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Preserving Choice: Lupron And The Medical Ethics Of Treating Transgender Children

Over the past year or so, there’s been a curious and sudden surge of awareness in the general public consciousness about the issue of transgender children. While their existence is something that has been going on for… well… forever, and the trans community has certainly been aware of the likely fact that gender identity is typically developed very early in life (even if not always precisely articulated and negotiated until later) and have been aware of the issues related to it, it seems that it wasn’t until 2011 that it was all that discussed or considered in the general imagination.

Yet now we’re beginning to find it in the news. The actual, mainstream news. There was Storm, the child in Ontario who was not openly assigned a gender by hir parents, the story of the identical twins Nicole and Jonas in Boston, one a trans girl and the other a cis boy, and the issue of Bobby Montoya, a young trans girl, being included in a Colorado Girl Scout troop. Last week a 10-year-old trans girl from England who has faced significant exploitation, dehumanization and misgendering by the media (I wonder which paper, possibly beginning with the word “Daily” and ending in the word “Mail”, may have been involved?), appeared with trans media activist Paris Lees on BBC Breakfast. I found out about this through the shower of horribly transphobic tweets that followed. And recently there’s been a controversy surrounding a father in Berlin’s efforts to have his 11 year old transgender daughter involuntarily admitted to a psychiatric hospital so as to ensure that she cannot follow through on her wish to prevent a masculinizing puberty (and ideally, in his view, “cure” her and have her somehow become a typical cisgender boy).

There’s a very key thing to remember: prevention.

I have no idea what’s triggered this cultural shift, and why this issue (and trans issues in general) are suddenly beginning to be paid attention to rather than ignored, ridiculed or sensationalized as they have been for the past half-century. Maybe some kind of zeitgeist thing with our movement? I may talk about that some time soon. As a whole I regard this as a good thing, a step in the right direction. This is how we move forward. We still have a very long way to go, and a long, hard, vicious fight ahead of us, and we’re a good fifteen years behind the gay/lesbian rights movement (at least), but we’re making progress. At least now people seem to know we exist. We’ve achieved visibility.

Trans children, though, raise a number of difficult ethical considerations, and while these stories allow on the one hand for a very humanizing portrayal of trans lives (it’s much, much harder to call a child a freak, an abomination, a sinner or someone who deserves to be stomped into a mudhole), it is also able to be almost effortlessly spun into a spooky tale of the horrors and moral failures of modern society by those with the means and motive to do so. With each story of trans lives and trans rights that are now entering the mainstream media (I know, mainstream media. I still feel a little bit shocked every time I type it) there also comes a reactionary transphobic response from the right wing viewing this as a collapse of some fundamental family value thing.

These responses to the stories of trans children inevitably swathe themselves in the panicky, transphobic, fear-mongering and painfully dishonest rhetoric of “doctors now giving sex changes to kids!” (where were you self-righteous fuckers when they were performing non-consensual genital surgery on intersex infants?!). There’s an undeniable parallel between this rhetorical tactic and the language of “Obama forcing religious organizations to pay for employees’ abortion-causing drugs!”  …it’s also every bit as much about controlling other people’s bodies and sexuality. What terrifies me is the degree of success that this kind of strategy has had in controlling the debate surrounding contraception and abortion, and how effectively they’ve been able to use these simple but incredibly disingenuous terms and redefinitions to frame the discourse to their own preference. I’m terrified that they’ll be able to similarly control the discussion surrounding transgender minors.

The thing is, the ethical ambiguities of transition for minors are apparent to anyone. If someone takes the statement “doctors are giving sex changes to kids!” at face value, of course they’re going to be appalled. Even the most trans-friendly cis readers will look at that and find it ethically dodgy and unscrupulous at best. A minor can’t possibly provide informed consent for a medical treatment with such intense, long-term and irreversible implications and consequences. It would be horrible to allow an 11-year old to just say “I want to be a girl!” and then go ahead and perform a vaginoplasty right then and there.

