An influential doctor and advocate of adolescent gender treatment has said he was unable to publish much-anticipated research into puberty-blocking drugs because of America’s difficult political environment.
Physician Johanna Olson-Kennedy began the study in 2015 as part of a broader multimillion-dollar federal project on transgender youth. She and her colleagues recruited 95 children from across the country and gave them puberty blockers. This prevents permanent physical changes, such as changes in the breasts or deepening of the voice, that can worsen gender problems known as gender dysphoria.
Researchers followed the children for two years to see if the treatment improved their mental health. An old Dutch study found that puberty blockers improved feelings of well-being, and the results prompted clinics around the world to routinely prescribe the drugs as part of what is now being called gender-affirming care. This gave me an opportunity to do so.
But similar trends have not been seen in American trials, Dr. Olson-Kennedy said in a wide-ranging interview. Puberty blockers did not lead to improvements in mental health, perhaps because the children were already doing well when the study began, she said.
“They’re doing very well when they come in, and they’re doing very well two years later,” said Dr. Olson Kennedy, who runs the nation’s largest youth gender clinic at Children’s Hospital Los Angeles.
This conclusion seemed to contradict previous descriptions of this group, in which Dr. Olson-Kennedy and colleagues noted that a quarter of the adolescents were depressed or suicidal before treatment.
In the nine years since the study was funded by the National Institutes of Health, Dr. Olson-Kennedy’s team has not released the data, as the medical care of this minority of adolescents has become a serious issue in American politics. Asked why, the findings could fuel the kind of political attacks that could lead to bans on youth gender treatment in more than 20 states, one of which will soon be considered by the Supreme Court. said.
“We don’t want our work to be weaponized,” she said. “You have to be right to the point, clear and concise, and that takes time.”
She said she plans to publish the data, but the team's publication has also been delayed because the NIH has cut some of the project’s funding. She also attributed the cuts to politics, but the NIH denied that. (This extensive project has received $9.7 million in government support to date.)
Dr. Joanna Olson-Kennedy Credit…Michael Thalberg/Getty Images
Dr. Olson-Kennedy is one of the country’s most vocal advocates for adolescent gender treatment and has served as an expert witness in numerous legal challenges to state bans. She said she was concerned that the study results could be used in court to refer to transgender youth and argue that they “shouldn’t use blockers because they have no effect.” Ta.
But other researchers were concerned about the idea of delaying consequences that would have an immediate impact on families around the world.
“I understand the fear of being weaponized, but it’s really important to get the science out there,” said one of the study’s original researchers, a clinical and research psychologist at Boston University. Amy Tichelman said.
Dr. Tichelman also noted that even if the drugs did not lead to psychological improvement, they may have prevented some children from getting worse. “No change is not necessarily a negative outcome; there may be a preventive aspect,” she says. “We won’t know until we investigate further.”
In the 1990s and 2000s, Dutch doctors began studying a small number of children who experienced severe gender dysphoria from an early age. For most of these children, negative emotions disappear by adolescence. Some people feel bad because of puberty.
Researchers have begun prescribing puberty-blocking drugs, long used to treat children whose puberty begins abnormally early, for people facing difficulties. Dutch scientists reasoned that by preventing permanent changes during adolescence, transgender youth would fare better psychologically and fit more comfortably into society as adults.
In 2011, researchers reported on the first 70 children treated with the so-called Dutch Protocol. Children were thoroughly evaluated to ensure they had persistent discomfort, supportive parents, and no serious mental illness that could interfere with treatment.
These patients showed psychological improvement after receiving puberty blockers, with fewer depressive symptoms and significantly fewer behavioral and emotional problems. All patients chose to proceed with sex reassignment by taking either testosterone or estrogen.
Even before the study was published, it had a huge impact, and clinics were opened around the world to treat transgender youth with puberty blockers and hormones.
In 2011, the British Youth Gender Clinic attempted to replicate the Dutch results in a study of 44 children. However, at a conference five years later, British researchers reported that the puberty blockers did not change the volunteers’ well-being, including rates of self-harm. These results were not published until 2020, several years after puberty blockers became standard treatment for children with gender dysphoria in the UK.
In 2020, Dr. Olson-Kennedy’s group reported on the early psychological profiles of children who participated in a U.S. study of puberty-blocking drugs. Their average age was 11 years. Before receiving the drug, about a quarter of the group reported symptoms of depression and significant anxiety. And a quarter reported having considered suicide. 8% reported having attempted suicide in the past.
In a progress report submitted to the NIH at the time, Dr. Olson-Kennedy outlined a hypothesis for how children would fare after taking puberty-blocking drugs for two years. injuries, suicidal tendencies, and over time my body self-esteem and quality of life improved. ”
That hypothesis seems unproven. “They have better mental health on average,” Dr. Olson-Kennedy said in an interview with The New York Times. “It’s not in the range of concern, either at the beginning or two years later.” She reiterated this thought over and over again.
Puberty blockers are prescribed to prevent permanent physical changes during puberty. Credit…Jamie Kelter Davis of The New York Times
Dr Olson-Kennedy follows up on how children can maintain a good early mental state when preliminary findings show a quarter of children have difficulties When asked in an email, he mentioned the average of the data in an interview, saying: She was still analyzing the complete data set.
Pediatrician Dr Hilary Cass, who published an extensive review of gender services for young people in the UK this year, says puberty blockers improve mental health despite scant evidence, due to delays from research groups in the US and UK. He said that the people had come to believe in him. I come to this conclusion.
“It’s really important to get the results out there so we can understand if it’s useful and for whom,” Dr. Cass said.
Her report found weak evidence for puberty blockers and noted some risks, including delayed bone growth and reduced fertility in some patients. This prompted Britain’s National Health Service to stop prescribing the drug outside of new clinical trials, following similar withdrawals in several other European countries.
An NIH spokesperson said the agency generally encourages the publication of data from grants, but researchers decide when and how to do so.
Dr. Olson-Kennedy and his colleagues have also not yet published the data they collected on how puberty blockers affected bone development in adolescents.
But there are many other papers coming out of the broader NIH project, including one in 2023 on older transgender and non-binary youth who took estrogen or testosterone to aid in their gender transition. This includes research from the year. After taking the hormone for two years, the volunteers showed improvements in life and body satisfaction, and patients given testosterone showed reductions in depression and anxiety. (2 out of 315 patients died by suicide, a rate much higher than in the general population.)
Dr. Olson-Kennedy pointed out that physicians’ clinical experience is often undervalued in research discussions. She said she has been prescribing puberty blockers and hormone treatments to transgender children and adolescents for 17 years and has observed how much benefit they can have.
Although the NIH study is large, it is “minimal compared to the number of people we have cared for,” she says.
Christina Jewett and Jane Ackermann contributed reporting.
