Prominent World Professional Association for Transgender Health (WPATH) physicians acknowledged that puberty blockers are more invasive than portrayed in the media and can have irreversible effects on minors such as infertility, bone loss and disruption of brain development, according to WPATH educational sessions obtained by the Daily Caller News Foundation.
WPATH is a transgender medical organization that has published influential clinical guidance for the sex reassignment industry, called Standards of Care, which recommend children receive puberty suppression, cross sex hormones and sex reassignment surgery. However, during educational sessions recorded in September 2022 that were part of a transgender medicalization certification program offered to WPATH licensed clinicians, WPATH doctors revealed that the consequences of puberty blockers for minors are often far more disruptive than portrayed in the media.
In an educational session titled “Foundations in Gender Affirming Hormone Therapy: Adults and Adolescents,” Dr. Daniel Metzger, a WPATH certified pediatric endocrinologist, explained how puberty blockers impede adolescents from developing the calcium stores needed to prevent osteoporosis later in life.
“Normally puberty is the time of putting the calcium into your piggy bank. This is how I explain it to families. You’ve got a piggy bank for your calcium and you better get it all in by 25 because at 25 you’re going to live off that piggy bank,” said Metzger.
“The puberty blockers slow that calcium accrual back into the bones quite a bit, back to the prepubertal level. We do know that even if you look at people now age 22, if you’ve done all of this and you’ve gone off and then you go back on the hormones’ that you want to have, you have not caught up by age 22. Which is about the time you need to fill up your piggy bank. This is a concern that not everybody is getting their piggy bank completely filled up with calcium.”
Metzger also discussed how the effect of puberty suppression on adolescents developing brains is not fully known.
“Obviously teenagers, their brains are changing. They’re unwiring, they’re rewiring. And if we’ve started one kid unwiring and half rewiring, and then we changed their puberty the other way and we’re unwiring, people have been trying to figure out what this does for kids’ brains,” said Metzger.
“They seem to do reasonably the same as their friends but we’re not looking at their IQ and their learning ability and lots of other things.”
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Metzger also warned that if puberty blockers are started too early, boys may not develop the genital tissue needed to create a surgical vagina later in life.
“When you think about vaginoplasty, the creation of a vagina in an assigned male, you need tissue, genital tissue, to create that vagina. And if we are taking an 11-year-old boy, who does not have a lot of genital tissue and blocking puberty right there, we’re preventing the growth of the vagina for down the road,” said Metzger.
During a question and answer segment, Metzger discussed the impact of puberty blockers on a child’s fertility, explaining how puberty blockers stop males from developing sperm. He said it was unknown if girls placed on puberty blockers during the initial stages of puberty, as recommended by WPATH, would have eggs mature enough for fertility preservation.
“Kids have zero idea about their fertility,” said Metzger.
In their clinical guidance, WPATH recommends that children are informed on the impact that sex reassignment medical interventions have on fertility, as well as understanding fertility preservation options. WPATH guidance calls puberty suppression ‘fully reversible,’ recommending their initiation at the first signs of physical puberty changes, which typically occurs as young as age 8.
During a session titled, “Foundations in Clinical Care for Transgender and Gender Diverse Adolescents,” Dr. Scott Leibowitz, a co-lead in the development of the adolescent chapter of the WPATH Standards of Care and member of the WPATH Board of Directors, challenged the reversibility of puberty suppression.
“I think when we just say, ‘Oh puberty blockers are just reversible and it’s a very noninvasive treatment,’ I would say it’s more invasive than often times the media makes it out to be or other people,” he said.
Leibowitz explained how puberty blockers suppress the release of sex hormones (estrogen and testosterone) that cause puberty, stopping puberty and the essential brain and bone maturation that occurs during pubertal development, calling the body’s need for binary sex hormones a challenge.
“There’s challenges with puberty suppression that we have to acknowledge and that’s why it’s ‘reversible asterisks,’” Leibowitz said. “One cannot be on puberty suppression endlessly. You get to a place where physiologically we need hormones.”
Leibowitz also challenged the need for evidence-based medical care, saying clinicians should not only consider medical evidence but should weigh ethical considerations, such as justice for transgender people, when prescribing sex reassignment medical treatments to adolescents,
“Regardless of the evidence base, as I said evidence is one part of this, there is an ethical human rights component to treating people. We don’t rely on evidence for every single treatment we do in medicine,” Leibowitz said.
“We have to look at the whole thing. Ethics, human rights, justice for trans people.”
Dr. Metzger, Dr. Scott Leibowitz, and WPATH did not respond to a request for comment.
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