Making this issue scarier is how enormously uninformed (or misinformed) the cis public are about transgenderism, transsexuality and related treatments, like lack of awareness of how ridiculously and needlessly difficult it is for even an adult to be approved for SRS. Most people simply aren’t going to understand the medical processes involved well enough to spot the lies, spin and manipulative rhetoric when they see it. Most people don’t know the differences  between and definitions of anti-androgens, feminizing and masculinizing sex hormones, lower surgery, top surgery, facial feminization surgery,  binding, tucking, tracheal shave, LHR, electrolysis, hysterectomy, etc. Most people just have a vague conception of “sex change operations”. Thanks to our good friend Shoddy Media Portrayals Of Transsexuality, the popular conception is that it’s an all-in-one surgical procedure: in walks a boy, out walks a girl (the popular conception doesn’t even include the vice versa, of course).

So if the reactionary, right-wing, transphobic contingent of society are able to control the terms of the discourse, and frame this as “doctors giving children sex changes!” (rather than, say, “transgender children being permitted access to medical options to preserve their choices and prevent traumatic and irreversible physical changes”), that will have terrible consequences in terms of how the public reacts to the issue of trans kids as it gains increasing visibility. There’s just not going to be enough cis people who understand this stuff well enough to fight that. We could easily end up in a situation where legislation is passed barring doctors from offering blockers to transgender children, and forcing them to endure an unwanted, hellish, traumatic living nightmare of an adolescence as their body develops in exactly the wrong way. And the general public aren’t going to give two damns about the number of suicides this will lead to, if they even hear about it. All they’ll hear is echoes of “doctors giving sex changes to kids!”

This is why it’s extremely important to address this now. To raise awareness and understanding, define the terms of the discourse and make sure the actual reality of what’s being discussed is clear. For instance, no one is talking about giving SRS to minors.  It’s important to do all this before the misconceptions, lies and spin become entrenched and people look at it as something other than what it is.

The most important thing is that people be aware of the actual treatment that is offered to trans kids. It is not SRS, and it’s not even masculinizing / feminizing hormones like testosterone or estradiol (except in very rare, special circumstances). Treatment for minors typically involves Lupron.

Lupron, or Leuprorolin, is an agonist against certain pituitary receptors. It down regulates secretion of luteinizing hormone and follicle-stimulating hormone, and leads to very significant reduction in testosterone and estradiol levels in both sexes.

Basically, what Lupron does is delay the onset of puberty and the irreversible physical changes that go along with it. Lupron does not, in and of itself, cause any significant irreversible changes. What it does is preserves the child’s choice. It maintains a physiologically “blank slate” state in regards to secondary sex characteristics until they’re old enough to make an informed decision about transition, and provide consent for more serious, long-term treatments like hormone replacement therapy or SRS (such as around age 17 or so). Naturally, the child can choose to present or identify in whatever manner they choose during this time, and should be able to socialize relatively easily as their identified sex.

This has enormous benefits for a transgender child. In the case of a trans girl, for instance, you’ll prevent skeletal masculinization (irreversible), deepening of the voice (irreversible), the development of body hair and facial hair (the latter of which can only be eliminated through lengthy and extremely painful and expensive laser or electrolysis treatments), and allow the physiological process of transitioning to female to be far, far easier than it otherwise would have been, and also provides the additional psycho-social benefit of her being much more easily able to blend in and be accepted as her identified sex. Perhaps most importantly, you prevent an extremely traumatic, miserable, painful adolescence. You allow her to be able to enjoy the remainder of her youth instead. Puberty is already a pretty traumatic and horrible thing to endure, but when you’re trans and your gender identity doesn’t match what you’re body is turning into it is, like I’ve said, a waking nightmare. Needlessly subjecting a child to that is beyond reprehensible. It’s a form of torture. I wouldn’t wish any young girl to go through what I went through.

Conversely, in the unlikely case that the child doesn’t end up choosing to transition, and instead ends up choosing to live as their assigned sex instead, there’s been little to no long-term consequences from the Lupron being used as a preventative medication. Once it is discontinued, adolescent development can continue normally. If for whatever reason it doesn’t, it can be easily assisted through administration of testosterone or estradiol and progesterone.

