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I got into an argument on JK Rowling recently. That was mildly annoying, but then it shifted to transgender stuff in general, and the puberty blocker discussion in particular was very vexing to me. I just genuinely don't know how anyone can be okay with the idea, especially now that we know way more about it than we did 10 years ago. The dismissal of the Cass Review on the part of the pro-trans side has increasingly looked like the stereotypical right winger doing mental somersaults to any science they dislike. But I have some questions on it, there were some things I didn't have great answers to.
What are the actual requirements for getting prescribed puberty blockers? The pro-trans tribe insists that it is a very rigorous process involving thorough checking of gender dysphoria, and it's not commonly done, despite being a readily available tool in the toolbox of clinical practice. I do not believe this after examples I have seen, but I have nothing to cite.
Is there any actual scientific evidence in favor of social contagion playing any part in transgenderism? The pro-trans tribe claims that social contagion plays no role, and to me, it's trivially true that social contagion plays an astounding part, as well as fetishism and abuse, and autism. I have no idea how many kids genuinely become gender dysphoric due to genetics, if there are any at all. And if there are any, I certainly don't think that it's a given that they need puberty blockers. How the hell did that become the default? But anyway, has The Science turned up anything on social contagion?
Are there any actually valid critiques of the Cass Review? Pro-trans tribe will cite the Yale Law retort, then when I point out the responses to it, either holes are poked in them or they just go back to their priors that the Cass Review was methodologically bad, done by a transphobe, misinterpreted studies, and went against the scientific consensus and ruined its own credibility. Actually, they say the same about the recent HHS Report. Please show me if there are any published valid critiques of the Cass Review besides the Yale thing.
What are the probabilities of serious consequences from puberty blockers? I brought up infertility, and the pro-trans tribe claimed that it's actually a very low chance and that it's not anyone's business anyway because not everyone wants to have kids. The latter half of that is completely inane when we're talking about life changing decisions for a demographic that cannot consent, but the former, I don't know. Do puberty blockers cause the infertility, the loss of ability to orgasm, and the complete lack of penis tissue with which to create a neovagina, or is it the ensuing hormones that do this?
Sadly, none of this will do anything to convince anyone on either side anyway. There's really no way out of this hole that has been created. Sometimes, I kind of hate this world. I really thought "don't give minors seriously debilitating life changing pills to solve a solely mental disorder" was an easy hill to stand on, but the fighting was just as vicious as anything else with the gender issue.
Edited to be slightly less angry.
Under US federal law, you can get prescribed something off-label just because your doctor thought it sounded good, so long as the drug was approved (and doesn't fall under DEA et all). I have a breakdown of WPATH's conventions over time here, but there's no requirement that a doctor doing trans-related care even be aware of WPATH, nevermind commit to it, and even those that run with WPATH tend to pick-and-choose from v7 and v8 if they aren't from one of the big gender clinics.
Most actual enforcement is predicted to fall under what insurance companies are willing to cover (except the ACA requires all covered plans include gender care) or what doctors expect to fear from civil lawsuits (except these are an absolute mess and no one has a good idea what the actual fallout will be under law today, and the interstate nature of how those lawsuits will shake out is going to make things even messier).
Physical consequences seems to depend very heavily on both when the drugs are first provided, and how long they're used. The 'precocious puberty' problem that a lot of the scientific data is based around relatively short-duration (1-2 years) use, where you maybe see a little bit of difference in bone health or adult height at the margins. What data we have from non-gender non-pre-normal-puberty use shows controllable bone health issues, but that control is dependent on use of estradiol or estrogen (in women), which is unlikely to be used for gender therapy in transmen.
Mental, people on puberty blockers are a lot more likely to (continue to) transition.
Both puberty blockers and hormone therapy are linked to certain types of cancers, to such a point where transmen not intended to have (biological) children are were once encouraged to have a hysterectomy by their late thirties (WPATH v8 limits this to cases with a family history or other risk factors). The actual incidence and impact is pretty low, though, and it's migrated through so many intermediates (therapy links to PCOS which links to endo cancer which links yada yada).
But the big question is the uncomfortable one of whether puberty blockers cause long-term sexual nonfunction, the infamous "never have an orgasm". Studies on this matter give more uncertainty, and Bowers' model seems... confused or at least simplified-for-normies (do you want to go on national television and have a conversation about childhood sexuality? Because I don't want to even think about it too hard), but the contours of those studies leave cause to be more cautious rather than less.
My gutcheck is that these issues will exist for those who undergo puberty blockers very early, for a long period, and then don't transition have at least reduced sexual drive; I don't think Bowers claim should be taken literally, but I do think there's a lot to be cautious about Tanner 2 or even early Tanner 3 start dates.
If we had a drug that perfectly cured severe schizophrenia, for example, with the side effect of reduced sexual functioning, would you consider it impermissible to provide to those who wanted it? Or is the objection about what the mental disorder is, first? And, from the other direction, early social gender transition has shown a pretty strong link to later transition (and I'm willing to bet not solely correlative). Would social transition be acceptable if the people in question waited until they were 20 to undergo chemical or surgical intervention?
I'm not going to claim that the answers should be clear, but I'm generally very skeptical of advocacy that doesn't leave space for anyone on the opposing side to be merely wrong or merely have different values.
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