TOPICS

For those new to this issue it’s best to know these terms before reading.

2) Consequences & permanent side-effects that result from the use of hormone blockers

Early studies show some improvement in the mental health of youth who undergo social transitions and early medical interventions (de Vries 2014), (Olson, 2016). This is why these practices have been adopted so quickly. Parents understandably want to help their upset child and make life easier for them.

Preventing suicides is another argument that is often used both by trans activists and some mental health and medical professionals. Suicide ideation is very high in trans youth in all studies. Suicide is a horrific tragedy for the person and their family. Any health professional would want to provide relief if that is what will stop it. But suicides are rare in dysphoric youth, and it doesn’t appear that lack of access to medical care is the sole reason for the suicides—, as some of these tragedies have occurred with youths receiving full support and medicalization. Also, it is not clear if transition solves suicide risk, as adult transitioners still retain high rates of suicide ideation.

Suicide is used as the main justification for what are medical experiments on children involving harsh medical techniques. We cover the issue of suicide here.

There are ethical questions about whether or not children can give consent to making decisions that may provide welcome relief in the short term, but have serious long-term consequences. 10-year-old children are now making decisions about procedures that can negatively impact sexual function, cause life-long dependence on hormone prescriptions and monitoring, irrevocably alter their bodies, and sterilize them. Surgeries are performed on minors now in the United States with the goal being to make this the norm in all countries.

A. Hormone blockers to cross-sex hormones stunt genital growth in males & may permanently damage sexual function

When young dysphoric males are given hormone blockers at the onset of puberty, it stops genital growth (“micro penis”), and this becomes permanent if the youth goes on to cross-sex hormones. There isn’t any evidence available as to whether all of these effects on sexual function in a pubertal male are “fully reversible” (we now no they are not-see updates) if the youth stops blockers and resumes a “normal puberty.” Suppose the youth does not want to go through life with an 11-year-old’s penis. In that case, the youth will now have to have a portion of their colon or peritoneal lining around the stomach extracted, along with skin from the abdomen, to make a “neovagina” (rather than inverting a penis, which is how doctors do it on adults).

There is a confirmed case of this happening to Jazz Jennings, a trans teen television celebrity who has a reality show (we view this as exploitation). The teen mentioned having little sexual desire, never having had an orgasm, had a penis the size of a child’s, and had to have an extra graft and painful surgeries to make a “neovagina.”

Here is another example of this situation described by a concerned parent on a transgender social media forum:

Need for a more complex surgery

A journal article confirms the above examples are in fact a problem:

In addition, various informants stressed the importance of the fact that the penis and scrotum should be developed enough to be able to use this tissue to create a vagina later in life. Very early use of puberty suppression impairs penile growth and consequently makes certain surgical techniques impossible

The argument for early intervention in males is to relieve emotional distress around passing, keep their height within a female range (which is currently unproven), make them more "feminine" appearing and sexually attractive to heterosexual males, and reduce the need for future surgeries later, (like facial feminizations). But the reality is that stunting genital development complicates surgery and will leave scarring from graft surgeries. It becomes impossible to do what surgeons call a "penile inversion vaginoplasty." Doctors describe this technique as the "gold standard” (see here and here):

Referred to as the "gold standard" MTF Vaginoplasty technique, Penile Inversion is often performed as a one-stage procedure, incorporating Orchiectomy, partial Penectomy, penile dissection and creation of the vaginal cavity, Labiaplasty and Clitoroplasty.
The gold standard in neovaginal reconstruction in male to female sex reassignment surgery is penile skin inversion technique with or without scrotal flaps, which enables adequate sensation of the neovagina, good neovaginal depth, good erotic sensitivity of the neclitoris, and esthetically acceptable labia minora and maiora.

This is a graphic of the rectosigmoid vaginoplasty that will be necessary in a puberty blocked male:

chet-plasticsurgery.com

The disadvantages of this surgery are listed on the mtfsurgery.net website:

• Additional abdominal surgery with intestinal anastomosis, which increases the risk of postoperative ileus.
• Visible abdominal scar.
• A longer surgery with added complexity and expense.
• Rectosigmoid graft lining the vagina is unlikely to provide the quality of sensation that is possible with Penile Inversion.
• The production of mucus from the colon graft can lead to excessive discharge, though this typically decreases significantly within 3–6 months. (Daily vaginal cleaning for 1 month can help.)
• Colon grafts must be screened for colon cancer and should be monitored if the patient develops inflammatory bowel disease

Another doctor says this about the skin graft option (he uses the F.A,V.E. option):

The problem with skin grafts is that they contract and usually require a life of painful dilation procedures. I am not a fan of the penile inversion technique because of the large groin scars and thin and usually inadequate tissue. I prefer a technique that I call the F.A.V.E. vaginoplasty in which the vaginal vault is made from a scroto-penile flap that has a more robust nature and more of a "glide plane" for comfort and has erogenous sensation as well. i use most of the penile shaft tissues to construct labia minora.

While this surgery may be satisfactory to most people who have it, it has not been performed as often on adults. Minors with “micro penis” are now an experimental generation to determine quality of outcome with the consequences are complete lack of sexual function for life.

Affirmative therapists/doctors have made the decision that preventing normal genital development is worth relieving the mental distress of a tween; many adult MTFs choose not to have bottom surgery

Here is a whole video presentation called “Here’s Why This Trans Woman Likes her Penis“ on a trans-identified male who likes being physically intact. It calls into question if it’s ethical to disallow a minor to explore whether they want bottom surgery in the interest of temporary stress relief.

The mental health and medical professionals who have pushed hard for this protocol, and are still pushing for lowering the age of consent laws (see here and here), are forcing dysphoric males to have surgery on their genitals to mimic any normalcy in adult appearance. But not all trans-identified males want bottom surgery. And some men are attracted to and have happy relationships with these individuals who aren’t altered.

The least invasive and extreme solution is utilized first in every other psychological or physical health condition. This is the only medical protocol where less invasive procedures are forbidden based on the questionable claims that it is conversion therapy and that youths will kill themselves if they are not puberty suppressed.

Below is a graphic of one survey of trans-identified males indicating that many do not want bottom surgery or are unsure (34%). 43% say they do not want or are unsure if they want testicle removal. Also, fairly high rates of them seem ok with not having facial feminization or voice surgeries. This contradicts the justification for castrating and creating sexual dysfunction in young dysphoric males with puberty blockers. These are adults:

National Center for Transgender Equality, 2015 Survey

Here are comments by Jae Alexis Lee, who transitioned as an adult, regarding reasons not to have genital surgery:

Unnecessary: Not every trans person needs GRS to address their gender dysphoria. We still don't have a definitive idea what causes people to be transgender but what we do know is that not all transgender people experience dysphoria the same way. Not every transgender person requires the same medical interventions [8]. For some trans people, the dysphoria or incongruence they may (or may not) experience with regards to their genitals is less significant than other treatment they may need. They may also feel that while they do experience genital related dysphoria, it isn't severe enough to be worth overcoming the other barriers.
Surgical Risks / Complications / Insufficient Outcomes: Let's be blunt for a moment: GRS does not always produce a result that replicates a cisgender person's anatomy. For some trans people, surgical intervention doesn't feel worth it because the results would be less than they feel they would be satisfied with. There are still significant risks of ending up non-orgasmic or having diminished sexual function. There are other surgical risks and complications that may deter trans people from electing to have surgery which again underscores how highly personal of a decision this is. Surgical techniques are improving [9] all the time and the science of providing surgical care for transgender people continues to advance. Some trans people are waiting for the science to reach a point where they feel they would be satisfied with results.
Trans people do not need surgery to validate their identity and many places are starting to wake up to that fact, removing surgical requirements to update identity documents and live an authentic life. What is important is that we work to make GRS accessible to trans people who need it and that we recognize that not every trans person does.

