Researcher’s fears of ‘weaponized’ data reignite focus on puberty-blocking drugs for transgender youth

By Brenda Goodman and Meg Tirrell, CNN

(CNN) — The benefits of puberty-blocking drugs for transgender children are drawing fresh attention after the scientist leading a major federally funded study was quoted by The New York Times as saying she had delayed publication of some of her results because of fears that they would be “weaponized” in a heated political climate.

Some advocates for gender-affirming care for youth say the report mischaracterizes the normal caution being taken by researchers to carefully present and interpret scientific data.

“It’s much ado about nothing and sensationalized in that way,” said Dr. Alex Keuroghlian, director of the Division of Education and Training at the Fenway Institute, a group that advocates for the heath needs of sexual and gender minorities and those affected by HIV.

The story, which was published Wednesday, quotes Dr. Johanna Olson-Kennedy, medical director at the Center for Transyouth Health and Development at Children’s Hospital of Los Angeles, one of the largest programs of its kind in the US.

Olson-Kennedy said that in the study, which she helped lead, puberty blockers did not appear to improve the mental health of 95 children ages 8 to 16 who were followed for two years to understand their mental and physical functioning as doctors used the medications to delay the physical changes associated with puberty, including things like body hair growth, menstruation and a deepening voice.

“They’re in really good shape when they come in, and they’re in really good shape after two years,” Olson-Kennedy told the Times.

Her description appears to contradict the baseline characteristics of the 95 study participants, which were published in 2022. That paper reports that more than 1 in 4 had clinically significant levels of depression, anxiety and suicidal thoughts. About 8% had reported a previous suicide attempt.

Olson-Kennedy did not respond to CNN’s request for comment.

The research project has received almost $10 million in federal funding since 2015. The researchers have published more than two dozen papers on its findings, although an update on the group of children who were followed for two years after they were prescribed puberty-blocking medications appears to be overdue.

Dr. Amy Tishelman, a psychologist and research associate professor at Boston College, said that she understood the impulse to be cautious but that it’s critical to publish the data.

“I feel it’s imperative for research, especially research funded by taxpayer money, to be published for the integrity of science,” said Tishelman, who helped write the initial grant for the project, which is called “The Impact of Early Medical Treatment on Transgender Youth.” “We need to be forthright about our findings.”

Tishelman said the idea that study participants didn’t see a change in their mental functioning doesn’t necessarily mean the therapy didn’t have a benefit.

“Puberty blockers may have prevented a decline in mental health,” she said, especially for kids who may have had greater body dysphoria – or a sense of being in the wrong body – after puberty.

It’s impossible to know without seeing the data, however, she said.

Numerous studies have documented high rates of suicide and suicidal thoughts in transgender children and teenagers, and the physical changes of puberty can greatly increase the distress of feeling trapped in the wrong body.

For years, doctors have prescribed puberty-blocking drugs to certain transgender children who are psychologically assessed as needing them as a way to lower this distress, a model called the Dutch protocol, based on early research supporting this approach in the Netherlands.

In 2017, the Endocrine Society – a professional group of scientists and medical providers who focus on hormone-related issues – published a clinical practice guideline that cites more than 260 studies supporting the use of hormonal therapies to support children and teens with gender dysphoria as well as medications to block puberty.

“Puberty-delaying medication is a safe, generally reversible, and conservative approach that gives transgender and gender-diverse teenagers and their families more time to explore their options,” the Endocrine Society said in a statement Friday.

What’s more, the society notes, the therapy is not experimental or unusual. “The same treatment has been used for more than 40 years to treat precocious puberty,” it said.

This year, however, an extensive but controversial research review in the UK called that practice into question, saying that the rationale for early puberty suppression was “unclear” and that any benefit for mental health was supported by “weak evidence.” The review – known as the Cass Review for Dr. Hilary Cass, the pediatrician who conducted it – and its methodology have come under sharp criticism from some scholars and practitioners.

It has prompted providers in the UK to scale back their use of the treatment.

The Cass Review was published amid a growing backlash against gender-affirming care for children. Since 2021, 26 US states have passed laws prohibiting or restricting minors from accessing gender-affirming care, which can include medications to suppress puberty as well as other medical interventions, such as hormones to support a gender transition.

One recent study found that these restrictions may have come at a cost, showing that suicide rates among youth have increased in states that have passed anti-transgender laws.

Another study published Monday in the journal JAMA Pediatrics reported high levels of satisfaction and low levels of regret among more than 220 young people who had accessed puberty blockers and hormone therapy as kids and teens.

The participants were followed starting in 2013 as part of the Trans Youth Project. Overall, 97% said they were satisfied and have continued with gender-affirming care. Nine children – about 4% of the sample – expressed regret over puberty blockers or hormones, and four discontinued their therapy.

Tishelman says she’s afraid that a more important point is getting lost in the controversy over Olson-Kennedy’s study findings: that scientists may be self-censoring for fear their work will be used against the people they’re trying to help.

“The real meaning of the story is that scientists may not be comfortable publishing data because of the political landscape right now in the country, and that’s very problematic,” she said.

CNN’s Jen Christensen contributed to this report.

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