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Talk:Puberty blocker/Archive 4

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Latest comment: 1 month ago by The Anome in topic Updates to UK section
Archive 1 Archive 2 Archive 3 Archive 4

"Gender-affirming care" for children necessarily includes puberty blockers

Latest comment: 1 month ago21 comments5 people in discussion

@XeCyranium: I would hope this was clear from other sources, but when a medical organization says that they oppose any laws and regulations that discriminate against transgender and gender-diverse individuals specifying explicitly that that includes children and adolescents, or that it strongly opposes any legislation or policy action that places restrictions on transgender health care and that criminalizes gender-affirming care, again specifying explicitly that it includes children, that is in fact necessarily support for puberty blockers even if they don't say so explicitly.

Now, I wouldn't be opposed to more explanatory text being devoted to each of these organizations explaining exactly what their positions are. I agree that it's relevant that many of these organizations are expressing a political opposition to restrictions on trans healthcare (and not, for instance, publishing medical recommendations on when puberty blockers are or aren't indicated). But don't just remove them! You're doing the equivalent of removing proofs about rectangles from the article on squares. Loki (talk) 01:31, 24 March 2024 (UTC)

I'm sorry but I disagree with the part where it needn't be explicit. It'd be like saying "the XYZ association supports the use of chelation therapy to treat mercury poisoning" but with a statement that only says "XYZ objects to legislation which would interfere with the treatment of mercury poisoning". But if you'd like to include it with a [better source needed] I'd understand. I mostly removed since I'd been surprised by the mention of a nursing association and thought it odd they would endorse a specific drug and then saw that their statement contained no such endorsement. XeCyranium (talk) 01:40, 24 March 2024 (UTC)
I did find an explicit source for the American College of Physicians here: [1] XeCyranium (talk) 01:56, 24 March 2024 (UTC)
And here's a source for the American Academy of Family Physicians: [2]. XeCyranium (talk) 02:20, 24 March 2024 (UTC)
This document from the American College of Obstetricians and Gynaecologists says that for the treatment of adolescents reference should be made to WPATH and Endocrine Society provisions so essentially supports it: [3]. XeCyranium (talk) 02:28, 24 March 2024 (UTC)
And I'm giving up on the American Osteopathic Association, they have the worst website layout imaginable on mobile, at least for me. If anybody is able to access it from another device it can be found at osteopathic.org. XeCyranium (talk) 02:35, 24 March 2024 (UTC)
Well, no, it's like an organization opposing laws against proper treatment of cancer and you removing that from the article on chemotherapy because they don't explicitly mention the word "chemotherapy". Puberty blockers are widely regarded to be the standard of care, so even if an organization doesn't mention them by name, if they talk about the standard of care in this area it does include puberty blockers.
I do agree that this is again a weird artifact of this being simultaneously a WP:MEDRS page and a page about a political controversy, but despite these most directly being statements about the political controversy they are also WP:MEDRS-quality sources about the treatment. Loki (talk) 02:04, 24 March 2024 (UTC)
I did find sources for three of the five organizations. To clarify what I mean with it needing to be near-explicit: I'm sure every medical body listed in this article would probably provide a statement to the effect of "we oppose any legislation that would seek to restrict treatment for transgender youth", but some of those same organizations don't endorse puberty blockers. Ergo I think an explicit endorsement is best. XeCyranium (talk) 21:51, 24 March 2024 (UTC)
LokiTheLiar please don't reinsert content with WP:VERIFIABILITY concerns unless you're going to use sources that actually support the statement you're including. If you're at a loss for sources I've posted some here in this very section. Please adhere to policy, if there are sources which actually support the content in question, which there are, use those. XeCyranium (talk) 21:28, 29 March 2024 (UTC)
The sources that were already there supported the statement I re-added. You looked at a bunch of sources that verified the claims, said they "failed verification" when they didn't, and then removed the claims for failing verification.
Feel free to add new sources but I dispute your removal in the first place or the idea the existing sources were in any way subpar. Loki (talk) 21:31, 29 March 2024 (UTC)
I would also like to get some extra eyes on this to avoid an edit war, so pinging past participants in similar discussions Snokalok, Your Friendly Neighborhood Sociologist, Barnards.tar.gz, Colin, TenorTwelve, WhatamIdoing and Sideswipe9th. Loki (talk) 23:03, 29 March 2024 (UTC)
I checked the page, it no longer exists. Could we get an archive or something? Snokalok (talk) 04:00, 30 March 2024 (UTC)
The disputed diff is this one and a few others like it going back and forth.