This article features trans identified males who kept and like their sex organs the way they are.

More evidence not all want bottom surgery and that there are consequences to bottom surgery many want to avoid:

As I mentioned earlier, there are many ways to be transgender. Not all MTFs will abhor their penises, and not all of them will be disturbed by erections, or necessarily want erections to stop. Some people will strongly feel that their penises need to go, or that they are very uncomfortable with the ways in which they function. Others may not feel that strong dysphoria about their genitalia, and neither scenario makes someone “more” transgender than another person. There is such diversity, even within people who identify as MTF.

Lynn Conway, comments on the seriousness of the impact that medical techniques going wrong could have on a transgender person:

The ability to easily become aroused, to desire intimate and sensual contact, and to achieve sexual release through orgasm is a precious gift to bring into love relationships, especially when combined with a desire to give full and complete pleasure to one's love partner too. A loss of these capabilities could ruin the woman's chances of experiencing her full humanity after transition, especially for finding and enjoying a passionate, deeply-bonded love relationship…Thus the decision for SRS must be taken with great internal soul searching and introspection, and with complete honesty with oneself about one's own gender identity, body image and likely psychic reactions to the body changes of SRS.

Professionals admit their treatment plans may negatively impact or permanently destroy a youth's sexual function.

Children puberty-suppressed at age 11 are not allowed to make these nuanced decisions the way an adult who has had the opportunity to explore their identity and body would. The reports of the apparent total lack of sexual response these children have later on should be highly alarming and are possible grounds for malpractice lawsuits.

Here Dr. Wren of Tavistock admits to this problem:

You could be the most transgender friendly service in the world and you would still have to consider some very, very grave issues. The timing of puberty suspension, for instance. Whether they can tolerate enough treatment to develop the lower part of the body so they develop physical sensations.

Below are some examples from Johanne Olson-Kennedy, the most aggressive advocate for socially and medically transitioning children and lowering age of consent laws, admitting that her protocol may be destroying sexual function permanently.

WPATH Facebook page March 19, 2016:

I hope that providers are discussing masturbation and orgasm with their patients around the time they are starting hormones. I certainly do because if we are to measure the success of post op procedures by orgasm potential and people have no experience of pre-op orgasm or other sexual experience we are failing.

Gender Odyssey 2017:

So how many people here saw the episode of ‘I Am Jazz’ where she went to the surgeon and the surgeon was like, “You can’t have a vagina, ugg. …for people with testicles who are blocked at tanner stage 2, they do not have a lot of penile tissue and when you do a procedure that you use the tissue of the penis to make a neovagina…usually you would just do an inversion and use that tissue but if you don’t have a lot you need to do graft from another part of the body, usually scrotal tissue. There are other ways that people do this, does not preclude you from having a vaginoplasty but I want people to think about this…
We have to think about these things. Blocking is one tool that’s an awesome tool for a lot of people. And what does that mean? Does that mean that trans feminine, trans girls who get blocked in tanner 2, we are we are making the assumption that all of them are going to have genital surgery? Are we doing that? Because we might be doing that. (Laughs nervously) I’m just saying we might be doing that. And so that actually is worthy of a conversation. Because many trans women do not have genital surgery. Love their genitals, enjoy their genitals, like to use them. That’s fantastic. We love people who love their bodies and use them and enjoy them. That’s a great human place to be. But we have to ask ourselves if you have tanner 2 male genitals are you going to be able to use them, are you going to want to be able to use them? Or we are we, just assuming that everybody is now going to have to say ‘Well I either need to go through puberty to get adult sized genitals or I’m going to have these genitals that I have or I’m getting surgery.’
Does that make sense?...If we are judging the success of vaginoplasty by post-surgical orgasm how do we know people are having orgasms prior to surgery if we are blocking them at tanner 2.

Here are quotes from doctors stressing the importance of discussing this topic with adults. These conversations are not possible with a 10, 11, or even 14-year-old making a decision to go on blockers:

Sexual expectations should be carefully discussed with the patients in preoperative preparation in order to help the patients deal with sexual changes and new function of new genitals. Aesthetic result, sexual arousal, lubrication as well as absence of pain during sexual intercourse are critical points of a successful male to female surgery.

Transfemme persons without bottom surgery find partners so why is this protocol “medically necessary”?

There are in fact some males, mostly presenting as heterosexual, who seemingly have a preference for trans-identified males. And for them bottom surgery is not a “deal breaker.” This sexual orientation is described as gynemimetophilia, gynandromorphophilia, or MSTW. It appears to be a distinct orientation from heterosexual or homosexual men, best described as a kind of bisexuality. Males have formed relationships with unaltered trans feminine people throughout history.

Unfortunately, this attraction is often pornified and prostituted. There are high rates of prostitution for males who want to be women. And “chasers” (people who fetishize this population) are a significant issue. Many do not wish to be fetishized and want relationships that recognize their full humanity as everyone else does. With the acceptance of dysphoric people and different types of bodies and gender presentations, the hope is individuals will feel comfortable forming relationships with trans-identified individuals, even if they haven’t had genital surgeries which are drastic, painful, often need to be repaired, require lifelong dilations, don’t self-clean, and have other risks.

At the time of an interview with comedian Amy Schumer, Bailey Jay stated Jay is still intact and seems happy with this. It’s also important to note that Bailey’s partner seemed perfectly happy with this as well.

Instead of activists aggressively passing anti-conversion therapy laws that prevent any therapist from helping a young person find alternative ways to cope with dysphoria long enough for their bodies to mature, perhaps they should encourage a more body-positive approach and provide role models who can support their identities, but model benefits of waiting, as an alternative to puberty blockers to cross-sex hormones (they exist: see below). Puberty blockers to cross-sex hormones close several important doors for a youth who is making this decision as young as 10 years old.

Blockers shut down the hormonal process in a developing tween/teen, which may affect sexual psychological maturation.

Hormone blockers are used to chemically castrate sex offenders. This is because they stop the chemical cascade that produces sex hormones by affecting the pituitary gland. They are chemically castrating dysphoric minors. The prevention of sexual development has physical effects and, inevitably, psychological effects that are not discussed other than to say they are positive. Preventing the process of both physical and psychological sexual maturation may affect desistance/persistence by preventing a youth from understanding their attractions and sexuality.