It is also important to note that absolutely no medical intervention, not even Lupron, is either necessary or prescribed until adolescence. This is a case of teenagers being given a harmless means of preserving their own choices that we’re talking about, not 9-year-olds being put under the knife. We need to make sure that remains EXCEPTIONALLY clear, and not allow anyone to distort this into seeming like the latter. A 9-year-old who was assigned male may identify as female, and her parents may permit her to present as female and refer to her by a female name and pronouns, but so what? That’s not an issue of bio-ethics, it’s simply a set of parents making a choice to be loving and accepting, making the choice that they feel (almost certainly correctly) is best for their daughter. It’s nobody’s fucking business.

Another issue worth considering is the ways in which we’ll often try to advise that now’s not the best time for trans people. And trans people will themselves use this rationalization in their own thought processes. It’s important to understand that this statement, this means of denying the legitimacy of a trans identity, is used at every point in a trans person’s life. Within this mentality, “now” will never be the “best time”. There was a fantastic write-up of this at Cisnormativity a little while ago that provided the inspiration for this post. Basically, we say that now isn’t the best time in the case of children because they’re not old enough to know their own gender yet (bullshit; gender is one of the very first things we understand about ourselves). We say that now isn’t the best time in the case of teenagers because it’s too complicated a time in their lives and they’re still trying to figure out their sexuality and they’re all hormonal and it’s “probably just a phase” and so on. We say that now isn’t the best time for young adults in their 20s because they need to find work, and they can’t afford it, and their friends and family will shun them, and they have too much to lose, and besides it’s “too late” now anyway and they’ll never “pass” or find love or be happy (this is the one that kills me… within these rationalizations we go immediately from thinking we’re “too young” to thinking we’re “too old”). We say that now isn’t the best time for adults in their 30s or older because it’s definitely “too late”, they have too many responsibilities, they may have a spouse and/or children that they don’t want to hurt, they have a career they can’t risk, they’re “just going through a mid-life crisis” etc. At every point in a trans person’s life, there’s a justification that can be found to claim that they ought not transition at this point. The arguments we use against allowing minors to define their gender for themselves are no more reasonable, rational or justified than the ones we use against adults.

Now that this issue has ceased to be a private matter of individuals and families, and instead emerged into cultural visibility, I do worry about where things will go. I periodically participate and volunteer with Vancouver’s Trans Youth Drop-In. It’s a fantastic organization, really. What they do is provide a nice, friendly, safe space for trans youth to just come and hang out. Food and beverages are provided, as well as things like movies, video games, art stuff, activities, etc. It’s really an awesome, wonderful thing, and provides exactly what a lot of young trans people need the most… a space where they can feel safe, accepted, understood and “normal”.

That group has been a bit of an inspiration for me. It’s amazing to see all these kids who had the strength, courage, self-awareness, clarity, love and support to be able to transition before putting themselves through all the pointless pain and self-hatred. It’s the kind of thing that I’d expect myself to be bitter, jealous and a bit resentful about, but for some reason I’m just… not. Instead I’m just happy for them. I admire them and wish them the lives they deserve, that we all deserve.

It’s probably been my most distinct motive with all of this, with taking on this sort of role and getting involved in trans activism and everything. There are a lot of risks involved, it’s draining and exhausting, it’s often rather thankless, it usually seems utterly bleak, it sometimes seems hopeless, I have to constantly read and write about incredibly depressing things, I expose myself to all kinds of hostility, I’ve chucked my ability to reliably go stealth out the window, and it certainly hasn’t made my own life any easier or provided any material reward. But what it keeps coming back to for me, over and over again, is that I want young trans people, and the generations to come, to have a better world than the one I got. I want them to be able to just be who they are and not have it tied up in all the shame and hatred and ridicule and everything. I don’t want them to have to worry about any of the stuff I’ve built a blog out of worrying about. Do you know what I mean?

So when I see this issue being discussed in the media, I’m excited and proud. But I am also scared out of my mind.

Please, can this one turn out alright?

Comments

  1. Chrisj says

    A minor side-point, in a way, but I wonder whether the reason that trans* people are suddenly becoming big news isn’t in part because the religious “right” know that the argument about homosexuals is simply a matter of time? That is, they’ve realised that they need a new “evil enemy” to spit at because in another decade or two it’ll be unacceptable for them to treat their current main targets like that in public.

