I was reminded yesterday that very intelligent people can come to believe that there are such things. I’m not nearly as bright as the person who reminded me of this, but I know a magic potion when I see one. I’m talking about puberty blockers, of course. The way a lot of people talk about them sounds like they are almost the opposite of the aging potion from Harry Potter and the Goblet of Fire. In case any readers don’t already know, I one of those gender-critical barbarians who believes a bunch those TERF-y heresies. I will not be discussing the ethics of transitioning children. This is just a short little post about the endocrine system.
The term “puberty blockers” refers to a class of drugs more properly called gonadotropin-releasing hormone agonists, abbreviated GnRH agonists in the medical literature. You may have learned as I did that that pituitary gland is the “master gland” of the endocrine system. This is a useful oversimplification for understanding the how the body works, but it’s missing a few pieces. For instance, how does the pituitary “know” when to release the right hormones and in what amounts? The answer is that it is connected to signaling systems in multiple parts of the body, including other parts of the brain.
Gonadotropin-releasing hormone (GnRH) comes from the hypothalamus and triggers the release of a class of hormones called gonadotropins from the pituitary gland. The two best understood and longest known gonadotropins are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones were named for their role in female reproduction because the clearer distinctions in stages of the menstrual cycle made them easier to detect, measure, and connect to physical events in the body. Even so, these same hormones also regulate processes in the male body, such as sperm production and prostate function.
The onset and regulation of puberty is controlled by interactions between the hypothalamus and pituitary gland. GnRH signaling reaches it peak in early puberty, triggering large releases estrogen and testosterone from the ovaries and testes respectively leading to development of secondary sex characteristics, and eventually to a mature reproductive system. But it’s not quite as simple as GnRH -> gonadotropins from the pituitary -> hormones from the gonads -> PUBERTY! If it really were so simple, then GnRH agonists might really be the simple and effective puberty blockers they are claimed to be. Puberty is not that simple. In place of those straight arrows we should think of a complex web connected to multiple systems all over the body.
To understand that web we need to look a little bit into the history of why doctors first wanted to meddle with it. The GnRH system was discovered long after most of the rest of the endocrine system was well understood. Doctors immediately wanted to interfere with this signaling system once it was discovered. Why? Cancer. It had long been known that the growth of some cancers of the prostate and uterus was stimulated by testosterone and estrogen respectively. Some cancers even have their own gonadotropin receptors and respond directly to FSH. Doctors had only the crudest methods to influence sex-hormone levels and only indirect ways to influence FSH. There were few options other than the most invasive surgeries with the most adverse effects.
When the first GnRH agonists came along, Lupron was the one of the first and most effective, they were heralded as miracle drugs. As always, claims of miracle drugs are never really true, but Lupron has saved lives and given many cancer patients a more satisfactory range of treatment options. It’s been most effective in the treatment of prostate cancer, especially the most aggressive cancers found in younger men. Lupron quickly shrinks the tumors and allows for partial removal of the prostate with no subsequent chemotherapy. Results in the cases of some types of uterine and ovarian cancers has been less dramatic, but many thousands of women have had very good results and many more women have been given precious time to explore options for treating their conditions.
Lupron and other GnRH agonists do have their critics, and rightly so. Most of these critics are women who have used low doses of Lupron to manage uterine fibroids or endometriosis for long periods of time. Interfering with the GnRH-pituitary connection over the long term disturbs a complex web of hormonal interactions. Do a search if you want to read about these side effects, but what I found were consistent reports of joint pain and joint degradation. These effects are different from what would be expected just from mild osteoporosis from lowered estrogen. It seems that the long defunct growth plates near the ends of their bones are becoming protein-rich and flexible, like the bones of young children. That’s fine for children, but it’s arthritis in adults.
And this brings us back to the complex web of puberty. If long term GnRH agonist use in adults when hormone interactions are lower, growth is complete, and normal functions of the reproductive organs have been established can cause severe side effects, I would think that the long term effects would be even more serious in a child put on a GnRH blocker in the peak hormone activity ages between 9-15. The Gn-RH and pituitary system is connected to everything, even to little hormone-releasing cells that decide whether they are going to deposit calcium crystals or destroy calcium crystals in our bones. It’s all interconnected, even the skin and its vitamin-D and the pancreas and its insulin.
And there is simply no data on medically transitioned adolescents. They are not even guinea pigs, because you have good data and controls on guinea pigs. We simply do not have quality information on transitioning children. What we do know is that transitioning adolescents makes them shorter. That’s probably not an issue for the males, but the girls will become “men” much shorter that the women they might have been. There are also reports of uterine bleeding in girls on GnRH blockers, and testicular pain and urinary urge incontinence in boys. That doesn’t sound like a magic potion to me.
Puberty cannot be blocked. It can be interfered with with varying results. There are no reverse Goblet of Fire potions.
So what prompted all this? Yesterday someone with a blog I love and have long read, a compassionate cult survivor, best parenting blog ever, kind and intelligent, made a post critiquing an article comparing today’s “kinder and gentler” homophobia to the rabid 80’s and 90’s homophobia she grew up with. This post was almost her best. The sad thing thing is that she almost bought as much into genderism as the vile person she was arguing against, and the liberal I was earlier last year would have cheered her on. She chose to pick on one point of her opponent when he said a 9yo girl was being hormonally transitioned. “Oh noes, that’s incorrect, she’s just taking ‘puberty blockers’ at age nine. She’s not scheduled for testosterone until she’s 15,” she responded as I slightly paraphrase.
What? Do you believe in magic? Could there really be such a thing as an anti-aging potion which combined with testosterone at 15 really make her a man? Will a straight girl she might fall for really accept her as a man? Probably not. Will she really go through the learning stages of understanding her attractions and become the fairly well-adjusted lesbian she likely could be? Probably not. GnRH agonists totally kill sexual attraction. And what if she’s straight once this all settles out? Not the likeliest outcome, but it does happen, and good luck for her if she does.
I don’t want to link to the article here because her commenters are Eye of Sauron types. She is on Patheos and well-known in atheist circles. Some of y’all probably know who I am talking about.