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Puberty blockers aren't reversible, because puberty has an end date. Also puberty is a natural function of the human body. We can only do our best to support c

Puberty blockers aren't reversible, because puberty has an end date. Also puberty is a natural function of the human body. We can only do our best to support children going through it, but it's not even worth contemplating whether we should "let" a child go through it or not. That makes no biological sense. For better or worse, humans are mammals whose offspring require _significant_ amount of care for much longer than any other mammal. We might not like it on a theoretical level, but practically speaking and evolutionarily, parents are responsible for their children until their children come of age. When it comes to legitimate trans kids the aim should be education of and societal support of parents to be as informed as possible, not to circumvent them if some _other_ adults deem it necessary. A doctor is not the legal caretaker of a child, only the parents are.

wizzwizz4 1y ago
Saying puberty has an end date is like saying the flooding caused by the removal of a dam has an end date. It's true, but that end date depends on when you remove the dam. (Although a better analogy would be a pump filling a reservoir, sex hormones being the flow rate, puberty being flooding, and GnRH pulsing being the action of the pump.) It's more accurate to say that puberty has a duration. > puberty is a natural function of the human body The onset of puberty is way earlier than it used to be. Per http://www.mum.org/menarage.htm http://www.mum.org/menarage.htm, "In 1860 the average menarche happened at 16.6 years,"; per https://www.thetimes.com/uk/science/article/girls-now-begin-puberty-aged-9-9v8fc6x3fmk https://www.thetimes.com/uk/science/article/girls-now-begin-..., "Girls now begin puberty aged 9". Delaying puberty until age 16 could be argued as the more natural stage (though I take such arguments 'round back, and beat them to death, especially if they support my beliefs: the naturalistic fallacy is too seductive to listen to). > That makes no biological sense. Biologically, there's no reason* we couldn't make them wait until adulthood to begin puberty. You've not quite identified where the ludicrousness is – though you're close. Past that point, I think you're doing what I did earlier, and arguing against a position I haven't taken. (Unfortunately, I'm less eloquent than you, so I'd spend several paragraphs if I were to correct you: I'll trust in your ability to work it out.) > the aim should be education of and societal support of parents to be as informed as possible A thousand agreements: this is the ideal. All other situations are pathological special-cases – though, like antivax parents, they're special-cases that the medical system does have to take into consideration. (I don't know whether you have a general-purpose equivalent of Gillick competence in Norway, but see https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines https://learning.nspcc.org.uk/child-protection-system/gillic....) This isn't a point I've been trying to focus on, since it follows once correct handling of the ideal "everyone's informed and with the child's best interests at heart" case is established. --- *: Biiiig asterisk here: abnormal pubertal timing is associated with health problems (see https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/ https://www.endocrinology.org/endocrinologist/134-winter19/f... and citations), but we don't have solid data on the arrow of causation, nor good data on confounders (social attitudes seem to be a problem in the US, and https://doi.org/10.1542/peds.2005-2939 https://doi.org/10.1542/peds.2005-2939 strongly suggests that social/psychological effects have a big impact on onset of puberty), so that would be a separate point. There are no known problems caused by the use of GnRH modulators to postpone puberty (except low bone density, which per https://doi.org/10.3389/fped.2022.968485 https://doi.org/10.3389/fped.2022.968485 and https://doi.org/10.1210/jcem.87.2.8202 https://doi.org/10.1210/jcem.87.2.8202 is temporary and goes away in puberty, and per https://doi.org/10.6061/clinics/2012(06)08 https://doi.org/10.6061/clinics/2012(06)08 doesn't occur at all – and can be ameliorated with calcium and vitamin D supplementation), and afaik there's no theoretical expectation of such problems (except, again, bone density: I'm not sure that anyone knows why that isn't more of an issue, since it is sometimes an issue when GnRH modulators are used post-puberty – though the patient information leaflets I've read still stress the treatment as extremely safe in adults (with more assurance than I'd have given, but hey, I'm not an expert)). For the sake of the thought experiment, please pretend there are no such issues.
- simianparrot 1y ago
  I haven't researched the topic in detail yet, but looking at official data in Norway the _average_ puberty age is 13,2 years and has remained stable for 70+ years. There's a lot of simply intuitive factors to consider with older data: It was, for example, beneficial to _hide_ puberty because of older societal norms about consumption of marriage. I'm not sure we can trust older data. My instinct tells me that _if_ the age is sliding, then the first place to look is where we've made the biggest human interventions already. Vaccination -- and no I'm not anti-vaccines, but like any medicine, these have various side-effects -- and likely significantly more important, food and additives. In Norway we do not allow growth hormones in feed for livestock that is to be consumed by humans; could that be a contributing factor elsewhere? Before we even start contemplating compounding these things with even more interventions we have to seriously look at what we've been doing already. This is a fundamental flaw in a lot of western medical practices these days: We see a symptom. We treat the symptom with a new intervention instead of first changing habits like food, activity, etc. The new intervention then has side effects causing symptoms we treat with another intervention. And on and on. I've experienced this myself, with side-effects of antihistamines being treated with proton pump inhibitors which causes digestive issues that led to other problems. Eventually I just had to read up on everything myself and figure out the root cause because the doctors -- and I went to _many_ -- just kept sending me to new investigative procedures and added more medication. When the solution all along was to just taper off antihistamines at the end of allergy season. I see the same in my entire family, and with friends. And Norway's healthcare system is apparently among the better of the world, which I find hard to believe.
  - seethedeaduu 1y ago
    Funny thing, norway is one of the worst western countries when it comes to trans healthcare. This of course ended up with undermining the future of Norwegian trans people. The world should wonder why the most successful trans people are american.
    - simianparrot 1y ago
      The world doesn’t wonder that. We look at the trans treatment in America as a warning. I know that probably sounds cruel to some Americans but we simply do not share your view in this.
seethedeaduu 1y ago
Would your heart let you say that to the face of a trans person who got refused hormones or blockers as a teen and ended up being irreversibly mutilated as an adult? I wonder...
- bobalob 1y ago
  Going through normal pubertal development is in no way whatsoever a process of being "irreversibly mutilated". What a daft claim.
- simianparrot 1y ago
  Yes, because this is simply a reality of life. It isn’t fair for anyone. We all have genetic and intrinsic shortcomings and weaknesses, illnesses and psychological variables. Blocking puberty for someone who doesn’t feel comfortable in their body as a child doesn’t guarantee the person will be happy with their now altered body later, medical procedures or not. Most follow up studies seem to indicate the opposite though I’m sure we can cherry pick either way. Nobody is born their ideal self. It’s a scale and we all suffer from it and have to work on it constantly. There is no magic button to swap someone’s body into their ideal self because at that age they can’t even know what that is; none of us knew before or during puberty. In fact I doubt even adults would know, but at least then you can take legal responsibility and not be manipulated as easily by external influences.
  - seethedeaduu 1y ago
    It's easy to talk about what trans people experience when you are not one yourself.
  - wizzwizz4 1y ago
    > Most follow up studies seem to indicate the opposite Where are you getting this stuff? I haven't seen a single study indicating that! Dr Hilary Cass's team tried to find a single such study, and at the time of the Interim Cass Review, they'd failed to find any pretext to refuse such medical treatment. (I haven't read the final Cass Review, because by all reports it's bigoted, pseudoscientific twaddle with recommendations that violate the Nuremberg Code.) You're completely wrong, here. https://slate.com/technology/2024/02/transgender-youth-health-care-regret-pamela-paul-nyt-data.html https://slate.com/technology/2024/02/transgender-youth-healt... says much of what I would've said, better: I've talked to a couple of people who've detransitioned, and can confirm that it was entirely due to social pressures. (Not counting gender-fluid folk who've hormonally transitioned 3+ times, since that's better described as "retransition".) Wovon man nicht sprechen kann, darüber muss man schweigen. (At least until you've learned to distinguish uncomfortable truth from seductive lie.)

