Main Edition
US
FR
Do you really get 'time to think'? Lisa Wiltse/Corbis/Getty Images
Responses were predictably mixed to the announcement last week that the NHS would no longer prescribe puberty blockers to youngsters. While some celebrated the end of an era of grotesque medical experimentation on children, others took to social media to warn of the inevitable suicide of desperate young people.
In the more hyperbolic echo chambers of social media, the decision was cast as a lifeline withdrawn for no other reason than state-sanctioned bigotry and transphobia, possibly as part of a covert programme of eugenics. The hysterical pitch of this suicide narrative eventually prompted Professor Louis Appleby, head of the national Suicide Prevention Strategy, to stage an intervention on X. He stated that invoking suicide in this debate was both “mistaken and potentially harmful” and called time on “that line about choosing a living daughter or a dead son” — a line that has terrified so many parents into submission when presented with a medical pathway as the only option for their distressed children. So what does the NHS withdrawal of puberty blockers as a treatment for gender distress actually mean?
Every drug prescribed by a doctor requires a licence issued by a relevant regulatory authority. These bodies carefully review the data from clinical trials to ensure that the drug is effective, safe and meets manufacturing quality standards. However, once licensed for one purpose, these drugs can then be used off-label for another. Off-label means the drug can be prescribed for a condition (or at a dose) other than that for which it has been approved. Off-label prescribing is common, particularly in paediatric medicine, as children are rarely participants in clinical trials for ethical reasons. Up to 20% of drugs may be prescribed off-label. Puberty blockers are licensed in children to treat precocious puberty, a condition where children hit puberty years before their peers, sometimes before the age of five. Although the impacts on bone density are recognised, the drugs are effective at preventing the short stature and ameliorate the significant emotional and behavioural difficulties associated with such an early onset.
Once a drug has a licence for one condition, doctors are free to prescribe the medication for an off-label use, if they have a reason to believe it might help. This is how puberty blockers came to be prescribed to children with gender related distress. The announcement last week effectively put an end to this practice in the NHS.
For as long as puberty blockers were being offered as an off-label treatment by the NHS, clinicians were both ethically and duty bound to monitor their effectiveness. This fundamental duty was largely ignored by the clinicians at Gids who failed to collect adequate data, and rolled out the experimental treatment regardless. In a sign of just how far outside the bounds of normal clinical practice Gids was operating, one senior clinician appeared to be under the impression that auditing the outcomes of the experimental treatments they offered would actually be illegal.
As a result of their failings, we are left with a vacuum of data on the safety and effectiveness of puberty blockers and are back to square one when it comes to evaluating the medication as a prospective treatment for children with gender distress. It’s one thing to attempt to persuade an ethics committee to allow you to monitor the impact of a treatment already in use, albeit in an off-label capacity, quite another to convince them to give the go-ahead to experiment in children with a powerful treatment that will interfere with a critical stage of maturation. Following the withdrawal of off-label prescribing, anyone attempting to design an NHS trial to explore the efficacy of these drugs will need to convince an ethics committee of a sound rationale for reintroducing the drugs in the first place.
In most clinical trials, identifying the target or primary outcome of the treatment is the easy part: antibiotics reduce infection, epilepsy medications stop seizures, cancer treatments eliminate malignancy. No one needs a trial to prove that puberty blockers block puberty — the drugs are unequivocally effective in this regard. But puberty is neither a disease nor an illness. It is a vital stage in the transition from childhood to adulthood, marked by changes that extend far beyond the development of secondary sex characteristics. The brain undergoes extensive rewiring during puberty, creating the adult capacity for nuanced thought and complex decision-making, a process that isn’t complete until well into the third decade of life. Changes in the brain also allow sexual identity to develop. And elsewhere in the body, respiratory and circulatory systems undergo rapid growth and development. The skeletal system changes, increasing in bone density and musculature. Puberty blockers interfere with all of these processes in ways that may or may not be completely reversible — we can’t be sure, as many have not been studied.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeHere is more food for thought, from the Midwestern Doc:
https://www.midwesterndoctor.com/p/puberty-blockers-are-incredibly-dangerous
A quick skim of that shows he is discussing the use of puberty blockers in adults. That is an entirely different use case from that in youth.
