Some Doctors Rebuff Alberta Medical Association for Claim Puberty Blockers ‘Not Irreversible’

Medical tools are seen in an exam room at a health clinic in Calgary on July 14, 2023. The Canadian Press/Jeff McIntosh

In a strong statement against Alberta’s recently announced strict limits on medical transitioning for minors, the province’s medical association says “the effects of puberty-blocking agents are not irreversible.”

Many doctors and recent scientific study reviews say the long-term effects of puberty blockers are not well understood and there are indications of high risk.

The risk that concerns Dr. Jane Anderson most is how puberty blockers may affect brain development.

“A lot of people who are promoting this transgender-affirming care forget what’s happening in the adolescent brain,” Dr. Anderson told The Epoch Times. She is vice-president of the American College of Pediatricians, an organization critical of medical transitioning and related policies that it says may harm children’s health and well-being.

“During puberty, many hormones, including the sex hormones, actually affect how the brain organizes itself—what neurons and cells are stimulated to grow, and what nerves or cells are eliminated,” she said.

“We’re taking away a month or two, three months, a year or more of the brain’s development. We do not know what the effects are, the results of that process, if we stop normal puberty.”

Clinical psychologist Dr. Erica Anderson, who is transgender and has facilitated gender transitions for others, is also worried about the risks. Brain development is one of those concerns, wrote Dr. Erica Anderson, a former staff member at the Benioff Children’s Hospital affiliated with the University of California, San Francisco, in an email to The Epoch Times.

“The systematic evidence reviews in the UK and multiple European countries have concluded that the evidence base in support of puberty blockers is weak,” Dr. Erica Anderson wrote, adding that health authorities in those countries are thus limiting the use of those medications to research studies and extraordinary clinical cases.

The Alberta Medical Association (AMA) did not reply as of publication to an Epoch Times request for comment on the risks raised by the two Dr. Andersons (no relation) and others.

The AMA’s Feb. 1 statement also says the children’s mental health “will be markedly worse when denied” medical interventions, such as puberty blockers. It notes the “suicidality” of transgender youth.

Dr. Jane Anderson said studies on the psychological effects of medical transitioning do not support the oft-repeated idea that minors must receive treatment to prevent suicide. Her organization published a position statement on Feb. 7 informed by a review of over 60 studies on the subject of mental health in adolescents with gender dysphoria.

One of the main takeaways, Dr. Jane Anderson said, is that trans-identified youth are indeed at higher risk of suicide, but less so than youth with depression, anorexia, and autism. These three conditions often coincide with gender dysphoria. Many trans-identifying youth also suffer from childhood trauma.

“Yes, they need care,” she said. “But they need mental health treatment.”

She noted that Lupron, the most commonly prescribed puberty blocker, even has “mood swings, including depression,” listed as one of the side effects on its package insert.

“What are we doing with altered mood in a patient who, 50 percent of them are already experiencing depression?” she said. “So we’re adding to their medical problems.”

Side Effects Listed on Package Insert

Lupron is approved in Canada for helping with precocious puberty—when puberty begins too soon and can negatively impact a child. It is also approved for treatment of endometriosis and prostate cancer. It’s used “off-label” to stop puberty in trans-identifying youth as young as 8, which the AMA says will give them time to decide if they want to change genders.

The medication’s monograph lists hypogonadism, which is decreased functional activity of the ovaries or testes, as a potential side effect. “These changes have been observed to reverse on discontinuation of therapy. However, whether the clinical symptoms of induced hypogonadism will reverse in all patients has not yet been established,” it states.

“There’s the possibility of a decreased fertility,” Dr. Jane Anderson said, noting that there’s much we don’t yet know about the long-term effects. “And certainly if they go on to cross-sex hormones, and then go on to sex surgeries, definitely their fertility is going to be affected.”

Multiple studies have shown that the vast majority of youth who go on puberty blockers, more than 95 percent, go on to take cross-sex hormones, which certainly have irreversible effects, including on fertility. Critics of medical transitioning for children have raised the alarm over the high rate of children who continue on the medical path after starting with puberty blockers.

Four out of five trans-identifying youth will “desist” and become reconciled with their biological sex if puberty blockers are not introduced, said endocrinologist Dr. William Malone in a gender dysphoria resource document for medical providers. Introducing puberty blockers makes it far more likely that those four will continue on the path of irreversible medical transition, he said.

Lupron’s monograph says another potential side effect is convulsions. And as for the mood changes Dr. Jane Anderson referred to, it says symptoms may include “crying, irritability, impatience, anger and aggression.”

‘Experimental’

In April 2023, researchers at Sweden’s Karolinska Institutet, which is among Europe’s most prestigious medical schools, published a review of the scientific literature on puberty blockers in the peer-reviewed journal Acta Paediatrica.

“Against the background of almost non-existent longterm data, we conclude that GnRHa [puberty blocker] treatment in children with gender dysphoria should be considered experimental treatment rather than standard procedure. This is to say that treatment should only be administered in the context of a clinical trial under informed consent,” said lead author Dr. Jonas F. Ludvigsson in a news release on the institute’s website in April 2023.

The review found no randomized trials, and only a few dozen observational studies. “The few longitudinal observational studies were hampered by small numbers and high attrition rates,” the paper states.

One of Lupron’s well-recognized side effects is decreased bone density. While many say the loss of bone density reverses when puberty blockers are stopped, the review said it was found to only have “partially” recovered when studied at the age of 22.

Youth who take puberty blockers are likely to gain weight within the first year, the review says.

Regarding psychosocial health, the review says “studies do not allow separation of potential effects of psychological intervention independent of hormonal effects.” Therefore, any mental health benefits attributed to the medication may instead come from counselling or other avenues.

It said there’s a “current lack of evidence for hormonal therapy improving gender dysphoria.”

UK’s Cass Review and Tavistock Controversy

The UK’s federal National Health Service (NHS) is undertaking a review of medical transitioning treatments for minors following a landmark court case against the Tavistock Institute, which facilitates transitioning.

In 2020, a UK high court ruled that minors under the age of 16 were likely incapable of weighing the risks of puberty blockers. It acknowledged the classification of puberty blockers as “experimental.” The decision was overturned, however, by a court of appeal which said clinicians, not judges, must evaluate these matters.

The NHS’s ongoing review, known as the Cass Review, has published an interim report that says there’s “very limited research on the sexual, cognitive or broader developmental outcomes” of puberty blockers.

“The administration of puberty blockers is arguably more controversial than administration of the feminising/masculinising hormones, because there are more uncertainties associated with their use,” it said.

It noted the short-term effects of headaches, hot flushes, weight gain, tiredness, low mood and anxiety, “all of which may make day-to-day functioning more difficult for a child or young person who is already experiencing distress.”

The report said there’s a high incidence of children on puberty blockers continuing with sex hormone treatment. “The reasons for this need to be better understood,” it says.

The UK’s official position on puberty blockers as stated on its NHS website is that “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”

“Although GIDS [Gender Identity Development Service at Tavistock] advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be,” it says.

“It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones.”