US Endocrine Society issues draft guidelines

Children under 15
with a gender identity problem should be treated with
puberty-delaying drugs to allow them to choose whether to live as
males or females in later life, say draft guidelines from the US
Endocrine Society. The guidelines state: "We recommend that
adolescents who fulfil eligibility and readiness criteria for gender
reassignment initially undergo treatment to suppress pubertal
development."

The recommendations
are largely based on the experience of a Dutch clinic where doctors
have prescribed puberty blockers to more than 70 children under-16s.
The youngest they have treated is 11, although the majority are 12 or
over.

"We don’t have any
patient who has regretted their decision on the treatment," says
Henriette Delemarre-van de Waal of Leiden University Medical Centre
who has helped treat them.

However, even
New Scientist, which normally
champions radical approaches to bioethical issues, questions this.
“Some 80 per cent of boys who experience transsexual feelings no
longer feel this way when they grow up. There is some evidence that
those who persist after the first flush of puberty are less likely to
change their minds, but this has been based on a handful of cases. So
too has our understanding of the side effects of delaying puberty –
or in the case of those who go through with gender reassignment,
preventing natural puberty from occurring at all.

“The issue becomes
thornier still when you consider that the age of puberty is falling.
Does, say, a 9-year-old have the emotional maturity to make a
decision of this magnitude? Unlikely.”

However, Dr Marvin
Belzer of Children’s Hospital in Los Angeles, who has treated several
12 and 13 year-olds with puberty blockers, suggests that the
procedure is ethical as long as the children give informed consent.
“While it’s possible that a teenager might change his or her mind,”
he told New Scientist,
“the question is, can we go back and say, ‘yes, but you and your
family had informed consent, and we knew that that was one of the
risks, but that risk was small’." ~ New
Scientist, Dec 10

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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