Reverse the Ban on Puberty Blockers?

My address to Durham University Debate Chamber

This weekend I was invited to speak at the Durham University Debate Society about the recent NHS ban on puberty blockers. I was arguing that puberty blockers SHOULD be banned. With 50 votes to 30, my side WON the debate (yay!). Here’s my speech:

I have been treating adolescents with mental health issues for over a decade now, and what we see is that rates of mental illness increase dramatically in the teenage years. We have far more psychiatric wards for adolescences, for example, then we do for young children. Half of all lifetime mental illnesses begin by age 14, and three quarters by age 24. So adolescence is a very vulnerable time psychologically. Why is this? Well, two things happen to us during this time. Firstly, our relationship to our parents and to society changes, and, secondly, our bodies change. These two things go hand in hand.

So, our teenage years are the time when we have to gradually separate from our parents and prepare for adulthood. We have to form our own desires, our own views, our own social group, our own identity. We start to realise how we are similar to our parents and how we are different from them, and we start to work out what it is that we want from life. This process can bring with it all sorts of difficulties. Many teenagers may feel that they are not ready for this, they are still trying to work out who they are. They may become anxious about what they discover about themselves, and to what extent they fit in with their peer group. It can be particularly difficult if, on top of all of this, they are experiencing some kind of chaos in their life. This could include, family breakdown, abuse or bullying. Perhaps they think they might be gay, or they may be autistic. This further complicates things. Alongside all this, their body changes. An adolescent’s brain and neurochemistry changes, their hormones change, and, of course, the body develops sexually. They go through puberty.

So puberty indicates to us and those around us that we are becoming an adult. Our family and broader community and society will respond to this by seeing and treating us differently. It’s quite a difficult and often stressful process, which is why it often causes a lot of mental distress.

Long before the diagnosis of Gender identity disorder existed or, as it’s now called, Gender Dysphoria, young teenage girls were being diagnosed with Anorexia Nervosa. This is a condition where you believe that you have change (transform), the size of your body to be comfortable in it. One of the diagnostic criteria for girls, alongside being underweight, was that they would be experiencing Amenorrhoea. This is when menstruation stops or fails to start. In other words, their puberty stops. Their puberty is blocked by malnourishment and their bodies remain in a childlike state. It’s long been understood within the psychiatric profession that whether consciously or unconsciously, these patients want to remain as a child. Adulthood and sexuality are too scary so the child wants to stop it from happening. Fast forward to today, and the same underlying concerns about the body, identity, sex, sexuality, and adulthood, present themselves in teenagers once more, but they come to believe that they need to change the sex of their body, not the size. Both attempts to solve psychological distress by changing the body are completely futile. If the problem is in the mind, that’s where the solution is. The body is not the problem. Taking a healthy body, and stopping it’s healthy functioning will only add to your problems.

When puberty blockers were first administered to adolescents, we were told that these drugs would put a pause on puberty to enable the child time to think and to decide whether they wanted to fully change to the opposite sex. The administration of these drugs was, therefore, built entirely on a lie. You cannot change your sex.

Now I could tell you all the damning evidence that has come out of the Cass Report, the most extensive review for gender distressed children in the world, by a highly esteemed paediatrician. I could tell you, for example, that Cass found that there is no evidence that puberty blockers help with a child’s mental health or distress, that they do not act as a pause because in 98% of cases the child goes on to take cross-sex hormones. Puberty blockers stop genuine sexual functions from developing, and they essentially bring about sterilisation. They have been linked to bone fractures and to chronic pain. They are an experimental treatment with no evidence base. I could go on, but I don’t think I need to because the fact that puberty blockers are built on a lie –the lie that you can change sex- is enough.

I’ve treated many young people who believe the answer to their problems is to change their body. The teenagers and young adults with Anorexia believed if they transformed their body to their dream weight, let’s say of seven stone, they would finally be comfortable and happy. Do you know what happens they get to ideal weight of seven stone? They don’t find the happiness they were expecting, and they realise that actually they want to be six stone. Then when they get to six stone, they realise that actually they want to weigh less than six stone. It never ends. It never solves the problem. We see the exact same thing happening with gender dysphoria. “I just want to put a pause on puberty, that will be enough to help me.” But it doesn’t help. Cass showed there was no evidence that mental distress reduces after puberty blockers. So they conclude that they need cross sex hormones, then they’ll be happy. Then they need cosmetic surgery, then everyone needs to refer to them by the correct pronouns, then their birth certificate needs to be changed, then the law needs to be changed, then everyone in the world needs to agree that they are the sex they say they are. But none of it will truly solve the problem because the problem was never located in the body. The problem was in the mind.