Why puberty blockers is a bad idea


Puberty blockers are sometimes used to medically 'treat' precocious puberty in cis people, this is however very questionable.

It was only when puberty blockers started to be used to delay puberty in trans people (for no good reason) that they finally came under scrutiny and results are bad.

Gonadotropin releasing hormone agonists (GnRHas) have been found to impair memory in adults, so the study by Wojniusz et al. (2016) on the possible cognitive effects of these drugs on children treated for idiopathic central precocious puberty (CPP) represents an important contribution to research in this area. Recent findings that GnRHas increase depression symptoms (Macoveanu et al., 2016) and slow reaction time (Stenbæk et al., 2016) in healthy women, and reduce long-term spatial memory in sheep (Hough et al., 2017) underline the importance of the research that Wojniusz et al. (2016) have undertaken. However, their reassuring statement in the abstract that girls undergoing GnRHa treatment for CPP and controls “showed very similar scores with regard to cognitive performance” and their conclusion that “GnRHa treated girls do not differ in their cognitive functioning … from the same age peers” (Wojniusz et al., 2016) may be overly optimistic. These statements minimize the fairly substantial difference found in IQ scores and may also overemphasize its lack of statistical significance, as given the small number of participants in the study statistical significance has a high threshold. The statements should be qualified to indicate that the research has, in fact, reinforced concerns over the impact of GnRHas on cognitive performance in children.

Girls treated for CPP with triptorelin acetate were tested with the short form Wechsler Intelligence Scale for Children III. It was found that the girls had a mean IQ of 94, as against a mean IQ of 102 for the matched control group (Wojniusz et al., 2016). These IQ estimations are presented as standardized IQ scores, which places a girl scoring 102 at the 55th percentile, and a girl scoring of 94 at the 34th percentile. It is questionable whether scores that indicate a percentile gap of this size can be described as “very similar.” The 8 point gap is not statistically significant (p = 0.09) but, as the authors point out, this may be a function of the small number of participants (15 treated girls, 15 controls).

The authors contend that despite the small number of participants the results can—probably—be relied on to indicate that if GnRHas do cause a decline in IQ, this decline will be under 1 standard deviation (SD), which “represents a boundary of what is a clinically interesting difference” (Wojniusz et al., 2016). The contention that a decline only becomes clinically interesting if it is of at least 1 standard deviation is unconvincing. Any findings which indicate that GnRHas cause a decline, even a modest decline, in IQ are likely to be of considerable interest to patients and their parents. It is a factor that they may well want to consider in deciding whether or not to take the drug. They may, for example, wish to consider the possible effect of GnRHas on a child's school and exam performance. In this respect it can be noted that 2 of the treated girls had been held back a year at school. Given their advanced physical maturity, children with precocious puberty may find it particularly uncomfortable to be put in a class where they are a year older than their class mates. If GnRHa treatment does cause a reduction in IQ, this may contribute to the decision to place a child in a lower age year group. Certainly, treatment that has a deleterious effect on IQ will do nothing to help children who are academically behind to catch up.

The question of whether a drop in IQ of around 8 points has clinical significance must also be considered in the context of the uncertain benefits of GnRHa treatment for CPP. The ability of GnRHas to increase final height has not been confirmed by randomized controlled trials (Bouvattier et al., 1999; Cassio et al., 1999). Where girls with CPP experience psychosocial difficulties, providing support rather than drugs may be the most appropriate response (Hayes, 2016).

The findings of Wojniusz et al. (2016) can be compared with those of a 2001 study in which 25 children treated for early puberty with triptorelin acetate were tested with the short form Wechsler Intelligence Scale for Children (Mul et al., 2001). In this longitudinal study, children took the IQ test before treatment and again after 2 years of treatment. It was found that their IQ dropped 7 points from 100 to 93. With 25 treated participants, this 7 point drop was significant (p = 0.002). In both studies the difference in the performance element of the test was greater than in the verbal element. The similarities between the findings of these two studies strengthens their reliability and increases the possibility that GnRHa treatment may have an adverse impact on cognitive functioning in children. This makes it yet more important for further research to be carried out into the effects GnRHas may have on cognitive performance in children.

Case study of global IQ drop: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694455/

If trans children could get on HRT earlier there wouldn't be any need to use puberty blockers at all. Instead we would have the following 3 option

A: start full HRT before puberty. This has the advantage of allowing the individual to pass better as a female but the price is very high, the child will become sterilized for life and SRS will be significantly more difficult since there isn't enough tissue to work with.

