President Joe Biden nailed his flag to the LGBTQI+ mast in the lead-up to the midterm elections. Back in June, he described movement towards expanding LGBTQI+ rights as an existential struggle. “We’re in a battle for the very soul of this nation, and that’s not hyperbole. We’re in a battle for the soul of the nation … it’s a battle I know we will win. We will win.”

A key weapon in this battle is claims by doctors that transgender treatment for young people is safe and, up to a point, reversible. In this the President has been supported by statements from leading medical associations. The president of the American Academy of Pediatrics, Moira Szilagyi, recently declared that “there is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate.” Indeed, the 2018 AAP guidelines described puberty blockers as “reversible”.

An article in Pediatrics in 2020 by Dr Jack Turban, a widely quoted expert on trans medicine, declares that: puberty blockers are “unique among gender-affirming medical interventions in that the resultant pubertal suppression is fully reversible, with the resumption of endogenous puberty after their discontinuation.”

This is also the position of the Endocrine Society and the Pediatric Endocrine Society.

However, criticism of this stance comes from an interesting source: Lesbians United, “a lesbian-only, all-volunteer organization based in the U.S.” In a press release accompanying a lengthy study of puberty blockers, it concludes that:

“the prescription of GnRH agonists to treat an actual or perceived mental illness constitutes medical malpractice and a crime against humanity; that parental consent to puberty suppression to treat an actual or perceived mental illness falls under the rubric of child abuse.”

The group goes on to attack the use of puberty blockers as “torture and abuse”. It says ominously that “Every medical professional who participated must be held accountable financially, professionally, and socially, and prosecuted to the fullest extent of the law.”

Lesbians United backs up its vehement language with a 32-page review of 300 scientific papers about puberty blockers written by an anonymous team of researchers. It concludes that

Substantial evidence from peer-reviewed scientific studies, case studies, and clinical trials suggests that puberty-blocking drugs can negatively affect the skeleton, cardiovascular system, thyroid, brain, genitals, reproductive system, digestive system, urinary tract, muscles, eyes, and immune system. Particularly urgent concerns for adolescents treated with puberty-blocking drugs are loss of bone mineral density and increased risk of osteoporosis; potential for decreased IQ and other cognitive deficits; increased risk of depression and suicidal thoughts; and stunted sexual and reproductive development.

And against claims by President Biden’s Administration and American medical journals, it declares that many of these disturbing effects are “wholly or partially irreversible”.

The Lesbians United team found that research on the use of puberty blockers is very sketchy for children and adolescents. GnRH agonists – the medical term – were first approved as drugs for men with prostate cancer. Research on their effects for this purpose is generally high quality. But research on the drugs as part of treatment for gender dysphoria is much lower quality, with small sample sizes. Sometimes the conclusions appear to contradict the evidence. There are very few long-term studies. Highly politicised language in some articles suggest that the authors were very biased.

The authors of the study conclude that: “claims that these drugs alleviate mental health symptoms and decrease suicidality [are] highly suspect.”