#medical47

[destroyyourbinder]

I want to thank Jacob for his enormous bravery in speaking out publicly about how the “puberty blocker” (GnRH agonist) protocol and the medicalization of his identity affected him as a struggling trans teenager. 

I want to note before I share the article that stories like Jacob’s are being politicized by groups like Mermaids (the primary transgender child lobbying organization in the UK) to claim that while "blockers” are “safe” and “reversible” and ought to be immediately provided to trans children who are beginning puberty, that any problems with GnRH agonists indicates that clinicians should begin cross-sex hormone treatment early. Organizations such as Mermaids and various other groups in the US frequently claim that there ought to be no formal lower age bound for the initiation of cross-sex HRT (i.e. testosterone for female children, estrogen and an anti-androgen drug for male children) and Johanna Olson-Kennedy (a pediatric gender “expert” and head of the gender clinic at Children’s Hospital Los Angeles) advocates regularly for female children to receive testosterone at twelve and has possibly given children as young as 8 testosterone treatment. So in sharing this kid’s story, I want to be careful, since there is a real danger that exposing the harms of using GnRH agonists such as Lupron on gender-variant children will lead to a change in strategy where these children are merely dosed early with cross-sex hormones, a protocol that to my knowledge that we have zero long-term data on. (Children are given GnRH agonists as a means to halt precocious puberty, and in fact, these drugs are approved for this purpose, so we have some data on their effects already. As far as I know, there has been no previous medical reason to give female children testosterone or male children anti-androgens and estrogen.) The article is behind a paywall but I am transcribing it here: Puberty blocking drugs: ‘For the past four years I’ve been stuck as a child’ Jacob has just turned 16 and for the past four years the teenager’s body has been put on pause. He has been on hormone blockers to stop puberty while he decides how far he is willing to go to become a transgender man.

He claims that taking blockers was “the worst decision I’ve ever made”.

Jacob was born a girl but felt unhappy with his gender. “I always felt so weak and pathetic and inferior to the men.” He started using the male pronoun and imagined himself growing up and “dating a woman”.

When Jacob became one of thousands of young adolescents to be referred for puberty blockers by the NHS’s main gender clinic for children he was delighted. “It was sold to me as a  miracle cure for being trans,” he claimed. He told another trans school friend about them, who started requesting blockers too.

Hormone blockers are only licensed in Britain to delay the onset of puberty for children suffering “precocious puberty” — that is, those who start developing abnormally early before the age of eight or nine.

However, their use is promoted by the transgender campaign group Mermaids as a way of giving young people “a pause button” while deciding whether to graduate to the irreversible, cross-sex hormones that will trigger the life-changing, fertility-reducing jump from one gender to another, once they reach 16. The vast majority of children who begin blockers go on to take that step.

Blockers are physically reversible, insofar as puberty will eventually restart once someone stops taking them. But no one — not even the directors of the country’s leading gender clinic, the Tavistock’s Gender Identity Development Service [GIDS] — knows their long-term impact, for example, on the teenage brain.

After just a few consultations at the Tavistock, Jacob was referred to the endocrinology clinic at University College London Hospitals [UCLH]. He claimed the clinic did not consider his background, such as the trauma of a sexual assault at primary school, or his parents’ difficult divorce. He and his mother were soon making regular visits to London from their small village in the west of England for the injections.

“They promise you that your breasts will disappear, that your voice will be deeper, that I would look and sound more like a boy. For me, that was the best thing that could have happened,” he said.

Only, Jacob found that wasn’t what happened at all. Far from becoming one of the lads, as he’d hoped, he felt even more alienated from them as their physiques changed and Jacob’s remained the same.

“At school, other people were maturing into adults. The guys I grew up with were growing hair and growing up. For someone who’s trying to fit in as a boy, that’s not what you want.” Jacob had always been the tallest among his friends. Now he was the shortest. When his little brother overtook him in height and strength, he found it too upsetting to be in the same room as him. “My little brother is 18 months younger and now he has completely outgrown me. I go to school and I feel like other people are developing and I still feel like a child,” he said. Jacob also claims he was not warned about the side-effects of the drugs. These have included insomnia, exhaustion, fatigue, low moods, rapid weight   gain which caused his skin to become covered with angry, itchy stretch marks, and a reduction in bone density. “I’d never broken a bone before [taking puberty blockers],” he says. “I’ve since broken four bones.” “I stubbed my toe, it broke. I fell over, my wrist broke. Same with my elbow.” As he took the blockers, Jacob’s mother watched her child become even more introverted and body-conscious. “The blockers contributed more to the self-image problems that were already there,” she said. Jacob found it increasingly difficult to concentrate on schoolwork. If sitting GSCEs is hard enough with raging hormones, it’s even harder without them, he said. “I’m someone with the developing mind of a 12-year-old who’s doing exams designed for a 16-year-old.”