Information about the “Lupron protocol” can be found in a discussion of cases of Lupron being used to control autistic children:

Lupron is the trade name for a drug called leuprolide acetate, a synthetic analog of a hormone known as gonadotropin releasing hormone (GnRH, a.k.a. LH-RH). After causing an initial stimulation of gonadotropin receptors by binding to them, chronic administration of Lupron inhibits gonadotropin secretion, specifically leutenizing hormone (LH) and follicle stimulating hormone (FSH). The end result is the inhibition of the synthesis of steroid hormones in the testes in men and in the ovaries in women. In men, testosterone and androgen levels fall to castrate levels, and in women estrogens are reduced to postmenopausal levels…

The article includes statements from endocrinologists condemning the practice of using Lupron on autism spectrum youth:

Simon Baron-Cohen, a professor of developmental psychopathology at the University of Cambridge in England and director of the Autism Research Center in Cambridge, said it is irresponsible to treat autistic children with Lupron.
“The idea of using it with vulnerable children with autism, who do not have a life-threatening disease and pose no danger to anyone, without a careful trial to determine the unwanted side effects or indeed any benefits, fills me with horror,” he said.
Experts in childhood hormones warn that Lupron can disrupt normal development, interfering with natural puberty and potentially putting children’s heart and bones at risk. The treatment also means subjecting children to daily injections, including painful shots deep into muscle every other week.

B. Hormone blockers to cross-sex hormones causes sterilization

There are abundant examples of trans-identified people, all who have transitioned as adults, who have talked about the importance of their fertility and their own biological children. Many transgender people have had children, and most report they have positive relationships with them, according to this study review by The Williams Institute:

Of the 51 studies included in this review, most found that between one quarter and one half of transgender people report being parents. In the U.S. general population, 65% of adult males and 74% of adult females are parents (Halle, 2002)...In studies that asked transgender parents about their relationships with their children, the vast majority re- ported that their relationships are good or positive generally, including after “coming out” as transgender or transitioning.

There are many examples of trans people with biological children or who want them

Studies show that a majority of trans-identifed females want children and some want biological children.

One ”non-binary” female is suing over the loss of fertility, indicating fertility may be very important to some. Here is an example of a 20-year-old pausing testosterone injections to become pregnant:

Having a biological child has always meant a lot to me.

This ”non-binary” female was willing to go through extremely serious gender dysphoria in order to stop testosterone, despite the fact that adoption is a different choice people can make:

Not being able to take my testosterone and anxiety and sleep medication meant that during the first trimester I was having those four-hour long panic attacks but it did normalise and settle as my body got used to it.

There are many similar stories in the media and it demonstrates trans-identified females are willing to withstand extremely intense dysphoria in order to carry a child that is biologically their own.

Those who transition as tweens, as many now do, will be sterilized and will not have eggs to bank. Uterus removal is recommended after several years on testosterone, so the above stories of trans-identified females having babies will not be possible the earlier a biological female goes on testosterone.

There are many trans-identified male parents. Most are adult transitioners who had children with women. But having biological children will not be an option for those who go on blockers at young ages.

Here is another article by an individual who talks about wanting children in the future and about the pressure on women to have children.

A surgeon for transgender patients confirms on her website that some dysphoric people choose to have biological children post transition. “Occasionally, patients wish to regain fertility by discontinuing HRT in order to store sperm or whatever.”

None of these options, listed on a fertility website inclusive of people with gender dysphoria, will be possible for child transitioners.

Aggressive supporters of medicalizing minors such as Dr. Norman Spack have doubts:

The biggest challenge is the issue of fertility. When young people halt their puberty before their bodies have developed, and then take cross-hormones for a few years, they’ll probably be infertile. You have to explain to the patients that if they go ahead, they may not be able to have children. When you’re talking to a 12-year-old, that’s a heavy-duty conversation. Does a kid that age really think about fertility? But if you don’t start treatment, they will always have trouble fitting in. And my patients always remind me that what’s most important to them is their identity.

One fertility expert in Britain describes the loss of fertility as being quite harmful to transitioned people:

Her comments follow remarks by the fertility expert Lord Winston, who said he was seeing transgender adults who had lost their ability to reproduce and were very “damaged”.

Some trans-identified males are looking forward to the day when womb transplants are possible, but sperm is still necessary in order to have biological children as of now. Gender Health Query strongly opposes any experimental processes that may endanger human fetuses to service the wants of trans-identified adults.

There is a precedent for future lawsuits from those sterilized as youth. The Swedish government is paying out claims to individuals who were sterilized as a result of a law that required sterilization as part of their transition. Fertility is certainly an important issue in those cases.

Summary of sterilization issues

There may be ways in the future to harvest DNA and make babies in alternative ways. Society will be having discussions about the ethics of manipulating biology, as that field is rapidly gaining knowledge on how to manipulate the creation of life. Our position is that anything that harms fetuses, children, or mothers and fathers is criminal in nature and must be opposed.

Currently:

1) Biological children are dependent on gametes that are destroyed with puberty blockers to cross-sex hormone use.

2) Many people who transitioned as adults describe the importance of their biological children.

3) Future fertility treatments may be more expensive than the plastic surgeries that early transitions are supposed to prevent. Waiting until after puberty would allow youths to bank sperm and eggs, avoiding this issue.

4) It’s not possible for 11 year olds to make well informed decisions about parenthood because of their lack of maturity, life experience, and the fact that they haven’t reached full cognitive development.

C. Other puberty blocker effects that may not be fully reversible (we now no they are not-see updates)

Puberty blockers have been used to treat precocious puberty (mostly in females, occasionally in males) for years, and doctors often claim they are safe. They work by decreasing gonadotropin (affecting the pituitary gland) and therefore decreasing testosterone and estradiol, halting normal puberty. Affirmation model advocates do this because the stress for dysphoric youth can increase in puberty, and they sell it as being able to give youth “time to explore” their gender identity. The other argument is that if they go on to transition, they will pass better and have to have fewer surgeries (debatable with puberty-suppressed males with “micro penis”).

Puberty blockers & negative effects on mental health, physical health, & IQ

It can be difficult to attribute long term effects of a drug, but a group of women are suing because they have some very serious conditions that they believe are side effects from Lupron, a commonly used puberty blocker for gender dysphoria, as girls:

More than 10,000 adverse event reports filed with the FDA reflect the experiences of women who’ve taken Lupron. The reports describe everything from brittle bones to faulty joints.

From another article:

‘My own story is that after taking Lupron [for endometriosis] I now have bone loss, severe bone and joint pain requiring heavy painkillers to get out of bed, chest pain, tachycardia, fibromyalgia and horrible memory loss, hair loss and weight gain. Prior to Lupron I ran and boxed everyday. I was healthy even though endometriosis caused significant pain. It has now been a year since my Lupron treatments and my life is in medical shambles.’
The women contacting the Network relate very similar experiences: they were healthy but — after using Lupron® – they report having lost their health, their jobs, and more. While only a small percentage of women seem to have such a severe reaction, there is no way to predict who will experience these frightening and debilitating side-effects. Nor does there seem to be any interest on the part of either the Food and Drug Administration (FDA) or Lupron®’s manufacturer to further investigate the drug’s safety or adverse events...
One researcher has commented: “GnRH analogs [like Lupron] are not like any other medication currently available for treatment of disease. As we continue to learn more about these analogs’ mechanisms of action, it is increasingly apparent that they do not just affect the gonadal [sex] hormones, but are powerful modulators of autonomic neural function.”22 Shouldn’t we know more about these drugs — and Lupron® in particular?

