Impact of Puberty Blockers on Adolescent Mental Health: Ongoing Debate

Since 2015, Johanna Olson-Kennedy, a prominent advocate for adolescent gender treatments, has led a federal study examining puberty blockers' mental health effects on transgender youth. Olson-Kennedy, who heads a leading youth gender clinic at the Children’s Hospital in Los Angeles, began the project as part of a larger National Institutes of Health (NIH) initiative on transgender health, which provided $9.7 million in funding. However, the study’s findings have not yet been published, reportedly due to Olson-Kennedy's concerns over the political ramifications of the data.

In the study, Olson-Kennedy and her team followed 95 children, each experiencing gender dysphoria, over two years to assess the impact of puberty blockers on their mental health. Puberty blockers, often used in gender-affirming care, are prescribed to pause physical changes like breast development or voice deepening, changes that might deepen feelings of dysphoria. These treatments were initially inspired by a Dutch study from the early 2000s, which found that puberty blockers improved mental well-being in transgender youth. Following these findings, many clinics globally adopted the approach, which has come to be known as gender-affirming care. But, unlike the Dutch study, Olson-Kennedy’s U.S.-based study reported no mental health improvements after two years of puberty blockers.

Olson-Kennedy suggested that the lack of improvement was likely due to the participants’ already favorable mental health at the beginning of the study, which she described as being "in good shape." This assessment appeared to contradict preliminary findings in which around one-quarter of participants reported symptoms of depression or suicidal thoughts before starting treatment. In response, Olson-Kennedy explained that her statement referred to overall data averages, and further analysis of the full data set is ongoing.

Despite the discrepancies in initial assessments, Olson-Kennedy voiced concerns that publishing the study could inadvertently strengthen arguments for state bans on puberty blockers, already in place in over 20 states. These states prohibit gender-affirming treatments for minors, reflecting the heated political climate surrounding transgender youth care in the United States. Olson-Kennedy emphasized her desire to ensure the study’s conclusions are “exactly on point, clear, and concise” before publication. She also noted that NIH funding reductions affected the project’s timeline, a claim that NIH denied, stating that publication timing is at the researchers' discretion.

Some of Olson-Kennedy’s collaborators have voiced reservations about delaying publication, citing the need for transparency regardless of potential backlash. Amy Tishelman, a clinical psychologist from Boston College who contributed to the study, asserted that the findings should be made public, even if they diverge from anticipated outcomes. Tishelman suggested that while puberty blockers may not yield positive changes in mental health, they could still prevent deterioration. “No change isn’t necessarily a negative finding — there could be a preventative aspect to it,” she said. Researchers like Tishelman argue that even seemingly neutral results can guide both clinical practice and patient decision-making.

Across the Atlantic, similar studies have also cast doubt on puberty blockers’ effectiveness in improving youth mental health. The United Kingdom's National Health Service (NHS) conducted a study in 2011 involving 44 transgender children, aiming to replicate the Dutch findings. However, their findings did not show improved mental health or reduced self-harm after two years on puberty blockers. The NHS did not publicly share these results until 2020, long after puberty blockers had become standard treatment for children with gender dysphoria in England. This delayed publication spurred criticism, and, following the findings, the NHS limited the use of puberty blockers outside clinical trials.

Hilary Cass, a pediatrician who recently reviewed England's youth gender services, echoed these concerns. Cass argued that withholding results from American and British studies has fostered an inaccurate perception that puberty blockers have guaranteed mental health benefits. In her review, Cass highlighted weak evidence for these benefits and pointed to associated risks, such as bone growth delays and fertility reduction in some cases. Her findings prompted the NHS to stop prescribing puberty blockers except within controlled clinical trials, aligning with similar policy shifts in several European nations.

While Olson-Kennedy’s team has not yet released findings on puberty blockers’ effects on bone health, other segments of the NIH-funded project have produced noteworthy results. A recent study from 2023 analyzed the outcomes for older transgender and nonbinary adolescents who used testosterone or estrogen. This study reported an increase in life and body satisfaction over two years, with reductions in depression and anxiety, particularly among those taking testosterone. However, the study also recorded two suicides among the 315 participants, indicating a suicide rate substantially higher than the general population.

Olson-Kennedy contends that clinical experience with puberty blockers and hormonal treatments should be valued alongside research findings. With 17 years of experience prescribing these treatments to transgender children and adolescents, Olson-Kennedy has witnessed the positive impact they can have on young people’s lives. She expressed frustration that large studies, despite their rigor, cannot always capture the nuances seen in clinical practice. Olson-Kennedy pointed out, “These are minuscule compared to the amount of people that we’ve taken care of.”

The NIH encourages publication of data funded by its grants but ultimately leaves the timing up to researchers. Olson-Kennedy has reassured that her team intends to release the data, emphasizing the importance of rigorous and careful analysis. Yet, delays have drawn criticism from some researchers, parents, and clinicians who stress the urgency of clear guidance on treatments that affect transgender youth worldwide. “It’s really important we get results out there so we understand whether it’s helpful or not, and for whom,” Cass argued.

In the ongoing debate on puberty blockers for transgender youth, researchers remain divided on how best to balance scientific transparency with the potential social and political ramifications of their findings. Although Olson-Kennedy’s study does not confirm that puberty blockers lead to improved mental health, some suggest that these treatments may still prevent further decline, underscoring the need for more nuanced research to understand the full impact on youth well-being.

Reference:

1. Ghorayshi, Azeen. “U.S. Study on Puberty Blockers Goes Unpublished Because of Politics, Doctor Says.” The New York Times, October 23, 2024. https://www.nytimes.com/2024/10/23/science/puberty-blockers-olson-kennedy.html.

(Input from various sources)

(Rehash/Yash Kamble/MSM)