Skipping The Puberty Blockers: American “Transgender Children” Doctors are Going Rogue
November 11, 2014
We’ve all seen the television shows and news reports on “Transgender Children”. They all state that “Nothing permanent is being done to children before the age of consent! Oh gosh no!”
Here’s a typical example of this rhetoric from yesterday’s Irish Examiner:
“Young children don’t need treatment yet,” explains Lacey. “They can make a social transition at home and at school. But older children may need hormone suppressors to delay puberty for a while. This gives them and their families breathing space to decide what’s best for the future.”
Hormone suppressors ((known as anti-androgens) delay the development of breasts, facial hair and other secondary sex characteristics. Males who identify as female take anti-androgens to block testosterone while females identifying as male take anti-androgens to block oestrogen.
“These suppressors are 100% reversible,” says Lacey. “Young people resume puberty if they stop taking them.”
The article continues:
“Prescribing cross-sex hormones is taken more seriously than hormone blockers. Teenagers must have socially transitioned and be aged over 16 to qualify.
“We have to be sure it’s the right thing to do,” explains Dr Brinkmann. “Cross-sex hormones have irreversible effects on fertility. There’s no going back.”
Guidelines from various pro-gender lobbying and medical groups back up this claim. The Endocrine Society states that no child under the age of sixteen should ever be administered cross-sex hormones by physicians under “parental consent” for the purpose of physically disguising the reproductive sex of the child to promote gender conformity. Even WPATH, the powerful pharmaceutical-industry funded transgender lobbying group acknowledges that decades of research show the majority of children who claim a “cross-sex identity” do not mature into transgender adults if left untreated, and in fact many grow up to be well-adjusted lesbian and gay adults. WPATH also states that children under sixteen should not be given cross-sex hormones which cause permanent changes (including sterilization). None of the “transgender children” clinics in the Netherlands, which pioneered the practice, have ever administered cross-sex hormones to children under sixteen. In the UK, parents who desire to have their children placed on puberty blockers (which paralyze the pituitary gland) must meet strict guidelines and be entered into a government research protocol. Cross-sex hormones are not administered prior to the age of sixteen. In Australia, a court order is required to provide “blockers” in an attempt to formalize oversight of these practices and protect children from abuse.
In the United States, however, it is coming to light that “transgender children” physicians, (that is, the doctors who have been championing and pioneering this practice without oversight), have been “going rogue” since the very start, ignoring all research and guidelines and pushing the limits of what the human bodies of these gender-nonconforming children are medically able to endure.
Last month, in a program specifically addressed to medical students, Dr. Johanna Olson, director of the LA Children’s Hospital transgender children clinic, admitted that she has been “skipping the blockers” and placing children as young as twelve directly on cross-sex hormones, starting with her very first patient.
Some are being started at an even younger age on the irreversible, lifetime treatments – which sterilize the children and introduce required ongoing medical monitoring, blood tests, etc. for the rest of their lives in a form of “elective” medical disability whose purpose, providers acknowledge, is essentially cosmetic.
Mina Kelemen of Hustonia Magazine authored a well-researched overview of the practice in an article this week which vividly depicts the home life of a boy named “Nicole”, who was placed on cross-sex hormones at the age of eleven by his physician, under his parents consent. From the piece, titled “What Do Transgender Children Need?”:
“Over the past 15 years, doctors have grown progressively more comfortable prescribing hormone blockers to transgender children, and transgender teenagers and their families aren’t waiting until adulthood for cross-sex hormones and sex reassignment surgery. They’re embarking on medically assisted transformations earlier. Much earlier. These days, such teens often learn about these procedures through a simple Google search, and the amount and availability of information out there is increasingly forcing parents like Nicole’s to make difficult decisions about whether to allow their children to undergo medical treatment, including life-altering hormones.
