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The Zembla investigation reveals that the scientific evidence for the treatment of transgender youth is insufficient. Concerns also exist regarding the impact of treatment on brain development, with research on this topic being announced seventeen years ago but never conducted. Puberty blockers are used to pause puberty in children with gender dysphoria, allowing time for reflection before irreversible hormone treatments and surgeries. However, the effectiveness of these blockers is questioned, and their potential effects on brain development remain unknown. Limited research suggests that they may influence brain development, but the implications for adolescents are unclear. Further research is needed to provide clarity and inform decision-making for transgender youth.

Dr. Olsen decides to start Josie on blockers and promises to give her estrogen in two years. Josie receives the blockers as an arm implant and holds on tight as she prepares for the next chapter of her life. The speaker reflects on how just 20 years ago, they wouldn't have been able to provide blockers, and Josie would have had to go through male puberty, which terrifies them. They express uncertainty about whether Josie would have survived male puberty.

A clinician explains that a chart could show a 15 year old female with a testosterone deficiency, but 'it's a boy that has a testosterone deficiency' and that 'testosterone ... doesn't raise any red flags.' An insurance claim showing 'a boy who has a testosterone deficiency on paper' can obscure fraud. The speaker calls the pattern the 'unholy trinity'—'The hospital system, the pharmaceutical industry, and health insurance companies.' Regarding drugs, puberty blockers 'was Lupron is the most common one,' plus testosterone and estrogen. Some of these drugs are used to chemically castrate sex offenders, and there are children with health issues who need them. There are lack of safeguards: Medicaid and similar insurers 'don't have a system in place where they verify to make sure this is correct before they reimburse.' There should be oversight. 'They actually put the sex they want to be, not the sex they are.'

Max, who identifies as a boy, is visiting the doctor to discuss hormone blockers to prevent puberty. He has started experiencing some breast growth and feels uncomfortable. His parent expresses concern about medical interventions and their effects on bone health and psychosocial development. The doctor explains that hormone blockers can halt puberty progression and reassures that if Max changes his mind, he can still go through female puberty later. The procedure involves inserting a small implant in Max's arm, which will last about 14 to 18 months. The entire process is quick, taking only about 10 to 15 minutes.

Puberty blockers are drugs given to children who wish to transition genders, halting their natural development. This practice can lead to lifelong dependency on hormones and sterilization, raising concerns about child welfare. The conversation touches on whether children can truly understand the implications of such decisions at a young age. One perspective argues that gender identity is a personal choice, while the opposing view emphasizes the importance of biological reality. The discussion highlights the risks of affirming a child's desire to transition without addressing underlying mental health issues. Ultimately, it questions the morality of medical interventions on minors, advocating for a more cautious approach that respects the complexities of gender identity and the well-being of children.

"For someone who is assigned male at birth and if they've already been through puberty, they could produce a semen specimen and have it frozen." "If someone is assigned female at birth and they are also all the way through puberty, you can do egg banking, which entails a little bit more." "Typically, you have to take some additional hormone injections and it's a procedure to go in and retrieve the eggs." "We think someone has to be probably in mid male puberty to produce semen." "There have been some case reports of transgender men who were assigned female at birth who weren't completely through puberty and have been able to do fertility preservation, but we don't know if that applies to everybody." "We definitely counsel all of our patients about fertility preservation." "Usually from their first visit, we're starting to talk about it."

The ovary doesn't produce estrogen anymore and the testicle doesn't produce testosterone. Thus, the signs that we see from these hormones are blocked and don't progress in puberty. The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult. We can prevent the need for any chest reconstruction in affirm trans males or facial feminization surgery in transfemales. They are also reversible, and thus if the patient decides to stop using pubertal blockers, their endogenous puberty will resume as previous. Using pubertal blockers can alleviate the depression or worsening gender dysphoria that is often associated with progressing pubertal changes. And lastly, the use of puberty suppression is recommended by the Pediatric Endocrine Society in their clinical guidelines for the treatment of transgender and gender diverse youth.

Clementine, a detransitioner, shares her experience with another person also named Clementine. She began puberty blockers at 12, testosterone at 13, and had a double mastectomy at 14. Testosterone caused her to experience psychosis, so she stopped taking it around age 17. Now 20, she detransitioned earlier this year and is undergoing reconstructive surgery. She notes that getting approval for reconstructive surgery has been more difficult than getting the initial double mastectomy. She expresses disbelief that people question the experiences of detransitioners.

