In exclusive interviews, two prominent providers sound off on puberty blockers, ‘affirmative’ care, the inhibition of sexual pleasure, and the suppression of dissent in their field.
For nearly a decade, the vanguard of the transgender-rights movement — doctors, activists, celebrities and transgender influencers — has defined the boundaries of the new orthodoxy surrounding transgender medical care: What’s true, what’s false, which questions can and cannot be asked.
Their allies in the media and Hollywood reported stories and created content that reaffirmed this orthodoxy. Anyone who dared disagree or depart from any of its core tenets, including young women who publicly detransitioned, were inevitably smeared as hateful and accused of harming children.
But that new orthodoxy has gone too far, according to two of the most prominent providers in the field of transgender medicine: Dr. Marci Bowers, a world-renowned vaginoplasty specialist who operated on reality-television star Jazz Jennings; and Erica Anderson, a clinical psychologist at the University of California San Francisco’s Child and Adolescent Gender Clinic.
In the course of their careers, both have seen thousands of patients. Both are board members of the World Professional Association for Transgender Health (WPATH), the organization that sets the standards worldwide for transgender medical care. And both are transgender women.
The widespread use of puberty blockers can be traced to the Netherlands. In the mid-1990s, Peggy Cohen-Kettenis, a psychologist in Amsterdam who had studied young people with gender dysphoria, helped raise awareness about the potential benefits of blockers — formerly used in the chemical castration of violent rapists. Pharmaceutical companies were happy to fund studies on the application of blockers in children, and, gradually, what’s called the Dutch Protocol was born. The thinking behind the protocol was: Why make a child who has suffered with gender dysphoria since preschool endure puberty, with all its discomforts and embarrassments, if that child were likely to transition as a young adult? Researchers believed blockers’ effects were reversible — just in case the child did not ultimately transition.
Cohen-Kettenis later grew doubtful about that initial assessment. “It is not clear yet how pubertal suppression will influence brain development,” she wrote in the European Journal of Endocrinology in 2006.
Once an adolescent has halted normal puberty and adopted an opposite-sex name, Bowers said: “You’re going to go socially to school as a girl, and you’ve made this commitment. How do you back out of that?”
Another problem created by puberty blockade — experts prefer “blockade” to “blockage” — was lack of tissue, which Dutch researchers noted back in 2008. At that time, Cohen-Kettenis and other researchers noted that, in natal males, early blockade might lead to “non-normal pubertal phallic growth,” meaning that “the genital tissue available for vaginoplasty might be less than optimal.”
The problem for kids whose puberty has been blocked early isn’t just a lack of tissue but of sexual development. Puberty not only stimulates growth of sex organs. It also endows them with erotic potential. “If you’ve never had an orgasm pre-surgery, and then your puberty’s blocked, it’s very difficult to achieve that afterwards,” Bowers said. “I consider that a big problem, actually. It’s kind of an overlooked problem that in our ‘informed consent’ of children undergoing puberty blockers, we’ve in some respects overlooked that a little bit.”
Jack Turban, the chief fellow in child and adolescent psychiatry at Stanford University School of Medicine, wrote, in 2018: “The only significant side effect is that the adolescent may fall behind on bone density.”
But lack of bone density is often just the start of the problem. Patients who take puberty blockers almost invariably wind up taking cross-sex hormones — and this combination tends to leave patients infertile and, as Bowers made clear, sexually dysfunctional.