Within the broad debate about transgender medicine, the narrower issue of the use of puberty blockers is attracting the attention of bioethicists. A recent article in the journal Bioethics examines the two most commonly used defences.
The first is the possibility of self-harm, attempted suicide and suicide. Gender dysphoric young people often threaten to commit suicide if they go through puberty. So puberty blockers are often justified as literally a life-saving medications.
However, emphasising this might do more harm than good. If children see that puberty blockers are only given to young people who threaten suicide, they might become more extreme in their behaviours.
This creates “a system in which [ransgender, non-binary, and gender questioning] youth are left with the credible threat of suicide as the primary effective means of advocating for themselves.”
A more positive reason – the one favoured by the authors – is that puberty blockers give children time to consider their future gender identity more calmly. They offer a philosophical justification: the right to an “open future”. This means that as future autonomous adults, they have a right to keep their options open.
The defense of the right to an open future is fundamentally grounded in the values of self-determination and self-fulfillment—or the ideals of autonomy and personal well-being—which are particularly implicated in choices that are deeply impactful on the future adult's self-determination with respect to crucial and irrevocable decisions that will determine the course of their life.
The authors contend that puberty blockers are low-risk, reversible interventions and that if a child wants to discontinue them, puberty will recommence. They insist that this argument is based on the best available evidence:” Available evidence and clinical consensus bear this out: in the specific case of PBT, long-term risks and irreversible effects do not appear to present a major concern.”
However, in the next sentence, they acknowledge that “available long-term follow-up data on [puberty blockers] for trans youth are limited”. (This is strongly denied by transgender critics.)
They conclude: “A truly equitable and inclusive approach to trans care must do more than just recognize that interventions such as PBT are not as bad as suicide and self-harm. It should recognize transgender and cisgender life paths as equally legitimate, without holding the latter to laxer standards of legitimacy, and it should recognize the value of PBT as a tool for supporting trans and questioning youth through a process of healthy self-discovery and self-authorship.”
Michael Cook is editor of BioEdge
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