A child will often know that they are transgender from the moment that they have any ability to express themselves, and parents will often tell us this. We have parents who tell us that their kids, they knew from the minute they were born practically, and actions like refusing to get a haircut or standing to urinate, trying on siblings' clothing, playing with the quote opposite gender toys, things like that. There is more and more a group of adolescents that we are seeing that really are coming to the realization that they might be trans or gender diverse a little bit later on in their life. So what we're seeing from them is that they always sort of knew something was maybe off and didn't have the understanding to know that they might be trans or have a different gender identity than the one they had been assigned. So that is a growing population that we are seeing and that's being recognized as being trans and able to be treated.

"The eligibility for getting gender affirming surgeries at Boston Children's Hospital is basically the same as it would be for most other hospitals or surgeons in The United States." "And that's the case because we all follow the World Professional Association for Transgender Health or WPATH standards of care." "For top surgery, you are requested, but not required to have been on gender affirming hormones for at least a year." "If you're a trans woman, it's really encouraged that you be on estrogen for at least a year because you want to maximize your natural breast growth." "Many surgical centers require you to be 18." "At Boston Children's Hospital for top surgeries, we'll see people as young as age 15 if they've been affirmed in their gender for a long period of time and don't really have any other life complications that make surgery inappropriate."

The speaker discusses the standards applied to children and the potential benefits of going on blockers. They mention that blockers can prevent the development of a deep voice, Adam's apple, and facial hair. The speaker shares their personal experience of spending $5,000 on facial hair removal and $25,000 on facial feminization surgery. They believe that blockers can prevent the need for such procedures and alleviate stress.

Admiral Rachel Levine, a pediatrician and the assistant secretary for the Department of Health and Human Services, addresses concerns about children transitioning before 18. She emphasizes the challenges of adolescence, particularly for those experiencing gender dysphoria. If a child feels female but is undergoing male puberty, it can be distressing. Critics argue that children are too young to make such decisions. Levine clarifies that for prepubertal children, no medical procedures are performed; instead, they are supported through therapy to explore their feelings.

Doctor Olsen faced a decision regarding Josie's treatment. She advised starting hormone blockers around age 13, ensuring Josie wouldn't have to wait until 16 to begin. Josie received the blockers as an implant in her arm, showing great bravery as she embraced this new chapter in her life. The doctor reflected on how, just twenty years ago, such treatment wouldn't have been possible, and Josie would have faced male puberty, which was a terrifying thought. The doctor expressed relief that they could provide this support now, emphasizing the importance of the decision for Josie's well-being.

"Puberty blockers work at the level of the pituitary gland and they actually suppress the release of the LH and the FSH so that the sex organs are no longer stimulated." "The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult." "They are also reversible, and thus if the patient decides to stop using pubertal blockers, their endogenous puberty will resume as previous." "Using pubertal blockers can alleviate the depression or worsening gender dysphoria that is often associated with progressing pubertal changes." "Lastly, the use of puberty suppression is recommended by the Pediatric Endocrine Society in their clinical guidelines for the treatment of transgender and gender diverse youth." "The practice of using puberty suppressors in transgender youth is new." "Since the first clinical guidelines were only published in 02/2009."

Michigan Medicine strives to be a safe, welcoming place for transgender individuals and to provide excellent health care regardless of gender. The goal of this video is to improve the comfort and competency of frontline staff in caring for transgender individuals. We will start by talking about gender identity, challenges the transgender community has faced in the health care system, and Michigan's policies regarding gender non-discrimination. The second half of this training is job specific. To discuss gender identity, it is important to understand the difference between sex and gender. Sex refers to one's reproductive organs, native hormones, and chromosomes, while gender identity refers to one's internal sense of gender, a person's basic sense of being a man or boy, a woman or girl, or another gender. Gender identity can be expressed by how individuals present themselves socially, including clothing, physical characteristics, speech, and mannerisms. All people, whether they are transgender or cisgender, meaning not transgender, have a gender identity and expression. Transgender is a term for individuals whose gender identity differs from the gender identity typically associated with their sex assigned at birth. There are many identities that fall under the umbrella of transgender. Transgender men, trans men, or trans masculine refer to people who are assigned female sex at birth but identify as men or masculine. Transgender women, trans women, or trans feminine refer to people who were assigned male sex at birth but identify as women or feminine. Other individuals may identify as genderqueer, agender, genderfluid, two spirited, bigender, or another identity that does not fit neatly into the categories of men or women. All major American medical societies, including the American Medical Association and American Psychological Association, endorse gender affirming care as the standard of care for transgender individuals. This means caring for people in a way that supports their gender transition and gender identity. Transgender people may undergo any one of a number of gender affirming medical interventions, including hormonal therapies like estrogen, testosterone, or hormone blockers, and surgical treatment to change body contours or genitalia. However, it is important to note that one does not have to undergo any medical or surgical treatment to be transgender. Some people are easily read as the gender they affirm while others are visibly gender non conforming or androgynous appearing.