He added: “The worst part was probably the depression. There were moments when I wanted everything to stop. Weight gain and depression — for someone who is already self-conscious about their body, that’s a lethal combination.” Clinicians who resigned from GIDS for ethical reasons said one of their main concerns was that young people were being sent down a medical pathway without proper exploration of the possibility they may simply be gay. Jacob is no closer to understanding who he may be attracted to at 16 as he   was at 12. “My friends are all talking about having sex and girlfriends, and going to prom... but I’ve never had a crush. I’ve never felt sexual attraction to anyone. I feel so out of place.” In hindsight, Jacob finds it surprising how little his background — and the reasons why he didn’t want to be a girl — were discussed before being referred for treatment. “They didn’t even look at my history or trauma,” claimed Jacob. “They sent a child whose circumstances and feelings they didn’t understand [for hormone treatment].” Jacob is speaking out about his experience to warn other transgender youngsters to think twice before starting blockers. “I was sold a miracle cure. They promised happiness with little evidence behind it. Then four years in, you realise, oh my God, I’ve no idea about the long-term effects.“

“They asked a 12-year-old to make a decision an adult would struggle with.” “It  was like, ‘here are the drugs’ and off we went. It’s a ridiculous process. It’s not gone the way they told me it was going to go.”

Mermaids, the transgender lobby group, claims that puberty blockers are safe and “completely reversible” and that not giving them to youngsters who   request them can be more damaging than prescribing them.

Gendered Intelligence, another trans campaign group, claims on its website that hormone blockers give children “breathing space to ensure that they are  sure about the permanent effects of cross-sex hormones, without the adverse effects of an incorrect puberty.” Jacob is scathing about such claims. “Breathing space! It really isn’t. I’ve not had any space to breathe the last four years.“

“They sell it to you as a break from feeling like a girl, and that’s fine for the first few months but as soon as everyone else around you starts developing it becomes ‘spot the transgender kid’, which is so easy because you’re stuck as a child.“

“If anything, I’ve been more depressed than before. My thyroid is messed up. I’m hungry all the time. I have no idea how my breast tissue will develop.” He claimed: “They push and push you on to this one-way train you’re not allowed off.” Asked whether it was misleading to promote puberty blockers as a “pause   button”, a spokesman for Mermaids said: “Mermaids cannot comment on   clinical cases as we are not involved in any individuals’ medical pathways.” “We offer young people and their families information, support and access to others in similar circumstances.” Gendered Intelligence declined to respond. Jacob claims the main focus of his treatment at the Tavistock was on the   milestones of transition — “how far you’re willing to go” — rather than discussion of the consequences.

He claims: “My Tavistock worker was saying to me, ‘once you have the testosterone, you’ll be a boy’. “But it shouldn’t be about milestones. Being trans is how you think; it should not be about how far down the line you’re will to go.” A spokesman for Tavistock said: “All young people considering the puberty blocker or cross-sex hormones are repeatedly made aware of the known potential impacts of these medical interventions... as well as the areas of impact that remain to some extent unknown.“

“The information that we give patients about the blockers makes it clear that they may get tired and experience low mood. We explain to young people that hormones give us energy and drive, not just our sex drive but our overall ‘get up and go’. “We also emphasised to them routinely that while on the blocker they would stay early puberty whilst their peers developed. This is a routine part of the discussion.“

“In the end the decision to go on blockers is a balancing act weighing up these factors against the perceived distress of undergoing puberty in the ‘wrong’ gender and developing unwanted and potential hard to change secondary sexual characteristics.” Jacob decided to come off the drugs on turning 16. He began to feel the benefits almost overnight. “I grew taller, I lost weight, I felt livelier. It was like getting the poison out of my system,” he said. He will now wait until reaching 18 before making any big decisions.“I’m just fed up with all of it. I’ve felt like a guinea pig from day one. [Blockers] only made my life more complicated and it was pretty complicated already.” He  added: “I’ll be 18 in two years, but for the past four years I’ve been stuck as a child. Blockers took away the chance I had to grow up with other kids. Now I want to give my body a break.”