The TL;DR explanation of why there's a dispute is that I think sources saying an organization supports gender-affirming care for trans kids is sufficient to say that organization supports the use of puberty blockers (because puberty blockers are standard of care). XeCyranium thinks that a source must specifically say the organization supports puberty blockers. Loki (talk) 00:52, 31 March 2024 (UTC)
Loki, I'm sure you've got the facts right in practice, but I'd like you to think for a moment about the precedent here. If an organization says "We oppose laws against treating trans kids", there's a big difference between "supporting mainstream medical care, such as family counseling and puberty blockers in 10 year olds" and "supporting conversion therapy" (or "going straight to gender-affirming hormone treatment in 10 year olds" at the other end of the spectrum). We really do need sources that provide specificity. Fortunately, it looks like those sources are available. It'll just require some work to dig them up.
@XeCyranium, I don't think that AOA has an official organizational statement about puberty blockers on their website. They provide general information (e.g., https://findado.osteopathic.org/raising-a-transgender-child ) but no official statement. Such a statement might not exist, or it might be published in a medical journal instead of on their website. WhatamIdoing (talk) 02:02, 31 March 2024 (UTC)
Thank you for looking into the osteopathic association. XeCyranium (talk) 02:58, 31 March 2024 (UTC)
I appreciate you inviting more editors but I feel I should reiterate what I said in my edit summary, WP:VERIFY isn't subject to editor consensus on a talk page, whether the source says something or not isn't up for debate. I don't object to three of the orgs assuming the sources I've found are useable. But the source you're insisting on simply doesn't say what you're attaching it to. XeCyranium (talk) 03:19, 31 March 2024 (UTC)
The policy itself isn't but how to interpret it and, crucially here, whether the sources actually support the claim or not absolutely is. I've already explained why I believe the sources in question do in fact source those claims. Loki (talk) 03:21, 31 March 2024 (UTC)
I think it is reasonable for editors to discuss and agree on whether X => Y and can be assumed. I'm not sure Loki has done his case any favours by arguing for different reasons why X => Y. There are various statements mentioned above that are proposed as implicitly meaning support for puberty blockers but I don't think most of them would find consensus here. Some examples:
  1. oppose any laws and regulations that discriminate against transgender and gender-diverse individuals, including children and adolescents
  2. strongly opposes any legislation or policy action that places restrictions on transgender health care and that criminalizes gender-affirming care, again specifying explicitly that it includes children
  3. opposition to restrictions on trans healthcare
  4. opposing laws against proper treatment
  5. Puberty blockers are widely regarded to be the standard of care, so even if an organization doesn't mention them by name, if they talk about the standard of care in this area...
  6. an organization supports gender-affirming care for trans kids
  7. oppose laws against treating trans kids
Even countries or organisations that agree on the use of puberty blockers for trans children might have quite different guidelines around their use. Even when they were more routinely used in NHS England (if "routinely" is an appropriate adjective for the tiny minority of referred patients who reached the end of the waiting list) I don't believe they were ever licenced for such use (correct me if I'm wrong) which is itself a negative (though not a fatal one: many epilepsy medicines are not licenced in children but yet used if an expert feels appropriate). I don't think "support/don't support" binary is appropriate for what is a nuanced medical decision.
What those US organisations are really saying is where the government can go stick itself, interfering with clinical choices for political ends, and that is ultimately are more binary argument that what the consensus is on the evidence for any one particular therapy. Wikipedia is not a political football, so I'm not particularly impressed by "Press release in response to Senator Stupid's latest law proposal" as any kind of MEDRS source. It is a political source. -- Colin°Talk 16:37, 31 March 2024 (UTC)
I know your perspective but I feel like you have to consider that a statement to the effect of "it would be wrong to legislate against treatment of a condition" isn't the same as an endorsement of a specific common component of said treatment. If the source just mentioned puberty blockers I'd have no problem, and again I don't think the statement is even wrong. Would it be a fair compromise to include three organizations for which I found sources, assuming you don't object to them, and include the other two with a [citation needed] tag for a given period? XeCyranium (talk) 01:20, 2 April 2024 (UTC)
I'd be okay with that if you included them with a [better source needed] tag instead. Loki (talk) 02:35, 2 April 2024 (UTC)
I included the ACOG and ACP sources but upon further looking into the AAFP I'm not sure if they actually do have practice guidelines on puberty blockers. The source I previously provided was only their coverage of the Endocrine Society's recommendations, but carries a disclaimer that it is not an endorsement from the AAFP. XeCyranium (talk) 23:46, 9 April 2024 (UTC)