And the FDA recently had to update warnings about GnRH agonists:

Last month, the FDA required the safety labels of GnRH agonists to be updated to include new psychiatric side effects causing emotional lability such as crying, irritability, impatient, anger and aggression. The labels were also updated with a warning that use of the drugs were linked to convulsions, particularly in patients with a history of seizures, epilepsy, cerebrovascular disorders, central nervous system anomalies or tumors, and in patients taking drugs that can increase the risk of convulsions, such as bupropion and SSRIs.

Here is another article discussing the FDA and the use of hormone blockers in children:

Off-label use in children comes with serious dangers, adults say
For young girls, Lupron was approved to delay the onset of puberty. Off-label, doctors commonly use it to help pediatric patients grow taller. But interviews with women who received the injections for at least a decade as children, conducted by Kaiser Health News, suggest that the drug causes lifelong health problems.
The problems documented in the Kaiser report include extremely brittle bones, anxiety, and seizures. In fact, the FDA told Kaiser Health News that it is currently reviewing the effect that Lupron has on pediatric patients and their nervous systems. But the agency has not yet placed a warning on the drug’s pediatric version describing the potential risk of seizures, bone loss, or mood disorders.

On the issue of bone health, one can see in the chart below how much bone density increases in adolescence. In this study, it is shown that the youths do not accrue bone density at the expected rate (but oddly the researchers paint the results as positive since there was no bone loss):

The study referenced that indicates bone loss in youths with GD often cited can be found here:

Bone Mass in Young Adulthood Following Gonadotropin, Klink et al. 2015

There isn’t long-term data on the effects of using hormone blockers to treat gender dysphoria in minors. In a right-leaning science commentary journal, The New Atlantis, more conservative doctors state:

Most critically, unlike children affected by precocious puberty, adolescents with gender dysphoria do not have any physiological disorders of puberty that are being corrected by the puberty-suppressing drugs. The fact that children with suppressed precocious puberty between ages 8 and 12 resume puberty at age 13 does not mean that adolescents suffering from gender dysphoria whose puberty is suppressed beginning at age 12 will simply resume normal pubertal development down the road if they choose to withdraw from the puberty-suppressing treatment and choose not to undergo other sex-reassignment procedures. Another troubling question that has been largely uninvestigated is what psychological consequences there might be for children with gender dysphoria whose puberty has been suppressed and who later come to identify as their biological sex.

Alice Dreger, who has a background in bio ethics, has a pertinent article on the use of Lupron and possible dangers.

Doctors in The Journal Pediatrics explain that studies about possible negative psychological and cognitive function impacts of puberty blockers are needed in this lengthy but informative quote, as affirmation model advocates always describe hormone blockers as “fully reversible” (we now no they are not-see updates):

By 2004, it was known that surgical castration of male animals can lead to “profound loss of synaptic density in the hippocampus and changes in learning and memory”[38][39] due to absence of testosterone. Synapses are the junctions between cells through which information is shared by tiny electrical impulses or chemical transmitters. Their reduction implies reduced or altered activity of that region of the brain. GnRH blockers are a means of chemical as opposed to surgical castration, therefore, the effect of reduction of testosterone by blocking the pituitary needed to be elucidated.
By 2007, as animal and behavioural studies suggested blockers “may have significant effects on memory” their effects were examined in humans. Interference in memory and executive function[40], and abnormal cerebral function was found in women receiving blockers for gynaecological reasons.[41]
In 2008, review of the effect of testosterone deprivation due to blockers in men receiving them for prostate cancer raised the “strong argument” that blockers, alone, caused “subtle but significant cognitive declines”.[42] Other studies confirmed “higher rates … of cognitive impairment” compared to controls[43], but were denied by some.[44] Laboratory studies were needed.
In 2009, scientists in universities in Glasgow and Oslo had begun collaborative research on the effect of blockers on the behaviour and brains of sheep. These foundational studies revealed that exposure of the pre-pubertal lamb to blockers led to an observable increase in the size of the amygdala[45], that the activities of a large number of genes in the amygdala and hippocampus were altered by the blockers[46] [47] and, not surprisingly, that some aspects of brain function were disturbed [48][49]. Female sheep had less emotional control and were more anxious. Males were more prone to “risk taking” and alterations in emotional reactivity. Males suffered reduction in spatial memory that persisted after treatment.[50]
These results suggest that blockers may alter the shape of the brain and the capacity of cells to communicate with each other at a molecular level[51] [52]. This could be due to a direct effect of the loss of GnRH or, alternatively, a reduction in GnRH-dependent production of local neurosteroids involved in the formation of synaptic connections when the brain is developing.[53] [54]
Contrary to the laboratory studies, a recent study by the Dutch group[55] on its own human patients asserted that no difference could be found in executive function between mid-teens on blockers and controls. Little reassurance can be gained from this conclusion, however, because close reading of the results reveals that males on blockers transgendering to females did have “significantly lower accuracy scores than the control groups”. However, the authors declared that “it is possible that this is just a chance finding due to the small size of the subgroup (of eight adolescents)”. Alternatively, it could have confirmed what had been revealed in sheep; but, indeed, the numbers were small.
Other psychological studies have suggested positive outcome in humans on hormonal therapy but all are weakened by small numbers and their reliance on observations by involved therapists.[56] Reviews stress lack of evidence[57]. It should be emphasised that, unlike older men with cancer whose brains are deteriorating with age, children are being given blockers at a time of great brain development. Moreover, compared to the men whose treatment lasted only months, many children receive blockers for years.

More discussion of hormone blockers, particularly related to an apparent drop in IQ points, below. Here is a review looking critically at a prior study that seemed to downplay the cognitive effects of hormone blockers on teenage girls treated for precocious puberty:

Gonadotropin releasing hormone agonists (GnRHas) have been found to impair memory in adults, so the study by Wojniusz et al. (2016) on the possible cognitive effects of these drugs on children treated for idiopathic central precocious puberty (CPP) represents an important contribution to research in this area. Recent findings that GnRHas increase depression symptoms (Macoveanu et al., 2016) and slow reaction time (Stenbæk et al., 2016) in healthy women, and reduce long-term spatial memory in sheep (Hough et al., 2017) underline the importance of the research that Wojniusz et al. (2016) have undertaken. However, their reassuring statement in the abstract that girls undergoing GnRHa treatment for CPP and controls “showed very similar scores with regard to cognitive performance” and their conclusion that “GnRHa treated girls do not differ in their cognitive functioning … from the same age peers” (Wojniusz et al., 2016) may be overly optimistic. These statements minimize the fairly substantial difference found in IQ scores and may also overemphasize its lack of statistical significance, as given the small number of participants in the study statistical significance has a high threshold.The statements should be qualified to indicate that the research has, in fact, reinforced concerns over the impact of GnRHas on cognitive performance in children.

Another quote about a different hormone blocking chemical:

Girls treated for CPP with triptorelin acetate were tested with the short form Wechsler Intelligence Scale for Children III. It was found that the girls had a mean IQ of 94, as against a mean IQ of 102...

