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Notes -
Hospital in Canada:
I suppose if the hospital's "Gender Pathways Service" is already prescribing puberty blockers so freely that there's no requirement for diagnosis beyond the child or child's parent getting a referral by saying something about transgenderism to the family doctor, giving them before the first appointment saves time. While doing so based on 0 appointments is obviously unusual, quite a few of the anecdotes I've heard mention prescriptions after the 1st appointment. The way you describe it used to be much more standard, I remember trans-activists complaining about previous requirements like living for 6-months to a year as the opposite gender, but doesn't seem common anymore.
It's possible they justify this with the argument that puberty blockers are much less significant than opposite-sex hormones and are just "giving the child time to choose" or some such thing, but that seems heavily contradicted by the evidence. For one it amounts to much the same decision: 97% of children put on puberty blockers go on to take hormones (page 38), but around 60%-90% of trans children who aren't given any intervention (the previously standard "watchful waiting" approach) grow up to not be trans. For another puberty blockers themselves, particularly when used to avert puberty entirely rather than delay precocious-puberty a couple years, are serious business. We know about them impacting bone density based on the use with precocious-puberty, but we also have reason to believe they impact brain development but have zero research on what that impact is in humans. The best I've found is this study on sheep. A concern mentioned by the NHS's independent review:
Given how the medical system is normally so obsessed with the precautionary principle (like the FDA shutting down early unapproved COVID testing) it seems crazy that something as significant as preventing puberty entirely has become standard practice based on no more than the same drugs previously being approved to delay precocious puberty. There's a severe lack of research on even the safety/side-effects of using those drugs that way, let alone a randomized control trial of effectiveness indicating it actually performs better as a treatment of trans-identifying children than doing nothing.
Broadly, I don't necessarily disagree, but surely got to be careful with selection effects here, and the direction of causation. It would seem likely that the kids who felt 'strongest' about their dysphoria would want to go on blockers immediately and those who weren't so sure watch and wait, and further that those kids who felt strongly would be more likely to persist in transition. Which is to say, it isn't that blockers make it more likely to continue transition, but that people more likely to continue transition take blockers.
The selection effects wouldn't be that straightforward because the second link is to a meta-study of studies by clinics on outcomes for all the children they diagnosed with gender dysphoria, none of whom were given puberty blockers. There unfortunately aren't many studies like that and the children in question were diagnosed before use of puberty-blockers became widespread.
Now, that definitely raises its own serious problems in comparing the two groups. In particular, the number of children diagnosed with gender dysphoria since those studies has risen enormously. At the recently-closed Tavistock/Gender Identity Development Service clinic in the UK, the NHS's only gender clinic for children, referrals rose from 94 in 2010 to 2,519 in 2018. So there's not a lot of reason to believe those diagnosed with gender dysphoria in the earlier studies included in that meta-study are representative of more than a small fraction of those diagnosed today. But it seems difficult to justify that those diagnosed with gender dysphoria before the increase would be more prone to desistance under a watchful-waiting approach than those who seemingly wouldn't have been diagnosed if they were born a decade earlier. It's possible to construct a narrative like that - I've heard arguments that the ability to diagnose gender dysphoria has become more accurate, or that the desisters would be better-off as trans but were forced back into the closet by a transphobic society. But it certainly doesn't seem safe to assume, let alone prescribing puberty-blockers based on that assumption.
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I just have to repeat that. Because the usual excuses I see made are that the doctors that screen these patients are just that damned good at their job. 100% success rate at identifying which pre-pubescents need puberty blockers. Nothing at all to do with the puberty blockers actually prolonging or increasing dysphoria.
But when the doctor hasn't even seen them yet, shifting the goalpost to "Yeah, I guess only kids that really want puberty blockers take puberty blockers" seem... weak? And inconsistent with everything everyone who's ever had any proximity to any children what so ever knows about this little thing called a "phase".
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Lol, yeah that’s pretty wild.
I stand very corrected.
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