Drugs That Delay Puberty May Help Gender-confused Teens

by VR Sreeraman on  December 7, 2008 at 12:35 PM Child Health News
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 Drugs That Delay Puberty May Help Gender-confused Teens
Young teenagers who have extreme gender identity disorder should be given puberty-blocking drugs to save them from experiencing distressing changes to their bodies which they perceive to be out of line with their true gender.

This is for the first time that the Endocrine Society has drafted international guidelines on the controversial issue, with the hope that delaying puberty would provide young teens with valuable thinking time, where they can decide if they want to begin gender reassignment using cross-sex hormones at the age of 16.

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And thus, the strategy would make it easier for them to live in their chosen gender. For example, potential male-to-female transsexuals will not have developed the deep voice, facial changes and body hair associated with adult masculinity.

The guidelines also noted that gender-reassignment surgery should be avoided until the age of 18.

"We recommend that adolescents who fulfill eligibility and readiness criteria for gender reassignment initially undergo treatment to suppress pubertal development," New Scientist quoted the guidelines as saying.

According to the guidelines, treatment should not begin before Tanner stage 2 or 3: when female breasts have begun to bud, and boys have experienced a slight enlargement of the penis and scrotum.

The reason-because the teenager's emotional reaction to these first physical changes can help predict if they will persist in wanting to change their sex.

All the recommends have come in line with the experience of a clinic in the Netherlands where doctors have so far prescribed puberty blockers to more than 70 under-16s. The youngest they have treated is 11, although the majority are 12 or over.

"We don't have any patient who has regretted their decision on the treatment," said Henriette Delemarre-van de Waal of Leiden University Medical Centre who has helped treat them.

However, many fear that teenagers will change their minds. For example, previous studies have suggested that just 20 percent of boys who show signs of gender identity disorder in childhood continue to show it into adulthood.

But despite the fact that the effects of puberty-blockers are reversible, there have been few trials exploring the long-term effects of delaying puberty in this way.

Another problem is of fertility-blocking puberty in boys before mature sperm have had the chance to develop removes the option of freezing sperm in case they later decide they want to start a family after undergoing gender-reassignment surgery.

However, enduring puberty with the feeling that you are in the wrong body can cause intense distress, and has even driven some teenagers to contemplate suicide.

Source: ANI

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Unfortunately New Scientist magazine has added prejudiced interpretation in their reporting of the Endocrine Society's draft 'Guidelines on Endocrine Treatment of Transsexuals'. Transsexual teens are not "confused". If they were there would be no thought of assisting them to become the sex with which they identify. Neither do they "choose" their gender. No one would choose the difficult path that leads to changing sex.

Unfortunately the draft guidelines have their own prejudices, which hopefully will be eradicated before the guidelines are finalised, since they have no place in the published works of an internationally respected body for medical and biological science. There are neither medical nor ethical justifications for any of the delays they recommend. Indeed there is plentiful evidence that such delay is unnecessary, and unhelpful.

The consistent reason behind all those intended delays is a wish to avoid harm by intervening in a patient who might change their mind, but that ignores the certain harm to the lives of those unnecessarily delayed, not least given the lack of acceptance of the child's most central identity that indicates. No hormones until 16 means a female puberty commencing on average 7 years later than her peers, which isolates terribly. No intervention until male-scale Tanner 2-3 means height, hands and feet much larger than other girls. Making a girl live with male genitalia until 18 is the most wicked way of enforcing sexual abstinence.

The only "evidence" behind the belief in delay and non-acceptance - papers reporting changes of mind in studies intended to promote cruel methods designed to force children to hide their true feelings - all turn out to be fatally flawed, with poor selection of subjects, inadequate records, and no-follow-up.

This is what comes from including mental health practitioners (MHP) in the guidelines panel. People who see no need to declare a conflict of interest in writing recommendation that they be employed in all cases. Or in misusing an Endocrine Society publication to promote their side in the current battle to have transsexuality removed from the lists (DSM and ICD) of mental disorders (and instead recognised as a physical mismatch of brain to body), because most people with transsexuality score within normal limits on all mental health indices, and reduce the involvement of MHPs to those cases where mental disorder seems possible, as with all other conditions.

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