This avoids a lot of dysphoria-provoking secondary sexual characteristics from progressing, and also avoids accidentally "transing" a cisgender teenager.
Nobody hesitates to give puberty blockers to cisgender teenagers, for other medical reasons. I knew a young girl who had to have puberty blockers because she had a precocious puberty and it was literally destroying her young body -- she was not old enough physically or mentally to be able to deal with it.
However, for whatever reason, there is a huge backlash against giving it to transgender teenagers, despite it representing the best and ultimate choice in self-determination -- "Take these for a few years and then when you are 18 you can decide which puberty you want to go through". It leaves room for the individual to decide. If the person decides against it before then, they can stop and puberty immediately resumes as normal.
When the suicide rates are as high as they are for transgender people, and there is the option of halting the things causing the suicidal feelings, the dysphoria, all of the physical and emotional and societal pain. Halting an onslaught of pain that is utterly soul destroying, and just giving them more time to make a choice and more of an informed decision, how can there be any empathically-cogent argument against that?
I’d guess they’d be significant but that’s just a guess.
AMAB patients have less penile tissue for vaginoplasty. They have other options though. I don't think anyone has studied mature penile size in AMAB patients who decided to go through male puberty. Few do.
And people insist that these drugs are harmless?
"The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172
"GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents."
I'd imagine you take the position that a child seeking this care is always confused. Could this be mistaken? Your argument would be void, if so.
Further, the quotes you make from the studies you cite are misleadingly cherry-picked - the studies themselves do not support the conclusion you imply they do. They are both calls for further research - they are not studies which draw any conclusions about the risk/benefit trade-offs of treatment and they do not state that treatment should be withheld.
> "The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development." -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172
No one denies this. Again, it comes down to benefits of treatment versus risks of no treatment.
> "GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents." - https://pubmed.ncbi.nlm.nih.gov/31319416/
Same here.
Surely a patient and doctor have the right to decide to risk infertility or a lack of bone density later in life in order to prevent severe mental anguish and potential suicide now? Would you rather demand the child continue to suffer so that they can have, according to you - as though it were your decision for whatever creepy reason, the best chance of making more children they may not even want or strong bones they may not even use on account of having committed suicide before reaching adulthood?
A child who insists that he is no longer a male (or never was) is definitely confused.
If that same child insists that he's black, even though both of his biological parents are white, would you take him at his word or save him from getting Dolezal'ed by an unforgiving woke mob?
Children don't make good decisions. Their brains are literally missing the hardware until about age 25. [1] We don't allow them to make permanent changes that they might regret.
Circular, self-reinforcing, argument. Invalid.
> If that same child insists that he's black, even though both of his biological parents are white, would you take him at his word or save him from getting Dolezal'ed by an unforgiving woke mob?
Non-sequitur. Dismissed. Child still in need of psychological treatment.
> Children don't make good decisions. Their brains are literally missing the hardware until about age 25. [1] We don't allow them to make permanent changes that they might regret.
Sure we do. All the time. We allow them to grow up - that's rather permanent. You're not upset about that. Of course, it just so happens to be something you don't personally disagree with, unlike the topic of discussion.
There isn't a moral equivalence between interfering in the process and allowing nature to run its course.
Argument from naturality. The moral equivalence arises from the context and circumstance - not on whether one chooses to interfere or not.
Inaction doesn't require justification unless action is obligatory.
The decision to help a child mutilate himself is never obligatory (or even justifiable).
"The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290172
"GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents."
The 1st paper said fertility may be compromised "if puberty is suppressed at an early stage and the patient completes phenotypic transition with the use of cross-sex hormones". Not if they decide not to transition. And cross sex hormones can compromise fertility on their own. The 2nd paper said "There is no substantiated evidence that GnRHa treatment for CPP impairs reproductive function or reduces fertility." Because those patients don't take cross sex hormones when they stop the blockers.
Unknown effects on brain development means no known effects. The only study mentioned found no significant detrimental effects.
Possible long-term side effects of puberty blockers Lower bone density. To protect against this, we work to make sure every patient gets enough exercise, calcium and vitamin D, which can help keep bones healthy and strong. We also closely monitor patients’ bone density. Delayed growth plate closure, leading to slightly taller adult height. Less development of genital tissue, which may limit options for gender affirming surgery (bottom surgery) later in life. Other possible long-term side effects that are not yet known.
https://www.stlouischildrens.org/conditions-treatments/trans...
I leave it to the reader to determine whether they think having to take vitamin supplement counts as a significant side-effects. I would note, however, that it is also important to put these side effects in context. The contraceptive pill, for instance, also has reduced bone density as a possible side-effect.
My reading of the research also does not indicate that it is majorly lacking. Medical research is written in a very conservative manner. Researchers avoid making claims beyond the limits of their research. This can look like doubt or uncertainty when it is not.
My experience as a Ph.D. researchers is exactly this.
> This can look like doubt or uncertainty when it is not.
No, it is absolutely real uncertainty. The difference between knowing a topic and knowing something about it is vast, and in the space is sophistry.
> How can there be any emphatically-cogent argument…?
Because drugging little kids should be a last resort. Using big words doesn't change the need to be extremely cautious in doing something as serious as blocking puberty.
Edit: I just noticed the original poster already converted this into a longform post, so the "reader app" version isn't really necessary https://liminalwarmth.com/the-hard-thing-about-hard-things-m...