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Chris's avatar

I was hoping this would be a very short article. Answer: It can't ethically be done. The End.

"What are the long-term effects of stopping natural puberty on brain and body development?" Nothing good. And you can't ethically test this when you're measuring something subjective like "gender identity".

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Emwisnie's avatar

I agree with you, the challenge here is that philosophical argumentation is insufficient for those who wish to maintain that the science is the only view into this issue.

If you want to convince those stuck in scientism then the sacrifice of children (although of course not their children) is necessary. If we carefully thought through the ethics on this issue we would never have subjected any human to this treatment ever in the course of human history. But we have, and now we have to deal with the notion that in some proportion of cases these interventions may appear harmless even if the act itself is harmful.

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David Charles's avatar

How in hell can the word ethical be used in an article about puberty blockers?

These people should be in prison.

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Regina's avatar

I recently had my first baby. During the course of the pregnancy and breastfeeding (ongoing) I noticed how often providers told me “We can’t do that for you.” Be it, dilate my eyes during an eye exam, allow me to use teeth whitening strips, certain types of skincare, etc. When I asked “What is the concern?” Often I was told “We don’t know exactly bc this can’t be studied in an ethical way.” And yet here we are with literally hundreds of thousands of children.

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Ute Heggen's avatar

Congratulations on becoming a mother! I remember all of that. Be well, make sure this child knows you cannot change sex! Enjoy, take lots of videos and photos and hopefully get sleep!

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Attachment Unavailable's avatar

I agree with you, Andy. I don't see how a clinical trial of this sort could ever be just or ethical. That's why they have been going full speed ahead on unjust and unethical trials on our children, and then trying to cover up all the damage it has done.

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George Q Tyrebyter's avatar

Actually, to the best of my knowledge, there are no "clinical trials" on GAC. There is one study, which is being run by complete idiots - including Olson-Kennedy (very prominent GA therapist). In 2 years, they have already lost track of 30% of cases.

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Hazel-rah's avatar

Yes. It ends up being a trick question, because it would be impossible to conduct such a trial ethically. Puberty blockers never should have been trialed for long-term use to begin with. The Dutch Protocol study should never have been done. It completely ignored the very obvious and profound question of what these kids would be giving up physiologically by never going through normal puberty.

So why did it happen?

The answer to that question deserves entire articles, books, documentaries and government inquiries, and hopefully it will get those, but the very short version is that at heart it was a theoretical conclusion looking for a justification.

They started with a Theory - that their medically-transitioning adult subjects who were unhappy with their secondary sex characteristics and trying to get rid of them, would be happier if they only could have started transition earlier, before those traits could develop.

So why not try transitioning some likely patients earlier, and see if they turn out happier?

But they weren't research-oriented scientists, they were clinicians. They were mostly blind to the problem with that theory. The only outcome they were focused on was the ideal patient, for whom everything worked out perfectly, who was completely happy and well-adjusted with their transitioned body. They weren't considering the reality that for every one of their patients with that result, there were going to be a bunch with less-ideal outcomes, some of them actually pretty awful. And that there would be no way to tell ahead of time which ones were which.

But they fooled themselves into believing that they could overcome that problem. They did their best to optimize their chances of success - they chose only kids who appeared to have the full support of their families (at the time anyway), who had no diagnosed co-morbidities (at the time).

They didn't think about what the kids were giving up, because again, they were hyperfocused on the theoretical ideal patient, for whom everything that they gave up turned out to be worth it.

Sterility? Yes, that was a given, everyone who has bottom surgery becomes sterile, their patients accepted that.

Side effects of the hormones? Yep there were some, but their ideal patients were insisting that it was all worth it. Their actual, objective health outcomes weren't supporting that, but the patients were in deep denial about that, and these clinicians were taking their word for it.

Complications from surgery? Worth it!

Damaged gonads and sex organs? Doesn't matter, the ideal patient is going to end up getting rid of them anyway!

Nonexistent sex life and minuscule dating pool? Lots of denial about that too, and easily blamed on the "hate" present in the general population.

And then there are the problems specific to starting before puberty.

A lifetime of no orgasm for the males.

Having to use a piece of the colon for the vaginoplasty because the penis was too small.

Pelvic floor damage for females.

Bone demineralization for both sexes.

And worst of all, a lack of cognitive/emotional maturation - they literally never grow up, not just in body but also in mind. Actual Peter Pans.

Some of it would have been difficult to anticipate, but some of it should have been, and NONE of it should have used actual children as guinea pigs.

THEY ARE ENDOCRINOLOGISTS. This is their specialty. They have no excuse.

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Ute Heggen's avatar

The Dutch protocol study (DeVries, Steensma, Cohen-Kettenis, et al, 2014) started with 70 subjects, dropped inexplicably to 55, lost 1 to suicide post surgery and lost 1 to sepsis post surgery. It should have been halted.