Oh I see. Adults, apparently, are in dire need of having their puberty blocked. 🙁
Do give it more than a quick skim, why dontcha?
You are drastically ignorant whereof you speak. Like most here.
Puberty blockers are prescribed in some case of endometriosis and certain cancers of sex organs — for adults.
I did read the whole thing, and it is no more than the evidence-less screeds I usually see from Social Conservatives. They always boil down to claims either that the side effects reporting system does not work, because there is no evidence for what they claim in it, or that puberty blockers are somehow exempt from it, again because there is no evidence of their claims. Also the usual lies that intended effects are side effects, and that temporary intended effects are permanent — without any evidence given of such permanence.
The whole of the SoCon case against gender affirming care is built solely on lies and deceit.
Hormonal treatments are prescribed for adults. In their case, they are not “puberty blockers.” Duh.
Whoever disagrees with you, must be called names. Yeah. Over and over. Way to go!
Imbecile. In adults blockers are prescribed for some cancers and for endometriosis. Puberty blockers are not sex hormones.
It is no matter of disagreement, it is a matter of you having not the foggiest factual knowledge of what you are prattling on about — combined with your mulish resistance to learning.
There have been 15,000 adverse side effects complaints to the FDA over the popular puberty blocker Lupron. There are forums out there for people—mainly women—who were given the drug Lupron for endometriosis and precocious puberty. Some of these women are wheelchair bound because of agonizing joint pain. Other side effects include: tooth loss, major brain fog that makes them unemployable, hair loss, osteoporosis in women in their 20s, chronic pain needing high power painkillers, high fracture rates , and more. These drugs are horrible, including for men who took them for prostate cancer. Imagine what Lupron is doing to young bodies.
And just as I said, there are no “side effects” to puberty blockers known to occur above baseline when used in youth, either for gender dysphoria or precocious puberty.
“Imagine what Lupron is doing to young bodies.” <– Nothing at all which is regrettable.
You are claiming the results in adults who are post-puberty are the same as in youth who have not undergone it.
And you are lying to claim it.
And I just saw my reply to that deleted by UnHerd. Great job protecting your transphobic propaganda platform.
He’s probably a bit of a monomaniac, just like you – but he does mention all ages and provide some alarming instances.
I’m no monomaniac — I just don’t approve of or let slide politically motivated child abuse or public support for it.
“but he does mention all ages and provide some alarming instances.” <– Not to the rational and factually informed.
The article is very good, but the author does seem to buy into the narrative.
Quoting a random passage:
“trans and gender diverse people”
What do these terms mean? They are never defined, meaning that they mean anything one likes.
Besides difficult definitions, the author skims over a very important point. Puberty blockers have been with us for decades and while they are used for a tiny number of children with precocious puberty, their rather frightening effects were always known and their usage even in those cases was strictly time limited.
Like too many doctors, the author is rather careless about why and how these dangerous drugs came to be prescribed on demand for supposedly gender confused children on an unprecedented scale. Evidence based medicine does not work on doctors’ so called beliefs about how they might help in a completely new scenario. Clinical trials were not conducted because the outcome was never in doubt.
Quite!
“their rather frightening effects were always known <– You are lying. They have no such effects.
I don’t see any downvoters supplying any evidence of such “frightening effects”.
You are here, as expected, a stupid psychopathic woman, although your real place is in a mental hospital.
And you have not the slightest factual excuse to have said that either.
Where do you get off calling other people liars? You’re a man pretending to be a woman, for G*d’s sake.
When they lie.
*
“You’re a man pretending to be a woman, for G*d’s sake.” <– Like that lie.
*
You have no excuse for your lies, let alone the grotesque child abuse you intend for the sake of them.
I thought the author explained this point quite clearly. She certainly answered some questions I’ve had for a long time.
Off-license prescriptions are an important part of the treatment for many conditions. Clinical trials are very expensive and time consuming. Once a drug is licensed no one has any motivation to do more trials.
The fact that these treatments were given to children, on nothing but the assumption that they would certainly help, without any concern over the long-term effects and without bothering to keep good records is the difference between medicine and quackery.
We’re all on the same page here.
Isnt she is quoting what the proponents of these drugs say when she uses this phrase? Elsewhere she talks about gender related distress
They are perfectly well defined and even obvious in context, you are simply lying to claim other wise.
