What the Science Says About Trans Teens on Puberty Blockers (CW: Self-Harm) (Patreon)

Transcript:

Last month Ken Paxton, the current Attorney General of Texas, published a nonbinding opinion that parents who provide their trans kids with science-based medical care should be investigated for child abuse. This was quickly followed by Greg Abbott, the current governor of Texas, publishing a directive to the Department of Family and Protective Services to do just that. That department immediately placed one of their own employees on administrative leave pending an investigation into them for helping their 16-year old trans child through gender-affirming care. The department demanded the family turn over the teen’s medical records. The family refused and has enlisted the help of the ACLU of Texas and Lambda Legal, who have filed a lawsuit to block the records request and challenge the legitimacy of Abbott’s order.

This is all, obviously, a gigantic clusterfuck that puts trans kids and their families at serious risk. So I just want to talk about it a little bit and go over a few things that seem to be confusing people, including myself at first.

First of all, what is the “gender-affirming care” that is suddenly considered child abuse in Texas? Well, Abbott’s directive to the DFPS lists the following: “reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen.”

Let’s take those in order. Surgeries DO sound like a big deal: maybe we SHOULD restrict teens from getting elective surgery that might be difficult or impossible to reverse, right? Well, it turns out that we already do: current medical guidelines by and large suggest that teens wait until they’re 18 to have procedures like genital or chest surgeries, usually after they’ve been on hormones for some time. Rarely, teens as young as 16 have been evaluated and found to be of sure enough mind to have surgery.

So, we can dismiss that as something that doesn’t really happen. Abbott also mentions puberty blockers, though, and that DOES tend to be prescribed for teens under the age of 18. So what are they, and why do people like Abbott think that they’re abusive for teens?

Puberty blockers do essentially what it says on the tin: they press the “pause” button on the flood of hormones we get when we enter puberty. They are completely reversible, in that once you decide you want to start puberty, you simply stop taking the blockers and boom, your hormones leap into action. Most puberty blockers are gonadotropin-releasing hormone (GnRH), delivered into the body via monthly injections or through an implant in the arm, just like this one I have in my arm that releases progestin into my body to prevent me from getting preggers. That’s right, I’m a cyborg and it’s fucking awesome.

Anyway, puberty blockers have been around for decades and are used to treat a variety of problems, including cancers that are affected by sex hormones like prostate cancer. Some kids experience puberty way earlier than normal which can cause a variety of issues, so they take the blockers until they’re closer to 10 or 11. Then they stop and have a totally normal puberty.

For trans kids, they can be a godsend (or a science-send I guess): you can probably imagine that if you fervently believe you are, say, a girl, things may get really upsetting when you start getting random erections and sprouting heavy facial hair. Hell, I find it upsetting when I sprout heavy facial hair and I’m not even trans.

Teens can start puberty blockers any time after puberty begins, usually 12 or so at the earliest. They help by giving a trans teen TIME: time to consider what they truly want, or time to get ready for what’s coming down the road. Once they’re older (current recommendations are 16, but exceptions as young as 14 can be made for very mature teens) they can decide to go off the blockers and either experience puberty as the sex they were assigned at birth or start taking hormones to essentially experience puberty as the opposite sex. After a year or more on hormones, they can then decide around the age of 18 if they want to proceed with surgeries.

So why do people like Abbott consider puberty blockers “child abuse” if a teen can go off them at any time and experience puberty like normal? Well, this was kind of tough to nail down, for the main reason that puberty blockers are overwhelmingly safe with little to no known negative side effects.

But opponents claim a few things about puberty blockers: one, that they’re irreversible (they are, as mentioned, easily reversible). And two, that they may cause loss of bone density and sterility later in life. I’ve even seen those things mentioned in places like the Mayo Clinic’s site, but they say blockers MAY cause these things. That’s not good enough for me so after reading far more research on this than I’d honestly like, it appears to me that the medical consensus is that none of that is true: puberty blockers do NOT cause loss of bone density or sterility. A systematic review of the literature by “authors designated by multiple pediatric endocrinology societies from around the globe” found “Adverse effects of GnRHa therapy are rare, and the associations of most reported adverse events with the GnRHa molecule itself are unclear. Decades of experience have shown that GnRHa treatment is both safe and efficacious.”

