Scientist's Concerns about Manipulated Data Revive Debate over Transgender Youth's Use of Hormone Suppressants
Some individuals arguing for youth's access to gender-affirming healthcare claim the article exaggerates and misrepresents the precautions taken by researchers as they present and analyze data scientifically.
Dr. Alex Keuroghlian, director of the Division of Education and Training at the Fenway Institute, stated, "It's all bluster and blown out of proportion."
The aforementioned report, published on Wednesday, cites Dr. Johanna Olson-Kennedy, medical director at the Center for Transyouth Health and Development at Children’s Hospital of Los Angeles, one of the largest such programs in the United States.
Olson-Kennedy explained that, in the study she co-led, puberty blockers did not seem to enhance the mental well-being of 95 youngsters aged 8 to 16, who were tracked for two years to examine their mental and physical functioning as doctors administered the medications to postpone the bodily changes associated with puberty, including body hair development, menstruation, and voice deepening.
"They come in healthy and leave healthy," Olson-Kennedy explained to the Times.
However, this description appears to contradict the initial characteristics of the 95 study participants, which were published in 2022. This study reveals that more than one in four exhibited clinically significant levels of depression, anxiety, and suicidal thoughts. Nearly 8% had disclosed a prior suicide attempt.
Olson-Kennedy did not respond to CNN's request for comment.
Since 2015, the research project has received approximately $10 million in federal funding. The researchers have since published over two dozen papers detailing their findings, although a review of the children who were monitored for two years following their initiation of puberty-blocking medications appears to be overdue.
Dr. Amy Tishelman, a psychologist and research associate professor at Boston College, acknowledged the desire for caution but emphasized the importance of publishing the findings.
"I believe it's crucial for research, especially research funded by taxpayer money, to be disclosed for the sake of scientific integrity," said Tishelman, who contributed to the initial grant for the project, titled "The Impact of Early Medical Treatment on Transgender Youth." "We must be transparent about our findings."
Tishelman noted that the absence of a perceived change in mental functioning does not necessarily imply the therapy had no benefit.
"Puberty blockers may have prevented a worsening of mental health," she said, particularly for kids who might have experienced greater body dysphoria – or a sense of being in the wrong body – following puberty.
However, she stressed that this can only be definitively established by examining the data.
Numerous studies have documented high suicide and suicidal ideation rates in transgender children and adolescents, and the physical changes of puberty can greatly exacerbate the distress of feeling trapped in the wrong body.
For years, doctors have prescribed puberty-delaying drugs to certain transgender children who undergo psychological evaluations, as a method of relieving this distress, following the Dutch protocol, which is based on early research supporting this approach in the Netherlands.
In 2017, the Endocrine Society – a professional association of scientists and medical providers focused on hormone-related issues – published a clinical practice guideline that cites over 260 studies supporting the use of hormonal therapies to support children and adolescents with gender dysphoria and medications to suppress puberty.
"Puberty-delaying medication is a safe, generally reversible, and conservative approach that gives transgender and gender-diverse teenagers and their families more time to explore their options," the Endocrine Society said in a statement.
The society also mentioned that the therapy is not experimental or unusual. "The same treatment has been used for more than 40 years to treat precocious puberty," it added.
This year, however, a controversial research review in the UK called into question the practice, stating that the rationale for early puberty suppression was "unclear" and that any mental health benefits were supported by "weak evidence." The review – known as the Cass Review for Dr. Hilary Cass, the pediatrician who conducted it – and its methodology have faced intense criticism from some scholars and practitioners.
This has prompted providers in the UK to reduce their use of the treatment.
The Cass Review was published as part of a growing backlash against gender-affirming care for children. Since 2021, 26 US states have passed laws prohibiting or limiting minors' access to gender-affirming care, which may include puberty-blocking medications and other medical interventions such as hormone therapy to support a gender transition.
One controversial study found that these restrictions may have had negative consequences, showing that suicide rates among youth have increased in states that have passed anti-transgender laws.
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Another study published in JAMA Pediatrics on Monday revealed high levels of satisfaction and low levels of regret among more than 220 young people who had received puberty blockers and hormone therapy as children and adolescents.
The participants were included in the Trans Youth Project starting in 2013. In total, 97% said they were satisfied and continued with gender-affirming care. Four children – around 4% of the sample – expressed regret over puberty blockers or hormones, and four discontinued their therapy.
Tishelman expressed concern that a more significant point might be being overshadowed in the debate over Olson-Kennedy's research findings: that researchers may be self-censoring out of fear their work may be used against those they're trying to help.
"The essence of the tale lies in the fact that scientists might feel uneasy in sharing data due to the current political climate in the nation, and this is quite a predicament," she expressed.
CNN’s Jen Christensen contributed to this report.
The study published in 2022 highlighted that over one-quarter of the 95 participants exhibited clinically significant levels of depression, anxiety, and suicidal thoughts, and nearly 8% had disclosed a prior suicide attempt (referring to the initial characteristics of the study participants).
Despite the potential mental health challenges observed in some participants, the use of puberty-delaying drugs can prevent a worsening of mental health for transgender children who might experience greater body dysphoria following puberty (emphasizing the potential benefits of the therapy).
