On Children and Hormone Blockers.

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princetonalec
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Every couple of weeks it seems to me like we get someone posting a link to an article or making a discussion post about "How dangerous" blockers are, and about "How they're damaging our children!". Now I understand that many people may not just understand how the system works, so I wanted to make a post which lays out the general process.
This is how, for lack of fringe cases,hormone blockers are prescribed to children. So if you didn't know about this process, hopefully this helps you form a more informed opinion on it.

Children aren't randomly given blockers just because they asked nicely. The process to get blockers requires

A) A referral to a specialist gender clinic service, with a waiting list of commonly 1-3 years. This means that a child won't suddenly say "I'm a boy now" and get drugs, they commonly have to wait. In Wales, before this referral can take place, children are required to have a full psychological evaluation with their local mental health services.

B) A full evaluation during their first session with the service, which rarely results in any prescriptions. When I say rarely I mean rarely. It's traditional for any medical intervention to be flat out denied within the first session, and is normally only finalized in the second or even third. This is the same for adults, but since we're talking about children this would mean that the first appointment gets them nothing in a majority of cases. And the second one is normally anywhere from 6 months to 2 years after the first, so again, not exactly being fast tracked onto drugs.

C) Requires a shared care agreement with the GP. Gender clinics aren't typically qualified to administer hormone treatment or hormone blockers, they're only qualified to prescribe them. I the primary care doctor doesn't feel comfortable providing this care to the child, they don't. There have been cases of children being denied hormone treatment or blockers because their GP denied the recommendation of the gender clinic. These kids normally have to go somewhere else.

D) Close monitoring during the entire time they're on blockers, which will be at the longest 3-4 years. Most children start blockers at the age of 16 anyway, but when looking at the longest possible case this would be just before puberty starts or at the beginning, which would be ages 12-13. And these are the best case scenarios, or the result of seeking private treatment. During this time any and all shots are administered by nursing staff, regular blood tests are mandatory to check levels of E and T in the blood respectively, and all children on this medication are regularly checked for any of the side effects which can occur as a result of being on blockers. And I only say blockers here, because in the UK you must be I believe at least 17 to be prescribed hormones (16 I believe in Scotland), where you basically start the entire process I just laid out from the beginning for a different medication.


I say this sincerely. I wish DESPERATELY that I lived in the world where these hormones were apparently just handed out like everyone is scaremongering they are, because then I wouldn't be looking down the barrel of a 3 year waiting list for a first appointment, and then another year for my second. After being on the waiting list for a year already, mind you.

Kids aren't given blockers on demand, they're closely monitored when they are given blockers, and the ultimate aim is to get them off and get them onto something more stable and long term than to just keep them on blockers forever.

I hope this has helped explain what can be a confusing and emotional subject.
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Dee-Emma
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Thank you for your clear summary. There does seem to be a moral panic on trans issues at the moment support by pressure groups and media stories and reflects a growing tide of intolerance many are experiencing. Sad times.
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princetonalec
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(Original post by Dee-Emma)
Thank you for your clear summary. There does seem to be a moral panic on trans issues at the moment support by pressure groups and media stories and reflects a growing tide of intolerance many are experiencing. Sad times.
It's really unfortunate, and it sucks to be a trans person during it. I almost feel like I need to do my best to defend it, since it's only recently that we got the right to have hormone treatment on the NHS as accessible as it is today.
Even then hate crimes against trans people keep going up, to even get our birth certificate changed we have to prove to a panel of strangers that we're serious about it with two years of paperwork evidence, and it feels like it would be incredibly easy to lose everything we've worked hard for because one or two people in power decide they don't like people like me...
Like i'm not asking everyone to throw rose petals at my feet as I walk by, i'm just asking people to actually learn the legal process of getting hormones and blockers before they act like it's people just asking a doctor nicely for painkillers and getting them on a whim. If it were that simple trust me, i'd be first in line for some free hormones!
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awkwardshortguy
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(Original post by princetonalec)
I say this sincerely. I wish DESPERATELY that I lived in the world where these hormones were apparently just handed out like everyone is scaremongering they are, because then I wouldn't be looking down the barrel of a 3 year waiting list for a first appointment, and then another year for my second. After being on the waiting list for a year already, mind you.
You would seriously want that? If they were handed out willy nilly imagine how many more people would have their bodies natural development interfered with - something that surely should only be considered a last resort in the interests of the patient's wellbeing.
(Original post by princetonalec)
Kids aren't given blockers on demand, they're closely monitored when they are given blockers, and the ultimate aim is to get them off and get them onto something more stable and long term than to just keep them on blockers forever.
What's the 'something'? Removal of glands producing the hormones the blockers would block?
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princetonalec
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(Original post by awkwardshortguy)
You would seriously want that? If they were handed out willy nilly imagine how many more people would have their bodies natural development interfered with - something that surely should only be considered a last resort in the interests of the patient's wellbeing.

