Even as children, many trans people do not feel that they belong to their biological sex. They have the option of temporarily halting their development into a man or woman with medication. But how often does that happen?
The topic drives many people crazy, although only a few are affected: puberty blockers. These drugs are seen by opponents as an outgrowth of a dangerous fad, by supporters as a legitimate way to save children from suffering in a crisis. Why is? At its core, it is about so-called gender dysphoria, i.e. about people who perceive their biological gender as wrong and suffer from it. In this situation, children have the opportunity to postpone puberty. The aim is to “give them more time for the decision-making phase,” as Jakob Maske, spokesman for the professional association of paediatricians, explains.
So-called GnRH analogues are synthetically manufactured substances that are similar to sex hormones. They block the binding sites of the body’s own GnRH and thus prevent the ovaries or testicles from forming the respective sex hormones. According to the professional association of paediatricians, these preparations are “very rarely” prescribed. There do not seem to be any prescription figures from pharmacists or health insurance companies. Maske does not want to accept the accusation that doctors prescribe puberty blockers too quickly: “I believe that this is prescribed very conscientiously,” says Maske. “This decision is made in a team with the child, the parents and at least two doctors from different disciplines. I don’t think it’s taken lightly.”
The topic recently caused a political controversy: representatives of the CDU and AfD criticized information on the rainbow portal of the Federal Ministry for Family Affairs as being too uncritical. There it says: “These drugs ensure that you don’t get into puberty. That means: Your body doesn’t develop further at first. Neither in the direction of women. Nor in the direction of men. So you have more time to think. And you you can think in peace: Which body suits me?” “It is unacceptable that the federal government recommends these drugs like cough drops!” criticized former Minister of Agriculture Julia Klöckner.
After the storm of protests, the ministry made it clear: “The federal government does not recommend taking puberty blockers.” These should only be “prescribed by medical specialists after careful medical indication based on scientific guidelines”.
Jakob Maske also emphasizes that puberty blockers are not harmless. A side effect is, for example, that growth is inhibited. The effect of the puberty blockers is reversible – if you stop them, sexual maturity begins. “But the growth may not be catchable again.”
The drugs could also affect mood, circulation and, most importantly, libido, says Maske. The latter is “counterproductive” if the wish is that the child accepts the biological sex after the longer time to think about it. If there is no sexual interest in the opposite sex, the child is more likely to feel confirmed to belong to the wrong sex. The fact that young people who interrupted their puberty with medication then want to keep their biological sex seems to be the exception: A study from the Netherlands published in October in “The Lancet Child
Does that mean that puberty blockers only got those who really needed them? Or have the puberty blockers paved a path that the children would not have walked without these drugs? The lead author of the Dutch study finds the results reassuring: the vast majority continue to use hormones for gender reassignment, “which is reassuring in the context of growing public concern about regrets about gender reassignment,” writes Marianne van der Loos of Vrije Universiteit Amsterdam.
A protocol for the treatment of juvenile gender dysphoria has existed in the Netherlands since the late 1990s. After a “thorough diagnosis”, according to van der Loos, the young people are first given puberty blockers to gain time and save them stress. From the age of 15 or 16, those who want to keep changing sex can start permanent hormone treatment.
In other countries, such as the US or Great Britain, attempts are being made to restrict or ban the use of puberty blockers and hormone treatments under the age of 18, the article says. Short-term studies have “shown the positive effects of puberty suppression treatment on the mental and physical health of adolescents”. However, long-term data were lacking.
Whether gender change is now a fashionable topic or whether only those affected dare to go public instead of “living in the wrong skin for life” – the pediatrician Maske does not want to decide. Another point is more important to him: “Every child needs individual counseling before starting such therapy and must then be closely monitored.”