B: have the child undergo enough male puberty such that sperm can be banked, after that full HRT is quickly introduced.

C: have the child undergo puberty and delay HRT.

The following study does seem to show puberty blockers to be better than C but even then it can be strongly argued A or B would have been a far better option.

Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2–0.6).
That does not mean the 83.1% (the vast majority) who didn't want puberty blockers in the first place would have benefitted. The current dogma is to push puberty blockers on all early transitioners denying them access to full HRT (which is safer and more effective). The study also only looked at self-reported suicidal ideation which is not the only important factor to consider, there is also other issues with the study


It is worth noting that its very rare for children that started on puberty blockers to desist, almost without exception they will proceed with cross-sex hormones meaning they will be infertile for life unless some medical advancement is made allowing them to somehow have biological children.

Spack has, he says, put “about 200 children” on to hormone blockers at the onset of puberty. Of these, 100% have gone on to take cross-sex hormones.
No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.” These were out of 70 children put on hormone blockers.

What was the point in delaying puberty if they all ended up on cross-sex hormones anyway?

Puberty blockers does not even do much for the bones in terms of feminization, many people put on blockers still end up needing surgery

It is worth noting that often FFS doesn't even help much if anything since the issue is bonestructure which is difficult to adjust via surgery.


Responding to Sciencebasedmedicine
They did an article trying to defend puberty blockers but their arguments of course does not hold up.

The authors of this study observed no significant effect of GnRHa treatment on ToL reaction times and accuracy performance scores compared to untreated trans youth with gender dysphoria.
While the study didn't find much difference in reaction times the study did find big difference in IQ and Accuracy which very much did not favor puberty blockers.


This is of course not the only study showing significant cognitive impairment from puberty blockers

Of note, the NICE Review omitted several studies examining the efficacy and safety of puberty blockers when utilized as part of gender-affirming treatment of transgender youths
This was probably done for good reasons, let's look at the first omitted study



We only see 2 factors controlled for here and the result was not even close to statistically significant in terms of short-term quality of life. The study did not even attempt to control for confounding factors such as parental support. The study also didn't look at the negative long-term implications of not recieving full HRT.

Here is an example of comparing puberty blockers to no treatment at all as if that is the only other alternative:

Van der Miesen et al. 2020 (published April 6, 2020) conducted a cross-sectional study of 272 adolescents not yet receiving care, comparing them to 178 trans youths receiving affirmative care and 651 cisgender youths. Subjects on blockers were found to have fewer emotional and behavioral problems compared to those trans subjects not receiving medical care. In affirmed subjects, mental health problems and self-harm/suicidality were endorsed at similar rates as for their cisgender peers, a striking result considering that trans youths suffer from a well-documented increased risk of self-harm, suicidality, emotional and behavioral problems, and poorer peer relations as compared to cis youths.

The study is hidden behind a paywall which itself is a red flag. it did not attempt to control for confounding factors such as parental support.



The controls were significantly older than the ones being treated


The biggest issue of course was that they did not have a group where the individuals recieved full HRT instead of puberty suppression, thus even if the study didn't have other flaws it would still not actually show puberty blockers to be the best treatment (it obviously isn't).
In addition, The Trans Youth Care Study, a longitudinal observational project, has been examining existing medical protocols for trans youths since September 2018, with 90 participants enrolled in the blocker cohort and 301 in the gender-affirming hormone cohort. Preliminary findings have noted better psychosocial functioning in subjects on GnRHa treatment compared to those on gender-affirming hormones, indicating that there could be possible benefits in trans youths accessing gender-affirming treatment earlier in life.
These groups were very different from each other, the cross-sex hormones studies consisted of 2/3 FtM while FtM individuals only made up 1/2 of the blocker group, there were of course also other differences between the groups and no multivariate regression was done.

It might be worth noting that the author is working in transgender healthcare and has thus a very significant conflict of interest, in this case the study author decided to deny science in favor of politics or his/her career. The ones being hurt by this are not only trans people but also cis people put on puberty blockers that do far more harm than good, he/she is a disgrace to trans people and should be condemned.