The lead and highlighting countries

Latest comment: 1 month ago12 comments5 people in discussion

Since there is dispute over removing it, I figure we should strike the current mention of the American and Australian medical bodies from the lead. My main reason for this is that we have multiple other countries that are included in the relevant section which we don't mention in the lead. Now one might say the solution is to add every country to the lead but at that point I think it becomes less a lead and more just a retreading of the section in question. XeCyranium (talk) 01:34, 24 March 2024 (UTC)

I feel I should also bring up [4] which I originally assumed was reverted by mistake to also reinsert the lead as it was. user:LokiTheLiar did you mean to continue to revert this edit? It seems like blatant WP:SYNTH to me, the source makes zero mention of Finland. XeCyranium (talk) 01:44, 24 March 2024 (UTC)
That was indeed a mistake. I agree the AAP source there is WP:SYNTH but not "On the other hand," as the source for the Finnish Ministry explicitly makes the comparison. Loki (talk) 01:49, 24 March 2024 (UTC)
I'd have no problem with saying that, the language itself didn't bother me it was the random American tidbit. XeCyranium (talk) 01:53, 24 March 2024 (UTC)
I'm not really sure where else to put this, but I'll attach this to concerns about naming individual, country-specific organizations and laws in the lead.
MEDORG doesn't actually talk about "international organizations". What the rest of the guideline means when it talks about "national and international expert bodies" is pretty much:
WPATH and Endocrine would fall under that last point. So would most (but not all) of the organizations listed in https://glaad.org/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory/ We usually understand "expert" as excluding political and outright quack organizations.
But: Just because we could create a laundry list of organizations that support caring for trans kids, or even that specifically mention support for using puberty blockers (e.g., the Pediatric Endocrine Society) doesn't mean that we actually should have such a list in this article at all (cf. Joe Biden presidential campaign endorsements vs Joe Biden), or that we should name-drop our favorites at the top of the article.
If we are treating this as primarily a medical article, the lead should usually contain straightforward factual statements on points such as:
  • what it is (e.g., drug class and how many different ones there are),
  • what it's used for,
  • how it works,
  • what the side effects or other problems are, and
  • what the history is (e.g., discovery, regulatory approval, availability).
For example: Antibiotics are drugs used for bacterial infections, they kill or at least stop further growth of bacteria, you might end up with diarrhea or other problems, we're all a bit worried about antibiotic resistance, and the discovery of antibiotics has literally saved millions of lives.
When I look at the lead that we have for puberty blockers now, I don't see the subject of this article being treated like a normal medical treatment. I see a strenuous "marketing" effort that leaves me with the feeling that there's something suspicious here. I'm being told that all the cool organizations endorse this treatment, and that we're under attack in all these states. (Oh, and those kids with precocious puberty don't matter, even though there are probably more kids with PP than kids taking puberty blockers as part of trans care, which is doubtless doubly discouraging for anyone trying to help a Kindergartner manage her menstrual period.) WhatamIdoing (talk) 03:09, 31 March 2024 (UTC)
Do we have any stats on how many are using these drugs for precocious puberty vs gender affirming? This page is not handling well the different uses of these drugs. For example, the page mentions this source wrt "women who took Lupron in order to grow taller" which appears to be an off label use. And I don't think our article reports this non-MEDRS source correctly, as the adverse effect reports are for the drug full stop, not one particular use. I think there is a danger we report on effects/side-effects for one patient group (e.g. v young children) or another (adolescents) and confuse the reader about which is relevant. And I suspect historically that's been the intention in this field, in that the safety profile for precocious puberty has been assumed for teenagers.
I agree the page is overloaded with legal and political stuff which are NEWS and less encyclopaedic than the medical aspects. -- Colin°Talk 09:54, 3 April 2024 (UTC)