Well said. Gender is a made up concept and confused with sex roles. Sex roles are collectively determined by societies and are not individual. Gender is the idea that individuals can determine their own role in society based on interior feelings. I don’t use the word “Gender” since it is a trap. Using the word acceeds to progressive ideology. The is only sex and the collectively socially constructed sex roles. Under progressivism I would be considered nonbinary. I’m not. I am a male who acts sometimes against common sex roles. I’m nurturing, gentle, highly agreeable, people oriented, and don’t enjoy traditional masculine pursuits. Likely due to extra estrogen during pregnancy. I’m a man. There is no gender. It’s mental. Like astrology.
‘Gender is a made up concept and confused with sex roles.” <– Gender is confused with sex roles — by the likes of you and by certain “soft” sciences. It is no more made up than is any word. It is the sexual dimorphism of the human brain producing the impulse to identify from among those you grow up with, those also of your gender so you can emulate them and thereby signal your gender. With a being as obviously complicatedly social as humanity, it is something which obviously will exist, and in fact is seen to exist quite durably in for example the case of David Reimer. It is neural development not changeable after birth.
It is no trap, and you have said demonstrating it is anything such. You have gender, it does not matter that you don’t like the idea, or that yours developed atypically.
Yeh, it’s an abstraction conflating a variety of social and psychological phenomena, and the intrinsically different experiences of men and women.
Gender ideologues are mesmerized by this magical abstraction. The power of language to shape illusions.
What, no downvotes for you? I almost gave you one not to make you feel left out. 😀
Thank you
Great article argued with real reason, care and respect. And when these qualities are brought to bear on this issue we see clearly just how irrational, reckless and cavalier this treatment regime has been and how much patient and practitioners have been consumed by a cultic authoritarian ideology.
“Great article argued with real reason, care and respect.” <– Not really, no, because there is no evidence at all supporting her claims.
‘In the more hyperbolic echo chambers of social media, the decision was cast as a lifeline withdrawn’.
See BBC (where’s that disinformation chappess ?) website today: ‘Trans treatment waiting list a ‘death sentence’’.
So the medics are in an impossible situation. Even detransitioners like Ritchie Heron (think that’s his name) say that if he’d been denied treatment, he’d have claimed it would lead to his suicide.
This is the downside of patient-centred care when the patients have been sucked into this cult.
The claims about lack of puberty blockers leading to suicide is completely spurious, if this were true then anyone over the age of about 30 would have known people at their schools dropping like flies through lack of transition- I don’t recall any suicide attempts by anyone in the area I grew up.
You SoCons are the ones in a cult, denying plain evidence you are wrong.
“This is the downside of patient-centred care when the patients have been sucked into this cult.”
Indeed! This entire situation keeps reminding me of an Edgar Allan Poe short story, “The System of Doctor Tarr and Professor Fether”, where the inhabitants of a mental asylum take over after locking up the real staff. As far as people who have been genuinely harmed by this cult are concerned, you don’t have to look far: search for Helena Kirschner, Keira Bell, or Daisy Strongin to name just a few. Daisy managed to get pregnant with her husband, but due to having been convinced to undergo a double mastectomy as a teenager, she will never be able to nurse her child. Her emotional pain is palpable and very real.
I recommend watching this documentary, which is not for the fainthearted: https://www.youtube.com/watch?v=3yvjFSX0TB0
“As far as people who have been genuinely harmed by this cult are concerned, you don’t have to look far: search for Helena Kirschner, Keira Bell, or Daisy Strongin to name just a few. Daisy managed to get pregnant with her husband, but due to having been convinced to undergo a double mastectomy as a teenager, she will never be able to nurse her child. Her emotional pain is palpable and very real.” <– Which in the case of Bell, is pain caused by them as adults by their own lies and deceptions. You are necessarily saying by your ignoring them, that the hundreds helped by comparison by gender affirming care do not count.
You are in a cult which claims they do not count. For the sake of saving 1 from any such pain, you want to force such pain on a hundred or so.
Things wont really change until using these drugs in this way is made illegal and we start seeing activist doctors and their enablers behind bars. That will send a strong message that the game is over.
