An Ethical Oversight: A response to Pipe Dream and Binghamton Review

Jonny Fast

On April 12th, Pipe Dream published an article titled Banning gender-affirming care is unscientific, abhorrent, discussing a recent wave of legislation banning certain gender dysphoria treatments for minors. As a disclaimer, I am not against the existence of trans people, but I believe that minors below the age of 18 should not be able to make a decision that can have dire consequences on their lives. The article was, in my personal opinion, a showcase of progressive ideas in their most radical form. While it is shocking to see such ideas being discussed, it does not surprise me, given the reputation of Pipe Dream, that they would publish such an article. Moreover, in the latest issue of Binghamton Review, an article written by a colleague of mine, Madeline Perez, responds to the article “Contemporary Arrogance”. The response is mostly fine, as the article in question was poorly written and contains many baseless claims. However, the response brings up the same points which were presented from Pipe Dream. As a writer of a publication that I believe to be a sanctuary of knowledge within this university, I can not sit idle as these claims go unchallenged. However, I also have respect for the principle of free speech, hence why I am writing this article. While progressives may claim that there is nothing wrong with these prepubescent hormone treatments, the truth of the matter is that if given to minors, these treatments are misguided at best and unscrupulous at worst.

To begin, I would like to list the claims stated by both the response article and the Pipe Dream opinion piece. In her article, “Contemporary Stupidity: A Response To Contemporary Arrogance”, the author claims that puberty blockers are prescribed, safe, reversible, and can be used to successfully treat patients, and possibly prevent the need for further surgery. To back up her claims, she cites an article by the Mayo Clinic describing said puberty blockers. According to the Mayo Clinic article, puberty blockers, specifically GnRH analogues, are molecules that block sex hormones, such as testosterone, from causing changes that would typically occur during puberty. Switching focus to Pipe Dream, the author of that article makes similar claims, more or less, though in a more condescending tone. As a result, I will take the claims in the Binghamton Review article as the main focus, as it features the same points but without any of the hallmarks of Pipe Dream opinion pieces, i.e. bad faith generalizations of political opponents and a lack of Oxford comma.

While puberty blockers will not result in death, this does not mean that these drugs are harmless. The Mayo Clinic report states that the changes are not permanent. However, if one reads further down the Mayo Clinic article, one would notice that puberty blockers have certain side effects including long-term effects on bone density and fertility⁶. While this could be avoided by only prescribing these treatments in the short term, the only way to effectively pause the effects of puberty is to prescribe them in the long term, as puberty is a phase which lasts throughout adolescence. Despite what our two aforementioned authors would like to claim, the possibility to cause abnormal bone density, or even worse, infertility, is not an effect of a “reversible treatment”. These effects are so prominent that the National Health Service of the UK recently decided to cease the use of this treatment on minors.⁷ The research article cited in the report concluded that further studies are needed to determine the effects of this medication. It’s clear from this article that there is no scientific consensus on the issue of puberty blockers; in fact, it seems that this treatment is quite experimental. However, this has not caused practitioners to cease these treatments on minors. In fact, access to these experimental treatments has been labeled as a human right (see Pipe Dream). Given the severity of these effects, the continued use of puberty blockers on minors should be considered unethical.

Even if scientists were able to develop a completely reversible and harmless version of the puberty blocker, there would still be ethical issues involved with administering the treatment. Going back to the Review article, the author claims that puberty blockers can be used to prevent the need for permanent surgeries. However, when looking at the impacts of these treatments on the incentives of those receiving them, one would conclude that the opposite is true. When puberty blockers are given, they restrict the development of masculine/feminine traits that would develop during puberty. This is because these treatments are designed to halt the release of hormones that trigger many of the changes brought about by puberty, thus keeping the minor in this transitional state. Without the release of these hormones, the patient would maintain an incentive to desire a more permanent solution, such as gender reassignment surgery. Since the patient would be making an uninformed decision due to their unfinished development, it is unwise to give minors the choice to make such a severe decision. Finally, the author states that if the minor is under the age of medical consent, 14-16 depending on the state of residence, the minor would require parental consent to undergo these treatments. However, the parents of such minors may be just as uninformed as the minors themselves, as misinformation regarding the treatment is constantly being spread. Moreover, activists and clinics have been pushing to administer these treatments so far as to ignore other possible causes for their discomfort, such as social pressures or a different, unrelated condition. This leads to some people with circumstances like Keira Bell and a subreddit of almost 20,000 people, who have de-transitioned and likely will not be able to revert back to their conditions before treatment.¹ If patients are directed towards an option by manipulated incentives with no consideration of alternatives, then one can hardly say that this is an informed decision.

If puberty blockers are unethical for use, then how should minors who suffer from gender dysphoria be treated? Looking at alternatives, the best option seems to be psychotherapy and/or mental health resources. Given that gender dysphoria is a physiological phenomenon, it seems appropriate that experts who understand how the mind develops can treat these patients. While there are currently issues about the accessibility of therapy, there are also benefits from its use. First off, therapy can be used to treat depression, anxiety, low self-esteem, and other symptoms which are common comorbidities in minors with gender dysphoria. Additionally, therapy does not have the ability to cause any drastic changes similar to puberty blockers. Finally, it’s possible that some minors may overcome their gender dysphoria and become comfortable with their own body, though this outcome is best achieved from the use of therapy.

While advocates for puberty blockers may be well-intentioned, one can see that there are multiple ethical concerns with the use of these drugs to treat minors. These concerns regard the long-term impacts that come from the use of these treatments on minors who have yet to understand themselves. Further studies should be performed before such treatments are even considered. To reiterate my disclaimer, this article was not written with the intent to harm trans people. If a consenting adult wishes to undergo a permanent procedure and is fully informed, I have no ethical issues with it. However, to grant this decision to children and adolescents may lead to more harm than good.

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