The MoH and puberty blockers
Is NZ's Ministry of Health promoting misinformation on puberty blockers?
Shout out to science
A cool thing I could say to my kids, in those strange, never-before days when Covid-19 first hit, was that our government is trying to keep us safe. It’s listening to experts, it’s looking at what's happening overseas, it’s assessing the evidence and then it’s making decisions. I could say, hand over heart, you and your friends might see some bonkers stuff online, about magnets and mind control, but you can trust the Ministry of Health (MoH) to give you the facts, as far as it knows them. And the science and the public health information worked. Thousands of lives were saved in New Zealand through lockdowns, vaccines and masks.
My kids, both teenagers, are also navigating their way through waves of highly politicised discussions about identity, gender and sex. The internet is awash in misinformation, bias and nonsense on this issue, at least as pervasive as lizard Jacinda and vaccines full of microchips. But I can’t say to my kids, take a deep breath and look at the MoH website on this stuff. It has your back. Because I don’t think it really does.
The Ministry is misrepresenting the science on puberty blockers. And it’s presenting controversial beliefs around sex and gender as fact. It’s putting popular theory above science, facts, and kids. It’s abandoned its clinical skepticism, and in doing so risks its well-earned reputation. A reputation crucial to the success of public health messaging.
What are puberty blockers and why is anyone bothered about them?
Puberty blockers contain a hormone that suppresses the production of the sex hormones that cause puberty. They’re prescribed to gender-questioning children before or in early puberty so that they don’t have to experience the natural pubertal changes of their biological sex. A biological sex which may be at odds with internal feelings about what their sex or gender is.
The push for healthy kids to have access to puberty blockers ships with a wider narrative that people can be born in the wrong body. This is not a scientific or rational belief. It’s a kind of faith, that people aren’t just born with a sex, but there is some higher supernatural truth at work, that there is a born sex and a true sex. People are, of course, entitled to hold that belief, so long as they cause no harm, but it shouldn’t be what shapes Ministry of Health information.
Advocates for blockers argue it’s a sometimes life saving treatment for kids whose distress around gender might cause them to self harm or suicide (the much quoted statistics on these risks are as heart-wrenching as they are wrong). Blockers, advocates argue, will simply pause puberty allowing children to decide what to do next. Go off the blockers and go back to your life, whatever direction it takes.
But puberty blockers are a powerful drug that interfere with healthy normal physical and emotional development. Putting aside the complex reasons why kids might be experiencing gender dysphoria or identifying as trans, there’s a growing body of evidence about a number of harmful effects of puberty blockers, and so far too little evidence to know all the possible harmful effects.
What does the NZ Ministry of Health say?
Here’s what our Ministry says about puberty blockers on its website:
Blockers are a safe and fully reversible medicine that may be used from early puberty through to later adolescence to help ease distress and allow time to fully explore gender health options.1
It also advises health professionals that:
The distress caused by the mismatch of sex assigned at birth and gender identity (often termed gender dysphoria) can be effectively reduced when access to timely, gender-affirming health care is available.2
What are the problems with the Ministry of Health statements?
Dubious sources
The Ministry has said in regards to its statement on puberty blockers:
The information on the Ministry of Health's (the Ministry) website is supported by the Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand published in 2018…It is also supported by the Standards of Care developed by the World Professional Association for Transgender Health.3
First let’s look at the World Professional Association for Transgender Health (WPATH) standards. Other groups question the approach taken in developing these Standards of Care, that’s another conversation, but let’s look at what WPATH says about puberty blockers:
The do list puberty blockers under a heading of “Fully reversible treatments” but that’s contradicted in the substance of the document. The standards say:
Neither puberty suppression nor allowing puberty to occur is a neutral act. On the one hand, functioning in later life can be compromised by the development of irreversible secondary sex characteristics during puberty and by years spent experiencing intense gender dysphoria. On the other hand, there are concerns about negative physical side effects of GnRH analogue use (e.g., on bone development and height). Although the very first results of this approach (as assessed for adolescents followed over 10 years) are promising (Cohen-Kettenis et al., 2011; Delemarre-van de Waal & Cohen-Kettenis, 2006), the long-term effects can only be determined when the earliest treated patients reach the appropriate age4.
It doesn’t sound fully reversible and it certainly doesn’t sound like it’s irrefutably safe. WPATH points to current concerns about safety and a lack of evidence to make the calls about safety. So the Ministry of Health statement is not supported by WPATH standards of care.
Let’s turn then to the New Zealand guidelines on gender-affirming care also listed as supporting the statement.
Their guidelines say that puberty blockers are considered fully reversible. A more cautious statement than the Ministry’s. Nowhere does it say that puberty blockers are safe. The sample consent forms for puberty blockers do list a number of possible negative side effects.5
I question whether the Ministry of Health’s strong statement that puberty blockers are safe and fully reversible is supported by these Guidelines. But the Guidelines do paint a rosy picture of puberty blockers which may colour MoH’s approach.
The ideological position underpinning the guidelines is that of gender ideology, evidenced most clearly through a glossary that presents a number of in vogue statements about biology, sex and gender as fact, despite them not being universally supported in scientific circles.
