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Gender dysphoria in children: puberty blockers study draws further criticism

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5647 (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

The Health Research Authority (HRA) have responded to these concerns regarding the study. It appears there was indeed little to worry about. In fact the HRA went so far as to praise the researchers for being in some areas "ahead of normal practice at the time", as the authors themselves report elsewhere (1).

This article also does not acknowledge the basic principle of Gillick competence and the capacity of adolescents, and that it may be entirely appropriate for "puberty blockers" to be used for people who are going through puberty, as that is their function.

This article also ignores the advantages of GnRHa. For instance, one prospective follow up study of 70 gender dysphoric adolescents in Australia found that "behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression" (2). An assessment of 55 transgender adults who had gone through puberty suppression similarly found that well-being was "similar to or better than same-age young adults from the general population" (3). Another study of 201 gender dysphoric adolescents recorded their global functioning every 6 months and found that who underwent puberty suppression and psychological support had much better psychosocial functioning than those who only had psychological support (4) - surely this is the control group this article asks for!

I am also concerned by this article framing adolescents continuing to identify as transgender as a negative outcome. If the Dutch study showed that no adolescent withdrew from puberty suppression, this to me shows that we are correctly identifying the young people who are transgender and providing them with the appropriate treatment. To suggest that this is a flaw is to position transgender status as a failure. The fact that this article is intrinsically concerned with this worries me, as it only serves to further stigmatise transgender children and adolescents.

1. Cohen, Deborah, and Hannah Barnes. “Questions Remain over Puberty-Blockers, as Review Clears Study.” BBC News, BBC, 15 Oct. 2019, https://www.bbc.co.uk/news/health-50046579.
2. De Vries, Annelou LC, et al. "Puberty suppression in adolescents with gender identity disorder: A prospective follow‐up study." The journal of sexual medicine 8.8 (2011): 2276-2283.
3. De Vries, Annelou LC, et al. "Young adult psychological outcome after puberty suppression and gender reassignment." Pediatrics 134.4 (2014): 696-704.
4. Costa, Rosalia, et al. "Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria." The journal of sexual medicine 12.11 (2015): 2206-2214.

Competing interests: No competing interests

17 October 2019
Riley Botelle
Medical Student
King's College London