Nicole was 11 when she decided she wanted hormone therapy to halt male puberty and promote the growth of feminine features. Her parents reluctantly agreed to support her decision, terrified by statistics showing that adolescents with gender dysphoria are at a higher risk for severe psychological distress, self-mutilation, and suicide. And so, for the past two years, Nicole has been taking pills twice a day—spironolactone, which blocks male hormones like testosterone, and estradiol, a synthetic form of estrogen often given as a hormone replacement to post-menopausal women, even though estradiol has been shown to increase the risk of breast cancer.
It wasn’t an easy decision. “I was brought up in a religious family,” says Nicole’s father, Jim, a Houston native. “We were taught, ‘Live right, or you’re going to burn.’” That dogma, he said, crumbled under the task of raising Nicole. Nicolas wasn’t just a boy who liked to wear pink. By the time he was in preschool, he was lining up with girls, napping on his princess blanket, and carrying his lunch to school in a box stamped with Disney’s latest heroine.
There is no medical consensus on the best course of treatment for gender-dysphoric prepubescent children, mainly because it’s almost impossible to tell which kids will continue to experience the condition as adolescents and adults. Citing informal studies, Drescher and Meyer estimate that only about 20 percent of prepubescent children who exhibit cross-gender behavior continue that behavior into adolescence. “You’re in unknown territory, where the experts disagree,” says Dr. Jack Drescher, a New York–based psychiatrist who, along with Dr. Kenneth J. Zucker of the University of Toronto’s Gender Identity Service, helped write the entry for gender dysphoria in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. “If most of these kids won’t grow up to be transgender,” says Drescher, “[socially transitioning] could be harmful,” never mind hormone therapy.
Jenn and Jim vividly remember the day the principal at Nicolas’s fundamentalist Christian preschool called them in for an emergency conference. Thrusting a copy of conservative psychologist James Dobson’s Bringing Up Boys at them, he instructed the couple to banish all of Nicolas’s girl stuff, including his beloved doll, Brenda, and stop the behavior before it progressed any further. Jim, an independent contractor who is happiest hammering nails, tried to interest Nicolas in baseball and skateboarding, but the only thing he ever wanted to do with his dad was play dolls.
In the days and weeks that followed, Nicolas grew increasingly anxious as catastrophe seemed to strike his favorite things. His parents, who had taught him the alphabet by assigning a letter and corresponding name to each of his 26 dolls, took them all away. They told him that his favorite blanket had been shredded in the washing machine, that his Disney lunch box was accidentally run over by his mother’s pickup truck. One day Jim found himself screaming and threatening to hit his son for refusing to wear boys’ shoes.”
Even some of the physicians who are driving the medicalization of “transgender children” expressed their discomfort in the Hustonia piece:
“Both Meyer and Drescher say they are most comfortable with waiting until age 16 to administer cross-sex hormones, as the Endocrine Society recommends. “That feels like the most do-no-harm approach,” Drescher says. And while Meyer prefers to get “as close to 16 as possible” in his own practice, he believes that the guidelines will soon be revised downward. “I think it’s in the process of changing to an age which is more appropriate for normal puberty,” he says. Meyer also notes that he sees more and more young children these days who have made the social transition from one gender to another. “That makes me really uneasy, but I don’t ever say to people, ‘I’m not going to take care of you,’” he tells me.”
One provider who feels no dis-ease with the practice is the above-mentioned Dr. Johanna Olson, who says in her address to medical students that when it comes to sex-roles the Hippocratic Oath simply doesn’t apply. When asked to discuss her first pediatric “transgender” client she responded:
“Just a general word about “First Do No Harm”. I think that idea is really subjective. And so I think what happens is, historically we come from a very paternalistic perspective in medicine. Where who… you know.. doctors are really given the purview of deciding what is going to be harmful and what isn’t. And that, in the world of gender, is really problematic. Because no one knows… no one knows an individual’s gender more than the individual. And so applying that paternalistic model to gender and gender-related care is intensely problematic. This was, so the young person that you were talking about was an assigned female who had a very strong male gender identity and had that identity – had been asserting that identity- for a long time, since early childhood. It was actually his mother who called me. And she called me (laughs) on Mother’s Day. And she said, ”You know, I…you… Please help me care of my child. Because the best Mother’s Day gift I can get is being able to bring my kid in for care because my kid ever since he start[ed] having a menstrual cycle has attempted suicide every month. And he’s twelve. And I don’t think I’m gonna have him here for next year’s Mother’s Day if somebody doesn’t do something for my kid”. And, um I had been doing, I had started doing trans work already but what this particular- [pauses, changes train of thought] so… immediately I said, so we should try to get your kid on blockers, so that we can halt this process, and then, and go from there. And I was not very adept at the time at being able to get blockers. I didn’t know how to do it, because I didn’t have a lot of experience with it, then I tried to get it and the insurance company said no, we’re not going to cover it.
