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New analysis shows massive increase in transgender children receiving puberty blockers

As locker rooms and pronoun usage give way to a deeper debate on puberty blockers and hormone therapy, recent data from Reuters shows that the number of transgender children who received puberty blockers more than doubled in the last few years.

Reuters, a news agency, teamed up with Komodo Health Inc., a health technology company, to analyze data related to transgender minors. They drew the data from both private and public health insurance claims in the United States.

The analysis found that in 2017, physicians initiated puberty blockers on about 600 American children ages 6 to 17 who were diagnosed with gender dysphoria. Gender dysphoria is the distress caused by the discrepancy between a person’s gender identity and biological sex. That number rose to nearly 1,400 by 2021.

In sync with growing research that questions the evidence in support of puberty blockers, these numbers also follow a rise in children diagnosed with gender dysphoria.

Between 2017 and 2021, the number of American children ages 6 to 17 diagnosed with gender dysphoria nearly tripled, going from 15,000 to 42,000.

According to the Mayo Clinic, children diagnosed with gender dysphoria are often prescribed GnRH analogues, like Lupron, that suppress the advancement of puberty. This is more commonly done around age 10 or 11 when puberty commences, though the drugs can be administered to younger children.

These drugs are not FDA-approved for the treatment of gender dysphoria, though they are licensed for and used to treat prostate cancer and precocious puberty.

The World Professional Association for Transgender Health says that after the suppression of puberty, adolescents may undergo cross-sex hormone therapy in which male-to-female transitioners receive estrogen and female-to-male transitioners receive testosterone. In changing the physical appearance of the patient’s body to match the desired gender, the patient’s gender dysphoria is expected to improve.

The analysis shows hormone therapy more than doubled among minors between 2017 and 2021 from 1,900 to 4,200.

Though surgeries are less frequent in minors, the Reuters data shows that between 2019 and 2021, at least 776 mastectomies were performed in the United States on patients ages 13 to 17. In the same period, among the same age group, 56 patients received genital surgeries. These numbers do not include procedures paid out of pocket.

All these treatments fall under the umbrella of gender-affirming care: social, psychological and medical interventions that affirm an individual’s gender identity.

Prior to 2010, medical treatment for gender dysphoric minors was rare. A decade-long study led Dutch clinicians to publish an intervention known as the Dutch protocol in 2006 which recommended puberty blockers and cross-sex hormones as treatments for certain transgender children. The practice soon achieved widespread acceptance in most western countries.

In 2007, Boston Children’s Hospital opened the first dedicated clinic for transgender children in the United States, basing its practices on the Dutch protocol.

Though gender-affirming care is now the standard endorsed by the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, concerns have increased over the last few years about the risks and effectiveness of these medical interventions in alleviating gender dysphoria and mental health issues like suicidality.

The U.S. Department of Health and Human Services lists puberty blockers as reversible. However, a recent research article by Oxford Professor of Sociology Michael Biggs says their effect on brain development remains uncertain. The article also says they can diminish bone density, fertility and sexual desire.

Biggs also scrutinized the original Dutch study and concluded it was poorly conducted. Among the problems he described was the lack of a randomized control trial, a poorly sized and carefully selected sample, and an inadequate scale for measuring gender dysphoria.

Similar problems have been pointed out in 16 studies published in the last decade that support the usage of puberty blockers and cross-sex hormones.

Last year, the UK’s National Health Service commissioned a review of the evidence from various affirmative studies. The assessment, conducted by the National Institute of Health and Care Excellence, found the evidence to be of very low quality. The review cited issues such as small samples and no control groups which subject the studies to bias.

Legislation was introduced in 22 states this year that would have curtailed minors’ access to gender-affirming medical interventions. Almost all failed to pass into law. A bill that passed in the Idaho House of Representatives in March would have criminalized providing gender-affirming medical treatments, including puberty blockers, to children. It also would have made it a felony for a parent or guardian to take their child to another state to access these treatments. The bill died in the Senate.

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