Good afternoon. I wanted to talk a little bit today about what happens when puberty is delayed.

If you look for this information in the context of transgendered individuals, you see a line of articles talking about lowered suicide rate.

Lowered suicide rate is undoubtedly a positive outcome. Nonetheless, the two are not directly related. There were transgendered individuals before there were puberty blockers. They made it to adulthood without this treatment.

So, the question becomes, is the use of puberty blockers a net positive or negative. Positive: lowered chances of self-harm. Negative: Medical side effects.

Some would have you think that there are no negative side effects of puberty blockers, but research says otherwise.

I chose this article from Pediatrics to highlight. https://pediatrics.aappublications.org/content/139/6/e20163177

The reason I chose this particular article, is because it looks at delayed puberty. So, for whatever reason, a boy or girl doesn't have the appropriate development at the appropriate age.

Hair growth, widening of hips/chest, lowering of the voice, starting menstruation.

Because it's happening naturally, it doesn't come with the added emotional risk of dysphoria. So what are the health affects of delayed puberty, either because puberty wasn't triggered or puberty was deliberately delayed?

So, to start with, this article is a literature review. It looks at the widest array of scientific articles published in this area that they can, and consolidates their conclusions into one paper.

These are excellent tools for getting a basic understanding of a scientific topic.

The first immediate effect is height. There has been a little bit of a question about whether these individuals tend to be shorter than average, or whether they achieve their potential height at a later time.

The answer to this has two parts.

First, if the child has at least one tall parent (and by tall, they mean in the 90th percentile, about 6'0.5" for men and 5'7" for women). Usually the child reaches their anticipated height.

Second, if the child has normal growth leading up to puberty, they are more likely to eventually achieve their targeted height.

Slow growth before puberty? Both parents in the average height range? You're likely to see a person of shorter stature with delayed puberty.

The next item is bone density.

Delayed puberty correlates with reduced bone mass in both males and females. The result of that is the increased risk of fracture, especially involving bones of the upper body. As little as one year of delay can cause this.

One additional issue is the psychology of not developing when your peers do. While it's true that dysphoria causes distress, so does delayed puberty.

This is especially true in men, who may have increased levels of depression, substance abuse, and anxiety later in life.

Here's some good news....

Delaying puberty reduces risk for breast, endometrial, and prostate cancer. These are cancers that are directly related to estrogen and testosterone exposure. Shorten the duration of exposure, lower the risks.

This is something people don't necessarily think of when thinking about puberty.... but delaying puberty can risk cardiovascular health.

For optimal cardiovascular health, you need to start puberty between the ages of 11 and 16.

This is specific to females.

There is a marginal increased risk of hypertension, heart attack, or stroke if onset of puberty is earlier or later than these ages.

Science isn't sure about why this is. It may be because delayed puberty is associated with obesity, or because late exposure to hormones may have an unknown effect on the cardiovascular system.

Current studies are looking at genetics, as well.

So, what this tells us is that delaying puberty isn't necessarily benign. It may have lasting effects well into adulthood, including bone density, cardiovascular health, and self-esteem.

And these are all things to consider when medicalizing children to create delayed puberty.