 Lisa Littman, a researcher, was hounded and lost her job as a consultant after coining the term “rapid onset gender dysphoria” (ROGD) to describe the social contagion of trans-identification among teens, mostly girls. Dr Bowers appeared to acknowledge the existence of “this ROGD thing” as she called it. “I think there probably are people who are influenced. There is a little bit of ‘Yeah, that’s so cool. Yeah, I kind of want to do that too.’” In some cases, she said, girls with eating disorders were being diagnosed with gender dysphoria, “then they see you for one visit, and then they recommend testosterone.”

Erica Anderson, a clinical psychologist at the University of California San Francisco’s Child and Adolescent Gender Centre told Ms Shrier that because of “sloppy health-care work”—“rushing people through the medicalisation” and an “abject failure” to properly evaluate patients’ mental health—she expected more young people to regret transitioning. Her clinic had seen twice as many females as males for two years running, she said.

It is exceedingly rare for health-care professionals in America to criticise—or even question—the practices that have become prevalent in the medical treatment of gender-dysphoric youth. Professional bodies, including the American Association of Paediatrics, have endorsed “gender-affirmative” care, a model that accepts patients’ self-diagnosis that they are trans, and the use of blockers. Anyone who publicly dissents tends to be castigated.

Will the airing of these views change the way trans-identifying children are treated? Laura Edwards-Leeper, a psychologist who helped found America’s first transgender clinic for children in Boston in 2007, has claimed (including to this newspaper) that too few teens undergo crucial mental-health assessments before starting treatment. She says Dr Bowers’s comments, especially about the effects of blockers on sexual function, have “shaken up” many in the field. Yet she notes some doctors are responding by talking about how they might control or slow treatment, without mentioning the role mental-health professionals should play in all this. That they are discussing the risks at all nonetheless constitutes progress.

This article appeared in the United States section of the print edition under the headline “Anatomy of a scandal”

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