Puberty Blocker Use in Boys May Cause Permanent Testicular Atrophy, Irreversible Damage to Fertility: Study

Activist Chris Elton carries a sign reading "Children Cannot Consent to Puberty Blockers" through West Hollywood, Calif., in 2022. Courtesy of Billboard Chris

A new study suggests puberty blockers may cause permanent damage to boys’ reproductive organs and irreversibly impair their fertility, undercutting the claim that their use is a harmless way to “explore gender identity.”

The Mayo Clinic study, published at the end of March and not yet peer reviewed, analyzed the largest clinically annotated pediatric testicular biorepository from teenage boys who suffered from gender dysphoria and were put on chronic puberty blockers.

The researchers concluded from a combination of gland atrophy and microscopic cell-level abnormalities that the use of puberty blockers risks permanent damage to reproductive fitness.

“At the tissue level, we report mild-to-severe sex gland atrophy in PB treated children,” the authors wrote.

After examining microscopic changes to testicular cells and subjecting them to novel computational analyses involving single cell RNA sequencing technology, the researchers flagged their concern that puberty blockers may impair fertility irreversibly.

“This combined with the noted gland atrophy and abnormalities from the histology data raise a potential concern regarding the complete ’reversibility' and reproductive fitness of SSC [spermatogonial stem cells],” the authors wrote. Spermatogonial stem cells serve as the foundation of sperm production and male fertility.

Despite the study’s findings, which are preliminary and have not yet been peer-reviewed, the Mayo Clinic website maintains that puberty blockers “don’t cause permanent physical changes” and merely “pause” puberty and so offer a “chance to explore gender identity.”

The study’s authors noted that, to date, no rigorous studies have been carried out on extended puberty blocker use in adolescents and its long-term consequence on reproductive fitness.

They also said that the consequences of exposure to puberty blockers on juvenile testicular development and reproductive fitness of spermatogonial stem cells remains poorly understood.

The scientists called for more research, which could confirm their preliminary indications of permanent testicular atrophy and irreversible impairment to fertility due to puberty blocker use in boys.

Questions Swirl

The study has been taken note of by several prominent critics of puberty blocker use in adolescents, including renowned author J.K. Rowling.

“You’re knowingly pushing the use of puberty blockers, even after the recent Mayo Clinic report that said they can cause ’mild-to-severe sex gland atrophy' - ie, withering testicles - fertility problems and even cancer,” she wrote in a post on X.

Ms. Rowling was directing her criticism at a UK-based gender clinic that publicly calls for easy access to puberty blockers and justifies it by claiming that their effects are reversible and “encourage positive mental health and social wellbeing for trans young people.”

Genevieve Gluck, a researcher and cofounder of Reduxx, a publication that takes a critical stance on transgender surgeries and treatments, said in a post on X that there’s been prior evidence indicating the harms of puberty blockers on women who were subjected to them.

“We already had the evidence that drugs euphemistically called ‘puberty blockers’ were toxic, before they were marketed towards children in the name of ’gender identity' - but the women who suffered were ignored,” she wrote.

Ms. Gluck wrote about the matter more extensively in an article on Substack that cites endocrinologist Dr. Will Malone as saying that, “it is misleading to state as fact that ‘puberty blockers are reversible’. No one knows if the physical and psychological impacts of halting normal puberty are reversible.”

She cited research conducted by Dr. Malone and Dr. Michael Laidlaw that found that children aged 12–15 were found to have abnormally low bone density after two years of pubertal suppression.

No Confirmed Benefit

While some advocates of “gender affirming” therapies and surgeries claim that they can help people suffering from gender dysphoria, the evidence for this is scant.

A national organization of pediatricians recently put out a policy statement saying that gender transition procedures like puberty blockers and cross-sex hormones provide no mental health benefit to youth with gender dysphoria.

“There are no long-term studies demonstrating benefits nor studies evaluating risks associated with the medical and surgical interventions” provided to adolescents with gender dysphoria, the American College of Pediatricians (ACPeds) said in a Feb. 7 position statement.

The group prepared the statement after reviewing more than 60 studies.

“There is no long-term evidence that mental health concerns are decreased or alleviated after ‘gender-affirming therapy,’” they wrote.

Many individuals who have undergone it “later regret those interventions and seek to align their gender identity with their sex.”

“Because of the risks of social, medical, and surgical interventions, many European countries are now cautioning against these interventions while encouraging mental health therapy,” the group added.

A 2020 report from Finland raised concerns about the possibility that hormone therapy like puberty blocker use “alters the course of gender identity development.” This means that puberty blockers “may consolidate a gender identity that would have otherwise changed in some of the treated adolescents.”

A May 2022 report from the Florida Agency for Health Care Administration said there were no studies comparing outcomes between a group of individuals with gender dysphoria using puberty blockers and not using the blockers.

“Therefore, it is unknown whether people with gender dysphoria who use puberty blockers experience more improvement in gender dysphoria, depression, anxiety, and quality of life than those with gender dysphoria who do not use them. There is very low certainty about the effects of puberty blockers on suicidal ideation,” it said.