WASHINGTON — Many children and families struggling with gender dysphoria are not receiving the facts about the permanent consequences associated with "experimental" puberty-blocking and sex-reassignment treatments, nor are they being told that justification for such treatments are not backed by strong scientific evidence, doctors warned Wednesday.
"Much of what is being done here can be considered experimental treatment," Paul Hruz, a St. Louis-based doctor who is a professor of pediatrics, endocrinology, cell biology and physiology at the Washington University School of Medicine, said during a panel discussion on transgender medicine hosted by the conservative think tank The Heritage Foundation.
"But that is not how the public is hearing about this and [not] what the patients themselves and the families who are dealing with this issue are being presented with."
Hruz, who co-authored the June report published in The New Atlantis titled Growing Pains: Problems With Puberty Suppression in Treating Gender Dysphoria, and Dr. Michelle Cretella, the president of the conservative American College of Pediatricians, joined Dr. Allen Josephson of the University of Louisville and Heritage Foundation senior fellow Ryan Anderson to discuss the dangers and long-term consequences linked to the use of hormone therapy and puberty suppression treatments on children.
Although a number of mainstream medical societies and organizations have been recommending over the last decade that children who suffer from gender dysphoria be given a puberty-blocking drug and later be treated with cross-sex hormones before potential sex reassignment surgeries, Hruz said that "the evidence behind this new treatment paradigm is slim to none."
"If you are going to take a standard approach to a treatment condition of any sort — not just gender issues, and make that drastic of a change — one would expect that there was a landmark study that was done, a randomized, controlled trial or a series of very important findings that consistently showed that this is a good idea," Hruz argued. "The reality is there is no science to back this drastic change."
"What I am saying to you is widely acknowledged by the experts that are putting this forward. I was just at an International Endocrine meeting last month and the new International Endocrine Society guidelines were being presented and the question was asked: 'What evidence is there that long-term we are doing good for these individuals?'" Hruz explained. "These are the people that put forward these treatment guidelines. The answer was: 'We have no evidence.'"
Hruz argued that the most reliable evidence about pubertal blockade or hormone therapy only highlights the "complications of therapy."
As children are beginning to identify as transgender at ages as young as 2 years old, Hruz criticized experts who advocate putting children through a process of pubertal suppression and present it to parents as a "safe and reversible form of intervention."
"Repeatedly by the experts, this is presented as safe and fully reversible form of intervention. Yet, there is no clear study that was done in this population," he said. "It is an off-label use of the medication and to make the claim when you have no data is really an injustice not only for our medical profession but for our entire society."
Hruz highlighted potential difficulties associated with pubertal blockade.
"The claim that it is fully reversible is self-contradictory because what you are doing when you do a pubertal blockade is you are interrupting a normal developmental process," he explained. "Even if five, six or seven years later you stop that intervention, you cannot go back in time. You have already altered that development. It is incorrect and totally false to say that it is reversible."
Hruz also said that it's well established that hormones play a vital role in skeletal development. He noted that there is concern that people who take puberty blockers may be at risk of Osteoporosis later in life.
Hruz stressed that an undoubted consequence of suppressing puberty and then treating children with cross-sex hormones is that it renders them infertile.
"When you follow up pubertal blockade with cross-sex hormones it's generally accepted that this is going to be irreversible," he explained. "Again, we are talking about children, children who ... are in the process of exploring and developing [their sexuality] and they are being made infertile at a time when they are making these decisions at these ages."
Cretella warned that gender clinics tell parents of children struggling with gender dysphoria that they "must" transition their child or else they will "grow up to commit suicide." However, such treatment is not Food and Drug Administration approved, she said.
"What the experts don't share with the family is this is an off-label use, it's not FDA-approved," Cretella said of the puberty-blocking drug Lupron.
When Lupron is used to treat prostate cancer in adult men, it is associated with memory problems, Cretella stated.
"We found similar findings when the Lupron is used to treat certain gynecological issues in adult women," she added. "We have never had long-term studies on puberty blockers being used in biologically normal children. This is experimentation."
According to Cretella, puberty blockers can sometimes further "psychosocially isolate" children from their peers because they won't develop normally at a time when most of their classmates are. At such a point, Cretella says that children are put on cross-sex hormones.
"These [estrogen and testosterone] are serious drugs," she stressed. "Over the lifetime, they raise your risk of cardiovascular disease — cardiac arrest, stroke, diabetes, various cancers. These are not benign medications. And, they also can cause depression, anxiety. I thought [depression and anxiety] is what we wanted to treat. This is the standard of care now. It is not supported by science. It's ideology."
Hruz confirmed that it is "very-well known" that the risk for cardiovascular disease and stroke are "significantly increased" when people undergo cross-sex hormone treatment.
At about the age of 15, Cretella said that girls who wish to be males are cleared to have their breasts removed.
"The [American Academy of Pediatricians] isn't concerned with the increasing numbers of adult women who are coming out online ... saying, 'My physicians and therapists shepherded us along this path. They transitioned us to male. We now have no breasts, we are sterile because of puberty blockers,'" Cretella said. "They are waking up at age 28 or so and saying 'Oh my gosh, what was done to me?'"
Hruz argued that science demands that ideas that are put forward in medicine, such as gender transition treatments, need to be challenged scientifically. He contended that the drive of political activists to silence all who criticize hormone therapy and pubertal suppression treatments is "a threat to our practice of medicine and scientific integrity itself."
"For any investigator to put forward an alternative hypothesis to this current treatment paradigm is met with hostility," he said.