Effects on the body, prescription… six questions about puberty blockers, at the heart of the law on the transidentity of minors ?
The transidentity of minors at the heart of a bill debated this Tuesday, May 28 in the Senate. EPA Illustration – Peter Foley
Puberty blockers are at the center of the debates, which promise to be lively this Tuesday, May 28 in the hemicycle, while senators will examine a bill relating to transidentity among minors. If this term is at the heart of the news, do you really know what it contains??
While the Senate examines this Tuesday, May 28, 2024, a text aimed at regulating gender transitions before the age of 18, let's zoom in on puberty blockers, these medications at the heart of the bill carried by the Republicans and fiercely denounced by the left and LGBT + associations.
What is it about?
These are synthetic hormones which, by imitating the real hormones of puberty, prevent the stimulation of the gonads (ovaries, testicles) and the secretion of sex steroids (estrogens, testosterone).
Some of these molecules are indicated against prostate cancer, against endometriosis, but also in children suffering from precocious puberty.
What effect and what duration ?
They should not be confused with sex hormones, prescribed later to young people in transition, from the age of 16, and which have permanent effects such as voice change.
Indeed, these puberty blockers make it possible to suspend the development of secondary sexual characteristics (chest, voice, hair) relating to gender with which the child does not identify. But when the adolescent stops the treatment, pubertal development resumes its evolution natural.
What purpose?
The goal of blockers is for "young people to explore their gender identity without experiencing the changes linked to puberty that they could experience badly", explains to AFP Annelou de Vries, a Dutch psychiatrist whose work is a reference on these treatments.
The idea is to "to gain time and peace of mind before making any decision on a medical intervention with potentially irreversible effects.
An impact on growth?
On the question of the adverse effects of these puberty blockers, due to lack of long-term research, there is no consensus. It’ elsewhere one of the main criticisms for calling for an end to these prescriptions.
The French Academy of Medicine warns regarding "the impact on growth, bone weakening& quot;.Interviewed by AFP, Catherine Gordon, American pediatric endocrinologist, recalls that many children in transition already have "low bone density before treatment", particularly due to eating disorders and a lack of physical exercise.
"It appears that bone densification associated with puberty is reduced in adolescents with gender dysphoria treated with blockers, but also that an encouraging increase is observed once they replace these blockers with & quot;gender-affirming hormones", explains the specialist.
Researchers are also concerned about potential lifelong consequences for cognitive and emotional health, with puberty being a time-limited phase during which the developing connections of the nervous system are constructed by hormonal and experience-related factors.
What are the conditions for access ?
To ensure their effectiveness and safety, Dr de Vries, one of the authors of the "Dutch protocol" which refers in particular to France, explains that puberty suppressants must be prescribed within a strict framework.
To be eligible, the patient must have reached stage 2 of Tanner puberty, usually around age 12, but who can start from age 8.
The protocol begins with aprecise diagnosis aimed in particular at detecting whether the young patient presents psychiatric or autistic disorders.
How are they currently prescribed ?
These molecules do not have a marketing authorization (AMM) to treat children with gender dysphoria, but this does not is not illegal however : in France, 20 % of prescriptions are given off-label.
In France, only 11% of young people supported in a gender transition had access to puberty blockers, after an average of 10 months< /strong> between the first consultation and the implementation of treatment, according to the Defender of Rights, who does not have absolute figures.
In theory in France, all therapeutic decisions for minors in transition must be supported and validated by multidisciplinary consultation meetings (RCP). Young people and their families are informed of the need for medical surveillance and long-term follow-up.
But a 2022 report points out that faced with a sensitive and rapidly growing demand for transition, responses are struggling to keep up, despite ;initiatives to develop them". And many young people do not have access to specialized consultations.
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