That day will never come and should not, and what will happen is the few doctors who are enthusiasts for your ideology will be regarded like the freak doctors and dentists who said we must to prevent everything from masturbation to schizophrenia, pull all of our teeth and use dentures.
You all are that insane.
LOL!
Remember this and see what laughs you have about it, say in 10 years time.
Only because you are ideologically, emotionally motivated to refuse to acknowledge what is already known.
You, Baxendale, and no one else here will be able to cite any actual side effects occurring above baseline in a person taking puberty blockers as a youth either for gender dysphoria or for precocious puberty, because there are none.
most studies report that the majority (70% or more) no longer meet the diagnostic criteria once they have gone through natural puberty.
This sort of wrong-think cannot and will not be tolerated by the people who get off in sterilizing children. For their own good, of course. What adults do is their business, but coming for the children is among the hallmarks of history’s worst people.
“most studies report that the majority (70% or more) no longer meet the diagnostic criteria once they have gone through natural puberty.” <– A claim never backed up by any citation — not after Zucker’s fraud was revealed. That is because actual desistance rates for people approved to transition medically per protocols is near 1%, as is regret afterwards.
Put simply, Zucker sold the lie that being gay is the same as being transgender, so every gay child he worked with who did not transition had “desisted”. I see that fraud is an author on the paper Baxendale cites . . .
Zucker sold the lie that being gay is the same as being transgender,
Is that anything like the lie being sold that identifying as a woman makes a man female? I’d hate to think people are selective about the lies they peddle.
“Is that anything like the lie being sold that identifying as a woman makes a man female?” <– There is no such lie. You are lying to claim that is what gender affirming care is about.
It is nothing but a lie and only liars pretend otherwise. Mengele is cheering you, though.
“It is nothing but a lie” <– Yes you told a lie. It is a lie to claim that “that identifying as a woman makes a man a woman” is what gender affirming care or what being transgender is about.
Mengele cheers you, you want to force some boys to have breasts and periods and you want to force some girls to have beards and deep voices.
There is no more, less, or other to you here in this.
Says the person who wants to castrate boys and chop the breasts off of girls.
Boys do not have periods. Girls do not have beards. But keep patting yourself on the back for sterilizing children.
“Says the person who wants to castrate boys and chop the breasts off of girls.” <– A lie.
“Boys do not have periods. Girls do not have beards.” <– Not usually, but sometimes yes.
You think there is such a thing as an exception proving a rule, when exceptions actually only can ever prove how a rule is wrong.
“But keep patting yourself on the back for sterilizing children.” <– And especially in the case of the UK, where such surgery is only available to adults, you are lying about that, too.
As well as learning nothing about puberty blockers, we have learned nothing about the effect of jumping out of a plane without a parachute. To fully assess the efficacy of parachutes, we would need healthy volunteers to jump out of a plane at 10,000 feet, some with parachutes, and some without. Ideally, those without parachutes would be furnished with a dummy parachute, to account for the placebo effect. We would also need to follow up on those jumpers who did not use the parachute, to better understand the phenomenon of “parachute regret”.
And at that, 85% of all medicine is based on what is called by some, “low quality” evidence — because it is literally not possible or it is unethical to develop, “high quality” evidence. So when someone claims gender affirming care is only based on “low quality” evidence, the correct reply is, “So what?!”
Hysterical thing is, your and my comment say the same thing — and your’s has 6 upvotes as of this writing. Mine has 8 downvotes.
I have to conclude the usual Social Conservative, transphobic denizen here at UnHerd cannot read for comprehension.
Talia, I don’t understand why you persist if you believe the denizens here at UnHerd are so cloth-eared. You surely don’t expect to have them understand your point of view by insulting them.
I am not insulting them, I am describing them accurately. If they find that to be insulting, it is on them to change the accuracy of how I now describe them. Innocent lurkers should have the benefit of an alternate and actually factual viewpoint — the “gender critical” ideologues and bigots here have abandoned empathy, facts, and reason.
Much of the psychological distress has been caused by the propagation of the fantasy that ‘sex is a social construct’: it isn’t, it is a fundamental biological fact. If however, you feed that fantasy, then when reality strikes, as it is bound to do, there is a a profound psychological disconnect and resultant distress.