    • KaraC says

      I fear you may well be right. Since we are little understood by the general public, we become an easy target to be labeled delusional and otherwise dehumanized. Natalie is right to call upon us to help educate and correctly frame the issues.

  2. A says

    Thanks a lot for pointing this out! I was aware that SRS is extremely hard to obtain for adults, and impossible for minors. However, I had assumed that a masculine puberty either happens or not – it’s fascinating that it can be blocked and restarted later.

  3. jeffengel says

    Do we have studies we can point to to confirm that gender self-identification – specifically, identifying as having a gender identity that doesn’t match one’s native anatomy – is stable from childhood through adolescence into adulthood? It would be exactly the thing to use to address concerns that childhood or early adolescent transgender identity isn’t some “phase” or “mistake”.

    • says

      I’m not aware of where to find the actual studies, but my understanding is that in early childhood it actually can be, and often is, “just a phase”. At least, open cross-sex behaviour often is… it can be all kinds of things, not simply a sign of a variant gender identity. I’m not sure whether or not that same fluidity is true of cross-sex identification in early childhood (the difference being between insisting on behaving like the “opposite” sex and consistently stating that you are the opposite sex).

      If I remember correctly, though, cross-sex identification in adolescence is almost never “just a phase”, especially the type that first emerges in adolescence (this kind typically being a negative response to the gendering of the body). It’s as unlikely as homosexual identification in adolescence to be a “phase” (though just as in homosexuality, it CAN, on rare occasions, happen).

      • Anders says

        Snooping around PubMed:

        Care of the child with the desire to change gender–Part I.
        Gibson B, Catlin AJ.
        Urol Nurs. 2011 Jul-Aug;31(4):222-9.
        PMID:
        21913596
        [PubMed]

        Care of the child with the desire to change genders–Part II: Female-to-male transition.
        Gibson B.
        Urol Nurs. 2011 Jul-Aug;31(4):230-5.
        PMID:
        21913597
        [PubMed]

        Care of the child with the desire to change genders–Part III: Male-to-female transition.
        Gibson B, Catlin AJ.
        Urol Nurs. 2011 Jul-Aug;31(4):236-41.
        PMID:
        21913598
        [PubMed]

        Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study.
        Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT.
        Clin Child Psychol Psychiatry. 2011 Oct;16(4):499-516. Epub 2011 Jan 7.
        PMID:
        21216800
        [PubMed - indexed for MEDLINE]

        Abstract
        The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14-18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different.

        Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study.
        de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT.
        J Sex Med. 2011 Aug;8(8):2276-83. doi: 10.1111/j.1743-6109.2010.01943.x. Epub 2010 Jul 14.
        PMID:
        20646177
        [PubMed - indexed for MEDLINE]

        Abstract
        INTRODUCTION:

        Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment.
        AIM:

        To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents.
        METHODS:

        Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment.
        MAIN OUTCOME MEASURES:

        Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinician’s rated Children’s Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed.
        RESULTS:

        Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.

        You need to learn how to navigate PubMed, Natalie.

        • Anders says

          The last study says that of 70 kids between 12 and 16 years of age, treated over 8 years with Lupron and Lupron-like drugs not a single one dropped out. If that is true, and not just a misunderstanding from my side, that is almost unbelievable. You always have drop-outs. Always. These kids must have an extraordinary commitment to this treatment.

          • Anders says

            I’m stupid. They enrolled when they were between 12 and 16 years and were (presumably) treated until they were 18 (although the abstract doesn’t say). So they were treated between 2 and 6 years. At the end of 8 years, a total of 70 adolescents had gone through the program. All progressed to HRT (I assume).

            It’s still almost unbelievable.

