Tag Archives: Mental Health

Politics & Current Affairs

Why Puberty Blockers Are Essential Healthcare Tools

Let’s talk about puberty blockers, an essential element of safe and successful gender-affirming care for transgender youth. Social media, politicians, and news outlets have shared a great deal of misleading information about what these drugs do, how they work, and whether they’re dangerous or reversible. This has even led some U.S. cities and regions to enact legislation against their use. Tragically, some localities have even established punitive measures against trans children and the parents who allow them this life-improving and sometimes even life-sustaining care. So let’s take a look at what they really are, how they really work, and why they’re such important mental and physical health tools for many trans kids. 

Puberty-blocking drugs don’t stop puberty for all time; they just stop it for right now. Their results are reversible. If kids stop using them, puberty resumes. There is no evidence that puberty blockers affect future fertility, though taking estrogen or testosterone with them may impact the ability to have children later.

Puberty blockers were approved by the FDA in 1993. According to Cedars Sinai Medical Centers, they’re considered very safe by the medical community. They may possibly affect height (they may delay growth-plate closure, which can lead to taller adult height), and may slightly lower bone density for some. But so far, research shows the effects to be minimal. Doctors and hospitals are required to provide detailed information about risks and downsides to children and their families before providing them with these medications. People with severe gender dysphoria (i.e., who feel their genders to be different that the one assigned to them at birth) usually feel that living in a body that feels more like them is worth being a little taller, or worth taking bone-strengthening minerals and drugs to avoid osteoporosis later in life.

When children feel strongly that their genders don’t match the ones assigned to them at birth, going through puberty can feel crushing and tragic—a permanent sign to the world to treat them as someone they know they’re not. According to the Mayo Clinic, puberty blocking drugs keep kids from going through major changes (some irreversible) like the development of breasts, body hair, and male genitalia; deepening of the voice; and menstruation.

To get rid of those signs, many people go through painful, expensive, and difficult surgery later. But there are certain things that happen to the body at puberty that may not be reversible even with surgery. Those who undergo surgery later often experience complications, pain, great expense, and all the risks that come with surgery and anesthesia. Yet they still don’t have physical outcomes as successful as they might have if given puberty blockers at the first signs of puberty.

Many trans children who go through puberty and see their bodies undergoing distressing, permanent changes suffer severe depression and other negative mental health challenges, according to the National Institutes of Health. Some engage in self-harm such as cutting, substance abuse, or suicide. If given access to puberty blockers, they can delay or stop many of those changes, buying them time until they’re adults and can decide legally how they want to present and identify themselves. Puberty blockers have been shown to significantly reduce depression and suicidality in trans children.

Puberty blockers have led to improved mental health, better social interactions with other kids, and sometimes avoidance of future gender-confirmation surgeries.

The physician information portal HCPLive (which is part of the MJH Life Sciences publishing company) writes, “Investigators said that previous data showed gender-affirming hormones (GAH), puberty blockers (PBs), and gender-affirming surgeries have been found to be independently associated with reduced depression, anxiety and additional adverse mental health outcomes. Puberty blockers administered during puberty can actually reduce suicide risk in this population. A decreased lifetime incidence of suicidal ideation was also found among adults who received access to puberty blockers during adolescence.”

In short, puberty blockers improve and even save lives. They don’t poison children, or take away their choices later. These drugs give children the freedom to delay major health and life choices until adulthood. They align physical and psychological health, and let children feel more like themselves. Providing them to children whose lives could be immeasurably improved—even saved—by them makes them an essential element of pediatric healthcare.

Articles, Oddments, Politics & Current Affairs

Avoid Bullies During (and After) the Holidays

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[Originally published in November 2016.]

