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Is there a doctor in the house? How about a structural engineer? Someone who hasn't slept through their statics class like I did?
Like I said I'm doing a deep dive into puberty blockers, since no one recommended anything better, I've stuck to that Science-Based Medicine article. I've been fixating on a single paragraph that I've been picking up, dropping, and picking up again:
The link leads to a paper titled "Development of Hip Bone Geometry During Gender‐Affirming Hormone Therapy in Transgender Adolescents Resembles That of the Experienced Gender When Pubertal Suspension Is Started in Early Puberty" (peer reviews available here). It's a retrospective study going through the data of the Amsterdam Cohort of Gender Dysphoria to find out if puberty blockers have an impact on the bone geometry (specifically on subperiosteal width, and endocortical diameter). It's a handy dataset, since, like the UK, until recently the Netherlands had only a single gender dysphoria clinic for the entire country, so anyone who wanted to transition had to go through them, so you don't have to worry about weird selection effects too much, and they tended run a bunch of tests on their patients, including dual‐energy X‐ray absorptiometry (DXA) scans, so the data is right there waiting to be analyzed.
When it comes to the results and the conclusion, I'm left squinting at what am I supposed to even be seeing here. The authors say they are looking at changes in bone geometry rather than the absolute levels, and a lot of the times the differences in changes between cis-men and cis-women aren't even noticable, so you can fit the trans population into either curve, or the changes for the trans population are so whack, that you can't fit them into either. The total amount of participants is pretty big, but by the time you split them into age/gender groups it ends up pretty small for each, and the values for the reference cis groups have a pretty big variance (and come from Sweden rather than the Netherlands, but I'll allow it), so I wonder if the whole exercise isn't a bit futile.
On the other hand an effect that seems to be staring me in the face is the effect on height. For both trans men and trans women, the earlier puberty blocking started, the taller the group seems to be. I always assumed blockers will make you shorter, since even gender clinics nowadays admit an impact on growth spurts. I expected it would follow the simple logic of: growth spurts happen during puberty -> but puberty is blocked -> therefore you'll end up shorter than otherwise. It turns out we have something called growth plates which close at the end of puberty and lock in our bone size. Puberty blockers prevent that process, which gives the bones some extra time to grow. It may well be that blockers still have a negative impact on growth spurts, but it's compensated by the delay in closing the growth plates.
On the gripping hand, I'm not sure about the conclusion. Eyeballing the average heights, the patients seem somewhat shorter than the average Dutch I remember seeing on the streets of Amsterdam, and there are also studies saying blockers have no, or a slightly negative effect on growth, so maybe we haven't completely escaped weird selection effects. There are also anecdotes, and statements from other gender clinics, so I'm getting the impression that we don't know either way.
Anyway, this is where statics come in. If it is true that blockers make you taller, my long experience in bending and breaking sticks tells me that other things being equal, a bone of a taller person will be easier to break. The paper concedes that blockers lower bone density, so it would seem it negatively impacts 2 factors responsible for bone health. Does that make sense to anyone else?
The annoying thing is that they used software for bone analysis that does a lot more than measure subperiosteal width and endocortical diameter. One of the papers they cited used the software to predict (with not horrible accuracy) the force a bone could withstand, and I have no idea why they didn't publish every parameter it could spit out. Their reason seems to be that they didn't have reference values to compare it to, but... so what? Just compare the values between different age groups. And while you're at it also add participants who never used blockers, and who never moved on to hormones which you specifically excluded.
That's it for now. No conclusion yet, just wanted a sanity check.
Castrati were famously very tall back in the day, for a comparable group of individuals
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