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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.
It's because it's both natural and we have a long track record of that path working.
It's a very difficult problem to come up with an alternative pathway that leads to physically and mentally healthy humans at our current level of tech. Unconstrained thinking is probably not a good idea when it comes to complex biological and psychological changes.
It becomes even more absurd to even attempt this in the name of people with disordered relations to their own body, when puberty itself may help resolve that disordered relationship.
Maybe people's intuitions that living their values will make them happy are just wrong. Maybe this is especially true for a group that is prone to a bunch of other mental disorders.
...
We can't exactly take it for granted that mentally ill people are holding values that will actually make them happy , or that they have a reasonable understanding of the risk they're taking on (especially when faced with dubious information from medical practitioners)or have reasonable expectations for these treatments.
Or hell, that their stated euphoria and relief will be lasting.
Society is entitled to say no. My doctor won't give me SARMs for some reason.
Discussions like this make you feel the void left by any natural law or common understanding of virtue.
I did stress that I'm playing Devil's
AdvocateDoctor. I don't want puberty blockers, if I had the misfortune of having a child who desired them, I would do almost anything in my power to dissuade them. I'm not in the business of prescribing them either, I'm not a psychiatrist for kids and teenagers. In fact, the UK is cracking down on even the relatively few (compared to the US) "legitimate" gender transitioning clinics.That being said: Natural law is bullshit. There is no coherent collection of principles that the term usefully refers to. Most adherents ignore the literal meaning and embrace a gazillion unprincipled exceptions. The closest it has to a working definition is status-quo bias.
Even teleological definitions have absurd conclusions. Is the meaning of life to maximize entropy? It is, if the outcome of a process defines its purpose.
Even mild exposure to different cultures and their associated values will tell you that beyond a small core (often contentious itself) there's no "common understanding of virtue".
Even simple sounding ideas, like "don't murder, or steal from your neighbors" will have people arguing ad-nauseum what counts murder or stealing or even a neighbor.
If I pity people who want to be the opposite of the sex they were at birth, then I pity people who genuinely believe in natural law or "objective" morality even more.
One of them is a matter of personal values. The other is basing your moral foundations on wishful thinking.
I'm a moral relativist and a moral chauvinist. I know my values are just as valid (or not) as anyone else's. I also happen to think they're better, with the implicit understanding that to use such a comparative term necessarily needs an observer by whose light it is better or worse (me). Anyone who has convinced themselves that there's objective grounding to their morality, well, I don't want to have what they're smoking.
Quite a few gynecologists and many endocrinologists would be out of a job if the outcome of human hormones acting as they would always had the desired outcome.
I don't contest that the overwhelming majority of people are neutral or slightly positive towards puberty, assuming they even cared to reflect on it.
I would be the last person to disagree about the limits of modern science, engineering and medicine. I also think we should be improving our tech (and we are).
On the other hand, constraining thinking to only that which is known to be possible is... a choice.
You might have gotten away with it a thousand years back, when the lives you and your grandpa lived were nigh interchangeable. That's not the case today, we're living in a scifi novel with reality's rather lax attitude towards plausibility.
And it might not. The rate of desistance with puberty is not 100%. A non-zero number of people will find themselves still wanting to transition, and face even greater hardship for even less change.
I'm for reflecting on whether or not that risk is worth taking, from the perspective of someone who has to:
They need to add up the benefits and risks themselves.
I do not hold happiness as the only terminal value, nor do most people. If they disagree, then they're welcome to start a fent habit.
Whether doing something will make a person happier, either in the short-term, in the long term, or just on average, is far from the only consideration when making a choice.
There are plenty of people who are just depressed, so we wouldn't be out of a job.
Mental illnesses are not made equal.
Someone who had an overwhelming desire to fly and tried to do so might have been better off in an insane asylum if they were born in the 1700s.
Today, they might be a hang-glider hobbyist, a pilot, an astronaut.
