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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.
I think more people could understand the depths of this debate better by steelmanning the pro puberty blocker/pro HRT side a little and seeing that allowing people to go though puberty normally is also not reversible. And a lot of transgender adults (and teens off the very basis that they are seeking out hormones) openly express that they wish they didn't have to go through their natural puberty.
So from their perspective what bans can end up doing is that instead of the person getting to decide which irreversible thing they go through based off their own desires, it's the government choosing for them.
There is no simple choice here, someone will be upset by permanent changes. A teenager who makes a mistake and gets on hormones without consideration, or a teenager who is forced to go without care and ends up as a sad trans adult who just wishes they had the autonomy given to make choices about their own body when they were younger.
And blockers came up as the compromise solution and promoting them as the free space where everything can be reversed seems just like wishful thinking from everyone. Because if it's true then it's a very easy solution that won't cause any harm.
The part many on the left are missing is that puberty itself is a large part of the mechanic by which teens become heteronormal. When I was around 12, I felt disgusted by teens, sexuality in general and was a somewhat odd kid to begin with. At that time there already was lots of talk about nonstandard sexualities and I strongly identified with asexuals. I also thought that I was very far from the average male, among other things refusing any kind of violence (I distinctly remember refusing to even watch shows/movies or play games portraying violence), an intellectual above all kinds of base instincts. Typical arrogant nerd stuff. Especially early puberty then felt like shit, very moody & scared of what happens with me. Then sometime in late puberty all of that went out of the window, suddenly I was a temperamentally fairly stereotypical guy. And even in retrospect, I had been to some degree in denial even when younger. In elementary school I was often beating up other kids for various reasons. I just learned that I was going nowhere with that attitude, so I had to force myself out of it and pretended that it never happened. Which combined with my otherwise bookish personality naturally led to the described intellectual self-image.
Conditionals are obviously hard to prove, but I could easily see my pre-puberty self taking puberty blockers to not become a disgusting, violent, sexual men. Especially with the argument that oh, it's reversible anyway, so just try it out. It would have been a grave mistake, but I wouldn't have known, and in particular it's easy then to then just stay the course and tell yourself you took the right option.
My wife is very similar in the other direction; She always was a tomboy who felt more comfortable with boys, then puberty hit and she changed. She also could see herself mistakenly choosing to take puberty blockers in her youth. And now our daughter is just the same, so we make sure to always tell her that her mom had the same struggles. Imagining her mistakenly getting talked into puberty blockers is horrifying, and worse, very plausible.
So overall while I have quite some sympathy, going through puberty seems like the less-bad option even for the majority of those who feel somewhat uncomfortable with their sex.
I'm going to play Devil's Doctor here:
You underwent a drastic change in your personality as a consequence of a hormonal surge that was out of your control. That's 'normal'. It's puberty.
Yet the person you became isn't the same person as the one before. I mean, puberty hit me hard, but I never felt as if my values or goals changed because of it (beyond being even more eager for the company of the fairer sex).
This seems to me to be analogous to a person who, for their entire life, had sworn off addictive substances, but ended up on benzos or opioids for Medical Reason and found themselves hooked, and are now unwilling to try and become sober.
Why should we so strongly privilege puberty because it's "natural"? Many things are natural, such as 50% infant mortality rates, dying of a heart attack at 50 or getting prostate cancer by 80.
Nature, a blind and indifferent force, cares nothing for our individual well-being or our carefully constructed notions of self. To equate "natural" with "good" or "desirable" is a fundamental error, a logical fallacy we often fall prey to.
In the UK, the laws around consent for minors are relatively simple. Past the age of 16, they're assumed to be competent to consent to or decline medical procedures until proven otherwise. Below that age, there's no strict cut-off, if they can prove to their clinician that they are able to weigh the risks and benefits, they are able to consent or withhold it, and even override parental demands.
Someone who wishes to be the opposite sex is someone I pity. Medical science as it currently stands can't provide them more a hollow facsimile of that transition, it's Singularity-complete based off my knowledge of biology. Even so, the desire is one I consider as valid as any.
