Puberty Blockers for Transgender Youths

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After two years of puberty blockers, Emma Basques was prescribed estrogen at 13, starting her transition.Credit…Verónica G. Cárdenas for The New York Times

To the Editor:

Re “Pressing Pause on Puberty” (front page, Nov. 14), about puberty blockers, which aid transgender adolescents but may pose some health risks:

This article, published during Transgender Awareness Week, fails to convey the choice faced by caregivers of transgender youths. Until there is a safer option, the benefits of delaying puberty necessitate the use of puberty blockers.

For many transgender people, puberty can be undone only through years of medical intervention, which creates its own set of medical and emotional risks. In essence, the choice is a potential latent risk versus a known present risk.

Also, by spotlighting three people, one of whom chose to stop gender-affirming care before adulthood, the article lends itself to the narrative that a large percentage of youths are receiving gender-affirming care too easily and will eventually change their minds (a frequent justification for banning gender-affirming care for youths).

One in three would certainly give anyone pause; however, some studies suggest the rate of youths who decline to continue gender-affirming care after medical intervention is about 1 in 50.

Taylor Morley
New York

To the Editor:

The scholarly and well-researched article raises significant safety issues about using puberty blockers in prepubescent and pubescent children as part of gender transitioning.

As one of three academic principal clinical investigators of studies that led to the initial F.D.A. approval of Lupron for the treatment of metastatic prostate cancer — and having studied this class of drugs, which includes puberty blockers, for more than four decades — I can say that physicians are still learning and continue to be concerned about the safety of these agents in adults.

Woefully little safety data are available for the likely more vulnerable younger population. Bone loss in adult men who have been on these agents is significant, and a leading cause of morbidity with long-term administration.

Other safety issues include cognitive, metabolic and cardiovascular effects, still under intense investigation. The prudent and ethical use of such agents in the younger population should demand that every pubertal or pre-pubertal child be part of rigorous clinical research studies that evaluate both the short-term and longer-term effects of these agents to better define the true risks and benefits rather than relying on anecdotal information.

Marc B. Garnick
The writer is a professor at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston.

To the Editor:

I am disappointed that The New York Times is contributing to the ongoing efforts to restrict trans access to health care by adding to the growing pile of articles about “concerned parents” that focus primarily on the risks, rather than the benefits, of gender-affirming care.

This treatment is lifesaving for trans individuals like me, and it is under constant attack by conservative politicians pandering to bigoted voters.

Articles like this one don’t exist in a vacuum. Infertility and the loss of bone density are minuscule prices to pay compared with the risk of suicide for trans patients who are blocked by doctors, parents or legislators from accessing gender-affirming treatment.

There are many medical interventions with potentially life-altering side effects. Why are gender-affirming treatments for trans individuals being singled out as uniquely dangerous and worthy of public scrutiny?

Diana J.
Florence, S.C.
The writer’s full name is not being published to protect her privacy.

To the Editor:

That puberty blockers have potential side effects (like many other medical interventions) is not newsworthy. For decades, puberty blockers have been prescribed to cisgender kids experiencing precocious puberty as well as to transgender youths with knowledge about potential bone density issues.

Parents are advised to bolster bone health with vitamin D, calcium and exercise. Once the patients receive gender-affirming hormones or decide to go off blockers and go through an endogenous puberty, their bone density increases.

There is broad agreement about the need for youth gender-affirming care from every major medical association. Parents who are choosing health care for their child are also confronted with the risk of doing nothing.

They must ask, “What is the cost — emotionally, academically, and in terms of identity development — of my child going through adolescence in acute distress?” As a clinical psychologist who works with adults and teens, I can tell you that the risks are profound, and the damage is often enduring.

Woodwyn Koons
Carpinteria, Calif.

Trump’s Antisemitic Dinner Guests at Mar-a-Lago

Nick Fuentes during a rally at the Michigan State Capitol in Lansing in 2020.Credit…Nicole Hester/Ann Arbor News, via Associated Press

To the Editor:

Re “Invited Over to Trump’s, an Outcast Rapper Brings Along a White Supremacist” (news article, Nov. 26), about a dinner with Kanye West and Nick Fuentes, a white supremacist leader:

In 2016 Donald Trump needed more than his MAGA base to win the presidency. Eventually many middle- and upper-middle-class suburban Republicans signed on, deciding that passing G.O.P. legislation eclipsed Mr. Trump’s troubling use of racial and religious slurs on the campaign trail.

At what point do voting choices become an extension of personal principle? If we welcome a Holocaust denier into our homes or country clubs, are we empowering the hate that leads to violence against Jews and slaughter in American synagogues?

In 2016 mainstream Republicans made peace with an ethically empty presidential nominee to advance G.O.P. priorities. They hoped the dignity of the office would tame Mr. Trump’s dangerous biases. The experiment failed.

As he begins his third presidential campaign, mainstream Republicans must ask themselves, “Are my tax cuts worth more than the hate and suffering unleashed by a political candidate embracing humanity’s darkest impulses?”

When we choose to stand with a man who dines with Holocaust deniers and white supremacists, who have we become?

Maryellen Donnellan
Falls Church, Va.

To the Editor:

During Thanksgiving week, former President Barack Obama volunteers by serving dinner at a homeless center. Former President Donald Trump hosts two antisemites, one of whom is a white supremacist.

Americans have to decide whom we align ourselves with. One path leads to self-destruction. Helping others is a path to redemption.

Julie Stewart
Waukee, Iowa

What a Robot Can’t Do

A robot making a delivery at the offices of internet company Naver on the outskirts of Seoul.Credit…Chang W. Lee/The New York Times

To the Editor:

Re “Robots Are Here to Help Humans With Office Chores” (Business, Nov. 23):

I shudder to think that robots may be taking away the coffee break, that daily rite sacred to the American worker. “Hey, let’s go get coffee” often opens the door to lifelong friendships.

More than 15 years ago, a colleague at a federal agency invited me to leave the office building in downtown San Francisco and join her for a “cup of Joe” at Peet’s Coffee just a block away. Over the years, we bonded over many cups of coffee. My former colleague is now one of my best friends.

All power to the coffee break!

Susan Rosenblum
Takoma Park, Md.

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