Despite a dismissive attitude in the original study, these authors have this to say:

The contention that a decline only becomes clinically interesting if it is of at least 1 standard deviation is unconvincing. Any findings which indicate that GnRHas cause a decline, even a modest decline, in IQ are likely to be of considerable interest to patients and their parents…In this respect it can be noted that 2 of the treated girls had been held back a year at school.
The findings of Wojniusz et al. (2016) can be compared with those of a 2001 study in which 25 children treated for early puberty with triptorelin acetate were tested with the short form Wechsler Intelligence Scale for Children (Mul et al., 2001). In this longitudinal study, children took the IQ test before treatment and again after 2 years of treatment. It was found that their IQ dropped 7 points from 100 to 93. With 25 treated participants, this 7 point drop was significant (p = 0.002). In both studies the difference in the performance element of the test was greater than in the verbal element. The similarities between the findings of these two studies strengthens their reliability and increases the possibility that GnRHa treatment may have an adverse impact on cognitive functioning in children.

Schneider (2017) involves one case of a youth on gonadotropin releasing hormone and shows a drop in IQ score for the individual:

Comparing the periods of follow-up, a reduction on Global IQ (GIQ) during pubertal suppression was observed. In T1, the GIQ was lower than before hormonal treatment (T0), and this finding was sustained by the third WISC-IV evaluation

Schneider et al.(2017): Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression

Adolescence is a crucial time for neurological development, and arresting this process with Lupron may affect this. Here Dr. Lisa Simons, a pediatrician at Lurie Children’s, discusses the reality that doctors don’t fully understand how hormones affect brain development in adolescence, or how blocking this process may affect them. She tells PBS that studies that look at the “neurocognitive effects” of puberty blockers are lacking and:

The bottom line is we don’t really know how sex hormones impact any adolescent’s brain development…We know that there’s a lot of brain development between childhood and adulthood, but it’s not clear what’s behind that.

Here is another comment, about the complicated and important effects hormones have on a young person’s brain development, in this Brain Cognition:

For example, puberty-related increases in gonadal hormones have been linked to a proliferation of receptors for oxytocin within the limbic system, including such structures as the amygdala and nucleus accumbens (Spear, 2009). Oxytocin neurotransmission has been implicated in a variety of social behaviors, including facilitation of social bonding and recognition and memory for positive social stimuli (Insel & Fernald, 2004).
This article discusses the monumental changes that happen in the brain during puberty—changes that are being manipulated by this protocol in minors with GD:
Adolescence is defined as the period of life that starts with the biological changes of puberty and ends when the individual attains a stable, independent role in society. (This definition may leave some readers wistfully pondering the second half of that equation). We now know that it is also a time of tremendous brain reorganization, which we are only just beginning to understand.

In Human Brain Mapping:

…there is tentative evidence to suggest that puberty might play an important role in some aspects of brain and cognitive development

There is mixed information as to whether or not puberty blockers affect bone density. Dr. Finlayson, a pediatric endocrinologist, says to PBS:

We do know that there is some decrease in bone density during treatment with pubertal suppression,” Finlayson said, adding that initial studies have shown that starting estrogen and testosterone can help regain the bone density. What Finlayson said there isn’t enough research on is whether someone who was on puberty blockers will regain all their bone strength, or if they might be at risk for osteoporosis in the future.

One recent paper discussed on a WPATH website found that:

Absolute bone mass remained stable during prolonged gonadal suppression but a delay in bone mass accrual is reflected by the decline of z-scores. This delay may compromise bone health later in life.Continuing BMD monitoring, well into adulthood, in adolescents with GD who started gender reassignment at an early age is warranted.

The Bone Journal reported that puberty suppression resulted in decreased bone growth in adolescents with gender dysphoria.

The effects of hormones like estradiol are extremely complicated, and affect many different processes in the body that hormone blockers could interfere with. This quote is long, but necessary to understand these intricate processes. It also includes some interesting information on effects on mitochondrial DNA. Mitochondrial DNA is something that is known to be negatively impacted in FtMs taking high doses of testosterone:

Lupron’s widespread use for pain-related, female reproductive disorders, such as endometriosis or fibroids is not well supported, with little research indicating its efficacy in reducing pain and no research delineating its effects on disease progression. Conversely, evidence of safety issues have long been recognized, especially within the patient communities where reports of chronic and life-altering side effects are common. We have many case reports on our site alone. Although, class-action and marketing lawsuits have arisen, Lupron continues to be misprescribed regularly to diagnose or treat pelvic pain disorders like endometriosis, generating over $700 million in revenue in 2010 and 2011 for the manufacturers and an array of serious and chronic health issue for its recipients.
The reported side effects of Lupron are staggering both in the breadth of physiological systems affected and the depth of symptom severity experienced (a partial list). Indeed, everything from the brain and nervous system to the musculature, skeletal, gastrointestinal and cardiac systems are affected by Lupron, sometimes irreversibly. This is in addition to thyroid, gallbladder and pancreatic side effects. How can one drug evoke so many seemingly disparate side effects? Is it possible that the magic of chemical castration is not as safe as we were led to believe; that hormones regulate a myriad of functions beyond reproduction? It is.
… Hormones, even those inappropriately designated sex hormones, like estradiol and testosterone, regulate all manner of physiological adaptations in virtually every tissue and organ in the body and they do so in conjunction with other hormones and by decidedly non-linear trajectories. That is, the dose-response functions are curvilinear where both too little and too much of a particular hormone can evoke serious negative consequences in body systems totally unrelated to reproduction. Chemical and surgical castration would fall into the ‘too little’ category...
Lupron, Maybe Not Such a Good Idea
Estradiol bound to mitochondrial receptors, controls a whole host of functions in the mitochondria, which then control cellular health throughout the brain and body. Without estradiol, the mitochondria become misshapen and dysfunctional and eventually die a messy death (necrosis), but not before inducing mutations in next generation mitochondria (mitochondrial life cycles include the regular birth of new mitochondria and the necessary death of old and damaged mitochondria). As the damage and mutations build and the ratio of healthy to damaged mitochondria shifts, cell death, tissue/organ damage and disease develop. Lupron, other drugs that tank estradiol, and ovariectomy, initiate mitochondrial damage. The mitochondrial damage represents a possible final common pathway by which Lupron induces the myriad of side-effects and adverse reactions associated with this drug.
A question that remains, is whether this damage can be offset by supporting mitochondrial machinery by other mechanisms. This is particularly important since millions of women have been exposed to Lupron and/or have had their ovaries removed. Other hormones and a myriad of nutrient factors are necessary for the enzymes within the mitochondrial machinery to work properly. Could we offset the damage evoked by too little (or too much) hormone by maximizing the efficiency of the other reactions. I think it is possible, at least theoretically and at least partially. That will be addressed in a subsequent post. For now, however, I think we ought to reconsider the use Lupron, other GnRH agonists, antagonists and the surgical removal of women’s ovaries. The damage evoked by eliminating estradiol is likely far greater than any potential benefit in an ill-understood disease process like endometriosis.

Some interesting general information on hormones and brain development, and gender and sexuality can be found in this article, “Sexual differentiation of human behavior: Effects of prenatal and pubertal organizational hormones.”

Effects specific to males

Puberty suppression in boys with precocious puberty helps them attain a normal height range, but may also be associated with obesity.

Puberty blockers may be associated with testicular cancer in males, which could affect a male youth if he eventually decides to go off of puberty blockers and desist/detransition.

Is reducing distress and passing better a good argument for disregarding possible risks from hormone blockers?

A counter argument to some of this alarming information about Lupron is that puberty suppression and therapy has been shown to reduce stress in dysphoric minors. While puberty suppression may have negative effects on the brain, it’s possible stress does as well, which is the justification used for giving children hormone blockers.

