Gender Dysphoria and Blockers
People living with gender dysphoria experience distress with their body’s sex characteristics, expectations imposed on members of their sex class, or both. The number of adolescents, particularly girls, presenting with gender dysphoria has risen exponentially in NZ and other countries since around 2010. Treating gender dysphoric adolescents with Gonadotropin-Releasing Hormone Agonists (GnRHa) to block pubertal development (i.e. “puberty blockers”) has become a "freely" available treatment option in New Zealand.
GnRHa block the release of sex hormones and are used to treat adults with endometriosis, prostate cancer, breast cancer, and chemically castrate sex offenders. GnRHa have also been approved for the treatment of early puberty in children. A child may sometimes enter puberty at an earlier age (e.g. 7) for various reasons. Early puberty can make life difficult, and GnRHa treatment halts further development. When blockers are withdrawn, pubertal development restarts and the child experiences normal puberty in adolescence (Calabria, 2020).
Treating gender dysphoric adolescents with puberty blockers is not approved and regarded as experimental. Doctors have leeway to prescribe unapproved medicines as long as they gain informed consent. The protocol allows children to begin treatment after reaching the initial stages (age ~12) (Heneghan and Jefferson, 2019).
Rationale and Ethics
The treatment has three aims (Vries et al., 2011):
- relieve a possible intensification of distress associated with the development of sex characteristics,
- give the child 'time to decide',
- assuming the child in adulthood will desire surgical interventions, a lack of sex development means their body will more closely resemble that of the opposite sex after surgery.
These rationales present ethical and diagnostic dilemmas. A selection of which follows:
- How does the clinician distinguish between elevated but otherwise normal distress associated with puberty and what may turn out to be ongoing and severe distress?
- Puberty blockers are brain-altering drugs, and the causes of dysphoria are not well understood. Blockers may worsen dysphoria and other mental health conditions.
- The child may feel they have already committed to a medical pathway. Often what seems like a small initial commitment at the time can turn out to have been influential and more consequential later - particularly when the child cannot consent or make mature decisions.
- The child's development will become noticeably out of step with their peers, potentially heightening negative feelings regarding their difference and body image.
- An adult transsexual may wish to resemble their target sex, but they do not have any experience of puberty blockers specifically. Projecting uninformed wishes on to a child assumes that the child represents an earlier 'version' of ambiguously similar adults.
- The child may naively believe that they can become the opposite sex.
Alongside the above challenges, this area of medicine has become polarised, and misinformation about puberty blockers is common. This site collates and summarises the medical literature and legal issues surrounding puberty blockers so that parents and doctors can be more fully informed. The information is not medical advice.
If you spot any errors, please get in touch.