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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.
Arguments concerning the science of anything relating to puberty blockers or hormones or anything else concerning transgenderism are useless, because no one making arguments on either side really cares about the science. All it is is cover for whatever argument they want to make. For instance, suppose some children develop a heart condition that they may grow out of but will become a dangerous, chronic problem if it persists into adulthood. There's a treatment that can significantly mitigate this risk if the child starts taking it around age ten, but it comes with a catch: It has its own risks, and can cause permanent damage itself if it's unnecessarily used. If you're a doctor making a recommendation or a parent looking to make a decision, then your conclusion would depend on a number of factors—the likelihood that the child will grow out of the condition, the amount of damage the untreated condition is likely to cause, the amount of damage the treatment is likely to cause, etc.
But that's a heart condition. It has no political, cultural, or social implications. The only circumstance in which society will judge you for your choice is if the scientific evidence clearly supports a particular course of action, e.g., if the chances of the kid growing out of it are low, the consequences of an untreated condition are severe, and the potential risks of treatment are mild. But if it's anywhere near a Hobson's choice, it would be unusual for people to make categorical statements about what the correct course of action is in all cases, or for there to be a sustained public effort to influence legislation on the issue.
So ultimately whether it's reversible doesn't matter. For the anti-trans crowd, if it were 100% consequence-free and there was next to no chance that the kid would grow out of wanting to be the opposite sex, they would still be against it on principle. The same is true in the other direction, though the hardcore trans activists are much fewer in number. So quote statistics and talk about risks until the end of time if you want to, but keep in mind that it's irrelevant to the conversation.
You don't find it a little bit strange that we've been having the trans debate in this space for something like 10 years, and these "well, the science doesn't really matter" arguments are surfacing only now that it can be shown that some pro-trans claims can't be scientifically backed, and that several of the experts that we were told to trust have been proven to lie on several occasions?
Hold on, "the science doesn't matter" is one thing, "reversibility doesn't matter" is another. If I had a kid, there's many ideas that they could come up with, that I would think are absolutely retarded, but might let them go through with them, just so they get it out of there system, if nothing else, and reversibility is one of the most important criteria I'd use for making the decision whether to let them do it, or call an absolute veto. This seems plainly obvious to me, and I can't wrap my head around how anyone could claim otherwise, so maybe you shouldn't so confidently speak for others (especially for people with values different from yours).
Also, if it doesn't matter, why did the pro trans side spend so much time and effort telling people puberty blockers are reversible, even though they knew they have no evidence for the claim?
In these situations we tell the patient and parent the risks and benefits to the best of our knowledge, and leave the decision to them. We don't try to guilt them into overriding it, and when someone brings evidence that the original risk/benefit assessment is wildly off the mark, we hear them out and adjust the practice to be in accordance with the best evidence. We don't call them heart-condition-o-phobes, we don't ban them from social media, and we don't send the police after them.
I think you're misunderstanding me; I'm not saying that the science is useless, but that the arguments based on the science are useless. They're almost always made in bad faith, because the people making them, at least on the anti-trans side, won't agree that gender dysphoria or whatever you want to call it is a condition in need of treatment. Thus, weighing the risk of treatment against the risk of no treatment is useless because any treatment will have some degree of risk, and to them the risk of no treatment is zero. It's like taking a medication for a dangerous condition.
I would add that, when it comes to the science we have now, I generally agree with everything you said, and that the pro-trans side similarly acts in bad faith by downplaying the risks and acting like every kid who plays with his sister's dolls is obviously trans and needs to be put on medication immediately. My gut feeling tells me that puberty blockers probably aren't a good idea, and that even if they were fully reversible, going through high school looking like a ten year old probably isn't any better for your mental health than being the "wrong" gender. But I recognize that a lot of my own apprehension is more cultural than scientific, and things change in the world of science. Maybe the current treatments are crude, but I imagine that there's a lot we still don't understand about endocrinology and physical development, and I wouldn't foreclose the possibility that more sophisticated treatments will become available in the future that reduce the risks associated with the current ones. But I don't trust that, if and when that day comes, the Tennessee legislature (for instance) will revise their opinion on the matter and change the law accordingly. To that end, despite my personal objections, I tend to bristle at state legislatures that seek to make the decision themselves rather than allow parents and doctors to make it together.
I partiallly agree, and partially disagree (or still misunderstand). I think you're right that science doesn't matter in the sense that this is, to a large extent, a conflict of values. I wrote about it in the past, how I thought the discussion is centered around science, and how to best treat the condition called gender dysphoria, or whether such a condition actually exists rather than being an artifact of another psychological issue, and how it turned out that the pro-trans side admitted that it doesn't care, that it was using the "medicalized narrative" strategically to build acceptance for their true goal - patient autonomy, and the pursuit of authenticity through body modification.
You might be right that this is symmetrical, in that it's merely convenient for the anti-trans side that the diagnosis of gender dysphoria is dubious, and that there are all these scientific, medical, and health concerns about the treatment, and if all of these concerns were shown to be moot by advances in technology, they'd still be against letting people modify their bodies to such a radical extent, but you're wrong about the science-based arguments being useless. The Science™ is the framework for resolving disagreements that our society has agreed upon, given conflicting values. This is the battleground that was picked, so this is where we have to fight. Also, trivially - if they were useless, the pro-trans side wouldn't be using them so much, even as they knew they can't be backed by evidence.
Why? This is business as usual, we get between parents and doctors all the time, sometimes about the very same drugs (and arguably about the very same condition) that we're discussing right now, and no one bats an eye. Is it somehow worse because it's the legislature doing it, instead of the medical licensing board?
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