Patients, and the parents of minor patients, deserve to have access to the full scope of what we know today about the risks associated with gender-transition treatments so that they can make fully informed decisions. Unfortunately, today, many discussions about medical gender-transition treatments minimize or even ignore the risks and physical costs, even those that are irreversible.
To learn more about gender-transition treatments, play this party game/icebreaker “Two Truths and a Lie.”
A. The number of young people who identify as transgender has increased in recent years.
B. Gender-transition treatments come with serious risks.
C. Use of puberty blockers for adolescents experiencing gender dysphoria is supported by long-term, longitudinal studies.
A. Truth. The number of young people who identify as transgender nearly doubled between 2017 and 2022. Today, about 5% of young people say they identify as transgender or non-binary, meaning they do not identify as male or female.
B. Truth. These risks include irreversible harm to sexual function, reproductive health, and general health. Gender-transition patients sometimes lose the ability to orgasm, experience sexual pleasure, reproduce, or breastfeed. They are also at higher risk of osteoporosis, seizures (in epileptic patients), cardiovascular problems, stroke, heart attack, and other health problems.
In addition to these physical risks, there is also the risk of regret; some gender-transitioning youth desist from treatment only to find that they have experienced stunted growth and/or other permanent changes to their voice and body that cannot be reversed.
C. Lie. No country has licensed puberty blockers as a treatment for gender dysphoria, likely because no long-term, longitudinal studies of puberty blockers for this new use exist. Puberty blockers were originally developed to treat precocious puberty (premature puberty development) and have not been approved by the FDA for delaying or stopping normal-stage puberty.
Though off-label use of a drug carries the risk of using medication for an unstudied purpose, the practice is affirmed by the FDA to be suitable under a physician’s discretion, and if no label-approved drug exists for the issue. While this position is a sweeping permission for physician discretion in general, using it to legitimize the use of puberty blockers to prevent normal puberty could be unwise because of how these drugs can affect aspects of essential physical development. In fact, in 2022, the FDA put a warning on puberty blockers because several minors on the drugs experienced tumor-like masses in the brain, including seeing bright lights that aren’t there, headache or vomiting, swelling of the optic nerve, increased blood pressure, and eye paralysis.
Bottom Line:
The lack of strong evidence for the benefit of gender-transition treatments—in light of the risks of these treatments—has caused some governments, including the UK, Finland, Sweden, and Norway to change their policies and limit youth access to these treatments.
In the United States, gender-transition patients should be informed of the risk-benefit analysis of puberty blockers, cross-sex hormones, and surgeries. To ignore or minimize the very serious risks associated with gender transitions is to fail to give patients the opportunity to provide informed consent, and this is particularly problematic for adolescents or minor patients. This area of medicine deserves greater study, scrutiny, oversight, and accountability.
If you want to learn more about gender-transition treatments, read our Policy Focus.