Why are blockers being given to cis children?
There is no good medical reason for delaying puberty (cis or trans), its done for social reasons. It's against christian moral dogma for young teens to be sexually active and people having early puberty may also be teased by peers.
We found no evidence from controlled experimental and observational studies that compared with no treatment, the use of GnRH analogs improved AH in girls with EP

One common justification for blocking early puberty is to stop early menstruation but that alone obviously cannot justify an experimental medical treatment.

Currently early sex/pregnancy is viewed as very bad which is likely a strong driving force for this child-abuse. In reality however early sex does not have to be a bad thing, it can be fun. The main difficulty with children having sex early is that the younger she is the less likely she will be to properly judge who is a suitable partner for her (if she is younger than 13) which does create some issues, without reliable parents or a reliable legal system the only thing remaining is having to rely on the female herself making decisions which isn't really viable if she is very young.

So until we have a reliable system for approving child marriages/relationships very early puberty might not actually provide a practical advantage in terms of allowing early sex/pregnancy. Pregnancy also has to be safe enough for the child which might not be the case if it's very early (such as at 8).


We shouldn't give medical treatments the benefit of the doubt
Uncertainty should not be used to justify a medical intervention "we do not yet know it's bad so let's keep doing it". There is an infinite amount of potential treatments you can do in various circumstances and unless you critically examine the evidence in each case you will end up doing harmful treatments.

When there is uncertainty you should assume it's not to the benefit of the treatment until you have data showing otherwise.

The uncertainty goes in both direction, a study indicating harm that isn't statistically significant could theoretically just be a fluke but it's just as likely that the harmful effect is even worse.

If you do medical treatments based on weak evidence then you will inevitably end up doing many harmful treatments since there will always be bad studies and propaganda used to push for treatments that isn't actually beneficial. A pharmaceutical company could theoretically just try random chemicals on humans and then eventually at some point they will get a p<0.05 result even though the treatment isn't actually beneficial in any way.


Study: IQ dropped by 7.1 points on average (p = 0.002) after 3 year usage of puberty blockers
The study author does try to twist these results into not being disastrous even though they clearly are.
The IQ levels for the whole group decreased signicantly, from 100.2 (12.7) at T1 to 93.1 (10.5) at T2 (p = 0.002) but this was not clinically relevant. A comparable signi cant decrease was present in both groups. There were no signi cant differences between groups A and B at T1 or T

The study authors tried to claim "puberty blockers might not be to blame for this" but there is no credible alternative. What else would cause a 7.1 drop in IQ ?
One hypothesis for the decrease in verbal IQ scores is that withdrawal of exposure of the brain to sex steroids brings the child
back into a more age-appropriate IQ range
As if having lower IQ would be a benefit. The study authors does seem to think that an IQ of 93.1 on average is appropriate since they are adopted (inferior genes of what?).


Swedish 'documentary' about puberty blockers
As usual the quality of the content from a scientific standpoint was pretty bad, it was mostly just interviewing some expert with no direct look at the scientific evidence. Instead it focused on a single anecdote about an FtM child who developed skeletal fractures from puberty blockers, he/she had been put on them for 5 years which is consider a lot longer than what's currently view as defensible (2 years or less).

They stated that there were 12 cases of side effects or regrets but didn't tell how many people who got treated.


They did tell in the documentary that puberty blockers were used because young people were viewed as being unable to consent to full HRT even though puberty blockers have more potential harm.


TheSerpent222 said:
I gotta say, whilst some of that is partially true, and that puberty blockers(aka lupron) has some whacky effects, none of that matters and has no real effect if those kids are also given hrt during puberty, which is what terfs always neglect to say. And yes I am 100% pro giving trans minors of pubertal age hrt, no matter their age as long as they're of pubertal age.

Because who knew, the negative effects of luprons terfs like to flaunt around get cancelled out if the patient also gets testosterone or estrogen on time, which they totally should.
No the current norm is to only give puberty blockers and delay cross-sex hormones for years.

Estradiol alone in sufficiently high doses will suporess testosterone eliminating the need to use additional anti-androgens, thus we do not actually have to use puberty blockers or anti-androgens at all in the case of people born male.

Lübbert et al. (1992) found ethynylestradiol only to be effective in reducing gonadotropins and testosterone to below-castrate levels in an experiment done in a single healthy male. This suggests that when an high-enough dose is used for MTF HRT no additional anti-androgen is needed. Shearer (1973) found that 100 mg/d of ethynylestradiol only, split in 2 doses per day lowered total testosterone to around 2.6 nmol/l in prostate cancer patients; no number is given, this is an estimate of the mean of the data in the graph.

