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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.
There is no simple choice here, and any method is going to inevitably have both false positives and false negatives. I think there are a couple of good reasons to err on the side of more false negatives, though. One is the basic principle that's often summed up as "first, do no harm." This isn't some iron-clad rule even within the medical community, much less reality itself, but it's a general call for epistemic humility in medicine such that, unless we can be really really sure that some intervention won't be a net harm, we ought to allow human biology to take its course. The other reason is the base rates: the odds that any given child is trans is minuscule, likely less than 1%, from what I recall about the stats. Now, we aren't sure what the odds are, conditional on the child believing that they're trans, but it's not clear that that conditional shifts the odds significantly, much less that it shifts the odds to 50.00001%, which would be the threshold at which it would make sense to even consider any sort of irreversible interventions.
What I think any sort of people who are for use of puberty blockers in trans children ought to do at this point is to generate credible scientific knowledge on how to accurately determine if a child is trans, as well as create credible mechanisms by which children are properly filtered out. At a bare minimum, it would have to include metaphorically tarring and feathering anyone who would refuse to publicize research on this topic based on the fear that it would be politically inconvenient, as well as encouraging criticisms of any research from people who are ideologically opposed to them. It's only through building such a credible mechanism of accurately identifying trans children and minimizing false positives that I think society in general would be on board with the program. Even then, there will always be people who oppose it entirely on principle, much like, even in 2025, there are people who believe homosexuality is a sin or are against miscegenation. Those people ought to just be ignored and will simply lose their credibility over time if giving puberty blockers to kids proves itself to be fine.
It seems like this would require defining what it means to be trans... any suggestions?
Seems like you're begging the question here. If people think something is wrong in principle, then it won't be "fine" by their lights even if it doesn't cause secondary problems.
Personally, no. I agree that it'd be incumbent upon anyone who wants society to be accepting of giving puberty blockers to trans children in order to transition them to provide a definition of "trans" that society in general would accept. For the past couple decades, I think we've seen them push the idea of "really really feels like they're the opposite sex," along the same lines as homosexuality being defined as something like "really really feels like they're sexually attracted to the same sex," but that clearly hasn't stuck. Given that we're talking about actual medical intervention, the definition would probably have to be a lot more objective.
Sure, just like how homosexuals still aren't "fine" by the lights of plenty of people today. But, again, we can just ignore those people and win over the people who can be won over based on the (lack of) those secondary problems.
But the homosexual community is still struggling with the issue: Turns out they can't ignore those people and instead seem compelled to eradicate them from all public fora. And I think trans advocates are cut of this same cloth. Dissent and debate are lethal to these movements, seemingly, in very similar ways for very similar reasons. Some feelings are good for governing behaviors. Things like the feeling that touching a stovetop hurts is a very good way to avoid severe damage to your limbs. However, these more complex feelings are much more of a crapshoot. Love is notoriously ephemeral. Sexual attraction is less so, but letting attraction have a strong influence on your sexual acts is still a recipe for disaster.
This struggle seems like an entirely voluntary decision and the source of entirely self-inflicted suffering. Unfortunately, that's often not easy to pull someone out of. My hope is that enough people just walk away from this that the people who choose to inflict this unnecessary suffering on themselves (and others) are sufficiently few as not to be a major issue.
Funnily enough, your choice of the word "struggle" actually reminds me of another rather famous Struggle that also seemed entirely voluntary and led to a ton of self-inflicted unnecessary suffering both to himself and his compatriots. Hopefully it doesn't come to anything like that.
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