One phrase the guidelines use is, Sex assigned at birth and that’s also been adopted by the Ministry. It’s a mealy-mouthed, inaccurate, confusing phrase that subverts common language to uphold the position that sex does not exist except in the mind, or as a social construct imposed on people.
Sex, in fact, is an actual thing, observed in utero and sometimes at birth. Recording of sex is based on chromosomal testing or observation of genitalia. If you deny the reality of biological sex—that it exists, it is not just assigned—you are also denying long-standing consensus around gametes, human reproduction, and human evolution.
When following guidelines, the Ministry should consider whether the guidelines are science-driven or philosophically-driven.
At best, incomplete information, at worst, inaccurate
The view that puberty blockers are safe and fully reversible is widely challenged. Concerns about puberty blockers are expressed by a number of evidence-focused organisations and national public health bodies. The reconsideration of puberty blockers as a standard treatment for gender dysphoria is a wide enough phenomenon for the Ministry to incorporate it into its own advice.
Stats for Gender, who aim to provide reliable data on gender, point to numerous studies showing puberty blockers have negative impacts on bone density and fertility.6
NHS in England, who once also ran the safe and fully reversible line, now say:
Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.
Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.
It's also not known whether hormone blockers affect the development of the teenage brain or children's bones. Side effects may also include hot flushes, fatigue and mood alterations.7
Socialstryleson, Sweden’s national health body, says the risks of puberty blockers outweigh the benefits.8
The National Academy of Medicine in France says:
If France allows the use of puberty blockers or cross-sex hormones with parental authorization and no age limitations, the greatest caution is needed in their use, taking into account the side-effects such as the impact on growth, bone weakening, risk of sterility, emotional and intellectual consequences and, for girls menopause-like symptoms.9
There’s plenty more.
Claiming gender dysphoria can be effectively reduced with gender-affirming care
Gender-affirming care typically includes accepting someone’s statement that they are a different sex or gender to their biological sex, and providing access to puberty blockers (a kind of hormone in itself), cross-sex hormones and surgery. There are wider conversations to be had, but thinking specifically about puberty blockers, there is little evidence to support the claim that gender affirming care is effective.
Most recently the interim Cass report on gender services in the UK states:
The Review is not able to provide definitive advice on the use of puberty blockers and feminising / masculinising hormones at this stage, due to gaps in the evidence base; however, recommendations will be developed as our research programme progresses.10
The Society for Evidence-Based Gender Medicine (SEGM) argues that the affirmation model is based on a single highly flawed Dutch study which involved all child onset gender dysphoria (as opposed to the now more common puberty onset gender dysphoria).11
Stats for Gender point to multiple studies that show there is limited evidence that puberty blockers lead to positive outcomes, or that they decrease rates of suicide (a common defence of puberty blockers).12
So what should the Ministry of Health do?
The Ministry needs to provide full and frank information to its readers. It needs to openly:
acknowledge that there is no clear consensus on the safety or the effectiveness of puberty blockers
alert readers to clinical studies that have found adverse effects of puberty blockers
alert readers to studies that show puberty blockers and other gender affirming treatments may not be effective treatments for gender dysphoria
replace any phrasing that says sex assigned at birth with the scientifically correct term sex
review their policies for assessing the use of guidelines and other source material.
Puberty blockers are not making sick or hurt kids better. It’s not removing a cancer or setting a broken bone. Puberty, distressing as it can be, is a natural human experience. It’s a serious thing to interfere with it. Blockers potentially make healthy kids, swept into a faith-based frenzy of gender confusion, sicker. There’s an ethical and professional obligation for the Ministry to be unwaveringly robust in the information they provide on this issue. Most particularly because children are involved.
The hugest victims of unbalanced information will be kids and parents who trust what the Ministry says and then expose themselves to risks or make life-altering decisions without the benefit of exposure to the full range of medical knowledge about the issue.
There’s also a much wider reputational risk. Because if the Ministry is willing, as it appears, to go for political palatability above clinical skepticism on this issue, why the hell should we would trust them on other issues?
Transgender New Zealanders: Children and young people, Ministry of Health.
Delivering health services to transgender people, Ministry of Health.
Response to your request for official information, Ministry of Health, 23 March 2021.
Puberty blockers cause infertility that can't be always be reversed in both sexes. They also stop brain development (which is a normal part of puberty). Wrong sex hormones given to girls to 'create' a man work by putting them into premature menopause. Premature or early menopause is associated with numerous adverse health outcomes including cognitive impairment, memory loss, dementia, parkinsonism, glaucoma, chronic heart disease, strokes, osteoporosis, mood disorders, sexual dysfunction, motor impairment and increased overall mortality. And they don't make you a man either. Frontal lobe development is not complete until between 18 and 30 years of age (depending on sex and birth order). No child is competent to give informed consent to these life changing procedures. There are going to be a lot of lawsuits and ACC claims in the future.
Like all our government departments, both at national and local level, the MoH is only consulting with people and groups invested in gender identity ideology. It's a real scandal that they have turned their ears off to those who have evidence that puberty blockers are not the harmless 'pause pills' they've been made out to be.