4 ms·

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 h

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.
justinjlynn 5y ago
You're speculating without data and catastrophising. No drug given for any condition is harmless or without risk, don't be daft. It's all about the benefits outweighing the risk, and taking responsibility for that is at the heart of what it means to practice medicine; which is also between a doctor and their patient. You know very well that the risk of not treating the condition is suicide and long-term mental health problems - not to mention a worsening of dysphoria symptoms. Whether or not the patient is willing to risk that potential outcome and other risks later to almost eliminate their risk of psychological distress up to committing suicide now is up to the patient and their team of medical advisers. Not anyone else.
- slumdev 5y ago
  It's neither speculating nor catastrophising. The risks are real and documented. A confused child cannot give informed consent in this situation: "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/
  - justinjlynn 5y ago
    > A confused child cannot give informed consent in this situation: I'd imagine you take the position that a child seeking this care is always confused. Could this be mistaken? Your argument would be void, if so. Further, the quotes you make from the studies you cite are misleadingly cherry-picked - the studies themselves do not support the conclusion you imply they do. They are both calls for further research - they are not studies which draw any conclusions about the risk/benefit trade-offs of treatment and they do not state that treatment should be withheld. > "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 No one denies this. Again, it comes down to benefits of treatment versus risks of no treatment. > "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/ Same here. Surely a patient and doctor have the right to decide to risk infertility or a lack of bone density later in life in order to prevent severe mental anguish and potential suicide now? Would you rather demand the child continue to suffer so that they can have, according to you - as though it were your decision for whatever creepy reason, the best chance of making more children they may not even want or strong bones they may not even use on account of having committed suicide before reaching adulthood?

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.

justinjlynn 5y ago

You're speculating without data and catastrophising. No drug given for any condition is harmless or without risk, don't be daft. It's all about the benefits outweighing the risk, and taking responsibility for that is at the heart of what it means to practice medicine; which is also between a doctor and their patient. You know very well that the risk of not treating the condition is suicide and long-term mental health problems - not to mention a worsening of dysphoria symptoms. Whether or not the patient is willing to risk that potential outcome and other risks later to almost eliminate their risk of psychological distress up to committing suicide now is up to the patient and their team of medical advisers. Not anyone else.

slumdev 5y ago
It's neither speculating nor catastrophising. The risks are real and documented. A confused child cannot give informed consent in this situation: "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/
- justinjlynn 5y ago
  > A confused child cannot give informed consent in this situation: I'd imagine you take the position that a child seeking this care is always confused. Could this be mistaken? Your argument would be void, if so. Further, the quotes you make from the studies you cite are misleadingly cherry-picked - the studies themselves do not support the conclusion you imply they do. They are both calls for further research - they are not studies which draw any conclusions about the risk/benefit trade-offs of treatment and they do not state that treatment should be withheld. > "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 No one denies this. Again, it comes down to benefits of treatment versus risks of no treatment. > "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/ Same here. Surely a patient and doctor have the right to decide to risk infertility or a lack of bone density later in life in order to prevent severe mental anguish and potential suicide now? Would you rather demand the child continue to suffer so that they can have, according to you - as though it were your decision for whatever creepy reason, the best chance of making more children they may not even want or strong bones they may not even use on account of having committed suicide before reaching adulthood?