[med student interjects: “So wait, these are, I’m sorry, you’re blocking the development of the menstrual cycle, the..? ]
Yes. The process of puberty that happens when you have ovaries. So, you can use these central blockers that are really effective at stopping that process. And, so I tried- but they’re incredibly expensive- and this was also very, very, new, this process of using these blockers for gender-nonconforming or trans youth was very new at the time. It had only been done in this country for about a year. And so I had tried to get it, couldn’t get it, and it was becoming more and more desperate with this family, and I went to my boss at the time and I said- I think we really need to employ a “harm reduction” model here, and I know this kid is only twelve, but I really think we need to put this kid on testosterone. And it was not really what people were doing. It was considered unheard-of to start a twelve year old on cross-sex hormones. And we just went for it and did it. And I really do think it saved his life, and he’s a thriving young college student now. Who’s done fantastic. But it really drove home the point of when we think about- we automatically assume as physicians, that doing nothing is a neutral option. But in the case of gender work it’s not. And so doing nothing is actually intensely damaging, and actually doing nothing causes harm, which is a different way to think about it.
[med student : “It sounds almost like the kind of intervention you need to do in an emergency- any sort of medical emergency. I mean maybe if you do noting that’s not a great idea, you just cant watch.]
That’s right. People, I mean, It comes form the fundamental assumption that people have: that your endogenous puberty and gender assignment is the correct one. Which, it’s- that’s not the case for people that are trans.
[med student: what do we know about the general experience people have, who are, whose gender is fluid, or is, or where, they are confused about their gender or feel they have a different gender than they were born with? I mean, what-]
Well I don’t think people are confused about their gender. I think the folks around them are confused around their gender. (laughs) You know we do have this- we name “gender confusion”- And I really think it’s a description of what the adults around the young person are going through: “gender confusion” (laughs).
[med student: so really you think they know, people know what their gender is, even when it’s,…okay..]
I think where it becomes complicated is that, if your gender is different from the one you were assigned, you don’t- you come to know that or recognize that not in a vacumn. You recognize that process happens with all of your external environment as a backboard? This gets very confusing and very hard to explain. If your gender identity is the same as your assigned gender, you don’t ever have to ask the question “is that my gender?” Right? You never have the occasion to ask that. But if it’s different, you are figuring it out in the context of your environmemt. It’s why three and four year olds who are gender non-conforming are so interesting. Because they actually are just doing what they do. Right? They don’t “come out”, they just are who they are. There is no process of “I have to overcome all these societal and cultural expectations in order to present my authentic self?” They just say “I like this. I’m doing this. I’m this”. It’s really great. And then you see them start to sort of get crushed at six and seven and eight years old where the society starts telling them, you know, “You’re a boy, you can’t wear a dress or “ your favorite color can’t be pink” or all of the other number of ways that we teach people how to be boys and girls.
[Med student: So… I’m curious, speaking about this original patient you had several years ago when he was twelve, and then now looking at the fact that it seems that we are still very much in a culture where gender is very much a binary and it’s assumed: if somebody is pregnant, the first question people ask them, even strangers, is “are you having a boy or a girl?” As you’ve mentioned, you go into a Toys R Us and there are the pink aisles and the blue aisles. And even everyday material items are very much gendered. So, how in that environment do you feel that you’ve had this clinic, that has grown, and you’ve been able to sort of make yourself available and known for people in your community? In spite being in an environment where being transgender or gender fluid or gender non-binary is still very much, sort of, almost a taboo topic?”]