Even if you start on a low effective dosage (not enough for T supression) the added masculinization from not supressing T will be rather limited and most will turn out just fine if they dose is raised over time until T is properly supressed.

It's also very likely that anti-androgens like bicalutamide and cyproterone acatate (12.5 mg/day or less) are safer than lupron, at least they are a lot more well-tested as transgender medicine.


The Jazz Jennings travesty
Jazz Jennings is a prominent trans individual who has received a lot of media attention. Because she got puberty blockers at 12 her penis never developed which made it even harder to create a neovagina, she also became permanently infertile since no sperm was banked (even though that would have only required partial male puberty).

Unsurprisingly the genital surgery she had didn't work out too well for her, she ended up having 2 additional surgeries in an attempt fo fix the problems that emerged after the first surgery. It's likely that she will never have anothing close to a cis female vagina even in terms of aesthetics. Alarmingly the doctors argued mid-surgery about whether or not to do a cut somewhere.

A cis hon capitalized on this to push her anti-trans (TERF) agenda:


She did later get banned from youtube but this guy wasn't:

btw: the drop in libido from full HRT is only temporary


Marci bowers which was one of her surgeons is now also critical of puberty blockers, this might be a case of her trying to deflect blame due to screwing up the surgery "the issue was the puberty blockers, i didn't do anything wrong".


After the surgery Jazz Jennings started collapsing mentally and also started gaining a lot of weight becoming morbidly obese, while the SRS might be what caused this other potential explanations are that it's due to the psychiatric drugs she has been prescribed or that they are not giving her a high enough dosage of estrogen.

Her mental health issues started at 12 which is the same age that she started her puberty blockers, a natural conclusion is that she got these issues from the puberty blockers she was prescribed (in addition to eventually becoming permanently infertile and not getting proper genital development).


It also seems like his family is trying to prevent her from starting on harward, Jazz Jennings seem very interested in started while her family seem to prefer that she delay that. Could it be the case that they do not want to lose control over her? something isn't right here.


Lupron horror stories
There is no shortage of horror stories, often severe effects persits years after the treatment was stopped.

The FDA currently has over 25,000 adverse event reports for Lupron products including more than 1500 deaths. Reactions include suicidal thoughts, stroke, muscle atrophy and debilitating bone and joint pain.

For years, Sharissa Derricott, 30, had no idea why her body seemed to be failing. At 21, a surgeon replaced her deteriorated jaw joint. She’s been diagnosed with degenerative disc disease and fibromyalgia, a chronic pain condition. Her teeth are shedding enamel and cracking.

None of it made sense to her until she discovered a community of women online who describe similar symptoms and have one thing in common: All had taken a drug called Lupron.


FDA report: puberty blockers may cause brain swelling and vision loss
Six cases were identified that supported a plausible association between GnRH agonist use and pseudotumor cerebri. All six cases were reported in birth-assigned females ages 5 to 12 years. Five were undergoing treatment for central precocious puberty and one for transgender care. The onset of pseudotumor cerebri symptoms ranged from three to 240 days after GnRH agonist initiation.

The new warning includes recommendations to monitor patients taking GnRH agonists for signs and symptoms of pseudotumor cerebri, including headache, papilledema, blurred or loss of vision, diplopia, pain behind the eye or pain with eye movement, tinnitus, dizziness and nausea.

These products include Lupron Depot-Ped (leuprolide acetate), Fensolvi (leuprolide acetate), Synarel (nafarelin), Supprelin LA (histrelin) and Triptodur (triptorelin).


Symptoms included visual disturbances (n=5), headache or vomiting (n=5), papilledema (n=3), blood pressure increase (n=1) and abducens neuropathy (n=1). Treatments included lumbar puncture (n=3), acetazolamide therapy (n=5) and ventricular peritoneal shunting (n=1).

At the time of the FDA’s review, symptoms had resolved in three patients, were resolving in one patient, had not resolved in one patient, and one patient’s status was unknown. GnRH agonist therapy was discontinued in three patients; the status of continued therapy was unknown for the remaining three patients.

The incidence rate of pseudotumor cerebri associated with GnRH agonist use in pediatric patients could not be reliably established due to the small number of cases and data limitations.