Did the people who jumped off cliffs or the Eiffel Tower with inadequate parachutes or mechanical contraptions count as mentally ill or suicidal? Not by most definitions I've heard of. They would still have been "better off" if society had caged them, or at least lived longer. Yet today, we soar.
Your argument argues, just as strongly, for doing our level best to present reliable information to patients. You could also force doctors to present information that better represented reality, on the pain of liability. You could have people be grilled by a different doctor or some other Authoritative Individual who had to be convinced that the patient understood the risks and benefits. This is already common practice in psychiatry, at least where I work. Things like detention under the Mental Health Act or forced treatment require multiple people uninvolved with the original case to sign off. This isn't trivially gamed either, I've seen the headaches my bosses get went they're trying to put these in place without unimpeachable evidence.
Death, be it ours, or that of the universe, doesn't mean temporary endeavors are worthless. At least not to me.
Even in the short term, the hedonic treadmill goes brrr. I'd love to win the lottery, even if a year later my happiness would have regressed to near baseline levels.
You should try a different doctor. Some are more flexible. If I had a patient who understood the risks and benefits, and I wasn't violating laws (because I wish to keep my license, my own moral proclivities aside), then I'd prescribe them.
There are many things that would nice if they were real. You know, a benevolent Creator, objective morality, a pill that changes your gender with no consequences.
Sometimes, you're shit out of luck. Sometimes you can make something just as good. Sometimes you pick the lesser evil out of available options while working on making better ones.
If you have a god-shaped hole, in a universe that doesn't have a god, make one yourself from applying linear algebra to {the majority of text Mankind has written}. If you can't become the opposite sex today, maybe settle for the terrible ersatź substitute.
All I say is maybe.
Hooo buddy, have I got some news to break to you about natural science. People debate conceptual primitives and what "counts" as them all the bloody time. I presume that you pity people who genuinely believe in natural physical law or "objective" reality, too?
These sentences contradict one another and result in something that is conceptually incoherent.
Ontology is a matter of convenience. All models are flawed, some models are useful. If there are two different models of reality that output the same results for all ranges of possible inputs, then choosing between them is a matter of convenience. If, for some reason, it became relevant, you could then worry about which one had the lowest Kolmogorov complexity or something.
Objective reality is a very useful concept to have, even if establishing it is likely unreachable. I can happily concede that the universe might be a cosmic dream, that this could be a simulation, that I'm perhaps a brain in a vat or a Boltzmann brain while happily acting as if this reality is shared, stable and predictable. The ability to compartmentalize or hold multiple levels of abstraction in your head when necessary can be handy.
There is certainly far more evidence for consistent and universal laws of physics than there is for objective and universal morality. Physicists can predict the outcome of systems spanning dozens of orders of magnitude within the limits of experimental error. Philosophers are lucky if they can get their buddy reading Kant in the cafeteria to agree with them.
1 to 4 establish the relativism. 5-7 explain why that's not a barrier for me preferring my morality over all others, as I believe that it both needs no justification beyond personal preference and that there isn't any more deep-seated justification for anyone's morality.
In other words: "Because there's no objective standard, all moralities are equally ungrounded. However, from my subjective viewpoint, I find my own morality preferable, and therefore I advocate for it." I avoid claiming objective superiority while still asserting subjective preference and a desire for propagation.
Please, do tell me me how these two concepts are impossible to reconcile. I think I just did that, so there's an existence proof for you. I would be much obliged if you also established reasons for there being an "objective" morality, or a reason why I should prefer that of someone else's over myself.
If you somehow succeed, I will either concede the point, or disappear into a gibbering mess of congealing brain matter from the cognitive dissonance I expect to experience.
...and yet, you must pity people who actually believe it, right?
Let's start with, "What does this sentence mean?" What does it mean for values to be "just as valid (or not)"? You seem to have not touched on this at all in your latest comment.
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