If informed consent is one of the pillars of clinical bioethics, puberty blockers fail the test, according to a leading psychiatrist and constitutional lawyer writing in the magazine Commentary . Paul McHugh, an emeritus professor of psychiatry at Johns Hopkins, and Gerard V. Bradley, a law professor at Notre Dame, argue that neither young people nor their parents can possibly understand what they are missing by delaying puberty, one of the most mysterious aspects of human physiology.
Their immediate purpose is to support a recently passed law in Arkansas which bans "gender transition services" for people under 18 because they are too young to give their informed consent. Seventeen other states wrote in support of the law claiming that legislation is needed because "the medical establishment has abandoned the field to the political zeitgeist".
However, a federal appeals court has temporarily blocked the law. U.S. District Judge James Moody found that children who had already embarked upon a course of puberty blockers would suffer "irreparable harm". Despite the legalese, he summarises the medical case for puberty blockers quite well:
Plaintiffs who have begun puberty blocking hormones will be forced to stop the treatments which will cause them to undergo endogenous puberty.
Plaintiffs who will soon enter puberty will lose access to puberty blockers. In each case, Patient Plaintiffs will have to live with physical characteristics that do not conform to their gender identity, putting them at high risk of gender dysphoria and lifelong physical and emotional pain.
Parent Plaintiffs face the irreparable harm of having to watch their children experience physical and emotional pain or of uprooting their families to move to another state where their children can receive medically necessary treatment.
Physician Plaintiffs face the irreparable harm of choosing between breaking the law and providing appropriate guidance and interventions for their transgender patients.
But do puberty blockers really heal the dysphoria and can they really be taken without harm? McHugh and Bradley argue that the medical evidence is slim. "These pharmaceutical interventions have grave, life-altering consequences, the benefits of which many dispute," they say.
The article in Commentary covers too much ground to summarise adequately, but McHugh and Bradley target two failings involved in transgender medicine for children and teenagers.
The first is "recklessness". Contrary to what most people think, puberty, is mysterious and little understood. A feature in the 125th anniversary issue of Science magazine, one of the world's leading journals, listed puberty as one of the 125 most compelling issues in science. Tinkering with a young person's physiology could be dangerous.
In other animals, all that they shall be is in place at puberty. For us, puberty amounts to a kind of second birth; it is the start of our becoming contributing members to our times. To block puberty and then artificially redirect its course is to tamper with a vital human developmental matter with no reason for confidence in what will emerge beyond a lifetime preoccupied with medico-surgical interventions to maintain the illusion that one's sex has changed.
The hormones involved in sexual differentiation also have organisational effects upon the brain. They are involved in shaping a young person's attitude to the outer world. "Altering the natural hormonal constitution in adolescence by providing hormonal synthetics opposite to one's genetic constitution cannot fail to disrupt these 'organizational' matters - again, with unknowable long-term effects."
Not much on this has surfaced in the media. But Australian paediatrician John Whitehall has pointed out that Scottish scientists found that sheep who had been given puberty blockers became cognitively and emotionally impaired.
The second is "thoughtlessness". Consent must be informed; people must understand the consequences of their actions. But a prepubescent person can hardly grasp what sterility, childlessness and life-long medication involves.
They predict that a single successful case against transgender treatment - like the UK's Bell v. Tavistock -will cause the experiment with transgender medicine to crumble.
With the appearance in the United States of even one well-publicized case such as Kelsey's, with its obvious potential for a major lawsuit, the transgender misadventure will come to a close. A public outcry will start, insurance companies will cease malpractice support as lawsuits emerge, and reputations of doctors and health systems will sink.
The damage to the victims will nonetheless be irreparable and (as Abigail Shrier's 2020 book on this subject has it) irreversible. Their sense of betrayal will be matched by the shame of everyone capable of feeling it.
McHugh and Bradley believe that most children with gender dysphoria do best is they are not treated. They eventually grow out of the sensation that they are living in the "wrong body" and come to terms with the male or female body with which they were born.
They conclude by saying: "we join with the people of Arkansas and say, 'Leave the kids alone.'" This is a terrific summary of the case against puberty blockers and well worth reading carefully.