    • thaismcrc says

      But even if it is stable, there’s also the question of the age of consent for certain medical interventions. Like Natalie said, what’s prescribed is totally reversible. The issue then becomes at what point is a person capable of making irreversible decisions. Basically, it is the question of when do people become adults, which is very, very difficult to answer. Of course, you don’t need to be an adult to have figured out your gender identity, but we, as a society, have established that certain things (like voting, owning property and making medical decisions) require a level of autonomous decision-making that children do not have. There’s a similar debate with regard to sexuality. What is the appropriate age of consent for sex? The truth is that there is no universal standard, that people develop differently, and the only thing we can do is say “starting at this age, we are confident that people have attained a level of maturity and autonomy that enables them to make that type of live-altering decision”.

  4. Marshall says

    What terrifies me is the degree of success that this kind of strategy has had in controlling the debate surrounding contraception and abortion, and how effectively they’ve been able to use these simple but incredibly disingenuous terms and redefinitions to frame the discourse to their own preference.

    THIS. The recent successes in this area really worry me. At CPAC a panel basically suggested re-framing the debate by simply calling the healthcare mandate that the bishops have been jumping up and down about an ‘abortion mandate’. If they could succeed in re-framing things in that way it introduces an entirely new dynamic into the discussion.

    And this is for things that are generally understood and accepted by the public at large, like contraception. When it comes to issues surrounding marginalized groups (and trans people in particular, as you said the level of public awareness is nowhere near that of many other groups) re-framing the debate would be even easier, and the moment you bring children into the equation emotions run high on all sides. As cliche as it is, it’s still a common tactic on the right, screaming “WHAT ABOUT THE CHILDREN?” as a way to inject the level of emotion necessary to whip people into a frenzy of fear about things they have very little understanding of.

  5. Anders says

    This debate has not reached Sweden yet, but I’ll tell you when it does. We’re usually two or three years behind North America.

    Side effets of Lupron includes depression (10-29%) and stroke (1%) + a lot of things that are generally not serious for kids (impotence, for instance). Note that these numbers are from use on adults and I have no idea whether the same is true for kids. My guess is not. Depression can be treated effectively and should not be irreversible if we have to stop treatment (e.g., irreversible psychotic depression – which should be fantastically rare).

    I’m still a little worried about long-term effects on this system. I found a study (http://jcem.endojournals.org/content/84/1/44.short) on long-term effects on girls treated for early puberty and they found that the girls who had received Lupron had a weaker response to LH (the hormone directly affected by Lupron – LH causes the testicles to produce testosterone). This may indicate that boys who receive Lupron will have a weaker response to LH including reduced fertility or even sterility. But that chain of reasoning has so many weak links its not even funny. If you say this is torture I believe you – why would you lie*?

    I’m so happy that you enjoy helping trans youth. Would you consider helping me as well? The Sekrit Projekt has collapsed into a parody – three cismen quibbling about stuff we quite frankly don’t know crap about. But this project is currently my pride and joy and I truly think it could benefit the trans community enormously. It would be something giving cispeople help to understand cis privilege and the hardships of trans life just by sitting down at a computer and make a few choices. Sound interesting? I will e-mail you shortly.

    • Anders says

      I forgot the asterisk…

      *unless it’s true that Transsexual people are out to convert innocent children to their wicked ways. Is it true that you get a set of steak knives when you’ve converted 30?

      • says

        No, you’re thinking of the gay agenda. The trans agenda is simply maintaining our status of privileged elites, and sneaking into bathrooms to listen to women pee. We’re a much more exclusive club. You have to petition for membership.

        • Emily says

          It’s really tough to get anyone to sign that petition, too. Once you get in, you get the key to The Secret Vault of Tranny Wisdom, and a master key to all the Women’s Bathrooms in your country of choice.

          ;)

        • Anders says

          Hah! I’m on to you. You’re just in it for the health benefits. After all, women live – on the average – longer than men. It’s just a trick to deplete our retirement funds, cheating honest, hardworking Fundamentalists of their well-earned money.

  6. Izzy Leonard says

    Brace yourself hard, Natalie. The Trans Rights movement may be where the Gay Rights movement was 10-15 years ago, but it is going to progress much, MUCH faster. They didn’t have the internet when they got going. Ever thought much about how gay activists found each other and networked in the 80′s? I can’t even imagine how it was possible. Nobody wonders how trans rights activists network today.

    This is going to play out fast, painfully, and almost entirely within our lifetimes. It is scary, but I am excited.