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Attachment Unavailable's avatar

I'm always thankful for others who are doing their due diligence in reading up on the facts surrounding this subject!

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Ute Heggen's avatar

There is no such thing as an "ethical clinical trial" for injecting children with poison that will deteriorate their bones. We already know "trans" ideology runs completely counter to accepted child development, such as Piaget's stages of development and the milestone of object permanence. The recent German, Finnish, Swedish and Danish studies of medical records already tell us that mental health does not improve with "transition" as inpatient stays in psychiatric hospitals, suicidal ideation and actual completed suicides go up in the years post surgeries and hormones. The Cass Review actually tells us all we need to know about the shaky foundations of this radical movement. As well, the damage to society, the girls and women who can't be guaranteed respect, dignity and fairness in sports, change rooms and toilets is not to be ignored. It is a psychiatric illness, often a result of trauma or abuse in childhood. The sexual fetish aspect is the placebo effect of that distracting activity. The LGB community is well advised to jettison the TQ--it is not a sexual orientation. Don't get me started on the physical and sexual assaults on the wives of suddenly demanding, crossdressing men. To learn about it though, because it it's real:

https://www.youtube.com/watch?v=owyUun77TKo&t=54s

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Mark Christenson's avatar

I was worried that there would be some justification (although I couldn’t for the life of me figure out how the author would get there). Was glad to see that there isn’t a way to ethically test PBs.

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Hippiesq's avatar

I agree with all the commenters here and with the conclusion of this article. There is no such thing as an ethical puberty blocker experiment. Because there is no medical illness that actually threatens the life or bodily function of the potential subjects, it makes absolutely no sense to subject these children to toxic chemicals that have many known and likely many unknown negative effects and put these children on a certain path to sterility, sexual dysfunction and a life-time of dependence on synthetic chemicals to keep them "healthy," but less healthy than they would be without such interventions to begin with. Children need to all be given the chance to grow up in their intact bodies. When we do experiments on cancer patients, it's because, if we didn't, many would die from the illness or at least lose functioning of various body parts. When we experiment on children with "gender distress," we are basically punishing these kids for being less resilient in the moment than other kids. It's a sick idea.

Lastly, I note that, as mentioned, using our medical resources for such an experiment is itself unethical. These kids can still live fine lives with "gender distress," especially if they aren't told that they will commit suicide if they don't change their appearance immediately! However, there are real medical illnesses that need experimental treatments. My trans-identified daughter told me about experimental drugs that were actually helping children with "childhood alzheimers" (something called San Philippo Syndrome). This disease robs young children of all their functional (including the ability to talk, walk, etc.) and then kills them by the time they are in their late teenage years. The study that was done showed real improvements for these children - and then they ran out of funding. One little girl my daughter was following started to slip and lose functioning pretty soon after stopping the treatments. Let's please put the money being spent to harm perfectly healthy children with "gender distress" into saving children with San Philippo Syndrome. We can help the "gender distressed "children by reminding them how lucky they are to have healthy bodies, helping them realize that they can be happy without changing their bodies, and allowing them to express their masculinity and/or femininity however they like - without chemical and surgical interventions that will harm their health.

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George Q Tyrebyter's avatar

Before a clinical trial into puberty blockers is considered, the basic understanding of the impact of PB on youth must be understood. None of that has been considered. Have animal trials on equivalent species been performed? The MOST BASIC information is missing - bone density, growth patterns. Most importantly, what do PBs do to the development of sexual function? What do PBs do to the increased brain development during puberty?

Let's consider how we would run a clinical trial in the addictive properties of heroin. Would we recruit adolescents, and then have 2 levels of heroin strength, to see if they would be addicted after 30 days of heroin? Actually, we wouldn't do that because we know that heroin is addictive. But my point is that we know so much more that such a study could be done. We know so little about PBs.

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Truth_Hurts's avatar

Indeed. I don't know the current status of the field but there should be many, many years of animal studies (mice do go through puberty!) before even Phase 1 trials in humans can begin. Even then, I doubt such an interventional drug study for minors would be approved by the FDA.

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Sufeitzy's avatar

In short, it can’t. Gender, as a fiction, can no more be a subject of medical research than Leprechaunism or Pixism.

The mere presence of gender, like claims of Demonic possession instead of schizophrenia or psychosis, automatically renders research meaningless.

Imagine “how we could legitimately look at trepanning as a treatment for Demonic possession.”

In any “unhappiness” study you’d have to first eliminate anxiety and unhappiness as being solely due to puberty as opposed to a delusion. Surprisingly anxiety at puberty is quite common, and I suspect if identified would simply wipe out all cases of “wrong body syndrome” dysphoria.