This sentence: The NICE review has been criticized by WPATH and EPATH for excluding studies combining puberty blockers and hormone replacement therapy and by parents of transgender youth for excluding evidence of its safety when used by cisgender youth undergoing precocious puberty. performs exactly that conflation. Precocious puberty lacks the psychological element that is the centrepiece of gender dysphoria, and the concern of Cass is the "unknown impacts on development, maturation and cognition if a child or young person is not exposed to the physical, psychological, physiological, neurochemical and sexual changes that accompany adolescent hormone surges".[5]
Precocious puberty is a separate condition, with a separate treatment regimen, and it cannot be assumed that safety and efficacy in one treatment context transfers to the other. Barnards.tar.gz (talk) 16:49, 5 April 2024 (UTC)
Efficacy, definitely, since the desired treatment outcome is different. (Or rather, the studies that say GnRH blockers work to prevent puberty are transferable but can't be taken to say that preventing puberty in trans kids improves outcomes.) But that's not what the quote you're talking about criticizes.
For safety, though, it doesn't make any sense to say someone is going to have more bone problems because they're trans. It's the same medication in very similar patients. Loki (talk) 20:26, 5 April 2024 (UTC)
The patients may be physically very similar but they are certainly not psychologically very similar, and the concerns raised by Cass and others are around the impact on cognitive development. Is the treatment really safe if it blocks psychosexual development, which is intertwined with identity development? This is not an issue in cases of precocious puberty, but it’s the very heart of the issue in cases of gender dysphoria. Then there’s the issue of blocking the development of mature decision-making abilities which are relied upon once the “time to think” is up.
So, it does not follow that the treatment being safe for precocious puberty makes it safe for use in children with radically different psychological symptoms.
Barnards.tar.gz (talk) 22:46, 5 April 2024 (UTC)
This sort of suggests that you (or Cass) would agree with YFNS that instead of puberty blockers, doctors should just directly prescribe HRT. But I at least very much doubt that Cass would agree with that, which suggests that what they say about just being concerned about delaying puberty at all is not really the issue.
I would say I don't have a source for this opinion, but I kind of do, since this is more-or-less what WPATH means by The selected studies by NICE only focused on the effects of puberty blockers, therefore studies that evaluated a combination of blockers, hormones, and/or surgeries were excluded. Loki (talk) 06:41, 6 April 2024 (UTC)
I’m very confused as to why you would think that I or Cass would come to that conclusion. What I’m saying is that assuming the effects of a drug on one population will be seen in a different population is invalid. Barnards.tar.gz (talk) 07:34, 6 April 2024 (UTC)
Looking at it from general principles, the main "physical" differences are likely to be due to the length of time on the drugs and the developmental stage the brain's in. Taking any hormone starting at age 3, and staying on it for 7 years, is likely to produce different effects than taking that same hormone starting at age 10 or 11, and staying on it for 12 to 24 months. Usually, you'd expect cumulative damage (e.g., bone loss) to be worse the longer you take a drug, but some effects only appear if the drug is taken during particular developmental stages or in combination with some other event (e.g., another drug or a comorbidity). We can't be certain that the drug side effects will be the same in these two groups, but IMO it's not entirely reasonable to write the article from the POV that, because it's unknown, then short-term use in older kids has a significant probability of having worse side effects than long-term use in little kids.
For this article, therefore, I suggest that we give the facts (e.g., the research is mostly done in younger kids with PP instead of older kids with TGD) without overemphasizing uncertainty or research limitations. WhatamIdoing (talk) 00:54, 13 April 2024 (UTC)

Overall article structure

Latest comment: 1 month ago20 comments7 people in discussion

This article doesn't follow the suggested form at Wikipedia:Manual of Style/Medicine-related articles#Drugs, treatments, and devices and I think the end result is that we're missing a lot of information. The suggested order is written with individual drugs in mind (e.g., for Fluoxetine (Prozac), not for Antidepressant or Selective serotonin reuptake inhibitor), but I think it is still useful as a sort of checklist that should be consulted and adapted to the needs of each subject.