wizzwizz4 1y ago

Saying puberty has an end date is like saying the flooding caused by the removal of a dam has an end date. It's true, but that end date depends on when you remove the dam. (Although a better analogy would be a pump filling a reservoir, sex hormones being the flow rate, puberty being flooding, and GnRH pulsing being the action of the pump.) It's more accurate to say that puberty has a duration. > puberty is a natural function of the human body The onset of puberty is way earlier than it used to be. Per http://www.mum.org/menarage.htm http://www.mum.org/menarage.htm, "In 1860 the average menarche happened at 16.6 years,"; per https://www.thetimes.com/uk/science/article/girls-now-begin-puberty-aged-9-9v8fc6x3fmk https://www.thetimes.com/uk/science/article/girls-now-begin-..., "Girls now begin puberty aged 9". Delaying puberty until age 16 could be argued as the more natural stage (though I take such arguments 'round back, and beat them to death, especially if they support my beliefs: the naturalistic fallacy is too seductive to listen to). > That makes no biological sense. Biologically, there's no reason* we couldn't make them wait until adulthood to begin puberty. You've not quite identified where the ludicrousness is – though you're close. Past that point, I think you're doing what I did earlier, and arguing against a position I haven't taken. (Unfortunately, I'm less eloquent than you, so I'd spend several paragraphs if I were to correct you: I'll trust in your ability to work it out.) > the aim should be education of and societal support of parents to be as informed as possible A thousand agreements: this is the ideal. All other situations are pathological special-cases – though, like antivax parents, they're special-cases that the medical system does have to take into consideration. (I don't know whether you have a general-purpose equivalent of Gillick competence in Norway, but see https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines https://learning.nspcc.org.uk/child-protection-system/gillic....) This isn't a point I've been trying to focus on, since it follows once correct handling of the ideal "everyone's informed and with the child's best interests at heart" case is established. --- *: Biiiig asterisk here: abnormal pubertal timing is associated with health problems (see https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/ https://www.endocrinology.org/endocrinologist/134-winter19/f... and citations), but we don't have solid data on the arrow of causation, nor good data on confounders (social attitudes seem to be a problem in the US, and https://doi.org/10.1542/peds.2005-2939 https://doi.org/10.1542/peds.2005-2939 strongly suggests that social/psychological effects have a big impact on onset of puberty), so that would be a separate point. There are no known problems caused by the use of GnRH modulators to postpone puberty (except low bone density, which per https://doi.org/10.3389/fped.2022.968485 https://doi.org/10.3389/fped.2022.968485 and https://doi.org/10.1210/jcem.87.2.8202 https://doi.org/10.1210/jcem.87.2.8202 is temporary and goes away in puberty, and per https://doi.org/10.6061/clinics/2012(06)08 https://doi.org/10.6061/clinics/2012(06)08 doesn't occur at all – and can be ameliorated with calcium and vitamin D supplementation), and afaik there's no theoretical expectation of such problems (except, again, bone density: I'm not sure that anyone knows why that isn't more of an issue, since it is sometimes an issue when GnRH modulators are used post-puberty – though the patient information leaflets I've read still stress the treatment as extremely safe in adults (with more assurance than I'd have given, but hey, I'm not an expert)). For the sake of the thought experiment, please pretend there are no such issues.

