I've been deliberating over this post now for a while alongside giving it a lot of thought. It's a topic I have to say I've generally dodged or diverted answering journalist questions because I've not wanted to comment; firstly I'm not a doctor, but nor do I have any personal experience to the topic (which is where I prefer to write from).
To the point though, puberty blockers and hormone replacement in transgender children / teenagers ... yep a biggie! Firstly yep I'm fully aware there would be a lot of professionals out there with different and greater insight to mine and as always I welcome comments. That said I am also going to give my thoughts now that I've had a little experience and consulted a few different medical opinions over the past few weeks.
In summary the topic intimidates me, mainly from the point of view of transitioning myself as a fairly OTT health conscious adult and I can assure you to get through all the elements of my transition; particularly the physical, mental and surgical elements (7 surgeries in 3.5 years) I've needed to call on and use EVERY resource (internal and external) available to me and still I'd say I'm not yet back to a '100%' I used to be ... and you think the Tour De France in intense - truly!! Whether I'll ever get back to that past 100% I've given up wondering and instead just see what level of health each day brings ...
SO that being said, a question that's always stuck with me is that it's all very well and good to be an adult celebrity (or not) transgender individual who confidently walks through such a massive physical and emotional and mental enduring process but WTF is that going to be like for a child who adamantly identifies as this so early in this day in age (from living this I'll never doubt them for one millisecond - it's real and the truth as if you are this you just know, no further explanation required really) ... but is medical progression also problematic in development?
As in it's a pretty major thing to experience an external substance injected into the body designed to halt puberty progress, "delay it" if you will whilst the teen makes sure (at age 16) they definitely want to medically transition (as in that's currently the correct standard practise from the medical practitioners perspective and the Government legality ... hmmm?!?) So at 16 you can begin hormone replacement or put another way; start your puberty experience ... completely over riding a time of body change where A LOAD of development is happening, huge amounts, everywhere!
With that said, having recently accompanied a young friend of mine on his first visit to a paediatric endocrinologist (thank god they exist!) I'm a little more settled and I still have questions. The point here I think is that early treatment is truly a 'new-ish' thing, and there aren't a load of medical studies yet done to refer to about the affects of all of this, if any!
But from researching and questioning doctors the way I like to (they love me deep down I'm sure, truly ;)) I can see that it does work and is pretty much okay. The main issue being that the intervention does sway a little from the 'normal range' puberty onset time period so the teen can allude the appearance of looking a different age to their peers as their puberty progresses differently.
There are a few things though that get me questioning what the blocker is actually targeting. There are a few different substances used, the main ones I can see work by suppressing signals from the pituitary gland (used similarly in some cancer treatments) which stops the hormone regulation signals to the ovaries or testes respectively (not just the sex organs directly - which I ignorantly thought was the case). As I say here though, I'm not a doctor, the specialists looking after this process are doing very well and I applaud their abilities to step in and offer this to trans kids as it is needed.
I am though just questioning questions a little as is shown in these diagrams ...
The pituitary gland does affect other things as well sex organ hormone production and does suppressing this affect these other developmental areas as well; i.e the adrenal ACTH, thyroid TSH, bone density measures, kidney ADH as well as the sex organ hormone release?
Specialists have commented that bone density mass development catches up within a few years of hormone replacement so it's of no consequence to long term to susceptibility of conditions like osteoporosis. The other elements I've not had comments to yet but I hope to in time and more so I would love to see more medical research reports done to the topic ...
Which brings me to my question has enough research been done and is this actually physically and physiologically healthy, particularly the element of restricting hormones until the age of 16 when most other kids start their puberty earlier, all for the sake of 'what if they change their mind?'. I'm not convinced, they aren't going to change their mind - truly, this is medical practitioner protection talking! But who knows maybe the odd one or two will, I'm looking forward to seeing that though and being proven wrong.
Blockers generally start around 10-12 once you get through any legal issues with that -- bless Human Rights Commissions for their work to this point as even this isn't that simple depending on what country you're in. But back to the point the age is dependent on their Tanner stage as to not affect their height growth too much - google that point though, tis another topic that isn't for this post. My personal issue is that 10-16 is a lot of years to be suppressing the above functions (in my opinion as an alternative health practitioner).
I believe hormone replacement should be available from 14 (as agreed by a child transgender child specialist I read from recently) especially if the teenager is requesting it. They are old enough and I think it is healthier. I do definitely think the legal restriction of access to hormone replacement at 16 should be challenged by medical practitioners and parents respectively. It's too late in my opinion particularly if a trans individual choices later in life to go ahead with the genital realignment surgeries ... they are going to want to be as healthy as humanly possible to avoid any of the (up to 40%) surgical complication rates (more joys to look forward to, truly!). I hope in time with doctor / medical advancements these reduce too, I'm confident they will as they work every day to do so.
In summary with this said mentioned, do I think a trans identified child (even with the new frontier that this is) be denied this process and have to grow into adult-hood before beginning any sort of medical transition -- absolutely not. It's likely they'll self harm themselves before that time, and THAT you will always have my word on.
There is a duty of care though I believe to more acutely watch body functions during this time; particularly mood, metabolism, thyroid function and bone density development etc etc. It it were my child I would be onto monitoring all of this constantly (without trying to make them a lab rat) and be the normal pain in the butt patient / civilian I always strive to be ;)
Cheers as always for reading!