Further, “There is no substantiated evidence that GnRHa treatment impairs reproductive function or reduces fertility,” and in regards to bone density, while “GnRHa treatment slows mineral accrual, after discontinuation BMD appears not to be significantly different from that of their peers by late adolescence. Reports of BMD among children and adolescents verified a decrement in BMD at the achievement of near AH, while accrual resumed after therapy, regardless of whether or not calcium supplementation was given. By late adolescence, all subjects had BMD within the normal range.”

Note that these were kids who experienced early puberty and they had heavier bone density prior to taking blockers, but even if trans kids did experience a loss of density that’s something they and their doctor could watch for and control either by switching to a different puberty blocker or by taking medications to increase bone growth. In other words, even if it does happen in rare cases it’s simply not a big deal.

We know all this because we have DECADES of research on puberty blockers used not just in trans teens but in countless kids with “precocious puberty” (the medical term, which makes it sound cuter than it is). Puberty blockers are safe, easily accessible, and easily stopped and the body naturally “reverses” them.

So to recap, the more-or-less ideal timeline goes something like this: you’re a child who feels gender dysphoria prior to puberty and your parent supports you with an environment that’s friendly and non judgemental. Wear the clothes you like. Cut your hair how you want. Use whatever pronouns you fancy. When puberty hits around 10 or 11, you discuss blockers with your doctor. You can go through puberty or delay its onset while you think more about who you are and who you want to be. You take the puberty blockers for a few years, and at 16 you decide that yes, you would like to transition to the opposite sex. You discuss it with your parents and your doctor and begin taking the hormones for whichever sex you’re transitioning to. You begin growing body hair and muscles and breasts and whatnot, and after a year or two on hormones you get a better idea of how your new body will feel, so you can decide one of three paths: “detransition” back to the sex you were assigned at birth which will require different hormone treatments, continue taking the hormones you’ve been on for longer, or undergoing surgery. You’re now 18 and if you’d like, you can make these decisions without your parents’ consent because you are an adult.

None of what I described is child abuse. What COULD be considered child abuse is the ideal situation imagined by people like Greg Abbott: your thoughts about how you feel in your own body are suppressed throughout childhood and when puberty arrives it’s terrifying and painful and confusing. You suddenly think about killing yourself at a rate twice that of your peers. You have a 40% chance of following through with that thought.

There’s a reason doctors refer to the use of puberty blockers in trans youth as literally “life-saving”. A large-scale survey conducted last December found that gender-affirming care for trans and nonbinary teens resulted in a signficant drop in depression, suicidal thoughts, and suicide attempts, and then ANOTHER big study published just last week found exactly the same: “gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.”

The science on this is crystal clear: the rational guidelines doctors have set up to treat kids with gender dysphoria are working. They aren’t just safe, they’re necessary to save lives. They’re saving and improving lives. As we’ve seen with other issues like abortion care, doctors and scientists have no need for politicians like Greg Abbott to insert themselves where they do not belong.

I’m so incredibly proud of the Texas families that are fighting back. It’s brave enough to support your kid who probably turned out a lot different than you had expected, and who probably brings a lot of heat on you for not “conforming.” To not only do that but to then step up and say “Fuck Greg Abbott, fuck the prospect of fines and jail time and CPS investigations: I’m going to love my kid the way they deserve to be loved”...my heart is with them.

If you’d like to support these families and these teens, you can donate now to Lamda Legal, which is not only fighting for transgender lives in Texas but also across the country. I have ads on this video and will be donating 100% of the ad revenue to Equality Texas, a nonprofit that fights for the rights of LGBTQI people across the state via political action. Thanks for watching and please stay safe!