Gender Disorder and Hormone Blocking Therapy

A recent article in the Daily Mail has caused a lot of wailing and gnashing of teeth across the web.

Article

The comments there are close to what you see all across the web where this is being discussed.

The heading is incorrect, the child isn’t undergoing a sex change, he’s using hormone blocking therapy to hold off puberty.

Some seem to think it’s brainwashing by rabid man hating lesbians, causing the child to want to cut his penis off. Others seem to think that allowing the child to undergo hormone therapy such as this is abuse. Many believe that it’s just a “phase” like most kids go through, and the parents are crazy to take it this far.

I don’t know much about gender disorders, but what is described here and what I’ve read about it since this uproar began is not a “normal” childhood phase. IMHO.

So, for the Great Debate: Is hormone blocking therapy (as it’s being used in the article) child abuse and medical malpractice?

I don’t claim to be an expert. However, nothing I have ever read even remotely suggests that an 11 year-old can even have a distinct sexual identity, at least not without a lot of conditioning, and even then wouldn’t really understand anything. I would think you ought to look damn closely at the doctors involved, and I have some serious doubts about the parents.

However, I’m biased. I consider “gender reassignment” to be largely a silly excercise for all involved.

It doesn’t help that the kid has lesbian parents. Personally, I don’t think that had anything to do with the kid being transsexual, but homophobia exists and is now added to the mix. That is, added more than usual.

IF the child is genuinely transsexual then such puberty-blocking treatments can delay certain types of gender development until the child is old enough to be able to give consent as an adult (18 - that would make for a late puberty, but there are perfectly normal people who enter puberty that late) for any permanent alterations made to his or her body.

By not blocking puberty the child might go through the “wrong” puberty, which will result in less satisfactory results IF the final decision is to undergo sexual reassignment surgery. In particular, male puberty would result in changes to the skeleton that are extremely difficult if not impossible to alter, not to mention a significantly lower voice and lots more body hair.

In sum - for a person who will undergo sex change surgery the delayed puberty will mean much better results of gender transition. In the case of a male-to-female transexual, the person will look like a woman instead of a man in drag. For a female-to-male transexual, the person will not have to undergo a mastectomy and will not have fat deposits in places women do and men usually don’t.

If it is finally determined that the person is not, in fact, a transexual then the hormone blocking can be ended and normal puberty will occur. No harm done.

It seems to me that this delay of puberty actually makes a hell of a lot sense if you have a situation where the kid’s status as transsexual or not is in question.

I also expect a LOT of people would get totally squicked over it due to ignorance, misunderstanding, prejudice, and the fact that for the normal person wanting to undergo surgery to change one’s genitalia to that extent is really hard to understand.

You don’t think 11 year olds know if they’re male or female?

Seriously?

Transsexuality isn’t sexual orientation (which some say is innate and others think isn’t know until puberty) it’s one’s identity as male or female. People figure out pretty early in life if they’re a boy or a girl and most of us never have a doubt about the issue.

My only question for such a drastic treatment is “does it actually improve the lives of the people who undergo it?” Transsexuals unable to live as their internal gender have a deplorably high suicide rate. Currently, medical thinking is that these people are less likely to kill themselves and in many cases are more functional after such surgery/treatment/transition than without it. If that is the case, I have to say sexual reassignment surgery and treatments (because it is more than just surgery) would seem to be the lesser of two evils, or even a positive, if the result is less death and more happiness, even if I don’t emotionally “get” what these people are going through.

Male or female is largely a word until puberty,. It doesn’t mean anything and the sex differences are minimal until then.

I agree mostly. My point is that it doesn’t matter until such time as there’s an actual diffrence. I would definitely have serious concerns that the child is trying to please his unusual parents, without really understanding what it means.

I understand that. At the same time, they are being sold a false bill of goods. Medicine cannot change ones sex, which is the key factor. That might change in the future, at which point I expect the very concept of identity to collapse, as well as most concepts of mental illness.

Frankly, I don’t deal in the concept of gender, which is a pointless excercise in guessing games.

In that we are not alike. I understand quite well.

Not true. From a very young age – three or four – boys and girls are very conscious of what gender they are. At that age, they are very vehement that boys do x and girls do y. Even if those things aren’t necessarily true, it’s how they gain their idea of what male/female are.

Gender identity, including gender identity that differs from the gender assigned at birth, in many cases can arise very early in life. Most children are aware from a very young age of being a boy or a girl and take an interest in the differences between the two. For some children, at this stage they manifest a conviction that they are the gender other than that assigned at birth.

