A Reply To A Hatchet Job.

Last week the New York Times had a hatchet job on us about puberty blockers… shame on them!

They Paused Puberty, but Is There a Cost?
Puberty blockers can ease transgender youths’ anguish and buy time to weigh options. But concerns are growing about long-termphysical effects and other consequences
By Megan Twohey and Christina Jewett
November 14, 2022


The medical guidance was direct.

But as an increasing number of adolescents identify as transgender — in the United States, an estimated 300,000 ages 13 to 17 and an untold number who are younger — concerns are growing among some medical professionals about the consequences of the drugs, a New York Times examination found. The questions are fueling government reviews in Europe, prompting a push for more research and leadingsome prominent specialists to reconsider at what age to prescribe them and for how long. A small number of doctors won’t recommend them at all.

[…]

That could lead to heightened risk of debilitating fractures earlier than would be expected from normal aging — in their 50s instead of 60s—and more immediate harm for patients who start treatment with already weak bones, experts say.

“There’s going to be a price,” said Dr. Sundeep Khosla, who leads a bone research lab at the Mayo Clinic. “And the price is probably going to be some deficit in skeletal mass.”

[…]

Dr. Khosla and Dr. Gordon don’t believe the effects on bones are reason for medical providers to halt use of the drugs in adolescents. Butthey think the risks should be factored into patient decisions and that bones should be carefully monitored.

WPATH has responded to the article...

The recent New York Times article, “They Paused Puberty, But Is There a Cost?”, furthers the atmosphere of misinformation and subjectivity that has grown to surround the area of gender affirming medical interventions for transgender youth. The methods of the authors of this piece come up short in their interpretation and application of available data; the article supports inaccurate narratives that puberty blocking medicines are conclusively harmful to long-term bone density or other health outcomes, and that transition reversal/regret is a common outcome for these treatments. Additionally lacking in the article is an explicit statement that any harms which may exist outweigh the substantial benefits these treatments confer to transgender youth, and we wish to respond below to certain specific statements and references made in this article.

The cited bone expert from Mayo Clinic, Dr. Sundeep Khosla, MD, is an adult endocrinologist who does not work clinically with transgender youth and has only a single publication on transgender health. This publication is not a research study, but a brief review commentary on the issue of bone density in adult transgender people. Transgender youth are not addressed in the commentary. In this paper, data are reviewed and discussed, and it is concluded that in the context of hormone therapy, “bone mineral density is generally preserved in both trans women and trans men”.

[…]

The single expert who performed the literature review, Dr. Farid Foroutan, PhD, is an epidemiologist with no experience in clinical medicine, child and identity development, bone density, or any aspect of the field of transgender health. Nearly the entirety of his professional experience lies in population health studies of heart disease. The interpretation of clinical studies, especially those with findings that are nuanced, inconclusive, or have a small effect size, require interpretation through a clinical lens, with clinician-scientists experienced in the translation of research data into clinical practice. In fact, Dr. Foroutan recently co-authored a paper which highlighted this very concern, so it is unclear why he did not advocate for a more nuanced and clinically grounded analysis, and an expanded roster of expertise on the review team.

[…]

Finally, the authors of this article suggest that “England’s National Health Service last month proposed restricting use of the drugs for trans youths to research settings.” In fact, the pivot that the National Health Service took was to enroll ALL youth initiating puberty blockers for treatment of gender dysphoria into a prospective research protocol so that more comprehensive data might be collected.

And of course the Republicans have latched on to this study and saying that the study vindicates them.