Eiland (2013):

We suggest that, due to a number of converging factors during this period of maturation, the adolescent brain may be particularly sensitive to stress-induced neurobehavioral dysfunctions with important consequences on an individual’s immediate and long-term health and well-being.

Distress during adolescence may also increase the likelihood of mental illness.

Gender-affirmative model advocates are currently making the questionable claim that hormone blockers are “fully reversible” (we now no they are not-see updates). The mental health argument is probably the more honest one, but it’s difficult to determine cost/benefit without more knowledge about the long-term effects of Lupron, or if puberty blockers benefit mental health in youth at all or worsen it (in updates linked below there is info indicating the mental health benefits argument is weak).

Another argument is that they will pass better if blocked at young ages by Norman Spack, endocrinologist:

He said in early September that offering services through pediatric care allows patients to start treatment early enough for the best cosmetic outcome, reducing chances of discrimination and allowing for better integration into society – according to the Associated Press.

It’s worth asking if this is also worth the health risks. Yes, to some dysphoric people passing can be very important for multiple reasons. But many young same-sex attracted dysphoric males are already very feminine, even at 18. In addition, in this section, some examples show how there are already men attracted to trans-identified males who were never puberty-suppressed. The problem lies in de-pornifying and addressing exploitation in that culture through greater acceptance and destigmatization. Testosterone is a potent hormone, and trans-identified females will not pass better by transitioning as minors. Affecting their fertility and possibly their IQ may not be worth it.

Recent reviews about the use of hormone blockers can be found in Richards et al. (2018) and Bangalore et al. (2019).

D. Many effects of cross-sex hormones are irreversible, and long-term effects on minors and young adults who transition are unknown, as most research is on late transitioning MtFs and FtMs

Many of the effects of cross-sex hormones, especially those from testosterone, are irreversible once a youth embarks upon taking them. There is a push to lower the age of consent laws for cross-sex hormones and in some cases, skip the hormone blocker protocol and just give the youth testosterone or estrogen.

Adult studies on hormone safety do not translate to early medical intervention cohorts.

Many trans-identified people do not seem to have significant issues on cross-sex hormones or don’t feel the issues are worth not transitioning. But good long-term studies on adults are unfortunately lacking. So the effects on people transitioning so young are unknown. For example, from the Transcare website of UCSF:

There is not much scientific evidence regarding the risks of cancer in transgender women.” All information we have about the effects of hormones on MTFs or FTMs comes from adults, most of whom have not been on hormones nearly as long as the child transitioners of today will be.

Here Dr. Rob Garofalo explains that they do not know the future impacts of these practices on minors:

There are so many unanswered questions around the long-term consequences, and whether your health risk profile really becomes that of a male or female,” Garofalo says. “If we start testosterone today, will you have the cardiac risk profile of a male or female as you grow older? Will you develop breast cancer because we’re administering estrogen?

Also, if a minor goes on cross-sex hormones and the young person changes his mind, some of the effects cannot be reversed. This 14-year-old boy, who obtained hormones through his mother (doctors may do this to avoid lawsuits), will now need a double mastectomy. Testosterone lowers the voice and thickens the bones, which will not be fully reversible in females.

John Whitehall is an Australian doctor concerned with the medical transition of minors. In the below quote he discusses some negative findings on male adult brains exposed to oestrogen (see more info below) and how these effects are unstudied in tweens and teens:

Courts have repeated the testimony of experts that the effects of cross-sex hormones are “partially reversible”. However, in none of the summaries does it appear that attention has been directed to the possibility of structural change on the brain, despite occasional warnings about mood swings, depression and anger…
As with blockers, the above studies were conducted on adult brains exposed to cross-sex hormones for only several months. What can be expected from exposure in childhood that continues for decades? No one knows. A 2016 review concludes that “long term clinical studies are yet to be published … risks may become more apparent as the duration of hormone exposure increases”[60].

There was a recent study done on a fairly young cohort in the Netherlands that shows a significant increase in heart and circulatory problems.

“The Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results from a Large Cohort Study”:

Trans men were over 3x more likely to have a heart attack than cis women.

The median age of the biological females in this study was only 23. This is young to be experiencing these elevated risks.

From this article on the study:

The study found that trans women were more than twice as likely to have a stroke as cis women and almost twice as likely to have a stroke as cis men.
Trans women were also five times and 4.5 times more likely to develop blood clots than cis women and cis men, respectively.
Trans women also had heart attacks more than twice as often as cis women, and trans men were over three times more likely to have a heart attack than cis women…

A doctor on social media comments on the fact that these risks are quite high and that other drugs have been banned due to less risk. The person’s status as an MD can’t be verified as the account is anonymous likely due to reasons that can be found in this section about an overly politicized climate:

In the study “The occurrence of benign brain tumours in transgender individuals during cross-sex hormone treatment” by Nota et al., 2018, the researches state they found an increased risk for benign brain tumors in MtFs and FtMs:

Based on our results we conclude that cross-sex hormone treatment is associated with a higher risk of meningiomas and prolactinomas in transwomen, which may be linked to cyproterone acetate usage, and somatotrophinomas in transmen.

Testosterone side effects

Listed below are some of the health risks listed by WPATH, the main organization who sets standards of care, for females taking cross-sex hormones:

FTMs: polycythemia, weight gain, balding, sleep apnea, possible cardiovascular disease, diabetes type 2, bone density loss and increased risk of cancers (breast, cervical, ovarian and uterine).

Testosterone use doesn't always have side effects for adult transitioners but can cause; menopause, vaginal atrophy, interstitial cystitis, abdominal pain, incontinence, thoracic outlet syndrome (WPATH-Facebook), causes mitochondrial damage, and can change one's personality and sexual orientation. Doctors do not know if female minors injecting testosterone will have males' health profiles and life expectancy or if their health outcomes will be better or worse than males' health outcomes. Adults may be free to take these risks, but it is unknown what the long-term health consequences are from beginning testosterone at age 14. The effects of testosterone on hair growth and the voice are irreversible. There are now several documented cases of teenage girls demanding this treatment (for up to several years ) and then desisting. This is a problem because they would have been coping with permanent hirsutism and a deeper voice or may not have desisted due to psychological effects.

The study "Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population" by Alzahrani et al. 2019, shows a risk of myocardial infarction for FtMs significantly higher than for female or male controls:

Multivariable analysis revealed that transgender men had a >2-fold and 4-fold increase in the rate of myocardial infarction compared with cisgender men (odds ratio, 2.53; 95% CI, 1.14–5.63; P=0.02) and cisgender women (odds ratio, 4.90; 95% CI, 2.21–10.90; P<0.01), respectively.

Is bio identical T completely safe for offspring of those taking it, unlike steroids which are definitely not safe to offspring?

There are currently no studies on the effects on offspring born to females injecting high doses of testosterone. But there is evidence that steroid use causes birth defects in the children of women who used them, even long after they were stopped. It is unclear if bio-identical testosterone can negatively affect females’ reproductive systems. There are many stories of trans-identified females carrying babies but not much knowledge about how their babies could be affected in terms of birth defects or hormonal or hormonal effects on the fetus if pregnancy happens before the testosterone is stopped.