Numerous trans people speak of having simply considered themselves to be their affirmed gender from the earliest times, and that it was a bizarre shock to be constantly told that they weren’t that gender.

In young people aware of being trans before puberty, the changes that accompany puberty can cause huge suffering, bringing on painful and sometimes debilitating body dysphoria.

When a trans identity emerges early, hormone blockers buy precious time for the child to continue to understand their gender identity before the irreversible physical changes of puberty, and resultant psychological damage, take place.

If the child comes to realize that physical transition is necessary, having used blockers and avoided the endogenous puberty will make the physical parts of transition far easier. In essence, the person will go through puberty only once, in the correct gender, rather than having to correct the results of the previous puberty.

If the child realizes that they are not trans, or that physical transition is not the right option for them, they can simply discontinue the blockers and endogenous puberty will continue. I know one young man personally whose situation this was; now an adult, he has no regrets about having used hormone blockers and having taken the time necessary.

The question is often posed: is it ethical to allow a child who may not be trans to undergo permanent physical change? My response would be: is it ethical to require a child who may be forcefully insisting that they are trans to undergo the permanent physical changes, and often psychological damage, resulting from endogenous puberty?

There is no evidence that same-gender parents are more apt to have gender-variant children than opposite-gender parents. The only thing that may happen is that such parents might be more accepting of such children (and only ‘might’, as sadly, many cissexual queer people are quite transphobic).

I don’t think it’s ethical even if they are. They’re either suffering from body dysmorphia or they’re placing too much emphasis on conforming to traditional gender roles. Either way, these permanent physical changes are going to be far more disruptive than actually fixing the problem.

Sex reassignment therapy has proven to be effective in resolving dysphoria and psychological issues related to trans identity, and is recognized as medically necessary for trans people who require it. It is much more effective when endogenous puberty does not proceed.

Dysphoria is not a matter of “conforming to traditional gender roles;” if it were, people would conform to the roles that they are being coerced by all of society into conforming to: the role assigned at birth. You seem to believe that a trans girl is simply a boy who is so feminine that he believes he ought to be a girl. This is not the case; for one thing, many trans women are masculine and many trans men are feminine, as are many cissexual women and men. Trans identity, especially early and persistent trans identity, has little to do with “traditional gender roles.”

Surgery is normally only available after the age of majority. The use of puberty blockers helps to ensure more satisfactory surgical outcomes.

I don’t think people fully comprehend the horror, disgust and anguish that puberty can bring to transpeople.

Men, imagine for a moment that slowly, over the course of months, your penis begins to shrink and your testicles recede inwards. It begins to grown inwards, forming a void, a space, tunneling right through you. From this tunnel come unfathomable fluids- a slick trail of slime, monthly blood. Strange smells. Down there blossoms into terrifying folds and wrinkles. You are afraid to even look at what a mess it has become. While you are helpless to stop it, fat begins to accumulate in your chest and hips. To your horror, it starts forming pendulous breasts, hanging there foreign and embarrassing. The very bones of your hips spread and widen. You have altered into something different, something not yours, something not you. You feel like a beast. something hideously malformed. What are you when your very body is deeply, primally, inalterably wrong?

As you walk through this world in this freakshow of a body, you get attention. Men start to whistle at you. They say crude things to you. They grab your disgusting, awkward, unwanted breasts on the school bus. They reference sticking this and that into the curse between your legs. A few times, you end up in situations where you are nearly forced to do this act in this body against your will. You feel sick at the idea that you can be raped, that that rape could plant a life in you, make you carry something you were never made to carry. While your friends bud into their sexuality, and pair off in innocent couplings behind the bleachers, you are left alone- physically repulsed by your own body, much less whatever unspeakable and bizarre things people want to do with it. Your early sexual feelings are tainted by self-loathing and confusion.

And everyone wants to know why you just can’t be happy the way you are.

How is an eleven year old child legally able to give his/her consent to the use of major hormonal drugs? I mean, a person cannot give their consent to legally use nicotine until they reach eighteen years of age.

Even if through some arcane sorcery I was made a woman, I wouldn’t become the deeply fucked up individual you describe. I don’t have any deep-seated loathing of the vagina. I’d just be a lesbian tomboy instead of a straight guy.

You really think it’s that easy? If you started getting a nice pair of boobs, you’d just shrug and not worry about it?

I know if I sprouted a penis, my first thought would be “cut that stuff off, don’t want it,” not “eh, I guess I’ll just be a femmy gay dude.”

Medicine can’t regrow a missing leg, either, but we don’t deny an amputee a prosthetic based on that fact.