Oh, no …I think it’s a great question. I mean first of all I’m in Los Angeles, so that helps very much. I think that there’s just a different kind of openness to other experiences. I do think that, you know, regardless of what we want to believe, you know, the trans experience has been happening since the beginning of humanity. And so regardless of how oppressive (laughs) our society is, people have still been having this experience, which speaks to the profound nature of having a gender that’s different than your assigned gender. And I think that… you know… I think that part of it is, as a medical provider, getting over “your own stuff”. I think that, you know, I don’t know why, I have no idea for what reason I never had “that stuff”, but I never had “that stuff”. I never had a problem mis-pronouning people. I never had, um, …I just didn’t have that whole “Oh my gosh, is this the right thing to do?”. Like, it’s just, I never had that experience, but I know that people who want to embark on this work do have that experience, and I think that getting over that and being a fierce advocate for getting people what they need and deserve, is going to… you know, I feel, really great about my work. I’m so, I love my work. I wake up every day excited to go to work. Not many people have that incredible privilege. I think that my enthusiasm and my complete belief in what I do, has gotten, um,- has led to me having increased numbers of patients. I feel very um, certain that this model of having strangers affirm peoples gender is ridiculous. It should be… it’s so outdated and so old, I think that providers that are responding and raising the bar for trans people are really necessary, and that’s what I hope to do and hope to continue to do.”
Dr. Olson on the future of the practice of transgendering children:
“I think, you know, “protocols” (laughs)… universally applied “protocols” to something as complex as gender are problematic. Just in theory they are. Because you know, having a cookie-cutter approach to something that is experienced differently for every individual becomes really difficult. So what we’ve, what, I think, what the medical community has tried to do through the Endocrine Society guidelines and through the WPATH, you know, standards of care, is put: I certainly know WPATH is really cognizant of this and they say these are meant to be guidelines and they obviously can, these are, you know, these are meant to be individualized for each person. I think that, we’ve tried to put together things that give medical providers specifically some sort of comfort. I think that medical providers are always more comfortable when there are things are written down and then labeled “guidelines” (laughs) [med student laughs] but I do think, then, what’s hard is when you are going to universally apply something to all these different experiences. And then it starts to become, then it starts to become, a barrier to care. Right? So guidelines are fantastic when they allow for increased access to care and they are bad when they diminish access to care. So what’s happened is that in 2009 the Endocrine Society put together guidelines that for the care of trans people including trans youth. And whenever medical guidelines are made: they’re made on the best available evidence. And the evidence available on trans youth is really scarce. So they had this very small body of literature primarily from the Netherlands that they used to make the guidelines. And what happened is that in the Netherlands the age of consent is sixteen which h drove some of their particular choices around research protocols. So now that got put into the Endocrine Society guidelines and is interpreted frequently as “cross-sex hormones shouldn’t be started until kids are sixteen” but that is actually not a protocol we should be following. I think that the care of trans youth needs to be individualized for each person and picking an arbitrary chronologic age is just …a big problem. And I think it’s being addressed right now because the Endocrine Society is actually revising those guidelines.”
You can listen to Dr. Olson’s entire address to medical students at the Short Coat Podcast website here [trigger warning: “uptalk”]: http://theshortcoat.com/tag/johanna-olson/
Prior to her work transgendering children Dr. Olson specialized in working with children with HIV, and children whose medical conditions cause unmanageable, intractable pain. A long-time figure in the California Democratic Party, Olson was co-founder and chair of the Democratic Progressive Caucus. She survived an impeachment attempt by the Democratic Youth Caucus, who accused her of abusive tactics and no-platforming after Olson used her medical credentials to testify against a Dennis Kuchinek sponsored platform to lower the voting age. Dr. Olson testified that the brains of those under eighteen were not yet competent for the complex decision making involved in choosing a political candidate. She is also the owner of the RedStar comic book company, and serves on the board of TYFA (Trans Youth Family Allies).