Here's a comparison of this article vs the others. This is a political hot button in some parts of the world, but so are other drugs (e.g., opioid crisis, SSRIs in children, etc.). I think that if we make this article's structure look somewhat more like a normal drug-class article, we'll end up with an article that is more informative about the substances themselves.

Comparison of article structures
Puberty blocker Analgesic Antacid Anticonvulsant Antidepressant MEDMOS suggestion

If you look through this and it doesn't feel like a fit at all, then we might want to talk about whether the subject of the article is actually puberty blockers, or if perhaps you'd prefer to have an article on Delaying puberty in trans children. WhatamIdoing (talk) 23:46, 20 March 2024 (UTC)

An article scoped along the lines of use of puberty blockers in trans adolescents does seem like it would be a notable topic separate from this article. The use of puberty blockers for precocious puberty is pretty non-controversial and we're not really doing that justice in the current structure of the article. As far as I can recall, there are some known adverse effects for their use in precocious puberty that we don't really cover in this article at present, with the current section on adverse effects almost exclusively focusing on their adverse effects from use on trans youth.
We already have articles on feminising hormone therapy and masculinising hormone therapy, so creating a specific article to summarise the use and politics surrounding the use of puberty blockers in trans youth wouldn't be unreasonable in my opinion. If we did create one, we should leave a summary style blurb and section behind pointing towards that specific article while restructuring this one. What we'd call that article I don't know though, though I'm not sure "trans children" is correct. This type of medication is typically prescribed at Tanner 2, so "trans adolescents" might be more appropriate. Is there anything more concise than Delaying puberty in trans adolescents? Sideswipe9th (talk) 00:18, 21 March 2024 (UTC)
I think such a split might well be useful. Combining the two is a bit like the issue we have at ketogenic diet where the article is about an epilepsy therapy that is nearly exclusively used in children, but people want to talk about the weight loss fad diet in overweight adults (which currently sits at Low carbohydrate diet). They have similarities but the population groups are totally different, the proportions of food kinds (i.e. dose) is different, and the side effects and intended effects are different. What similarities there are has to come from sources explicitly noting similarities. -- Colin°Talk 11:47, 21 March 2024 (UTC)
If this gets split out, I think as far as naming I'd suggest separating out the current section that's taken over this page, so something like Puberty Blockers (Gender-affirming Care). Anything else is going to be subject to value judgements about tanner stages, age limits, terminology used in RSs and so on. Void if removed (talk) 13:57, 21 March 2024 (UTC)
What I worry about with this wording is that it risks leading a passive observer to think of the two as entirely different treatments, when really this is one treatment being used for multiple purposes.
Perhaps “Use of Puberty Blockers in Gender Affirming Care” Snokalok (talk) 14:33, 21 March 2024 (UTC)
No, it is two entirely different treatments, even if the same drug is used. There are quite a lot of drugs used to treat entirely different things. Like epilepsy drugs for neuropathic pain. Precocious puberty has totally separate causes, treatment intention and age when stopped.
This article currently is a weird one. It isn't a drug article like Triptorelin and it isn't a drug-class article like Gonadotropin-releasing hormone agonist. Those drugs could be used for prostate cancer, say, and nobody is blocking puberty in a 70-year-old man.
Is "gender affirming care" quite right? The puberty blocking is "to temporarily halt the development of secondary sex characteristics" and "allow patients more time to solidify their gender identity, without developing secondary sex characteristics, and give transgender youth a smoother transition into their desired gender identity as an adult". I'm not aware that anyone is affirming agender/immature as an body option, where the child remains forever pre-pubertal? Are they? It facilitates a later gender affirming stage, which is either to go on to sex hormones or to affirm that assigned-at-birth?
The "gender affirming" use of these drugs isn't "puberty blocking" but to reduce testosterone in trans women, say, who are also taking female hormones.
So I'm wondering if reliable sources talk about these being pre gender affirming care, or something like that? -- Colin°Talk 17:56, 21 March 2024 (UTC)