"Sometimes it may be just a phase of development where they're exploring their gender identity and they're kind of getting a sense of who they are, but a lot of children do end up identifying as that gender into young adulthood and adulthood." "The only real way we know for sure that they're going to continue in that gender identity is just to allow them to develop over time." "And so that's what we recommend to parents is to give them the space." "Even if parents are concerned that it's a phase, we never want to tell the child that they shouldn't be expressing their gender identity or that they should be, ashamed for the way that they're expressing their identity because that can be quite harmful." "We just want to give the child a chance to develop and explore on their own."

Beauty blockers have been used by doctors for kids experiencing precocious puberty. The conversation then shifts to transgender children, with one speaker arguing that gender affirming care is life-saving and reduces suicide rates. The other speaker questions the lack of studies on suicide rates among transgender children and argues against medical interventions like hormone therapy and surgeries. The conversation becomes heated, with one speaker claiming that transgender children don't exist and that they should be accepted as they are, while the other argues that they need medical interventions. The debate centers around the belief that transgender children are either born in the wrong body or that they should be accepted without medical interventions.

If you're transgender or nonbinary and feel uncomfortable with your puberty experiences, you're not alone. Puberty blockers can temporarily halt the changes caused by hormones like testosterone and estrogen, giving you more time to figure out your gender identity. It's okay to not have all the answers right now, as understanding yourself takes time. Talking to a trusted adult, nurse, or doctor can be helpful. To learn more, visit plannedparenthood.org/teens.

Beauty blockers have been used by doctors for children experiencing precocious puberty. The conversation then shifts to transgender children, with one speaker arguing that gender affirming care is life-saving and reduces suicide rates. The other speaker questions the lack of studies on suicide rates among transgender children and challenges the necessity of medical interventions such as hormone therapy and surgeries. The conversation becomes heated as they discuss the cutting off of body parts and the speaker's belief that there is no such thing as a transgender child. The debate centers around the message being sent to children and the potential harm or benefit of gender affirming care.

Karen Selva, pediatric endocrinologist and medical director of Randall Children's Hospital T Clinic, discusses puberty blockers for transgender and gender expansive youth. Puberty blockers work at the level of the pituitary gland and they actually suppress the release of the LH and the FSH so that the sex organs are no longer stimulated; The signs are blocked and don't progress. The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult. We can prevent chest reconstruction in affirm trans males or facial feminization surgery in transfemales. They are reversible; if stopped, endogenous puberty resumes. They can alleviate depression or worsening gender dysphoria. The Pediatric Endocrine Society recommends puberty suppression in clinical guidelines for transgender and gender diverse youth. The practice is new; first guidelines were published in 02/2009, and long-term data are not yet available.

Planned Parenthood is reportedly becoming a top provider of puberty blockers to teenagers in America after the overturning of Roe v. Wade. Almost 12,000 teenagers aged 12-17 have allegedly been treated with puberty blockers or "pro trans counseling" by Planned Parenthood, often with no prior history of gender dysphoria or medical diagnosis. Detransitioners' stories are exposing the alleged inadequacy of Planned Parenthood's counseling. One woman, Helena Kirschner, was allegedly given four times the typical starting dose of testosterone hormone replacement therapy by a nurse practitioner in under an hour. Another woman, Pat Katzen, allegedly received a testosterone prescription after a 30-minute phone call with a Planned Parenthood doctor. Given Planned Parenthood's influence on sex education curriculum and its $700 million in annual taxpayer funding, the speaker suggests the organization is running a "pyramid scheme" to indoctrinate children into believing they were "born in the wrong body" and then prescribe them medication.

In 2021, a study found no significant changes in mental health or gender dysphoria among children on puberty blockers. A recent reanalysis showed that after 12 months, 34% had worsened, 29% improved, and 37% stayed the same. The original study lacked a control group, so causation couldn't be determined. Blocking puberty may ease future gender transition, but this wasn't the focus of the study. The key lesson is to adapt practice when new evidence emerges.