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Gender dysphoria in children: puberty blockers study draws further criticism

BMJ 2019; 366 doi: (Published 20 September 2019) Cite this as: BMJ 2019;366:l5647

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Re: Gender dysphoria in children: puberty blockers study draws further criticism

Investigative journalism has an inherent publication bias, it is difficult if not impossible to find a published piece of investigative journalism that did not purport to find what it went looking for. Furthermore, unlike scientific research the investigative journalist does not start with a null hypothesis. It is therefore highly questionable whether a piece of investigative journalism is the appropriate way to examine an unpublished scientific study and whether a scientific journal should blur the boundaries by publishing such a piece.

Cohen and Barnes view the complicated subject of the treatment of gender dysphoria in adolescence through a well-worn narrow media lens that fails to encompass the relevant socio-political, ethical and scientific issues.

Commentators from within the community such as Paris Lees have analysed the treatment of trans people by the media and the tropes that recur. These tend to be more overt within tabloid journalism. In relation to the treatment of young trans people, parallels have been drawn with the treatment of the gay community in the 1980s where fears were repeatedly expressed of non-heteronormative contagion. The suggestion that young people can be contaminated by non-heterocisnormative identities through social contagion can be used to challenge the legitimacy of providing education, support, advocacy and treatment. This is currently evident within the current objections and protest by certain groups in relation to LGBT+ education in schools.

Concern about the media portrayal of trans people led to Lees’ work with All About Trans (formerly Trans Media Watch) which aims to engage with and inform the media (

Characteristically the rhetoric in media headlines is inflammatory compared to the actual content of an article, emphasises age, and/or other perceived vulnerability (often using sexualised language such as “groom” in the example below) and focuses on interventions rather than identities:

“I’ve seen girls who change gender groom younger ones to so the same….and in nearly every case they are autistic says school teacher” Mail on Sunday (online content) 18th November 2018.

“Up to 150 autistic children could have been given sex-change drugs on NHS despite not being transgender” The Sun (online content) 22nd July 2018.

“Fury at BBC sex change show for 6 year olds” Mail on Sunday (print edition) 30th October 2016.

In the window containing “a patient’s perspective”, Cohen and Barnes choose the headline “We’re just so young that we just trust the doctors” (emphasis on age/vulnerability and influence by professionals) rather than choosing “it feels as if someone is finally listening to you” or “they have helping you as their best interest” (emphasis on therapeutic collaboration and a patient centred approach).

A US commentator, Cristan Williams ( in October 2018 published an online critique of the media reporting of Rapid Onset Gender Dysphoria (ROGD) in relation to young transgender people. One of the assertions made by the media piece on ROGD was that “many cases resolve within a couple of years”. Williams could find no evidence to support this statement, even in the research undertaken by one of the advocates of ROGD. ROGD is a concept that has been heavily criticised by the World Professional Association for Transgender Care (WPATH), the international organisation that sets the standards of care for transgender people. The suggestion of a natural lack of persistence of trans identities over time is implicit in Cohen and Barnes piece with the added implication that professionals and/or treatment may be responsible for persistence occurring.

Cohen and Barnes repeatedly refer to gonadotropin releasing hormone analogues (usually abbreviated to “GnRH analogues”) as “puberty blockers” whilst only once acknowledging that these medicines would only be used for children “in established puberty”. They focus heavily on the chronological age of the patients and cite in positive terms the previous policy of only treating those 16 and over. They do not discuss that the age at which puberty becomes established may be well below 16, nor do they state that the cut off of 16 related to capacity legislation rather than developmental stage. Physiological age and chronological age often do not correspond, particularly when considering adolescents or the elderly. This is an important concept in medicine that the authors appear to have missed.

The authors place emphasis on the hazards of treatment whilst not considering the hazards of not treating. This is just as unbalanced as the directly inverse way that experimental treatments or potential treatments for other complex childhood conditions such as cancers are treated by the media where the benefits are often exaggerated ahead of the full findings from clinical trials.

In summary Cohen and Barnes by accident or design serve to frustrate the very openness of debate they profess to seek. It is difficult when faced with this type of reporting to expect to have a reasoned impartial scientific dialogue. My fear is that this piece will only serve to inhibit further attempts to advance scientific knowledge in this area.

Competing interests: No competing interests

12 October 2019
Michael J Shaw
Consultant in Gender Dysphoria
Northern Region Gender Dysphoria Service