simianparrot 1y ago
I haven't researched the topic in detail yet, but looking at official data in Norway the _average_ puberty age is 13,2 years and has remained stable for 70+ years. There's a lot of simply intuitive factors to consider with older data: It was, for example, beneficial to _hide_ puberty because of older societal norms about consumption of marriage. I'm not sure we can trust older data. My instinct tells me that _if_ the age is sliding, then the first place to look is where we've made the biggest human interventions already. Vaccination -- and no I'm not anti-vaccines, but like any medicine, these have various side-effects -- and likely significantly more important, food and additives. In Norway we do not allow growth hormones in feed for livestock that is to be consumed by humans; could that be a contributing factor elsewhere? Before we even start contemplating compounding these things with even more interventions we have to seriously look at what we've been doing already. This is a fundamental flaw in a lot of western medical practices these days: We see a symptom. We treat the symptom with a new intervention instead of first changing habits like food, activity, etc. The new intervention then has side effects causing symptoms we treat with another intervention. And on and on. I've experienced this myself, with side-effects of antihistamines being treated with proton pump inhibitors which causes digestive issues that led to other problems. Eventually I just had to read up on everything myself and figure out the root cause because the doctors -- and I went to _many_ -- just kept sending me to new investigative procedures and added more medication. When the solution all along was to just taper off antihistamines at the end of allergy season. I see the same in my entire family, and with friends. And Norway's healthcare system is apparently among the better of the world, which I find hard to believe.
- seethedeaduu 1y ago
  Funny thing, norway is one of the worst western countries when it comes to trans healthcare. This of course ended up with undermining the future of Norwegian trans people. The world should wonder why the most successful trans people are american.
  - simianparrot 1y ago
    The world doesn’t wonder that. We look at the trans treatment in America as a warning. I know that probably sounds cruel to some Americans but we simply do not share your view in this.

seethedeaduu 1y ago

Would your heart let you say that to the face of a trans person who got refused hormones or blockers as a teen and ended up being irreversibly mutilated as an adult? I wonder...

bobalob 1y ago
Going through normal pubertal development is in no way whatsoever a process of being "irreversibly mutilated". What a daft claim.
simianparrot 1y ago
Yes, because this is simply a reality of life. It isn’t fair for anyone. We all have genetic and intrinsic shortcomings and weaknesses, illnesses and psychological variables. Blocking puberty for someone who doesn’t feel comfortable in their body as a child doesn’t guarantee the person will be happy with their now altered body later, medical procedures or not. Most follow up studies seem to indicate the opposite though I’m sure we can cherry pick either way. Nobody is born their ideal self. It’s a scale and we all suffer from it and have to work on it constantly. There is no magic button to swap someone’s body into their ideal self because at that age they can’t even know what that is; none of us knew before or during puberty. In fact I doubt even adults would know, but at least then you can take legal responsibility and not be manipulated as easily by external influences.
- seethedeaduu 1y ago
  It's easy to talk about what trans people experience when you are not one yourself.
- wizzwizz4 1y ago
  > Most follow up studies seem to indicate the opposite Where are you getting this stuff? I haven't seen a single study indicating that! Dr Hilary Cass's team tried to find a single such study, and at the time of the Interim Cass Review, they'd failed to find any pretext to refuse such medical treatment. (I haven't read the final Cass Review, because by all reports it's bigoted, pseudoscientific twaddle with recommendations that violate the Nuremberg Code.) You're completely wrong, here. https://slate.com/technology/2024/02/transgender-youth-health-care-regret-pamela-paul-nyt-data.html https://slate.com/technology/2024/02/transgender-youth-healt... says much of what I would've said, better: I've talked to a couple of people who've detransitioned, and can confirm that it was entirely due to social pressures. (Not counting gender-fluid folk who've hormonally transitioned 3+ times, since that's better described as "retransition".) Wovon man nicht sprechen kann, darüber muss man schweigen. (At least until you've learned to distinguish uncomfortable truth from seductive lie.)