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One of the responses I sometimes get when I talk about blockers and the concerns around using them for gender dysphoric children is along the lines of “but we’ve used them in precocious puberty for years, it’s basically the same”.
Holding off on a natural process for those who are experiencing a physical issue &holding off on it in order to substitute that natural process with an entirely different one are not the same. Still, I wanted to learn more about how we are treating precocious puberty.
Especially given papers I’ve read about girls with precocious puberty who seem to have had their perception of time altered by blockers or their IQ affected. These are the sort of risks one might take on to fix a physical problem. To do it so people can pass as an adult though?
As a quick segue the most recent study I read about the effect of blockers on the brain focused on children with dysphoria&mentioned a 9 point drop in operational memory&the arresting of natural white matter…
Back to the issue at hand: I found out that there are two types of precocious puberty, and only one (the most common) Central Precocious Puberty responds to blockers, because the other kind doesn’t involve the same mechanism.
Central precocious puberty is more common in girls than boys, occurring at a rate of about 1 in 5000-10000. It can cause physical problems such as short stature as an adult. Even so, not all children with central precocious puberty are medicated.
Many clinicians are thoughtful about the process of prescribing hormone blockers to this patient group. They run several different kinds of test&they evaluate each individual case for how quickly the puberty is advancing, which is apparently crucial in determining a next step.
I read one clinician talking about how his standard response would be to wait 6 months from the time of diagnosis to evaluate how fast things were moving before he considered prescribing. Another said that age was a huge factor in whether it was the right thing to do to prescribe
I.e a 7 and a half year old would be much less likely to get treatment than a child of 5. So it’s clear that they don’t hand these drugs out thoughtlessly, like they are peardrops, to these children.
There’s also a difference in race that came up while I was looking into this. Black girls start puberty earlier than white girls.This raises more horror for me: it means if you are a black dysphoric girl,you’re likely to be put on blockers at a younger age than your white peers
Where, in the treatment of precocious puberty, they would realise that as they start puberty earlier, it’s even less reason to put a black girl on blockers at say 7, with a gender dysphoria diagnosis they’re just going to take note of her reaching tanner stage 2 more quickly.
To show you this difference,in real terms, in a 1997 Pediatrics study of 17,077 girls,more than a 1/4 of black girls,27%, & 7% of white girls had reached at least Tanner stage 2,by the age of 7. By 8,nearly half of black girls,48%,&15% of white girls had reached at least stage2
(Black boys also start puberty earlier than white boys, so the same concerns would apply to them, though boys start later than girls.)
More generally, in 2006, stage 2 development in all girls was observed to be occurring an average of ten months earlier than it was in 1991. A less dramatic, but still observable trend of puberty starting earlier was seen in boys, too
The classic ages of starting used to be boys at 9, girls at 8. Many doctors looking at how things are changing would now note, though this is still controversial, that it might be more accurate to consider it normal for boys to start at 8, white girls at 7 & black girls at 6
When we look at the medication of dysphoric children, then, and the way it is being done, we might expect to see the starting age to be decreasing overtime and to be extending already to a far younger group. I think this raises even more ethical questions around consent.
There really is no seeming comparison between the patient groups, when it comes to dysphoric children and those with central precocious puberty. Either in diagnosis, in the care being offered or in the seriousness with which doctors are treating the prescription of blockers.
So, If someone tells you that we’ve been using them for one group so it’s hunky dory to be using them for the other, despite the differences in what is happening to the children involved, they simply have no idea, at all, about the reality of what is going on with each condition.
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