Puberty blockers have become widely used for gender dysphoria only in the past decade. Photo / Matese Fields, Unsplash, File
Puberty blockers have become widely used for gender dysphoria only in the past decade. Photo / Matese Fields, Unsplash, File
Opinion by Jan Rivers
OPINION
Having last year removed advice that puberty blockers are a safe and reversible medicine, the Ministry of Health has said it will publish an evidence brief on the medicine in May.
A number of overseas reviews are likely to influence this decision. Those in the UK by NICE andOxford University, Ireland, Finland, Sweden, Norway and Australia have shown evidence for the use of puberty blockers is poor.
The editor-in-chief of the British Medical Journal has written that much of the guidance from medical associations proposes treatments that are not supported by evidence and that the risk of overtreatment is real.
The NZ Media Council recognises there is a legitimate debate but there has been little media coverage of the issue here.
Other sources show why the “safe and reversible” claims have had to go.
The Pharmac data sheet for the PB Goserelin says it must not be used in children. FDA advisory notifications advise of serious health risks.
Analysis of academic research has found that, after two years of use, the drugs were linked to abnormally low bone density in up to a third of young adolescents.
Dr Marci Bowers, president of the World Professional Association for Transgender Health (WPATH), has said that any male child whose puberty is fully suppressed will never orgasm, an important part of human loving, and their penis will not grow to full size.
There’s more. Children carefully selected by Dutch clinicians in the early 2000s for treatment are doing poorly compared with their peers. It appears that social transition makes puberty blockers more likely but children’s mental health does not improve.
Once a child is taking puberty blockers, cross-sex hormones follow but testosterone frequently causes pelvic pain encouraging hysterectomy and pain from chest binders leads to a greater likelihood of mastectomy.
Clinicians and others may tell parents their child will commit suicide without treatment. However, this is not supported by research and evidence shows it is rare.
New Zealand rates of puberty blocker use are much higher than the UK, where the Tavistock Clinic’s Gender Service (GIDS) is being closed due to unsafe practices. In New Zealand, Dr Sue Bagshaw reports that 65 per cent of her clinic’s 100 patients receive them. The Tavistock GIDS clinic prescribed blockers to about 6 per cent.
The overall New Zealand rate is higher too. Pharmac data shows New Zealand has had 703 children on puberty blockers compared with about 1000 prescribed them in England over the same 10-year period.
The “guidelines for gender-affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand” require no diagnosis. Rather, clinicians are advised they should “recognise that each individual is the expert of their own gender identity”. That is, each child, regardless of their age, and any other mental health issues, is to be treated as an expert.
Treatment is already highly devolved and work is under way to make puberty blockers available from more general practices.
Moreover, the 2022 World Professional Association for Transgender Health standard has removed surgery age limits. Surgery, such as a double mastectomy, has already been performed on a New Zealander aged 16. (”Born in the Wrong Body”, The Listener, June 26, 2021).
Meanwhile, the Ministry of Education Relationship, Sexuality and Education Guidelines present being transgender as an option to all primary school children, who are encouraged to use their preferred name and pronouns.
Auckland University researchers asked thousands of 8-year-old children which gender they identified with.
Schools turn to “rainbow” advocacy groups that give extra attention and support to these children. Such interventions question the claim that no one encourages children to be transgender.
Given what the health system now knows about blockers, attempts to explain gender identities as if they are a neutral and cost-free option seem very unwise.
- Jan Rivers is a former public servant and independent researcher on sex and gender and co-author of Sex Gender and Women’s Rights which was published in 2021 in Policy Quarterly.
