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Opinion piece in the Wall Street Journal: the truth about puberty blockers

The FDA has not approved them for gender dysphoria, and their effects are severe and permanent.

Par Gérald Posner le 7 juin 2023

The transgender craze has brought with it a new euphemism: "gender-affirming care", meaning surgical and pharmacological interventions designed to make the body more like that of the opposite sex. Gender-affirming care for children involves the use of "puberty blockers": one of five powerful synthetic drugs that block the natural production of sex hormones.

The Food and Drug Administration has approved these drugs to treat prostate cancer, endometriosis, certain types of infertility and a rare childhood disease caused by a genetic mutation. But it has never approved them for gender dysphoria, the clinical term for the belief that one's body is the wrong sex.

The drugs, led by AbbVie's Lupron, are prescribed to minors "off-label". (They are also used off-label for the chemical castration of recidivist sex offenders). Off-label distribution is legal; about half of all prescriptions in the U.S. are for off-label use. But off-label use circumvents the FDA's authority to review drugs for safety and efficacy, particularly when patients are children. Some US states have eliminated the need for parental consent for adolescents as young as 15 to start puberty blockers. Proponents of puberty blockers claim there are few drawbacks. The Department of Health and Human Services claims that puberty blockers are "reversible". It omits evidence that "by interfering with the usual process of developing sexual orientation and gender identity", these drugs "effectively 'lock' children and young people into a treatment pathway", according to a UK National Health Service report, which cites studies concluding that 96% to 98% of minors prescribed puberty blockers proceed to cross-sex hormones.

Gender advocates also falsely claim that puberty blockers for children and adolescents have been "used safely since the late 1980s", as a recent Scientific American article puts it. This ignores substantial evidence of harmful long-term side effects.

The Center for Investigative Reporting revealed in 2017 that the FDA had received more than 10,000 adverse event reports from women who had been given Lupron off-label as children to help them grow. They reported thinning and brittle bones, teeth that lost enamel or cracked, degenerative spinal discs, painful joints, drastic mood swings, seizures, migraines and suicidal thoughts. Some have developed fibromyalgia. Fertility and cognitive problems have been reported.

In 2016, the FDA ordered AbbVie to add a warning that children on Lupron could develop new or intensified psychiatric problems. Transgender children are at least three times more likely than the general population to suffer from anxiety, depression and neurodevelopmental disorders. Last year, the FDA added another warning for children about the risk of brain swelling and vision loss.

The lack of research demonstrating that the benefits outweigh the risks has led to significant pushback in the U.S. and abroad. Republican legislatures in a dozen states have reduced or banned gender-affirming care for minors. Finland, citing concerns about side effects, reduced puberty blockers and cross-gender hormones for minors in 2020. Sweden followed suit in 2022 and Norway this year. Britain's National Health Service closed the country's largest gender clinic for young people after 35 clinicians resigned over three years, complaining that they were forced to over-diagnose gay, mentally ill and autistic teenagers and prescribe drugs that worsened their conditions. Yet the USA and most European countries adopt a standard of care that pushes young people towards "gender-affirming" treatments. It bypasses "watchful waiting" and talk therapy, and diagnoses many children as gender dysphoric when they're simply going through a phase.

Gender-affirming care for children is undoubtedly a flashpoint in the American culture wars. It's also a human experiment on children and adolescents, the most vulnerable patients. Ignoring the long-term dangers posed by the unrestricted, off-label distribution of powerful puberty blockers and cross-sex hormones, combined with the significant over-diagnosis of minors as gender dysphoric, borders on child abuse. M. Posner est l'auteur de "Pharma : Greed, Lies and the Poisoning of America".


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