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Are puberty blockers chemical castration?
A follow-up to the discussion with @netstack
This was originally a deep-chain reply, but after a few spergy, reddit-tier replies on my end, and @netstack's saintly curiosity, the conversation resulted in a decent-quality argument, that I'd like to get more eyes on and see I missed any obvious objections.
I did some extra digging as well. The wiki for Lupron links to the paper "Reforming (purportedly) Non-Punitive Responses to Sexual Offending", and while it's about triptorelin instead of Lupron, it's another GnRH. In any case a systematic review of the use of GnRH on sexual offenders (sci-hub) should hopefully settle the matter.
As a side note this paper makes me think the difference between GnRH's and DMPA's is that the former have (or promised to have) fewer side effects, not that they work on a fundamentally different principle (and while we're on the subject, let me just say I'm rather bemused at all the handwringing in all these papers about the side effects of these drugs on convicted sex offenders, when I compare them to the dismissal of any such concerns around giving the same drugs to children).
No, it just completely went over my head, lol.
This is a fun one. From what I understand chemical castration is meant to be reversible. This is what the wiki for chemical castration says right on the top, and I saw, but failed to bookmark, a paper that made that claim about DMPA's specifically, but that seems to be the general consensus on chemical castration:
So if irreversibility is a necessary condition for classifying something as chemical castration... than it seems that chemical castration does not meet the standard.
Now, I'm somewhat sympathetic to the "non-central" argument, you can argue that something that's reversible doesn't quite have that quality of having one's balls cut off that you'd expect from a term like "castration". It is also true you're going to have a hard time finding sources about the reversibility of puberty blockers, since dr. Cass' team looked, and all they can say is:
But when gender care providers themselves tell me that "puberty blockers are reversible (asterisk)", the asterisk being you can't stay on them too long, or that if you start them too early you're never going to have an orgasm, when celebrity cases like Jazz Jennings say they don't regret going on blockers, but the downside was "there wasn't enough tissue to work with when it came to the surgery" (and also don't know what an orgasm is), when the industry comes up with procedures like sigmoid vaginoplasties or zero depth vaginoplasties to either hack around or throw up their hands about the issue, can we say that there are good reasons to suspect some of the changes may be irreversible? What is even supposed to be the mechanism for reversibility? For a fully developed adult it's just a question of restoring testosterone levels and sperm counts, but for a child that never went through puberty we're basically hoping their body will catch up with development as if nothing ever happened.
Yeah, I know that as far as evidence goes, this doesn't rise to the standard of a proper well-designed study, but like I said in the other comment, the gender industry isn't particularly transparent about results they don't like. I understand wanting to remain agnostic on the reversibility question, but if you grant that these concerns are reasonable, it seems like puberty blockers are an at least as, and may possibly turn out to be more of, a central example of chemical castration, than chemical castration itself.
This is one of the topics that really broke my trust with the medical 'experts', along with the covid stuff.
There are some basic common sense things to know about medicine and if someone is going to make a claim contradicting it they need to have a lot of evidence and some damn good explanations.
The idea that halting a major development milestone would be harmless breaks every bit of common sense about child health. The idea that infection with a sickness does not grant any kind of immunity is also insane.
You have to be so so careful with this kind of thinking when it comes to medicine.
First, I'll say yeah everything related to Trans healthcare is fucked and if you put a doctor in a safe space you have a shockingly high likelihood that what they have to say is grossly off-narrative, but what is allowed to be said in public is totally different.
Okay, but-
Medicine is a mix of really obvious common sense things, sometimes with a clearly understood basis (a lot of cardiac physiology is just fluid going through tubes! Easy to model!) and things that are basically the most complicated thing we know about (ex: the brain).
It is not always clear when something is common sense and when it is not. Extremely unclear. To the point where professional medical researchers in a field will get this wrong, stake research and money and decades on something and totally not understand if it was common sense or not.
The classic manifestation of this is blithely labeled "clinical significance." Something can make sense in a lab or a Petri dish, or in a monitored study, but you unleash it on our population you find out it does jack shit.
This came up a lot during COVID - such and such trend medication would appear to have an impact on viral replication in a lab and then you'd give it to people and it would have no impact at all or reduce symptoms by one hour on average or something like that.
Sometimes we'd have a common sense explanation ("oh it's kinda like Tamiflu you just need to give it super early after exposure...so it's mostly useless") sometimes we don't.
Clinical medicine involves a lot of heuristics and experience to help figure out what is common sense and to guess ahead of research because research is slow and expensive and a lot of what we do is never researched because nobody can monetize it or research would be unethical.
It's a mess, but most physicians were just like "oh it's going to be like Tamilfu" from the word go and tuned out, while everyone else in the population didn't even know they had to think that way.
I'm getting a bit unfocused so to bring it back-
Common sense in child health frequently doesn't apply. The field is going to have findings that don't make sense to you (even if I don't agree this is one of them). Consider that for a long time "spanking is good for child development" was common sense. Then it wasn't. I'd bet money the research base for both conclusions is frustratingly unhelpful.
And for your other example-
Looking at the immune system as "oh you get sick and then you get immunity" is like looking at Moore's Law and then assuming it will go on forever. Are you going to be right most of the time? Sure, but does that tell you anything about the nuances of the system or for how long it will apply? No.
Plenty of infectious organisms don't trigger your immune system in a normal way or have weird interactions. For example: Herpesviruses. You have them forever! Does that count as immunity? Or not immunity? Shit I don't know.
TLDR: Common sense applies in medicine in a lot of places but sometimes not in what seems like an obvious place. This causes angst.
I agree with what you're saying but I also agree with cjet79's central point that "if someone is going to make a claim contradicting [most people's common sense about medicine] they need to have a lot of evidence and some damn good explanations."
I think this is true in general, not just in medicine. If you're going to make claims that contradict peoples' common sense, then you need to be prepared to carry a heavy burden of persuasion, and you should empathize with (rather than attack or belittle) those people who are unpersuaded and trust their (perhaps incorrect) common sense. This is where the medical establishment really messed up. Even on issues where I think the establishment is correct (e.g., the covid vaccines are effective, adults should be allowed to medically transition) I still think the establishment has done a horrible job of messaging, and has blamed its failures on the people it failed to convince.
I mean to some extent the fundamental problem is that patients are idiots (also, people are idiots).
For example it is pervasive common sense in the U.S. that doctors in general (and notably for this forum - psychiatrists in specific) are pill pushers first and foremost.
Meanwhile every doctor is trained to and will tell you to make lifestyle modifications and live a healthy life first. If they do not it's not because they don't believe it's because they've given up because nobody listens.
Then patients say they want to do X supplement or go to the chiropractor or whatever in order to maintain health instead of taking medication which the pill pushing doctor wants them on...
Ultimately you do what you can but people will ignore you and believe whatever they want and be resistant to being told what is or is not common sense and what is or is not good evidence.
Convincing people of stuff they don't want to believe is not something that doctors are more magically equipped to do than anyone else, but that is what would be required.
I do think public health is directionally wrong on some of this stuff, but insisting "okay but this time when people are wrong or confused you have to be more careful" isn't helpful.
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