“There is little evidence of demonstrable harm from [puberty blocking drugs]” observed the paediatrician Prof Gary Butler of London’s University College Hospital, who supervised their administration to children referred by the (now closed) Tavistock Gender Identity and Development Services (GIDS) Clinic.
“We know their effect is reversible, buying time [to decide whether or not to transition with cross-sex hormones] and that they reduce distress.” Further, he adds, their use results in “improved physical and psychological adaptation and wellbeing in young gender-variant people”. That was back in 2019, writing in the influential academic journal Archives of Disease in Childhood.
The recently published Cass Review, chaired by the paediatrician Dr Hilary Cass, took a rather more critical view, judging rather the scientific rationale for puberty blockers to be “wholly inadequate” to be sure they work in the way intended, so for example, a 16-year-old “natal female” after three years will be smaller than her peers who have experienced the pubertal growth spurt, and without the secondary sexual characteristics of breasts and pubic hair. But the findings of 50 studies assessing the outcome – for good or ill – of such an intervention are deemed “inconsistent and contradictory”. “No conclusions can be drawn about their impact on gender dysphoria.”
Hence Dr Cass’s insistence on correcting this “evidence deficit” by ensuring in future transitioning drugs only be prescribed as part of a properly conducted research programme. Take 100 adolescents with gender dysphoria and allocate them to two groups – half to be prescribed puberty blockers and the remaining 50, acting as a control group receiving only “psychosocial support”. Monitor the long-term outcome over several years and see which group “does better”.
There is no other way to come to a reasoned judgement. The obvious difficulty, however, of any such comparison is that whereas 90 per cent of those taking puberty blockers go on to transition with hormones and often reassignment surgery, a similar proportion of those in the control group will not – having become “comfortable with their birth sex”.
The consequences of these two trajectories being so very different, the outcomes in essence are incomparable. So, contra Prof Butler, puberty blockers can never be demonstrated to be a sensible option for “gender-variant people”.
Tonsillectomy must be balanced
Back in the 1960s, a quarter of children would have had their tonsils removed (a tonsillectomy) by their 12th birthday. Myself included, in Aberdeen Royal Infirmary and I still vividly recall being wheeled down the corridor to the operating theatre with the reward of a boiled sweet under my pillow on my return.
Around that time doctors began to question whether it was really necessary for so many to have the procedure – to which the answer was clearly no. Since then, the number of tonsillectomies has plummeted by 90 per cent and is now restricted to those who experience several episodes of tonsillitis a year.
But perhaps this downward trend in the numbers deemed eligible has gone too far? The fever, sore throat – like swallowing razor blades – and painful, swollen glands of tonsillitis are most unpleasant. Each episode usually rapidly improves with antibiotics but sometimes it may not, being of sufficient severity to warrant hospital admission-increasingly common over the past two decades.
Still, the putative benefits of tonsillectomy have to be balanced against it being a painful operation requiring a couple of weeks off work and the risk of surgical complications. The issue has recently been resolved in favour of tonsillectomy over “conservative management” (treating each attack of tonsillitis with antibiotics) – though not as emphatically as might be anticipated. Those having the operation reported half as many episodes of sore throat over the subsequent two years, but almost one fifth experienced the complication of post-operative bleeding.
Email comments and queries in confidence to Drjames@telegraph.co.uk
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