5 ms·

What, if any, are the permanent consequences of being on puberty blockers from, say, 13-18? I’d guess they’d be significant but that’s just a guess.

angus-prune 5y ago
All the research I’ve seen shows no significant consequences to taking puberty blockers. Puberty proceeds as normal once the puberty blockers have been stopped. Puberty has quite a wide range of onset ages and this is not taking the range that far beyond the historical range.
- nahnahno 5y ago
  What research have you done? Because it doesn't take long to find evidence that they have a list of side effects including some not-so-innocuous ones, and the admission that research is lacking: Possible long-term side effects of puberty blockers Lower bone density. To protect against this, we work to make sure every patient gets enough exercise, calcium and vitamin D, which can help keep bones healthy and strong. We also closely monitor patients’ bone density. Delayed growth plate closure, leading to slightly taller adult height. Less development of genital tissue, which may limit options for gender affirming surgery (bottom surgery) later in life. Other possible long-term side effects that are not yet known. https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers https://www.stlouischildrens.org/conditions-treatments/trans...
  - angus-prune 5y ago
    Quite extensive research actually. The overwhelming medical consensus is that puberty blockers are safe, and this is backed up by over three decades of their use in treating trans youth and even longer in treating precocious puberty. I leave it to the reader to determine whether they think having to take vitamin supplement counts as a significant side-effects. I would note, however, that it is also important to put these side effects in context. The contraceptive pill, for instance, also has reduced bone density as a possible side-effect. My reading of the research also does not indicate that it is majorly lacking. Medical research is written in a very conservative manner. Researchers avoid making claims beyond the limits of their research. This can look like doubt or uncertainty when it is not.
    - nahnahno 5y ago
      > Researchers avoid making claims beyond the limits of their research. My experience as a Ph.D. researchers is exactly this. > This can look like doubt or uncertainty when it is not. No, it is absolutely real uncertainty. The difference between knowing a topic and knowing something about it is vast, and in the space is sophistry.
  - slumdev 5y ago
    It's negligent that a hospital's website doesn't mention the severest consequence of puberty blockers: infertility.
pseudalopex 5y ago
Decreased bone density is a concern. This is monitored. It can be mitigated with supplements and exercise. And it isn't known if it's permanent or only for the duration of treatment as far as I know. AMAB patients have less penile tissue for vaginoplasty. They have other options though. I don't think anyone has studied mature penile size in AMAB patients who decided to go through male puberty. Few do.
- slumdev 5y ago
  So an "AMAB patient" who takes puberty blockers never develops into an adult man and would require surgery to simulate the appearance of being an adult man if he decided he wanted that? And people insist that these drugs are harmless?
  - pseudalopex 5y ago
    No. Patients who stop taking puberty blockers and don't take other hormones go through puberty more or less like they would have without blockers.
    - slumdev 5y ago
      The research does not agree. "The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172 "GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents." https://pubmed.ncbi.nlm.nih.gov/31319416/ https://pubmed.ncbi.nlm.nih.gov/31319416/
      - pseudalopex 5y ago
        I addressed bone density. The 1st paper said it wasn't clear if the effects were permanent. It identified several confounding factors in the relevant study. It went on to recommend monitoring, supplements, and exercise. It also said switching from puberty blockers to cross sex hormones at 14 instead of 16 would help. The 1st paper said fertility may be compromised "if puberty is suppressed at an early stage and the patient completes phenotypic transition with the use of cross-sex hormones". Not if they decide not to transition. And cross sex hormones can compromise fertility on their own. The 2nd paper said "There is no substantiated evidence that GnRHa treatment for CPP impairs reproductive function or reduces fertility." Because those patients don't take cross sex hormones when they stop the blockers. Unknown effects on brain development means no known effects. The only study mentioned found no significant detrimental effects.

angus-prune 5y ago

All the research I’ve seen shows no significant consequences to taking puberty blockers. Puberty proceeds as normal once the puberty blockers have been stopped. Puberty has quite a wide range of onset ages and this is not taking the range that far beyond the historical range.

nahnahno 5y ago
What research have you done? Because it doesn't take long to find evidence that they have a list of side effects including some not-so-innocuous ones, and the admission that research is lacking: Possible long-term side effects of puberty blockers Lower bone density. To protect against this, we work to make sure every patient gets enough exercise, calcium and vitamin D, which can help keep bones healthy and strong. We also closely monitor patients’ bone density. Delayed growth plate closure, leading to slightly taller adult height. Less development of genital tissue, which may limit options for gender affirming surgery (bottom surgery) later in life. Other possible long-term side effects that are not yet known. https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers https://www.stlouischildrens.org/conditions-treatments/trans...
- angus-prune 5y ago
  Quite extensive research actually. The overwhelming medical consensus is that puberty blockers are safe, and this is backed up by over three decades of their use in treating trans youth and even longer in treating precocious puberty. I leave it to the reader to determine whether they think having to take vitamin supplement counts as a significant side-effects. I would note, however, that it is also important to put these side effects in context. The contraceptive pill, for instance, also has reduced bone density as a possible side-effect. My reading of the research also does not indicate that it is majorly lacking. Medical research is written in a very conservative manner. Researchers avoid making claims beyond the limits of their research. This can look like doubt or uncertainty when it is not.
  - nahnahno 5y ago
    > Researchers avoid making claims beyond the limits of their research. My experience as a Ph.D. researchers is exactly this. > This can look like doubt or uncertainty when it is not. No, it is absolutely real uncertainty. The difference between knowing a topic and knowing something about it is vast, and in the space is sophistry.
- slumdev 5y ago
  It's negligent that a hospital's website doesn't mention the severest consequence of puberty blockers: infertility.

pseudalopex 5y ago

Decreased bone density is a concern. This is monitored. It can be mitigated with supplements and exercise. And it isn't known if it's permanent or only for the duration of treatment as far as I know. AMAB patients have less penile tissue for vaginoplasty. They have other options though. I don't think anyone has studied mature penile size in AMAB patients who decided to go through male puberty. Few do.

slumdev 5y ago
So an "AMAB patient" who takes puberty blockers never develops into an adult man and would require surgery to simulate the appearance of being an adult man if he decided he wanted that? And people insist that these drugs are harmless?
- pseudalopex 5y ago
  No. Patients who stop taking puberty blockers and don't take other hormones go through puberty more or less like they would have without blockers.
  - slumdev 5y ago
    The research does not agree. "The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172 "GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents." https://pubmed.ncbi.nlm.nih.gov/31319416/ https://pubmed.ncbi.nlm.nih.gov/31319416/
    - pseudalopex 5y ago
      I addressed bone density. The 1st paper said it wasn't clear if the effects were permanent. It identified several confounding factors in the relevant study. It went on to recommend monitoring, supplements, and exercise. It also said switching from puberty blockers to cross sex hormones at 14 instead of 16 would help. The 1st paper said fertility may be compromised "if puberty is suppressed at an early stage and the patient completes phenotypic transition with the use of cross-sex hormones". Not if they decide not to transition. And cross sex hormones can compromise fertility on their own. The 2nd paper said "There is no substantiated evidence that GnRHa treatment for CPP impairs reproductive function or reduces fertility." Because those patients don't take cross sex hormones when they stop the blockers. Unknown effects on brain development means no known effects. The only study mentioned found no significant detrimental effects.