A Page 1 story in The New York Times yesterday acknowledged a number of shocking facts about the long-term impact of puberty blockers and cross-sex hormones on children and teens who receive the drugs as “life-saving” treatment for gender dysphoria. 

The story confirms that the contradictions of trans medicine protocols for children and teens who feel “trapped in the wrong body” are finally receiving an honest, science-based reassessment that is long overdue.

In 2021, according to the Times, insurance carriers reported that 42,000 minors were diagnosed with gender dysphoria and “4,780 patients with that diagnosis were put on puberty blockers covered by insurance.” 

Now, “concerns are growing among some medical professionals about the consequences of the drugs” used by many clinics and physicians to treat children as young as 6 years old.

Here are some key takeaways:

1. Two studies that followed “trans patients’ bone strength while using blockers and through the first years of sex hormone treatment found that many do not fully rebound. … That could lead to heightened risk of debilitating fractures earlier than would be expected from normal aging — in their 50s instead of 60s — and more immediate harm for patients who start treatment with already weak bones …”

“There’s going to be a price,” said Dr. Sundeep Khosla, who leads a bone research lab at the Mayo Clinic. “And the price is probably going to be some deficit in skeletal mass.” 

2. New studies show that “the drugs are associated with deficits in bone development.”

“During the teen years, bone density typically increases by about 8 to 12% a year.” 

The Times commissioned an analysis of “seven studies from the Netherlands, Canada and England involving about 500 transgender teens from 1998 through 2021,” and it learned that while teens were on blockers, they “did not gain any bone density, on average — and lost significant ground compared to their peers.”

3. While thousands of young U.S. patients are receiving puberty blockers, there is no database tracking their progress or the health impacts of the drugs.

The National Institutes of Health awarded $7 million to four top American gender clinics “to examine the effects of blockers and hormone treatment on transgender youth. In explaining their study, the researchers pointed out that the United States had produced no data on the impact or safety of blockers, particularly among transgender patients under 12, leaving a ‘gap in evidence for this practice.’”

The clinicians say they will release their findings next year and blame pandemic disruptions for the delay.

4. No one knows how many children are receiving these medications, as there is “no centralized tracking of blocker prescriptions in the United States.”

“Komodo Health, a health technology company, compiled private and public insurance data for Reuters, showing a sharp increase in the number of children ages 6 to 17 diagnosed with gender dysphoria, from about 15,000 in 2017 to about 42,000 in 2021. During that time, 4,780 patients with that diagnosis were put on puberty blockers covered by insurance, the data shows, with new prescriptions growing each year. But the data does not capture the many cases in which insurance does not cover the drugs for that use, leaving families to pay out of pocket.”

5. The FDA has not approved the use of puberty blockers for gender dysphoria, and so they are prescribed “off-label.”

Reportedly, leading American practitioners “asked AbbVie and Endo Pharmaceuticals, maker of another blocker, to seek F.D.A. approval for the drugs’ use among trans adolescents. The drugmakers would have to fund research for a patient population that made up just a small part of their market. But the physicians argued that regulatory approval could help establish the safety of the treatment and broaden insurance coverage of the drugs, which can cost tens of thousands of dollars a year. In the end, AbbVie and Endo said no. The companies declined to comment on the decision.”

6. There are concerns about the impact on brain development.

“Some doctors and researchers are concerned that puberty blockers may somehow disrupt a formative period of mental growth. With adolescence comes critical thinking, more sophisticated self-reflection and other significant leaps in brain development. Sex hormones have been shown to affect social and problem-solving skills. It’s believed that brain growth is connected to gender identity, but research in these areas is still very new.”

So while puberty blockers have been sold as a way for a young patient to hit the pause button as they grapple with gender dysphoria, it is not yet clear whether that could do serious damage.

“If the brain is expecting to receive those hormones at a certain time and doesn’t, what happens?” said Dr. Sheri Berenbaum, head of a gender research lab at Penn State, and one of the authors of the paper. “We don’t know.”

Let’s hope that the American Academy of Pediatrics and the Biden administration, which has sought to force physicians to provide these medications upon demand, have read the story in the Times. It deserves everyone’s attention.

In June, President Biden directed the U.S. Department of Education and the Department of Health and Human Services to broaden access to gender-affirming care, and look for opportunities to ways to impede state efforts designed to curb such treatments for minors struggling with gender dysphoria. Meanwhile, Catholic hospitals and physicians have filed legal challenges to Biden’s executive orders requiring them to provide trans minors with affirmative care, or face financial penalties.

The American Academy of Pediatrics has endorsed gender-affirming protocols that direct physicians and families to accept without question a child’s identification with the opposite sex. And the professional association has been accused of suppressing debate with its ranks on this matter. 

The AAP is “working very hard to give an appearance that everything’s been decided and there’s no debate. The growing numbers of detransitioners suggests that [pediatricians] don’t really know what we’re doing in this case,” Dr. Julia Mason, a pediatrician, an AAP fellow, and a member of the group of clinicians and researchers challenging the affirmative care model, told The Wall Street Journal in 2021.

This year, five AAP members expressed concern about a “drugs-first” response to gender dysphoria, and called for a comprehensive evaluation of the patient’s background and mental health issues before as the first priority.

Paul Hruz, a pediatric endocrinologist and research scientist, told the Register that the Times’ story “acknowledging the weak scientific evidence used to support the affirmative model for care of children with gender dysphoria may be a turning point in the often heated cultural discussion of this sensitive topic.”

“This NYT article exposes many of the known and potential risks of halting normally-timed puberty. While the strongest current evidence is on adverse effects on bone density, there many other serious questions about this practice. This included the potential for this intervention to consolidate sex-discordant gender identity for those who would otherwise resolve their gender identity questions as they progress through puberty.”

Hruz underscored the “urgent need to conduct high-quality scientific investigation of the risks and benefits of halting normally-timed puberty for gender-dysphoric youth. This should include properly-controlled trials to test alternate hypotheses, including the benefits of primary psychological interventions.”