  7. Anders says

    This is a bit personal, but Natalie? You said you were 14 when you worked everything out. Would Lupron have been an option for you? Is there a limit to how far puberty can have gone for Lupron to be an option?

    • says

      Lupron would be an option at almost any point in adolescence. It won’t undo much of the “damage” that’s already been done, but it would prevent further changes. In my case, not much had happened by the time I was 14. I was just beginning to masculinize. Lupron would have been ENORMOUSLY beneficial.

    • says

      Sadly, there is knowing about yourself, and then there is knowing that the medical options exist. Not every adolescent trans person is vocal about their feelings. I could (if I had not been terrified of saying anyting) have said, with confidence, at the age of at least 11 (maybe earlier, my memories are blurry), that I would gladly not have gone through male puberty if I had known such a possibility were available. The early signs of puberty were already appearing, and I was horrified by every knew thing I noticed. But the thing is, while I knew that this was a nightmare I wanted to stop, what I didn’t know was that there was any way out of the nightmare (whether or not it was readily accessible in 1991 is another question). Or, for that matter, if I could tell anyone without being laughed at and ridiculed into oblivion…

  8. Decnavda says

    Thank you very much for this. Prior to reading this post, I had in my mind destinguished between supporting “transgendered” kids versus “transsexual” kids – I had no idea that suppresing puberty in a reversable manner was even possible. Delaying the choice makes perfect sense, and humanity’s ability to do so is a miracle of science. Let’s see someone do this through prayer.

  9. Anders says

    Lupron is a fascinating drug in itself. GnRH is normally released in pulses from hypothalamus. Lupron acts like GnRH, but since it is given as a depot prearation, changing the release pattern from pulses to a constant level it has the opposite effect.

  10. Anders says

    Most people don’t know the differences between and definitions of anti-androgens, feminizing and masculinizing sex hormones, lower surgery, top surgery, facial feminization surgery, binding, tucking, tracheal shave, LHR, electrolysis, hysterectomy, etc. Most people just have a vague conception of “sex change operations”. Thanks to our good friend Shoddy Media Portrayals Of Transsexuality, the popular conception is that it’s an all-in-one surgical procedure: in walks a boy, out walks a girl (the popular conception doesn’t even include the vice versa, of course).

    Will there be a series of posts on the different phases on transition – at least the trans woman route that you would be familiar with? It would be muchos appreciated. From what I understand it takes some 5-7 years, so a little more than a single visit may be required.

  11. Makoto says

    Thanks for posting this. It’s hard to counter misinformation out there without knowing the facts, and I often don’t know the questions to start asking without getting flooded with falsehoods. Much appreciated!

  12. valeriekeefe says

    I think my only concern with this piece is the double-standard when relating to puberty: The idea that a cis puberty is something any teen can consent to, but a trans puberty needs to be held off until the age of majority.

    Logically then every child, no matter how sure and how repeatably they assert their gender identity, should be on a prophylactic course of Lupron.

    And perhaps we should consider that not all first puberties are equal: That testosterone does more to mark a person than estrogen. That much was apparent when you were discussing the horrific effects of puberty. Estrogen didn’t appear.

    At any rate, delaying a puberty, a puberty that someone is repeatedly and emphatically consenting to, and letting the efficacy of that puberty diminish, is still policing trans identities.

    • says

      I know what you’re saying, and yeah, it’s true that testosterone causes more dramatic and less reversible physiological changes than estrogen. But I think if you were to ask a trans guy about the horrific effects of a feminizing puberty when you don’t identify as female, he’d have PLENTY to say on the matter.

      • valeriekeefe says

        I agree, I was just pointing out that perhaps the discussion on unwanted puberty is, and might, in terms of community opinion, stand to be, a little cismisandristic.

        (Not that I have any problem with a little healthy cismisandry. ^_^)

    • says

      Logically then every child, no matter how sure and how repeatably they assert their gender identity, should be on a prophylactic course of Lupron.

      I like this idea. But, of course, cis children don’t assert their gender, their genitals do it for them, and so cis people generally assume that ours do the same, and are a better authorty on the subject than we are.