The consequences of steroid use are discussed in a Chicago Tribune article about girls who use steroids in sports:

Other long-term risks include liver cancer, depression, and birth defects in children of mothers who once used steroids.

From a pregnancy informational website:

The maternal use of steroids and possible birth defects from steroids should be a major concern for women considering pregnancy. While steroids are a medically necessary at times, the effect of steroids on the unborn child is a real worry…Research has shown that besides decreasing inflammation and increasing muscle strength and growth, the long term use of anabolic steroids may change the reproductive system of some women. This is the direct result of a decrease in estrogen and progesterone levels in the body and changes in the level of testosterone. Female athletes who compete and use steroids for growth and strength may be most affected.

Taking oral Turinabol is not the same thing as injecting bio-identical testosterone. However, there is debate about whether bio-identical hormones are entirely safe compared to synthetic alternatives like Premarin, even in hormone replacement therapy for menopause and andropause (“Men claim they suffered heart attacks, strokes and blood clots as a result of using the drugs.”). Many side effects, including birth defects, are recorded in East German athletes given steroids:

A study of 52 of the athletes has revealed that not only do they have serious health issues, but their children have high rates of physical and mental deformities.

Hopefully bioidentical testosterone will have a much better safety profile.

Estrogen side effects

These are the health risks listed by WPATH to males who want to be females taking cross-sex hormones:

MTFs: gallstones, weight gain, blood clots (venous thromboembolisms) and sexual dysfunction; also possible cardiovascular disease, diabetes type 2 and breast cancer.

Here is an article on circulatory health risks:

The study found that transgender women, who are assigned the male sex at birth, were twice as likely as cisgender men or women to have the blood clot condition venous thromboembolism. Transgender women on hormone therapy were also found to be 80 to 90 percent more likely to have stroke or a heart attack than cisgender women.

Getahun et al, 2018 “Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons”

The below quote is from Dr. Whitehall regarding an Australian court case. He cites studies showing possible negative cognitive effects of oestrogen on males’ brains:

Animal studies mentioned above on the effects of androgen deprivation should have raised concerns about similar effects of puberty blockers on the brains of natal boys. The added effect of oestrogen should have been considered because by 2006 it was described in medical literature.
Three studies have compared the effects of cross-sex hormones on the brain before and after treatment. One, in which oestrogen and an added anti-testosterone drug were given to transgendering males, found a reduction in brain “ten times the average annual decrease in healthy adults” after only four months. After a similar time, the brain volume increased in females receiving testosterone.
Other studies[58] confirm that shrinkage of male brains on oestrogen is associated with reduction in the size of grey matter after only six months. Increased size of grey matter in females on testosterone is associated with altered microstructure of neurons[59].
Oestrogen may reduce grey matter in males by inducing apoptosis, or death of neuronal and supporting cells. Testosterone may increase the size of female grey matter by an anabolic effect on molecular components of cells. As brains are chromosomally programmed before birth to respond to specific stimulation of appropriate sex hormones in puberty, there should be no surprise at disruption when the hormone they were expecting has been substituted by one they were not.

There may be other unexpected side effects in males taking estrogen. They appear to have an increased risk for MS, a very serious neurological condition.

Conclusions: We report a positive association (a near seven-fold elevation of rates) between GID and subsequent MS in males. Our findings support a postulated association between low testosterone and MS risk, and highlight a need for further exploration of the influence of feminizing sex hormones on MS risk.T

While most adults taking these hormones are shown to be ok, with so many young people taking them, the negative consequences may be worse due to more time spent on these hormones.

E. Surgery on minors.

Dysphoric people who have turned to surgeries are not entirely new. There are known cases of feminine males voluntarily castrating themselves going back to ancient Greece and Rome. There’s also a long history of this among the Hijra in India. However, some of this may be due to a culture that is extremely abusive towards the Hijra or for religious reasons. They are scant, but there are some stories of females binding their chests in an attempt to live stealthily as males. Today, even with surgery being available to adults, there are times when young people are so dysphoric that they try to obtain black market hormones and harm their bodies. Wanting to help these extremely dysphoric youths is understandable.

Because of this extreme desire to transition in some dysphoric minors, many trans activists and some medical professionals want to lower the age of consent for surgeries whose consequences are irreversible. Surgeries on minors are done in the United States, and the push is to make this the norm everywhere. A double mastectomy without parental consent is legal for 15-year-olds in Oregon, and this age or lower will likely be the law in other states soon. Below is one of the many examples of surgery done on minors in the United States. This study shows that doctors have performed mastectomies on females as young as 13:

Here is a case of surgery performed on a developmentally disabled female 14-year-old.

While there are youths who will want to transition in adulthood, lowering the age of consent puts tweens and teens who may not yet have stable identities (many lesbian, bisexual, and autistic) at risk, as a new pattern is emerging that most females transitioning did not suffer from early intense childhood GD. Currently, WPATH Standards of Care and the Endocrine Society guidelines advocate for surgery at 18 years old, yet there is a lot of activist effort to change this. (WPATH has now removed age restrictions-see blog updates)

We can find an interesting case study in Thailand. This country is a bastion of sex reassignment surgery, where Westerners often go for cheaper procedures. Thailand had to raise, not lower, the age of consent. They require parental consent for an 18-year-old, and one must be 21 to have surgery without parental consent. This was due to a spike in SRS regret. This can be expected in the future as standards are relaxed:

Thai gay rights campaigner Nathee Teerarojanapong said the greater legal protections are necessary to guard against gender swaps that too often backfire on those who make an irreversible choice. ‘I got so many calls where they said they are so sorry that they did a sex change,’says Nathee. "They make a big mistake and they want to come back and be the same. But they cannot!’

Many surgeries carry risk of death, even if it is unlikely. This 25-year-old female died of complications from a hysterectomy. In the Dutch study that showed positive psychological outcomes (this study is heavily promoted by affirmation model advocates), out of a cohort of 55 medically transitioned young patients, one of them died from the vaginoplasty surgery. Vaginoplasties (warning:graphic content) carry other risks. They have complications such as fistulas, require ongoing neovaginal dilations, often require second surgeries because the neovaginas collapse, and can risk sexual dysfunction. The push is to perform these surgeries on minors.

Lynn Conway, transgender activist, discusses the intensity of bottom surgery:

Vaginoplasty (sex reassignment surgery) is a dramatic and irrevocable final step in male to female gender transition. This step is usually taken only after the deepest introspection and counselling regarding all the options. For those needing complete gender correction, this surgery is a lifesaving and life enhancing miracle, and can enable them to live a full and joyous life afterwards. However, carrying out of a mistaken urge for such a complete transformation could lead to permanent and terrifying emotional and psychological consequences.

Bottom surgery for females has the highest complication rate for any transition surgery. Phalloplasty is a dangerous and extreme medical procedure (warning: graphic content). Doctors take a section of nerves and flesh from an arm or a leg, a skin graft is taken from another site to cover the donor site, and the urethra is channeled into an attached, sown-together neophallus. An online influencer named Cayden Carter has had 33 surgeries and has been on an ileostomy bag due to complications from a phalloplasty that went septic. Carter is one of several females suing Dr. Curtis Crane for botched phallo surgery with debilitating and severe consequences. So far, doctors have not performed this surgery on female minors, but double mastectomies have, which may soon change if current trends continue.