“Much of the psychological distress has been caused by the propagation of the fantasy that ‘sex is a social construct’:” <– Prove that.
“it isn’t” <– The idea advanced by Social Conservatives that sexual development of people is so substantially perfect, that laws may be written and policies predicated on it’s perfection is not only a social construct, it is a pernicious myth. It is the only real “gender ideology” involved here.
“it is a fundamental biological fact.” <– It is a biological fact, one of many, all equally fundamental.
I must honestly admit that if I had the opportunity to knock out the teeth of the parents of this girl in the photo and beat them half to death, I would do it with pleasure and with a sense of accomplishment.
The author of this article also must be punished, because this is a classical mass hysteria case. Right before the eyes of this “specialist”, girls, as is typical for them as the most vulnerable group to mass hysteria, are becoming the main victims of this epidemic, and she continues to talk about “gender disorder”. It’s hard to know whether this is stupidity or cowardice. I’m leaning towards the second option
PS. Let me emphasize. The author, Sallie Baxendale claims to be a consultant clinical neuropsychologist and a professor of clinical neuropsychology at University College London. She should be familiar with the phenomenon of mass psychogenic diseases, but she prefers to hide behind the fence of pseudo-scientific reasoning, while we are talking about turning girls into disabled people, about the destruction of their entire subsequent lives. Even Dr. Mengele was more humane, he killed his “patients” faster.
This article makes me sick
You have said nothing for which there is any relevant factual excuse — that is why you will never supply any.
There is nothing “affirming” about mutilating kids, and stealing their reproductive lives before they even have a chance to understand anything. Grotesque, ugly and criminal!
Nonsense, what is being affirmed is the person themselves, and their gender. They are not their sex anymore than yours is you. “You” only exist between your ears — that is the whole of your regrettable personality.
There is no mutilation involved, the surgeries and HRT when sought and provided have exactly the results described beforehand.
“it is likely that vulnerable children”
How is ‘vulnerable’ defined?
Already it seems unhinged that our leadership cohorts got seduced by this Insane Misogynist Homophobe’s Cult for so long, while the majority of the rest of us shoved our heads wilfully in the sand. The political, academic and media functionaries, enablers and opportunists who formed the second and third tiers of this abuse-of-the-vulnerable network are scattering at high speed, panicked by the prospect that they’ll be held to account at some future Nurembergian public bloodletting for our collective complicity.
As for the zealots who drove this – one will repeat it, endlessly – Insane Misogynist Homophobe’s Cult? Well, this small but disproportionately influential clique doesn’t have much choice but to double down. On the gender affirmation therapy clinical side are the surgeons and anesthetists, the nurses and endocrinologists, the psychiatrists and counsellors who presided calmly over the chemical abuse and surgical mutilation of physically normal, healthy, functioning bodies, owned by – for the most part – humans, still young (in years or emotional stability), who were simply struggling with mental health, emerging/uncertain sexuality and/or by no means uncommon identity/body image issues. They are so ethically and professionally enmeshed in this ruinous, anti-Hippocratic fiasco that to concede even the slightest error of judgement now would be to plead guilty to medical negligence.
As for the worst, the most visible and vocal and effectively bullying of the ‘trans activists’? Well, most of them are trans women. Meaning, for the most part, biological men who have at some point in their lives voluntarily cut their healthy, functioning d*cks and b*lls off. That’s a life-changing and irreversible thing to do. A small, biologically lucky number of them have been able to transition themselves into living as passable, sometimes very attractive, women. But most look like what they are: men, with male features and male frames, merely masquerading as conventionally unattractive women. The delusional, happy-shiny ‘advertising’ of the ‘gender-affirmation model’ of ‘therapy’…has simply turned out to be a mocking con.
These are the ‘trans activists’ who will fight to the bitter, absolutist end to keep reassuring themselves of the wisdom of the irreversible bodily choices they have made – entirely unnecessarily, for there is absolutely no need for chemical and surgical radical intervention, if all one wants/needs to do to be happy is live as and in a non-conforming guise. What other choice do they have, when the political, intellectual and medical establishments of their times have betrayed them so badly? This insanity should never have been allowed to endure for so long. It needs to stop now. Grimly, some of our most vulnerable people are going to get badly hurt all over again, in the stopping of it.