Your understanding is actually incorrect, puberty blockers are administered to trans children in the exact same manner as they are to cis children with precocious puberty. They’re not used concurrently with estrogen to block testosterone, those are medications like cyproacetate. Puberty blockers are used prior to estrogen to buy time to decide since puberty is a time sensitive matter. Snokalok (talk) 23:45, 21 March 2024 (UTC)
Regardless, the common medical parlance is to refer to them as gender affirming Snokalok (talk) 23:47, 21 March 2024 (UTC)
I suspect we disagree on what "exact same manner" means. If you look at the clinical guidelines for PP and what the clinician has to test for, consider, the range of possible treatments, the issues to monitor, when to start, when to stop, not forgetting the biggie of age-group, there's nothing the same about it other than what's in the medicine and its administrative route. I don't think we should conflate two different treatments, which each have entirely separate clinical guidelines, licencing (or lack of), eligibility criteria, causes, aims, and so on. -- 08:55, 22 March 2024 (UTC) Colin°Talk 08:55, 22 March 2024 (UTC)
This sort of thing is why I suggested just using what's there now as the least bad/most likely consensus. Getting into the whys and wherefores and age groups and terminological conflicts is gnarly. Frankly, when medical bodies are at odds over what the purpose even is or who it applies to, any title will inevitably pick sides on that disagreement.
I think it is clearest to use the language of the NICE reviews and NHS clinical commissioning ("children and adolescents with gender dysphoria/incongruence") but this is language WPATH etc are moving away from as pathologising so comes with its own set of conflicts. "Gender-affirming care" while not IMO as clinically bland and explanatory, does have the advantage of longstanding consensus on this page, and in the interests of avoiding yet another source-counting debate over who is or is not FRINGE I'd just stick to what's there right now, personally. Void if removed (talk) 09:30, 22 March 2024 (UTC)
@Sideswipe9th, I think "children" is fine, because Tanner II is usually around age 10 or 11 these days. In biological terms, they may be pubertal adolescents, but in social and legal terms, they're still children.
If we split the article, would it make sense to split by sex (male/female) or gender (trans boy/girl/non-binary) as well? The considerations (e.g., effects of endogenous testosterone on facial structure) do not apply equally to all body types or life goals. WhatamIdoing (talk) 17:13, 21 March 2024 (UTC)
On children vs adolescents; I'm pretty sure the reliable literature on this topic use either adolescent or youth, not children. The treatment protocols for trans children (pre-pubertal) are basically just social transition (ie name and pronoun changes, allowing the child to chose their own clothing and hair style, etc). Pubertal suppression really doesn't start until Tanner 2, at which case most sources I'm familiar with consider the individual an adolescent.
On splitting by sex or gender; No, I don't think we need a split on gender or sex here. There'd be a large amount of repetitive content between the two/three articles, as the treatment protocol itself is the same; same medications, same dose, same dose schedule. The differences in effects on secondary sex characteristics could be handled I think by separate subsections for male and female. Sideswipe9th (talk) 18:09, 21 March 2024 (UTC)
Just realised the argument on children vs adolescents in the title would be stronger with sources. WPATH SoC 8 has separate chapters for children, adolescents, and adults, and doesn't discuss puberty blockers until the adolescent chapter. The Endocrine Society guidelines also start their guidelines on puberty blockers in the "treatment of adolescents" chapter. The Australian SoC for trans and gender diverse children and adolescents don't give any guidance on puberty blockers until their adolescent chapter. The American Psychological Association's guidelines only briefly discuss puberty suppression in the context of adolescents.
The only major English language guideline (not searched other languages due to language barrier) that I've found that deviates from discussing puberty blockers solely in the context of adolescence is the NHS England guidelines and the 2020 NICE evidence review that has been subject to extensive discussion above. Both of those discuss puberty blockers for both childhood and adolescence. However the majority of the studies within the NICE evidence review use adolescents when referring to their respective cohorts. Sideswipe9th (talk) 18:32, 21 March 2024 (UTC)
The medical guidelines are talking about adolescents. Shall we prioritize the medical viewpoint over other viewpoints?
The options look like this:
  • Medical viewpoint: The patient is 11 years old and Tanner stage 2, so "adolescent".
  • Social viewpoint: The 11-year-old next door is a great kid.
  • Legal viewpoint: 11 year olds are children.
Wikipedians have a tendency towards overmedicalization. Is that a tendency that we want to embrace here, or to resist? WhatamIdoing (talk) 01:22, 31 March 2024 (UTC)
