The Department of Health and Human Services recently proposed a slate of regulations that would effectively ban hospitals from using puberty blockers for children, citing research that shows the drugs can cause irreversible harm. Activist groups decried the move, claiming that puberty blockers—when prescribed to children diagnosed with gender dysphoria—are reversible and merely pause development.

Those activists are mistaken. The drugs do have lasting effects, and there’s little credible evidence that puberty blockers actually help patients. In fact, there is growing reason to believe they are exacerbating the very dysphoria they are supposed to resolve and placing vulnerable children on a largely self-reinforcing path toward permanent transitions, often with serious and lasting physical consequences.

What many people don’t realize is that although gender nonconformity has existed throughout history, persistent pediatric gender dysphoria—defined as distress severe enough to prompt a desire for medical transition—was exceedingly rare, particularly among children, until relatively recently.

A Rare Condition Becomes Common After the Dutch Protocol

We know this because long-term follow-up studies conducted before the advent of pediatric medical transition consistently found that most gender-nonconforming children did not go on to experience persistent dysphoria or pursue medical transition as adults, even in countries where adult transition was legal and publicly funded.

That changed in the 2010s after Dutch clinicians introduced a new framework, the so-called Dutch Protocol, which for the first time offered children a medical pathway beginning with puberty suppression.

Consider studies begun before pediatric medical transition existed. In the 1980s, Dutch researchers began tracking a group of “gender variant” children, those who behaved or wished to be like the opposite sex as they reached adulthood.

Medical gender reassignment was legal and covered by Dutch health insurance. But roughly two decades later, not a single one of the gender variant children had decided to pursue a medical transition. Instead, their gender distress appeared to resolve on its own, with many ultimately identifying as gay or lesbian as adults.

Contrast that with today, when children as young as 8 years old can be prescribed drugs that halt normal pubertal development. Modern studies show that once children begin receiving puberty blockers, the majority go on to take cross-sex hormones, with very few discontinuing medical transition once suppression has begun.

In other words, the widely accepted notion that medicalized care is necessary to treat gender dysphoria seems to have created a clinical pipeline—one that channels children toward permanent medicalization rather than allowing their distress to resolve naturally.

Flawed Evidence and Hidden Harms in the Dutch Studies

The same studies used to justify this approach reveal its flaws. The original Dutch Protocol studies, conducted in the early 2010s, set out to determine whether intervening during adolescence rather than adulthood would yield better outcomes. Interviewing patients who received puberty blockers and cross-sex hormones during adolescence, the researchers concluded that these medical interventions were able to “resolve” dysphoria.

Yet later analysis has shown serious problems with the researchers’ approach. Most notably, they changed the key outcome measures between baseline and follow-up assessments. Girls, for example, were initially asked questions tied to their biological sex. Did they have distress about breasts, menstruation, or being treated as girls?

At follow-up, those same participants were instead asked whether they were distressed by male sex characteristics they did not have and whether they felt comfortable being treated as boys. Predictably, distress appeared to decrease, but this apparent improvement likely reflected the change in measurement rather than a true therapeutic effect of the intervention.

Even more troubling, the researchers found—and later analyses suggest they hid—ample evidence of harm resulting from their interventions. Although the researchers claimed to have followed up groups of children who first underwent puberty suppression and then began taking cross-sex hormones, the final analysis included only adolescents who were deemed psychologically stable enough to proceed to treatment with cross-sex hormones. Those who experienced negative outcomes during the puberty suppression phase were excluded.

Several participants who experienced serious harm were reclassified as “nonparticipants,” and their information was omitted from final outcome analyses. At least three developed severe obesity and insulin resistance during treatment. One discontinued medical transition before the study concluded. Another died after the occurrence of surgical complications connected to insufficient genital tissue, a known consequence of puberty suppression.

Other research has shown that puberty suppression, especially when followed by administration of cross-sex hormones, frequently results in permanent infertility and impaired sexual function.

These findings should be front and center when we talk about puberty blockers today. Although these drugs are often described as benign and their effects are described as reversible, the reality is far less certain. There are no randomized controlled trials demonstrating that puberty blockers improve long-term mental health outcomes for children with gender dysphoria. The evidence we do have suggests significant risks, including the entrenchment of, rather than the relief of, dysphoria, as well as lasting physiologic harm.

Health policy leaders are right to proceed with caution. Right now, the widespread use of puberty blockers amounts to conducting large-scale, uncontrolled medical experiments on children. The more we normalize these interventions, the greater the risk that children will be steered onto irreversible paths they might never have chosen if given time, psychologic support, and honest information.

Dr. Julia Mason is a board-certified pediatrician and fellow of the American Academy of Pediatrics. She is a founding board member of the Society for Evidence-Based Gender Medicine (SEGM).

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates