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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

Rapid Response:

Welcome and necessary exploration of the experimental treatment of children.

The BMJ is to be commended for looking into the research on puberty blocking treatment for children with gender dysphoria. The views of academic CAMHS psychiatrists that don't work in the gender field, Professors Scott and Ford, are a welcome addition to the discussion. The more input to the debate from informed but 'impartial' psychiatrists, the better medicine will be equipped to avoid going astray.

However, it is surprising that they do not see at least the significant risk of over use of treatments with unknown long term outcomes. 100% of puberty blocked children going onto cross sex hormones is remarkable in that it suggests that either clinicians are able to predict outcomes with 100% accuracy (unheard of in any other area of psychiatry ) or that starting puberty blockers, in of itself, leads to cross sex hormones at the age of 16.

The fact that many medications used for minors are unlicensed, is a weak argument to defend the unlicensed use of puberty blockers. It could be argued that the rates of unlicensed psychotropic medication use for CAMHS patients, across the field, is excessive. No doubt that will also, in time, get the attention it needs, as is happening in learning disability and old age psychiatry currently.

Using common sense begs the question ; where are all the middle aged women wanting to transition to male? The ones that this research suggests would have been suffering in gender confused silence 20-30 years ago ?

Competing interests: No competing interests

17 October 2019
Damian Clifford
Previously adult psychiatrist, now training in psychodynamic psychotherapy
None
Cornwall