Mature adults may have the right to make these choices, although regulations prevent medical malpractice, and phalloplasty has an unethically high complication rate and poor results. Minors agree to these surgeries for psychological problems, not physical health or life-threatening physical conditions.

F. Conclusion to early medical treatments on minors

Some youths are so dysphoric that they engage in self-mutilation or try to obtain hormones illegally, which is very unsafe. These are the reasons early social transitions are done and why trans activists push for them. But there is currently little evidence that this a solution to what may be a lifelong struggle with gender dysphoria. Most societies strongly emphasize gender, and it is difficult to know how much alternative ways of providing cultural support for gender-nonconforming people could alleviate some of this distress. But in our society, physical appearance is very important to people, and these youth experience distress around developing secondary sex characteristics.

But these early medical transitions have been harmful (or potentially so) in the cases of young detransitioners/desisters who, as minors, permanently altered their bodies or had to be protected from doing so by their parents. Even if these cases don’t end up being common, they have grave implications for those young people who, just 20 years ago, could have matured naturally with their bodies intact. A young person’s brain cannot fully assess risks until age 25.

The long-term consequences for minors who would transition in adulthood are also potentially serious, affecting their physical health, fertility, and sexuality. Doing a cost-benefit analysis of these consequences is impossible without a control group and without lots of time passing. In the meantime, 11-year-old children make these decisions at this very movement. Or they may make these decisions as young as 4, if social transitions decrease the likelihood of youth adapting to their natural body without hormones and surgery.

Not all trans-identified people agree with medical techniques being performed on minors

While most trans activists seem to support early interventions, some of the loudest voices questioning the transitioning of minors are trans-identified. Some have the life experiences of seeing surgeries go wrong, and transition failing to solve all of the problems of their trans-identified friends.

Blaire White, right leaning YouTube celebrity who is attracted to men and has been effeminate since childhood, is strongly opposed to the medical transition of minors. (The Rubin Report 22:38):

I’m definitely against children transitioning. I think it is a horrible decision to let a child make a life changing decision and to be sterile because that is a consequence of transitioning so young. You can’t have kids. And just the drugs they go on, there’s a lot of problematic things that go along with that (discusses micro penis issue)…And puberty blockers are hailed as the most important thing to go on…Trans activists for lack of better terms just completely gloss over this and make it seem that it’s something it’s not.

In this article,“I’m transgender. Please don’t normalise transgenderism,” an Australian MtF raises concern about the huge spike in children being diagnosed as transgender, what seems like social contagion in schools, and medical treatments on young people.

It would be interesting and helpful to know if having support programs where trans individuals such as these (who advocate for waiting), could be role models that encourage patience to dysphoric minors so their bodies can mature (avoiding false positives, micro penis, sterilization, bone health, and other unknown effects). This however, or any other practices that support body acceptance, are or will soon be (depending on area) illegal under anti-conversion therapy. Some therapists claim they do not understand if doing anything to encourage body acceptance or patience is legal or not.

Pros and cons of early medical treatment

We have provided a breakdown of pro and con arguments around social and medical transition on minors in the moral dilemmas section. Another overview of pros and cons of hormone blockers and cross-sex hormones can be found in this article. A few of the pros and cons are listed below.

To summarize, these are the risks or possible risks of not medically intervening in minors with gender dysphoria:

1) Unalleviated mental distress, with possible cases involving self-harm.

2) Failing to act on something that could reduce suicide ideation (questionable-data is proving to be weak or nonexistent-see updates).

3) The development of unwanted secondary sex characteristics that will require surgeries later, not needed with early intervention.

4) Strained relationships between the parent and the child who wants immediate results.

These are some of the risks of early medical interventions:

1) False positives on dysphoric youth who would outgrow GD and most likely grow up to be gay, lesbian, or in some case bisexual or even straight.

2) Castrating would be effeminate gay males.

3) Taking away the choice of what type of surgery a trans youth may want or the choice not to have bottom surgery at all.

3) Possibly permanently destroying sexual function in males when blocked too young.

4) Creating a need for a vaginoplasty surgery that is more complicated and causes permanent scarring.

6) Sterilization of both males and females.

7) Possible bone weakening.

8) Possible effects of Lupron on mental function and physical health including those claimed by women who received Lupron for precocious puberty.

A review of medical side effects from hormone blockers and cross sex hormones can be found in a video by endocrinologist William Malone.

Whether or not the risks of early medical transition are worth the downsides depends on who you talk to. Some parents want more caution from the mental health and medical community when it comes to transitioning their children. Some parents want less medical gatekeeping, particularly ones involved in running support groups. Many trans adults are pushing to lower age of consent laws. But many of them are late transitioning males or females (often previously lesbian-identified), who often didn’t realize they were trans until they were older, having survived their teen years. And many of these adults advocating for sterilizing and sexuality-destroying procedures have biological children they say they are thankful they have. It calls into question whether they are motivated, at least in part, by a personal need for societal validation. Are these individuals the authority for the child population, especially when they often appear defensive and hostile to the concept of desistance? Since it is very questionable if an 11-year-old can genuinely consent to these life-altering procedures, people look to the opinions of mental health and medical professionals, who also disagree.

Dr Meyers, a pro medical transition advocate:

A lot of people are concerned that delaying puberty may cause some harm,” said Meyer. “On a whole, much less harm is done by giving blockers than by not giving blockers.”

What justifies this statement? Can one really say that decreasing a teenagers intense (but temporary) distress, is more important than preventing the severe side effects women are listing on lawsuits against the makers of Lupron—like impairing a youth’s cognition or fertility? Below are some differing opinions from more skeptical doctors:

Puberty suppression hormones prevent the development of secondary sex characteristics, arrest bone growth, decrease bone accretion, prevent full organization and maturation of the brain, and inhibit fertility. Cross-gender hormones increase a child’s risk for coronary disease and sterility. Oral estrogen, which is administered to gender dysphoric boys, may cause thrombosis, cardiovascular disease, weight gain, hypertriglyceridemia, elevated blood pressure, decreased glucose tolerance, gallbladder disease, prolactinoma, and breast cancer. Similarly, testosterone administered to gender dysphoric girls may negatively affect their cholesterol; increase their homocysteine levels (a risk factor for heart disease); cause hepatotoxicity and polycythemia (an excess of red blood cells); increase their risk of sleep apnea; cause insulin resistance; and have unknown effects on breast, endometrial and ovarian tissues. Finally, girls may legally obtain a mastectomy at sixteen, which carries with it its own unique set of future problems, especially because it is irreversible.

Is preventing a child from going through a puberty they don’t want a greater child abuse than providing them a quick fix with medical consequences to their problems and medically defacing children who would have naturally adapted to their biological reality? Adults should fully support all youth in their gender nonconformity, but ethical questions surround these serious medical interventions. People concerned about these issues include straight, LGB people, and trans-identified people who cover the ideological range from conservative to liberal. Doctors and therapists don’t all agree on the best approach.

These choices are up to the person in the adult population (things are indeed moving towards an “informed consent” model). And there are youth who may know that they will forever want medical transition and those youths have rights, but an informed cost-benefit analysis—of genital disfiguring protocols, health consequences, and sterilization—cannot truly be made by minors because of immature cognitive brain development and lack of life experience.