A new report written by three well-respected medical experts and scholars questions the safety and effectiveness of pressuring gender-confused children to undergo "radical" and "experimental" puberty-blocking hormone therapy even though the treatment and its side-effects haven't yet been adequately researched by the science and medical communities.
The new report, Growing Pains: Problems With Puberty Suppression in Treating Gender Dysphoria, was published by quarterly journal The New Atlantis on Tuesday.
It argues that while puberty suppression therapy through hormone intervention is increasingly being recommended for children with gender dysphoria and at younger ages, there is little evidence that shows that puberty suppression is "reversible, safe, or effective for treating gender dysphoria."
"Psychologists do not understand what causes gender dysphoria in children and adolescents, or how to distinguish reliably between children who will only temporarily express feelings of being the opposite sex from children whose gender dysphoria will be more persistent. Until much more is known about gender dysphoria, and until controlled clinical trials of puberty suppression are carried out, this intervention should be considered experimental," the report states. "Regardless of the good intentions of the physicians and parents, to expose young people to such treatments is to endanger them."
The report was authored by Paul Hruz, an associate professor of pediatrics, endocrinology and diabetes and associate professor of cell biology and physiology at Washington University in St. Louis; Lawrence Mayer, Johns Hopkins University School of Medicine scholar in residence and professor of statistics and biostatistics at Arizona State University; and Paul McHugh, Johns Hopkins University's distinguished service professor of psychiatry.
It is a follow-up to a special report written by McHugh and Mayer last year for The New Atlantis on gender and sexuality. The scholars argued, among many other things, that studies have shown that gender dysphoria in children most often does not persist into adulthood.
However, the new report argues that puberty blocking treatments may make it more likely that patients who might have otherwise identified as a member of their biological sex when they become an adult will still continue to identify as a member of the opposite sex from which they were born.
The authors criticize a 2016 guide for families of transgender children that was produced by the American Academy of Pediatrics and the American College of Osteopathic Pediatricians, in partnership with the pro-LGBT political advocacy group Human Rights Campaign. The guide, they argue, promotes a "drastic and experimental measure."
"The guide says that 'to prevent the consequences of going through a puberty that doesn't match a transgender child's identity, healthcare providers may use fully reversible medications that put puberty on hold.' Delaying puberty, according to the guide, gives the child and family time 'to explore gender-related feelings and options,'" the authors cite.
"Reading these various guidelines gives the impression that there is a well-established scientific consensus about the safety and efficacy of the use of puberty-blocking agents for children with gender dysphoria, and that parents of such children should think of it as a prudent and scientifically proven treatment option. But whether blocking puberty is the best way to treat gender dysphoria in children remains far from settled and it should be considered not a prudent option with demonstrated effectiveness but a drastic and experimental measure."
The report explains that there has been "no controlled clinical trials comparing the outcomes of puberty suppression to the outcomes of alternative therapeutic approaches — there are reasons to suspect that the treatments could have negative consequences for neurological development."
During a conference call Tuesday, Hruz warned that many parents who allow their children to go through with this treatment might not be confronted with the fact that it is still in an experimental stage. The report states that the use of GnRH analogue drugs for gender dysphoria still has yet to be approved by the Food and Drug Administration
"Thinking about it as a physician and scientist, in all other areas, we would demand rigorous information in using a new treatment for a new indication. In essence, what is being done with these children is uncontrolled experimentation on them and they are not even being told that they are being experimented on. It is not presented in that way," Hruz stated.
"So the normal safeguards that are normally present when experimenting on children are not being provided for them. The parents who are asked to allow their children to go through these treatments are not told accurately the status of the knowledge and there are many questions that remain."
In their report, the authors contend that the growing accepted assertion that puberty-blocking treatments are "fully reversible" overlooks basic facts about the effects of the drug if taken for a prolonged period of time.
"In developmental biology, it makes little sense to describe anything as 'reversible.' If a child does not develop certain characteristics at age 12 because of a medical intervention, then his or her developing those characteristics at age 18 is not a 'reversal,' since the sequence of development has already been disrupted," they state.
Moreover, taking the drugs can make a person infertile and cause other unknown side-effects that haven't been well researched yet.
The authors conclude that "more research is needed to resolve unanswered questions and to elucidate new ways to help people cope with gender dysphoria with less permanent and drastic treatments."
"The use of puberty suppression for minors is a radical step that presumes a great deal of knowledge competence despite the ignorance in the scientific about the nature of gender identity," the authors assert.
Considering that McHugh and Mayer faced immense backlash from many in the LGBT advocacy community who tried to discredit their 2016 report because it was published in a non-peer-reviewed journal, a FAQ page released by The New Atlantis defends the authors from likely arguments that could come from political activists who try to discredit the report.
"The Human Rights Campaign, among other critics, has tried to discredit The New Atlantis by pointing out that it is not peer-reviewed. Yet HRC promoted a special 'gender resolution' issue of National Geographic — also not a peer-reviewed publication — which dealt with 'how science is helping us understand gender,'" the FAQ page reads. "We will let readers decide for themselves whether HRC and its allies are truly concerned with scientific integrity or simply looking for an excuse, no matter how feeble, to ignore medical experts who disagree with them."
McHugh has also been criticized by LGBT advocates who try to discredit his research as "anti-LGBT work."
"Dr. McHugh has on many occasions been attacked personally by activists who are unable to discredit his work but see it as a threat to their own agendas," the FAQ page states. "Nevertheless, his record as a scientist, clinician and leader in the field of psychiatry is unimpeachable, as is demonstrated by his position at the Johns Hopkins School of Medicine and his membership in the National Academy of Medicine."
Hruz, who was not an author on Mayer and McHugh's highly-read 2016 report, explained on Tuesday's call that the report "provides a background to understand what is being proposed as a safe and effective and recommended treatment and raises the concerns. There are side effects that we don't have knowledge [of] and it is not being studied in a rigorous way."
He also commented on the issue of political ideology interfering in scientific debates.
"It is very evident that there is an element of ideology superimposing itself into science that is present here. Good scientists and good physicians are accepting this without the same rigor that they would otherwise demand," he said.
"It is very clear that the ideology is driving suppression of people that recognize the difficulty that is going on here, at least among academics, that the discussion that would normally go on is being muted because of the ideology and how vocal the advocates for this particular intervention is preventing people from raising legitimate scientific and medical questions."