If they understand that:
A)Puberty blockers have risks and might not be truly reversible if they change their mind.
B) It won't solve all their problems, it won't physically make them indistinguishable from their desired sex.
Then I see no reason to declare that they're making a mistake. By the values they hold, it's the right decision. If they're forced to pass through puberty, they might desist, or they might spend their life wracked with regret that they didn't pull the trigger (hopefully not literally). You can pass far easier before testosterone wracks your body. It's a helluva drug/hormone.
A lot of life-changing decisions can be ones that change the person making them irrevocably, and into a person who would affirm them in retrospect. But I would yell at someone who suggested that couples who are iffy about childbirth be forced to have a child in the hopes that'll change their mind, or fix their marriage or some other well-intentioned goal. Or if we suddenly were to say that everyone should be made to try alcohol and cigarettes because the kind of people who try them tend to stick to it.
We're forced to deal with a messy world that doesn't always readily cough up pathways to our desires when we ask. I'm all for overcoming biology, and I think that people who understand what they're getting into are entitled to ask for even imperfect solutions.
Want to be more muscular? Try tren, if you know what you're in for. Want to lose weight? Take ozempic, while keeping an eye on your eyesight and pancreas. Want to be the other sex? This is the closest we can get you today.
I basically agree with you about values and freedom. I guess my main fear is around the information environment we provide re: "This is the closest we can get you today." I'm not an expert but I get the impression that many (maybe most?) people who attempt to transition are deeply mislead about both the best and worst-case outcomes. I just don't expect any modern Western institution to be able to honest about what wretched results most transitioners end up having, nor about what most people honestly think of them.
Relatedly, Blanchard wrote about how his MtF patients could usually see that the other MtF patients clearly did not pass, but believed that they themselves did.
I think you could make similar arguments about the information environment surrounding lots of other early life choices, or educational choices such as pursuing arts degrees. But most of those are less catastrophic and irreversible. I guess at least Western society now does a pretty good job of showing the downsides of joining the army.
I have no opposition to making every reasonable effort to expose people to reality. Of course, with the matter as politicized as it is, easier said than done. There are just as many people committed to cracking eggs at all costs as there people who will claim that puberty blockers gave their cancer cancer.
At any rate, if I had solutions for people making bad decisions, I'd probably be accepting a dozen Nobel prizes right now. All I can say is that we should let people make their own choices, and if they're hard and risky choices, do our best to ensure they're exposed to the facts they need.
I don't think that's true. Or at least, my impression is that almost every elementary through high school teacher in north america who talks about the issue gives the impression that it's basically possible to successfully transition.
I don't think I'm willing to bite the libertarian bullet here. E.g. I don't want my kids to have the option to do heroin, even if it's paired with a pamphlet explaining the real likely outcomes. However, I don't even think that that's a viable option. Seems like our options are: ban and demonize heroin, or legalize it and subsidize its use (as was recently done in British Columbia).
Same with transitioning kids: I don't see how we ever get to a world where it's both legal and the pros and cons are presented honestly. So I think I'd rather throw the few kids who could conceivably benefit from it under the bus and ban it for everybody.
What if they need surgery and a helpful anesthetist asks them if they'd like some diamorphine for the pain and hands them a brochure? That's heroin.
I like neither option, or at least not the "subsidize its use". We live in a world where heroin can be legally used, in the appropriate context. I reject all the bad options and advocate for the good ones. If that doesn't suffice, then I'll choose the least bad one, as I presume you would too.
There are plenty of psychiatric interventions I grapple with at work that require careful scrutiny and vetting! Electroshock therapy was highly controversial and demonized. It's still being used as ECT, and saves lives.
A prospective filter would have to be very expensive to outweigh my other goal, which is to increase personal liberty. Someone who doesn't value the latter is entirely correct if they have a lower threshold for giving up early. We would have the issue of having similar values, but weighting them separately depending on the context.
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