What's the 'something'? Removal of glands producing the hormones the blockers would block?
1) Sarcasm doesn't follow that well in text after all. The point of this post was the narrative often painted by people who have no idea how the system works of people being given hormones on a whim is false. I joked saying I'd like this reality, because current waiting lists are painful. Hormone treatment and hormone blockers will never be given just because. Sorry you couldn't grab the sarcasm there.
2) It's hormone treatment? What did you think hormone blockers were for, exactly? The idea is you go on hormone blockers so you don't develop secondary sex characteristics, such as growing breasts or facial hair, to avoid needing to get treatment for these things later in life. A young man may have hormone blockers so he doesn't grow breasts, ultimately saving the NHS money so he doesn't need to have them removed at a later date.
The general roadmap is blockers onto HRT (hormone replacement therapy), not removing any and all hormone production within a body.
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DiddyDec
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I will wait to see what the High Court ruling is on the matter.
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BlueIndigoViolet
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(Original post by DiddyDecAlt)
I will wait to see what the High Court ruling is on the matter.
definitely welcome the review - definitely a ethical grey area when considering children
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alexgmt
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(Original post by DiddyDecAlt)
I will wait to see what the High Court ruling is on the matter.
This high court ruling would give precedent to prevent U18's from getting contraception like the pill, so it seems highly unlikely that the legislation would rule against blockers.
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DiddyDec
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(Original post by alexgmt)
This high court ruling would give precedent to prevent U18's from getting contraception like the pill, so it seems highly unlikely that the legislation would rule against blockers.
No it wouldn't, contraception is held under the Gillick competence test which is not being challenged. It's use for something other than what it was intended is being challenged.
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awkwardshortguy
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(Original post by princetonalec)
2) It's hormone treatment? What did you think hormone blockers were for, exactly? The idea is you go on hormone blockers so you don't develop secondary sex characteristics, such as growing breasts or facial hair, to avoid needing to get treatment for these things later in life. A young man may have hormone blockers so he doesn't grow breasts, ultimately saving the NHS money so he doesn't need to have them removed at a later date.
The general roadmap is blockers onto HRT (hormone replacement therapy), not removing any and all hormone production within a body.
I guessed what hormone blockers were for and it seems I was correct in fact. What I may have been wrong about was thinking that once a person is taken off blockers they might develop secondary sexual characteristics associated with their biological sex then, regardless of what hormones that person is treated with.
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InArduisFouette
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(Original post by DiddyDecAlt)
I will wait to see what the High Court ruling is on the matter.
(Original post by BlueIndigoViolet)
definitely welcome the review - definitely a ethical grey area when considering children
it;s an application for a judicial review as to whether there should be a case

and there is no ethical grey area here, the ethics of affirming care for transgender people have been settled for decades from a legal and clinicla point of view

refusing affirming care is De Facto and De Jure Child abuse .

there are a lot of fascists and religious loons who deliberately mis characterise Affirming care to take advanage of the guilibility of the average person ...
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InArduisFouette
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(Original post by DiddyDecAlt)
No it wouldn't, contraception is held under the Gillick competence test which is not being challenged. It's use for something other than what it was intended is being challenged.
Gillick competence is used for all health care

trying to prevent trans YP from accessing affirming care is not only unethical and in breach of international law, the current UK approach is significantly behind the curve with regard to the evidence base
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InArduisFouette
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(Original post by awkwardshortguy)
I guessed what hormone blockers were for and it seems I was correct in fact. What I may have been wrong about was thinking that once a person is taken off blockers they might develop secondary sexual characteristics associated with their biological sex then, regardless of what hormones that person is treated with.
there are two reasons to use GnRH analogues to delay puberty in a transgender young person

1. to allow 'breathing space' over their identity - reaslisiticalyl for many trans YP theis only needs to be a very short period o time a few months

2. to prevent secondary sexual characteristics from progressing

if you stop the treatment then whatever endogenous hormones are being produced will resume and that puberty will happen - which is where the transphobes confuse themselves by claiming blockers lead to medical transition - ignoring that blockers are under prescribed by a significant amount at present
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DiddyDec
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(Original post by InArduisFouette)
it;s an application for a judicial review as to whether there should be a case

and there is no ethical grey area here, the ethics of affirming care for transgender people have been settled for decades from a legal and clinicla point of view

refusing affirming care is De Facto and De Jure Child abuse .

