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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.

鈥淚 think that we should protect children and their ability to make adult decisions when they鈥檙e adults,鈥� 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 鈥� on top of already over the 鈥� 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 鈥� 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 鈥渇act鈥� 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亚色 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 鈥渕istaken belief鈥� that infertility routinely results from treatments for gender-diverse children, while , writing about detransition, claimed that hormonal therapy causes 鈥渙ften irreversible鈥� 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 鈥� 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 鈥減ause button鈥� 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鈥檚 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 鈥渨e should protect the rights of parents to make their own decision with regards to their children,鈥� because, given the age of the child, parents are typically involved in the decision to start puberty blockers.

However, there is 鈥� 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 鈥�.鈥�

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 鈥渇acts,鈥� none of which reflect the heterogeneity that we and others have encountered in 鈥� 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 鈥� who 鈥� 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

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Study draws attention to insufficient clinical care and support for those who discontinue or seek to reverse prior gender-affirming interventions

TORONTO, July 25, 2022 鈥� Medical education, research and clinical guidelines are all available to support the initiation of gender-affirming care for transgender people, but a 91亚色-led qualitative study has found these resources are sparse when patients discontinue or reverse gender-affirming medical or surgical interventions 鈥� referred to as detransition.

The study results published today in the journal indicate that individuals detransition for various reasons including physical and mental health concerns or an evolving gender identity, such as shifting from trans men or trans women, to non-binary or re-identifying with their birth sex.

鈥淎 majority of respondents reported little decisional regrets regarding prior gender-affirming interventions, however participants frequently discussed stopping gender-affirming hormones 鈥榗old turkey鈥� without medical supervision, facing provider stigma, and experiencing clinicians who lacked detransition-related clinical knowledge,鈥� says , lead author of the study.

鈥淚 actually just stopped talking to them [clinicians]鈥� I felt like they were going to be mad at me [for detransitioning],鈥� said one study participant who quit taking testosterone and seeing her therapist. 鈥淚 had like almost no supports when that was happening.鈥� Although during her initial medical transition she had positive relationships with her healthcare providers and therapist, she felt guilt and shame about detransitioning, and was worried that her clinicians would misinterpret her initial transition as a mistake and subsequent detransition as regret.

鈥淩ather than relying on clinicians who were often a source of distrust, many turned instead to online detransition networks and social media. Often, they did not have a clear understanding of what health implications to expect when stopping gender-affirming hormones,鈥� points out MacKinnon.

Medical detransition was often experienced as physically and psychologically challenging. Some individuals initiated the process after gonadectomies or lower surgeries, which meant switching from masculinizing to feminizing hormones or vice-versa.  

鈥淭he first doctor I went to 鈥� and the second doctor 鈥� both didn't have a clue what was going on 鈥� I feel like more information [is needed] around specifically people who need to get off testosterone to go back onto another [hormone],鈥� said another study participant who now identifies as female. In her initial transition process as a transgender young person, her gender dysphoria had been treated with testosterone and both oophorectomy and hysterectomy. However, when she was seeking medical support to detransition and switch from testosterone to estrogen, she felt her medical providers were unprepared to meet her needs.

Aside from physical and mental health concerns, factors motivating detransition included surgical complications and post-operative pain, unsupportive parents or romantic partners, and employment discrimination. In the last two years, the COVID-19 pandemic and related lockdowns was an additional impediment, causing difficulty accessing clinical appointments or gender-affirming surgeries.

For the study, 28 adults between the ages of 20-53 鈥� the majority of whom were assigned female at birth 鈥� were interviewed about their experiences of detransition, including their healthcare encounters when discontinuing or reversing gender-affirming medical or surgical care.

MacKinnon and other researchers from Simon Fraser University, University of British Columbia, University of Michigan, and University of Toronto who worked on this study, conclude that further research and clinical guidance is required to address the unmet needs of those who discontinue or seek to reverse prior gender-affirming interventions.

91亚色 is a modern, multi-campus, urban university located in Toronto, Ontario. Backed by a diverse group of students, faculty, staff, alumni and partners, we bring a uniquely global perspective to help solve societal challenges, drive positive change and prepare our students for success. 91亚色's fully bilingual Glendon Campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education. 91亚色鈥檚 campuses in Costa Rica and India offer students exceptional transnational learning opportunities and innovative programs. Together, we can make things right for our communities, our planet, and our future.

Media Contact:
Gloria Suhasini, 91亚色 Media Relations, 647-463-4354, suhasini@yorku.ca

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