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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.
The ultimate pro-puberty-blocker argument is that if treatment is not provided children will commit suicide. Last time I looked at this (mid-pandemic), there were no randomly controlled trials on suicide rates in trans children under different treatment regimens. If you looked at the effect sizes of the few existing small Scandinavian studies about the effectiveness of different transitioning methods on suicide rates, it looked like social transition had about the same effect size as medical transition.
I'm generally in favor of doing more RCTs on children whose parents consent (and on pregnant women). There are so many medical questions that we don't have answers to because medical ethics has raised the standards for informed consent higher than is reasonable.
This response to the Cass review was particularly hilarious: a paper written by two lawyers attempting to dispute the "evidentiary standards" of the Cass review, which manages to misinterpret the Cass review as well as misquote two of the scientific meta-analyses used by the Cass review. If that's the highest quality of argument they can put forward (in NEJM of all places!), then I'm going to guess that the actual "evidentiary standards" in support of their position are quite weak.
(And indeed, the Cass review is up front about there being no RCTs available for use.)
Your Jesse Singal link seems to be broken.
Thank you. Should be fixed, but might be paywalled. The title of the article is "If The New England Journal Of Medicine Doesn’t Correct This Error, You Cannot Trust Anything It Publishes", written on Mar 11, 2025.
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