there are a lot of fascists and religious loons who deliberately mis characterise Affirming care to take advanage of the guilibility of the average person ...
I will wait nonetheless.
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CoolCavy
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(Original post by princetonalec)

I say this sincerely. I wish DESPERATELY that I lived in the world where these hormones were apparently just handed out like everyone is scaremongering they are, because then I wouldn't be looking down the barrel of a 3 year waiting list for a first appointment, and then another year for my second. After being on the waiting list for a year already, mind you.
The answer to long waitlists isn't just to hand them out like sweets, it's not one or the other. Transition should be gatekeeped to a certain extent since it is a a largely irreversible change that has profound effects on an individuals life (for better or for worse).
How long that gatekeeping should be is up to professionals, the one thing that is clear is that more funding and professionalise are needed to fulfil demand whilst ensuring that people are fully assessed and supported.
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InArduisFouette
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(Original post by DiddyDecAlt)
Ok then, believe what you like.
anyone who has any kind of clinicla acumen and understanding of evidence base should support affirming care .

you might be well advised to ask 'Doctor' Andrew Thorne a Social worker who could not stay in his lane what happens when you promote right wing extremists and their views ...
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InArduisFouette
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(Original post by CoolCavy)
The answer to long waitlists isn't just to hand them out like sweets, it's not one or the other. Transition should be gatekeeped to a certain extent since it is a a largely irreversible change that has profound effects on an individuals life (for better or for worse).
How long that gatekeeping should be is up to professionals, the one thing that is clear is that more funding and professionalise are needed to fulfil demand whilst ensuring that people are fully assessed and supported.
you are digging yourself into a hole here

there is NO indication for gatekeeping with regard to the clinical care of transgender individuals.

you have to understand what Gatekeeping actually means in this clinical setting

It is not the clinical stewardship of the medical and surgical interventions - this is in place and mainly works very well as seen by the very low regret and detransition rates ...

Gatekeeping in trans people;s care has been associated with Conversion Therapy, cis-hetero normative judgements based on appearance as to whether someone is a candidate for transition ( i.e. how well they will pass) not otmention policing of sexuality and gender expression by cisgender ( and few notable Stockholmn syndrome trans clinicians ) clinicians on a power trip.
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Napp
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Question; what makes your opinion on the process more prescient than the experts opinion on it? I mean with all due respect i'm more inclined to take a doctors view on this..
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princetonalec
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(Original post by Napp)
Question; what makes your opinion on the process more prescient than the experts opinion on it? I mean with all due respect i'm more inclined to take a doctors view on this..
Well I'm trans for one, so I've lived it and been bombarded constantly with people showing me all the 'evidence' for it being wrong.
And two, if you could find me a place where I disagreed with doctors in my initial post that would be swell. I said a lot of people get misinformation on how blockers are handed out.
Do I think they need to be perscribed "more"? Yes. Because dysphoria can result in suicide (something I myself have attempted as a child), severe mental health issues, and a general distaste for living.
But they're not because of underfunding and understaffing of the GICs across the country.
No doctor is handing out hormone blockers left and right, and no doctor thinks they should. It's everyone else who seems to think that you can just waltz into your GP and demand treatment for this, meanwhile I'm having to desperately transfer asap because my GP decided to refer me to a clinic and then say they wouldn't feel comfortable to provide care, something they are required to do after referring me to the clinic.
I really have no idea what your point is. Not only are doctors not handing out hormones willy nilly, but they're not being strongarmed into it either.
And I agree that it should continue to be monitored? Which is what all doctors who specialise in this area of health care want anyway?
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Stiff Little Fingers
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(Original post by awkwardshortguy)
What's the 'something'? Removal of glands producing the hormones the blockers would block?
If that's the way the person wants to proceed then yes. The point of puberty blockers are that they're a safe, reversible method of delaying puberty (the main drug leuprorelin has been used for 35 years for this exact purpose of treating early puberty) to give the person taking it breathing time - if they desist then, like those being treated for precocious puberty, they come off the drug and their natal puberty progresses as normal. If they don't, they begin to take hormone replacement therapy and may opt for a gonadectomy as part of that. The entire point is that it is reversible while proceeding through an unwanted puberty is far less so, requiring more invasive methods or in the case of some things (e.g. voice drop in those that go through a typically male puberty), irreversible and something you instead have to try and work round.
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