Fascinatingly psychiatry doesn’t seem to have made a connection between puberty anxiety, the ever growing early puberty entry in girls, and the fantasy of puberty “pause” - I note a concept created by psychiatrists? Pause? I guess that’s up there with lobotomy and drilling holes in skulls for demons.

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Emwisnie's avatar

“The mere presence of gender, like claims of Demonic possession instead of schizophrenia or psychosis, automatically renders research meaningless.”

This assumes that demonic possession is not real and all cases of demonic possession must be mental illness. Even the American Psychiatric Association makes the claim that spiritual possession a real phenomenon and spiritual practices appear to alleviate these cases where psychiatric care fails. These cases are known to be extremely rare.

The trick is to be able to discern when mental illness is present and treating for it instead of assuming every case of demonic possession is mental illness or no mental illnesses is comorbid with possession.

Same too for gender. Many people do believe there is a self-conception of a person’s sex, some people call this gender. Some people have a profound distortion of their self conception, that is called gender dysphoria.

The trick is to know when it is gender dysphoria and how best to treat it (non-intrusive psychological care) and when it simply isn’t present (the majority of cases). The wrong thing to do is to assume no cases of gender dysphoria are real and all are complex psychiatric or psychological cluster problems or all derive from sexual trauma or other co-morbidities.

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Jul 16
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Sufeitzy's avatar

Growth hormone would kick in two years later so that child should have ovulation suspended until it is synched with the other hormonal systems.

Frighteningly, in some countries (Sweden) when a girl starts growing too fast some parents accelerate puberty to keep her short.

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Mary O'Connor's avatar

Thank you Andy Lewis for this great column and Colin for publishing it. As a medical researcher, I was trained, as all must be, on the ethical requirements for medical research. As you so clearly write, these requirements cannot be met for puberty blockers.

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Sandra Pinches's avatar

During the 1990's-2000's adult men looking for "sexual reassignment surgery" were told that they would be able to have orgasms with their surgical vaginas, because the surgeons preserved the original penile tissue that could have orgasms. I don't know if the gender surgeons all promised this outcome as certain, but I do know that trans-identified men generally expected that they would be able to have "vaginal orgasms." This has turned out not to be true. I doubt if the surgeons know what percentage of transitioned men are able to function sexually or to what extent, because there hasn't been enough well designed research on long term outcomes with surgical vaginas in men.

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Jul 16
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Sandra Pinches's avatar

I worry that people will continue to do crazier and crazier things with their bodies as technology enables it. I think that the increasing availability of cosmetic genital surgeries was the main reason for the increase in self-diagnosed gender dysphoria cases during the Nineties.

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GBM's avatar

Another barrier to controlled studies is the absolute requirement that enrollees not be surrounded by ideologically biased caregivers who are dedicated to a specific outcome which the trial is trying to assess. This is one of the most egregious aspects of current gender-affirming care. In the name of supportive care, these confused, immature patients are surrounded by cheerleaders who are committed to their OWN personally endorsed long-term outcomes. Nevertheless, an undetermined minority eventually elect to detransition.

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Catherine Robilliard's avatar

Some men get off on children being mutilated. Thousands are making big money from it. The all important buck are f-k are strong forces.

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James Hammerton's avatar

As I understand it, puberty blockers are sometimes used to treat precocious puberty. How was this established to be a safe, effective treatment?

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Emwisnie's avatar

I would really appreciate if we stopped using language that inferred trans-ideology is tantamount to religious practice, i.e. “a sacrament–a ritualistic baptismal entry into the world of “trans” identities.” Stop alienating your religious audience.

A sacrament is not an “entry way into an ideology”, a sacrament is the divine institution of grace through a symbolic ritual. The sacrament does something material to soul of the person, whether or not the person believes it to be true, or the person conferring the sacrament believes it to be true or not. It isn’t a visible material change, but a spiritual one.

Providing hormones to children does not “baptise them”, it’s not conferring spiritual grace, it doesn’t leave an indelible mark on their soul that is not erasable. Providing hormones to developing children materially alters their physical development and materially changes these children in physically irreversible ways that are profoundly harmful to both their body and their soul.

Please just speak to the ideology as it is. I think we want to assume that religion is to blame for this practice, but religious people persistently have pushed back against the atheists and naturalists who promote this practice. We are consistent in our use of theology and philosophy to rationally argue the point that these so-called treatments are not only ethically dangerous but are inherently irrational.

Don’t assume science alone is going to solve this catastrophe, a good understanding of philosophy and theology will vastly improve the ethical arguments in this issue. We can help you, don’t push us away because you think demeaning your enemy by calling them “religious” is somehow helpful, they’ll just dig their heels in further.

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