As the holidays approach, I’m reminded of multiple painful Thanksgiving dinners years ago during which I felt forced to spend time with a relative who repeatedly bullied me. She insulted me in my own house, picked fights with me in front of others and blamed me for actions I hadn’t taken, and for words I never said. Ultimately, I refused to be treated that way anymore, and stopped spending holidays with someone who insisted on telling lies about me and attacking me for things I didn’t do. Having to refuse to see her at holidays was very painful, but spending time with someone who claimed to love me yet also berated, insulted and lied to me and about me was worse.

If you find yourself in a situation in which you are dreading holidays because you fear that you will be insulted or attacked, or worry that you will feel trapped and helpless, remember: there is no rule that says you must be with other people at holiday time. We have all been told that spending a holiday alone is terrifying and awful, and that holiday solitude means we are bad or worthless, unloved or unloving. None of that is true.

If you dread the holidays because you fear you have no alternative but to walk into the lion’s den and be eaten, know that it is perfectly okay to stay home (or go away someplace) and celebrate the day in your own way. You can be thankful and be a good person even if you eat a bowl of soup by yourself or with only your partner or immediate family, then take yourself out to a movie. You can sleep in and catch up on your novel, or binge watch your favorite TV show, or listen to podcasts while you do puzzles, or take a long walk with your favorite dog. You can eat spaghetti instead of turkey. You always have options.

The biggest concern about opting out of powerfully painful social interactions is often about how others will view you afterwards: will they shun you, punish you, talk about you behind your back if you don’t attend? They might. Your refusing to attend an event could cause a family rift. Not attending Thanksgiving with your in-laws or sister or dad might mean getting angry phone calls about it later, so there is a trade-off and a risk of future pain. But if you are miserable being with other people because they treat you with contempt or disregard, is that a healthy dynamic to perpetuate? If they (or you) become abusive when provoked, especially in the current political climate when so many of us are fragile, thin-skinned and worried about the future, engaging with others in anger after one too many glasses of holiday wine could be not only emotionally but physically unsafe.

If being with a person, even one whom you love, makes you feel sick, sad, worthless, angry or frustrated and efforts to interact in a healthier way haven’t worked, clinging to that relationship even though it brings out the worst in you and others can be very damaging. Being unwilling to accept another’s bad behavior just because it comes from a family member does not make you monstrous. Avoiding abusive situations is just good self care.

Depression is often exacerbated over the holidays when we compare what we think we need to feel fulfilled with what seems to be available to us. We may be reminded of past hurts, losses, shame and regrets, and they may overwhelm our feelings of love, happiness or safety. If you fear that being with certain people is not safe for you and will bring on destructive feelings toward yourself (or them), remember: you don’t have to engage. You don’t have to attend events. You can have a quiet holiday on your own without falling apart. Others may respond with hurt feelings, and you may have to deal with your own feelings of guilt (often not deserved) if you prioritize your own mental health above placating those who cause you distress. But if you’re an adult, you do have a choice about where you spend your time and with whom. Please don’t put yourself or others in harm’s way.

History, Politics & Current Affairs

The Myth of the Ever-More-Fragile College Student

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Photo by Matthieu Spohn for New York Magazine: Science of Us

New York Magazine’s Science of Us website, which features articles related to human behavior, shared this article  by debunking what has been a creeping assumption among media outlets, college counselors and other alarmists that Millennials are fragile, anxious and unfit for the “real world,” and have been coddled and weakened by our overweening, infantilizing society.

Cultural critics posit that today’s college-aged young adults are becoming more stressed, anxious, depressed and generally emotionally frail than ever before, and they say that colleges and society in general are babying them and causing increased neuroticism. This long, extremely detailed and well-researched article points to evidence that those who believe that today’s youth are going to Hell in a handbasket rely too much on their own confirmation bias; undervalue the importance of huge socioeconomic changes over the past decade (including a deep and damaging recession); and, most importantly, ignore actual metrics and provable data that show their negative assumptions about Millennials to be overblown at best and highly inaccurate at worst.

Those who deride Millennials often extrapolate from small samples while ignoring actual, repeatable results from larger longitudinal studies at colleges across the nation. I highly recommend this article for a more factually based and nuanced perspective.