Puberty Blockers

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.

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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.”

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