Transsexuals are all too aware that there are limits to what medicine and surgery can do. That is why some actually don’t have the final bottom surgeries to rearrange the genitals and settle for “looking right” in clothing.

Again, the question is “do these people function better with such surgery than without?”, not whether the surgery is perfect or not. It’s the same reason we make glass eyes for someone missing their eyes - it doesn’t change the fact the patient is bind, but it can vastly improve their social functioning and interaction with other people who no longer squick out due to an eyeless face. The results aren’t perfect, a sighted person is still going to notice things aren’t quite right, but the end result is better even if not perfect or even quite normal. Likewise, a transwomen functions much better if she looks like a woman rather than a man in drag because of how other people interact with her.

I think there is a LOT of misunderstanding about this puberty blocking.

It is NOT the use of hormones, it is the use of a hormone BLOCKER. Specifically, gonadotropin-releasing hormone agonist. This acts on the pituitary, and shuts down production of sex hormones in the gonads by suppressing the signal to make them, which comes from the pituitary. No hormones are added, and the body’s production of natural hormones is reduced. It is used for other medical conditions, such a precocious puberty and for a much longer period of time than in treating transsexuals, with minimal to no side effects. They are also used in the treatment of hormone-sensitive cancers, reproductive disorders like endometriosis and fibroids, IVF, and a few other disorders. These are common drugs and well understood.

Remember, the first rule of medicine is to do no harm - this can NOT be done on a whim. It requires a medical/psychiatric diagnosis and consultation with a doctor. It has to be part of a therapy program. The child does not give consent, the parents give consent for this line of treatment.

And here’s the most important thing to remember - this does not CAUSE permanent physical changes, it PREVENTS them. Temporarily. It buys time for the child and his or her doctors/therapists/etc. to first, determine if it is a case of transsexuality or if it’s something else, and secondly, to determine the best course of action going forward.

Blocking puberty until 18 does not cause lasting harm, and in a few cases may well prevent harm. That is the point, they prevent the lasting physical changes of
puberty until a rational, careful, and well-thought-out decision can be made, and until the child is an adult and able to mentally and legally make adult decisions with lasting consequences.

It is the opposite of making permanent physical changes and the therapy can be withdrawn at any time.

I don’t think I would be absolutely horrified if my sex organs were swapped for another’s. It would squeak me out at first, but that’s just because the change would shock me. But I’d adjust eventually.

However, just because I think I’d adjust doesn’t mean I don’t allow for other people having a hard time with it. I can buy the idea that some people just don’t care either way (especially if they don’t have a strong sexual identity), while others do care.

There must be a lot of people who really really care. These people probably tend to be the prototypes of their gender roles. The little girls who like frilly dresses and carrying around dolly and being little miss princess. The little boys who like getting scruffed up during their various adventures and mischief. And then the rest of us are more like, “OK, I’m a girl? I guess I’ll go with the program. No big deal. Give me that dress over there and I’ll cooperate. Not all of this comes natural, but I’m not going to burn my bra over it.” Or, “I’m a boy? I’m not really macho, but I’ll dress the part. I can hide my feminine ways so as to conform to this society. No big deal.”

The transsexuals are the ones who find such behavior intolerable, because they happen to be more like the first cohort–the ones who identify strongly with gender roles.

This is how I have conceptualized it. Not that NOT understanding means I can’t have an opinion either way, but I think it helps to remove your own judgment from the picture.

How perfectly strange that many people are leery of homosexual adoption.

@Broomstick - I’m being told that the drugs used to block the hormones are not harmless, and can cause lifelong side effects.

Clear child abuse.

Well, it depends on dosage and length of time used, of course.

At high doses for long periods of time yes, there certainly can be side effects. Among the more serious include osteoporosis, as an example. They can cause hot flashes short term.

However - the dosage given to a prepubescent child to block puberty are significantly lower than those used for, say, cancer therapy. Children don’t experience the hot flashes (so far as I know) because that’s a symptom of hormonal withdrawal - it isn’t used to drop hormone levels in these kids, it’s used to stop them from rising in the first place. Using them for 5-7 years to block puberty is not as long as the decades they are sometimes used in adults.

So yes, they’re drugs, mis-used they can have side effects. Even used properly there can be side effects. However, for puberty blocking there’s far less likely to be a problem than in some of the other applications.

Needless to say, proper monitoring of the use of such medication needs to be in place. If a child did have a bad reaction or bad side effects the cost-benefit equation would have to be re-evaluated.

Given that something like 25% of transgender children/teens have attempted suicide at least once by the age of 20, and other scary statistics like that, the risks of puberty blocking don’t strike me as that horrific.