Doctors Recommend Puberty Blockers for Trans Kids

Recommendations by the international Endocrine Society released last month suggest that children who identify as the opposite gender may be given valuable breathing room if puberty is delayed through medical intervention.

A Dec.10 article in the magazine New Scientist reported on the recommendation, which is a first in the arena of handling cases of juvenile gender identity issues.

Among the benefits of the suggested treatment, the article said, is the fact that puberty-delaying treatments using hormones could make it easier for those children whose sense of being in the wrong-gendered body to transition, through surgical and hormonal means, to a closer physical approximation of the gender to which they feel they belong.

However, there is some concern that the hormone treatment may be used on children for whom the sense of being in the wrong body is a transient one; the article cited a study that suggests that only one-fifth of boys who experience a sense that they should be girls continue into adulthood with feelings that their bodies reflect the wrong gender.

For some transgendered children, the sense of being in the wrong body can lead to psychological distress so severe that it constitutes a threat to their health, leading to suicide or attempted suicide.

Such extremity may in itself justify the use of puberty-delaying treatments; however, as an added measure against subjecting children for whom the sensation of being in the wrong body is transient to such treatments, the guidelines specify that the treatment ought not to be administered until the first physical changes of adolescence have begun.

Such changes--which include the start of breast development for girls and the development of the external genitalia for boys--can be accompanied by strong, adverse emotional responses. In those cases, such negative emotions may act as an early indication that a sense of being the wrong gender physically will continue into adulthood.

With use of such treatments, puberty could be delayed until age 16; but any treatments meant to allow a young person to transition to a more gender-appropriate body ought to be administered no earlier than age 18, according to the recommendations.

In any case, the treatment is bound to generate controversy; indeed, an ABC News report from last spring, which predated the new guidelines, indicated that in the U.S. such treatments had been confused with actual gender reassignment for juveniles.

But in a clinical trial at Leiden University Medical Center in the Netherlands, in which about six dozen children (most 12 and older) were treated with puberty-delaying hormone therapy, the results have reportedly been overwhelmingly successful: the article quoted Henriette Delemarre-van de Waal, who said that, so far, "we don't have any patient who has regretted their decision on the treatment."

Delemarre-van de Waal stressed, however, that the treatment is not prescribed lightly, but reserved for cases in which the sense of gender disconnect is extreme.

The article noted that despite the need for such treatments to begin early to achieve the most effective result, many countries do not allow it for children under the age of 16.

But attitudes toward transgenderism, especially in children, may be beginning to change as the issue becomes more routinely identified with health issues.

The article said that the treatment has begun to be used in Australia, Canada, Germany, and even in the United States.

For children who feel that their bodies are alien to their true gender identities, early intervention may be crucial--even life-saving: the article cited the case of a British child who identified as transgendered when she was four. Though biologically a boy, the child insisted that she was a girl; when the physical changes of puberty began to set in, the child began to harm herself and even to indicate a desire to amputate her own penis.

Said her mother, "It was awful."

The mother continued, "She was devastated and disgusted that things were happening to her body that she couldn't understand."

But the child could not receive treatment to delay puberty in her own country; she had to obtain the therapy in America.

Delemarre-van de Waal indicated that in extreme cases, such marked rejection of a child's physical gender was not uncommon.

Said Delemarre-van de Waal, "They self-harm, they develop an enormous aversion against their bodies, they isolate themselves and their school performance suffers."

The more pronounced gender-specific differentiation that occurs when children reach puberty can scar them into adulthood; said Imperial College London's Richard Green, "It is distressing as an adult that these changes at puberty stand in the way of your appearing as a man or woman."

But such early treatments could mean irreversible effects; if a physiologically male child were to be treated with puberty-delaying therapy, and then underwent surgical gender reassignment, she would never have the ability to produce her own offspring, because she would have neither ova nor had a time during which, as a male, she would have produced viable sperm cells.

Though the male bone structure would be well developed by age 16, making it harder for an adult transsexual to appear female, holding off on the puberty-delaying treatment would also mean that the individual's sperm could be obtained and stored for later reproductive purposes.

Something similar could be the case for girls who later become male; in one instance, a girl who later became a man decided that he wished to employ his remaining female reproductive organs to carry a child.

That option might have been removed, had she received the puberty-delaying treatment, argued the Institute of Child Health's Russell Viner.

Said Viner, "When is it reasonable to let a young person remove major life choices?"

That is a risk, admitted Marvin Belzer, who is with the Children's Hospital Los Angeles, but a small one. Said Belzer, "Some day there's going to be a kid we've treated who comes back and says 'It was wrong--I wish I hadn't done it.'"

In that case, Belzer said, it would be best to be in a position to be able to say, "'Yes, but you and your family gave informed consent, and we knew that was one of the risks, but that risk was small...'"

One of the authors of the recommendations, Peggy Cohen-Kettenis, was also quoted in the article.

Said Cohen-Kettenis, who is with the Free University of Amsterdam Medical Center, "People are always afraid that it will be harmful for the children, but what they never take into account is that it is also harmful to not give them this treatment."

Perhaps the true authorities in the matter are transgendered individuals themselves. The British child who was so disturbed by the onset of puberty that she spoke of removing her own male genitalia, for example, "stated categorically that, 'I would rather die than be a man,'" according to her mother, while Celia MacCleod spent the first 60 years of her life as a man--and expresses the thought that such therapeutic intervention might have made her eventual transition easier, especially in terms of how her voice developed, but also in terms of body hair, bone structure, and facial characteristics, all of which involved varying degrees of intervention, from electrolysis to plastic surgery.

Said MacCleod of the therapy to delay puberty, "I think it will make it easier for people to express themselves and ask for help.

"The idea of being able to have that breathing space of putting puberty on hold and knowing that you're not getting these irreversible changes, I think that's breathtaking."