I don’t support separating this as it is the same medicine. I will also note that sources will often talk about precocious puberty and transgender children in the same article in reference to each other. Also “Delaying puberty in trans children” is not a neutral wording as it gives the impression this is an experiment on trans kids, which it is not. -TenorTwelve (talk) 07:23, 23 March 2024 (UTC)
@TenorTwelve, what makes you think that delaying puberty is treating trans kids like guinea pigs? Presumably the goal of giving puberty blockers to trans kids is to delay puberty, so "delaying puberty" sounds like a pretty simple, factual description to me. WhatamIdoing (talk) 02:04, 13 April 2024 (UTC)
I am not comparing children’s health care to an experiment and if I gave that impression, I apologize. I’m looking at this from multiple angles. “Delaying puberty” is factually correct. My worry is that it could be misinterpreted in a way to question the motives of the administration of health care. Though that wasn’t my point. I wrote this to oppose separating the article into precocious puberty and trans care because they are the same medicine and the two are often mentioned jointly in reliable sources.-TenorTwelve (talk) 09:27, 13 April 2024 (UTC)
I wonder if it's really true that the two are often mentioned jointly in reliable sources, or if it's instead more true that sources about trans kids mention precocious puberty (e.g., as a way of indicating that it is a medical treatment that's been successfully used for years in a condition that isn't socially controversial). It could be that the trans sources mention PP but the PP sources don't mention trans. WhatamIdoing (talk) 00:25, 17 April 2024 (UTC)
I've done a little literature search on PubMed. Here's what I've found. The term "puberty blocker" is not used in the literature to refer to treatment for precocious puberty. There are a number of treatments for precocious puberty and "GnRH analogues" or "GnRH analog" are the terms that those dealing with precocious puberty used to refer to the treatment it shares with trans kids and we have an article on them: Gonadotropin-releasing hormone agonist. If you try searching for "puberty blocker" and "precocious puberty" together you will find nothing. Whereas searching for "puberty blocker" or "puberty blockers" uncovers only trans topics. If you search for "GnRH analogues" and similar words and for individual drugs, you find that they get used for precocious puberty but also for treating female and male cancers that are hormone encouraged, and other random stuff. And nobody says to a 60 year old with prostate cancer that we're going to put you on puberty blockers.
The term "puberty blocker" is a trans-therapy term. I think that's a killer blow for the the idea that this article is about precocious puberty at all, or about any other uses of these drugs such as cancer treatment. And I suspect there's a good reason people choose to link this to the treatment for precocious puberty rather than breast cancer as "Around 10% of the patients taking XYZ die of breast cancer within five years" doesn't sound so great.
If you look in the history, you see the first version of this article was talking about treating trans kids and the mention of precocious puberty is explicitly talking about an earlier use of such drugs, but not this one.
The very fact that such drugs are not licenced for treating trans kids means that even articles on the individual drugs will suffer generally from a weakness of literature on their use for that, since the manufacturer never ran trials on that group. So I think the literature on the drugs themselves and the literature on precocious puberty will not generally mention treating trans kids other than as an aside.
In contrast of course there is motivation in the trans literature to refer to the earlier, safe, licenced treatment for an entirely different patient group. In that regard, it is similar to how e.g. an article on migraine treatments might mention that some of the drugs are also used to treat other conditions, but just as aside.
Rather than split the article, I suggest the article titled Puberty blocker focus entirely on the therapy for trans kids, mentioning precocious puberty as an aside, as that is exactly what the literature does with that term. -- Colin°Talk 08:17, 17 April 2024 (UTC)
All excellent points, @Colin Zeno27 (talk) 09:53, 17 April 2024 (UTC)

Updates to UK section

Latest comment: 1 month ago2 comments2 people in discussion

I don’t want to get involved in editing a medical article. But I think the UK section of this article should be updated to say (a) that private clinics may have trouble with the regulator if they prescribe puberty blockers [6], and (b) that the Scottish Sandyford Clinic has announced that it has ‘paused’ prescribing puberty blockers [7]. Sweet6970 (talk) 16:56, 18 April 2024 (UTC)

Agreed. — The Anome (talk) 12:11, 20 April 2024 (UTC)
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