91��ɫ

The real threat to gender-diverse children is the politicization of care issues like puberty blockers and detransition

Under the pretext of protecting children, Pierre Poilievre, leader of the Conservative Party of Canada, has to the use of puberty blockers for gender-diverse children.

“I think that we should protect children and their ability to make adult decisions when they’re adults,” Poilievre said.

Poilievre is one among many politicians to wade into debates surrounding gender-affirming health care in recent years. Alberta Premier Danielle Smith has , including prohibiting puberty blockers for children aged 15 and under.

But the growth of politicization and misinformation on this issue — on top of already over the — probably pose a bigger threat to gender-diverse people than puberty blockers.

who study the and gender-diverse people who have accessed gender-affirming health care. and also a parent. And who also research — the process of discontinuing or reversing a gender transition.

We both personally know countless people who have been helped by transitioning, as well as others who were that can have .

We have noticed that what is presented as “fact” in these debates has distorted real complexities of gender-affirming health care, creating a rift between conservative and progressive information outlets. The result has left many in the dark about what is really at stake. Conservative leader Pierre Poilievre speaks to the media about puberty blockers and trans children.

Fertility and gender-affirming medicine

Take the New 91��ɫ Times as an example. Two opinion columnists recently wrote about gender-affirming care for minors, making drastically different remarks about the fertility implications of this care.

Opinion columnist asserted that it is a “mistaken belief” that infertility routinely results from treatments for gender-diverse children, while , writing about detransition, claimed that hormonal therapy causes “often irreversible” infertility.

But the reality of fertility and gender-affirming treatments is in the details. Research on fertility outcomes is lackluster to begin with, but outcomes are highly sensitive to whether .

For children who start puberty blockers followed by cross-sex hormones without ever undergoing natal puberty, because reproductive maturity is not achieved, and saving sperm or eggs for the future is with current assisted reproductive technologies. However, for transgender people who begin cross-sex hormones after undergoing at least some natal puberty, fertility does not seem to be permanently affected.

indicates that for those who went through natal puberty, taking cross-sex hormones alone is .

Puberty blockers

The history of transgender medicine and reproductive rights has been fraught with injustice. When puberty blockers , transgender adults were being coercively sterilized. In 2014, the Netherlands struck down a policy requiring .

Pediatric gender medicine is a , and while the it also .

In fact, fertility is not the only issue at stake with puberty blockers. There are uncertain , as well as — issues clinicians and researchers are paying close attention to.

A team of Dutch clinicians who were among the first to offer transgender children puberty blockers that these drugs may not be just a “pause button” to explore identity, as originally intended. Instead, they should be thought of as the first step of a medical gender transition, because a .

But there are also major , which could hurt transgender girls more than boys. Testosterone’s effects on the body can be difficult to reverse, so undergoing a masculinizing puberty could render transfeminine kids more . Irreversible body changes from puberty can not only heighten distress and reduce social acceptance, but also contribute to a need for future surgeries.

Given that puberty may occur as early as for some children, this is a high-stakes medical decision never taken lightly by families or clinicians. by saying that “we should protect the rights of parents to make their own decision with regards to their children,” because, given the age of the child, parents are typically involved in the decision to start puberty blockers.

However, there is — in either direction.

Detransition debate

Puberty-blocking drugs are not the only politicized topic in gender-affirming health care. .

On one side, opponents of gender-affirming care distort studies to argue detransition has and draw from testimonies of regretful detransitioners as a “.”

Proponents retort by dismissing detransition either by alluding to its and , or by .

As a result, the public is exposed to two different sets of “facts,” none of which reflect the heterogeneity that we and others have encountered in — different for detransitioning; a range of emotions including ; expansive patterns of . All of it must be studied for gender-related medical care to continue being evidence-informed.

But threats, or outright restrictions, from politicians will not advance this care. What is badly needed from governments is investments in higher quality research and systems of care so treatments can be accessed in the safest possible terms. There are currently gaps in the affecting access, quality, and safety.

Guidelines, dilemmas and the need for high-quality research

This area of health care already developed through a review of the evidence and . But that does not mean the science is settled or that the medicine has no room for improvement.

Gender-affirming care is riddled that have . The changing landscape of transgender health care, and are all low-hanging fruit for opportunistic politicians like Poilievre.

On the polarization of these topics, anthropologist and medical doctor — who — wrote:

But by not being able to tolerate some of the unknowns, or banning treatments outright, we miss a crucial opportunity to advance knowledge that is needed to help gender-diverse children and their families.

Debate should not centre on whether to ban blockers, but on how to build a high-quality health and social care system that can support all gender-diverse people. Doing so depends on our collective ability to tolerate complexity.

As published in the