    • Anders says

      Wouldn’t estrogen close the epiphyseal plates, causing trans men to be shorter than the average man? Does Lupron block the normal growth spurt?

  13. Sheila says

    The “Maybe you should never transition” article got covered (and derailed) on metafilter. Due to that trainw reck, I searched for articles on the outcome of treatments for transgender children.

    Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up

    “[...] This first report on long-term effects of puberty suppression suggests that negative side effects are limited and that it can be a useful additional tool in the diagnosis and treatment of gender dysphoric adolescents.”

    You should also keep handy a list of references for what happens to children who aren’t allowed any treatment.

    • Anders says

      Very interesting. Now, that was begun at Tanner Stage P3 (pubic hair is curly) and B3 (breasts are beginning to form). Presumably better results could be had by starting treatment earlier – if the patient is reliably classified as having gender dysphoria. Very, very interesting.

      I’m a little miffed that I didn’t find that myself, actually.

  14. sidneyia says

    Does taking hormone blockers during puberty make it harder for a trans woman to have SRS later on, if she so chooses? That is, does she need to have adult anatomy for the surgery to be successful?

    (Note – this is intended as a purely medical question. I am definitely NOT of the opinion that children can’t make the choice to transition. This is just something I’ve been curious about for a long time. If it’s inappropriate to ask medical questions here, please let me know.)

    • says

      That’s a good question, actually. I imagine it actually could end up creating some real challenges in terms of the amount of available material with which to construct a neo-vagina. But certainly material can be borrowed from elsewhere to help out with additional depth… there are other methods, such as using skin taken from the inner thigh, or material from the colon.

      I know that loss of material if one of the main reasons that it is advised that a trans woman not undergo orchiectomy if she’s planning on pursuing SRS soon afterward.

  15. Emburii says

    The comments for the article on the eleven-year-old girl are surprisingly supportive; there’s one outright troll and a few people playing concerned cave dwellers, but mostly it’s people rightly dumping on the father for his close-mindedness and cruelty. A bright spot, maybe?

  16. Movius says

    There was a panel at TAMOz in 2010 on Science Based Medicine that is vaguely related. During a discussion on common surgeries that are often performed in situations where the benefit is not proven beyond placebo, Dr. Steve Novella made the comment that most doctors do not keep up to date with the medical literature as much as they should. Thus, even if a treatment has recently shown to be wrong, doctors will continue to prescribe it by reflex, (and the reverse too.) So, even though medical science is self-correcting in the long run, it can take up to 20 years for these things to sort themselves out.

    It might be cold comfort to those who have or are in the process of missing out on 20 years of treatment. But todays knowledge combined with the slow, relentless grind towards a science-based view of medicine should see those growing up transgender in 2030-40 having much better treatment.

  17. says

    “…a situation where legislation is passed barring doctors from offering blockers to transgender children…”

    Ohhhhhhhhh @#$%. I hope not. I didn’t think of that, but maybe it could happen. On the potentially more hopeful side, maybe some cis children would want to delay puberty too?

    By the way, a lot of doctors still /are/ recommending or performing nonconsensual sex-enforcing surgeries on children. I recently met an activist who tries to talk doctors out of it–she compares their methods to similar methods from the Middle Ages (no joke), and it’s remarkable how they don’t like that.

  18. Nikki says

    Lupron causes osteoporosis. Why isn’t this a concern for trans youth? I have endometriosis with pelvic adhesions. I was offered Lupron as a treatment for my endo because birth control did not help me. I REFUSED to take Lupron because ALL of the endo patients in my support group had horrible things to say about it.

    One of the girls in my my support group shrunk TWO INCHES from being on Lupron for two years. She had reached the “maximum allowable treatment” and extensive surgeries.

    Have they even researched the longterm effects of Lupron on children? Nine years of Lupron is a LOT. Sounds VERY scary :(

    Why on earth are you all saying this drug is harmless? I absolutely do not agree with you here.

    I sure hope they find a safer alternative for trans youth.

    • valeriekeefe says

      They have, it’s called Es-Tro-Gen.

      But we must protect children from the horrible spectre of being trans, mustn’t we?

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