Puberty Suppression and FGM

Can we see past our own cultural blind spots?

By Mona Charen Published on June 23, 2017

Michigan is set to become the 26th American state to join the federal government in criminalizing female genital mutilation, even as two Detroit area doctors and one of their wives await trial for inflicting the procedure on a number of young girls. FGM, which is common in some parts of Africa and the Middle East, involves using a razor to remove all or part of a girl’s clitoris and parts of the vulva.

By Western standards, this amounts to child abuse and criminal assault. FGM defenders claim that the practice makes girls feel “clean;” that it helps them to fit into their subculture; and that it promotes good marriages.

We’re not swayed by such rationalizations — but can we see past our own cultural blind spots?

Our clinics are performing their own mutilations on perfectly healthy people — delaying puberty in boys and girls with “gender dysphoria.”

While adults are free to make their own decisions about their bodies, and there may well be some percentage of the population who are happier to live as a simulacrum of the opposite sex, the rapid adoption of puberty-blocking hormone treatments for children — with a view to facilitating sex reassignment surgeries at age 18 or above — is nearly as disturbing as FGM. Children, after all, are not capable of making irrevocable decisions about their own welfare, and, as Drs. Paul Hruz, Lawrence Mayer and Paul McHugh object in the spring edition of The New Atlantis (“Growing Pains”), the use of puberty-blocking hormone treatments is “drastic” and highly experimental.

Our clinics are performing their own mutilations on perfectly healthy people — delaying puberty in boys and girls with “gender dysphoria.”

These drugs have been in use only since 1993 for rare cases of “precocious puberty” (before age 8 in girls and 9 in boys). The use of such drugs to delay puberty until a normal age, Hruz, Mayer and McHugh argue, is justified because doctors understand what causes “precocious puberty.” They do not have a comparable grasp on the causes of gender dysphoria, and for that reason among others, the resort to puberty-blocking hormones is not good medicine.

The physical effects include retarding growth (which may or may not be reversed by later cross-hormone treatment), reduced bone density, possible increased susceptibility to cancer, obesity in natal males and, if followed up by sex reassignment surgery, permanent infertility. In addition, all transsexuals are consigned to a lifelong regimen of cross-sex hormones, the effects of which have not been well studied. If such drugs were proposed to treat anything other than a sexual complaint in children, the medical community would be in an uproar.

Children must rely on parents and other adults to see them through developmental stages and safeguard their welfare. Parents, in turn, rely on experts to advise them about childhood problems, and that’s where our current rage for transgender identities becomes disturbing and unhinged. Whereas the normal protocols for medical interventions include careful testing, clinical trials, and follow-up studies, the medical establishment is heedlessly plunging into “affirmative treatment” for gender dysphoria. Rather than helping the child to align his or her identity with his or her biological sex, the model encourages affirmation of the child’s delusion. Puberty suppression is presented as a completely reversible pause in development — an opportunity for the child to “explore” his identity unconfused by the hormonal changes of puberty.

All transsexuals are consigned to a lifelong regimen of cross-sex hormones, the effects of which have not been well studied.

But that benign interpretation is dubious. Though data are scant because of the very small samples of gender dysphoric children who have actually been studied, the Diagnostic and Statistical Manual of Mental Disorders claims that somewhere between 2 and 30 percent of males and 12 and 50 percent of females experiencing gender dysphoria will persist in their nonconforming gender identity post-puberty. Dr. Michelle Cretella estimates that between 85 and 90 percent of gender dysphoric children outgrow it when they pass through puberty.

The psychological effects of puberty suppression are probably even more profound than the physical. A child who has spent years acting and being treated as the opposite sex, especially by parents, cannot be said to be a blank slate ready to “reverse” the effects of puberty-blocking drugs later if the child so wishes. His or her self-concept will already have been markedly affected. Further, as Hruz, Mayer and McHugh note, there are no large-scale studies that have tracked patients who withdrew from treatment and then progressed through normal puberty. Nor is it clear that delaying puberty helps a child through the psychological terrain of evolving identity. Normal sexual development very likely helps that process in most cases. Doctors are prescribing powerful drugs to interfere with something — puberty — that is not a disease.

Before resorting to dire and irreversible “treatments” on otherwise healthy children, we ought to remove our own cultural blinders.

We are living in the midst of a rage for sexual mutability, and rising numbers of children are reporting cross-sex identification. But is this a cultural fad we’re unconsciously imposing on them? Before resorting to dire and irreversible “treatments” on otherwise healthy children, we ought to remove our own cultural blinders.


Mona Charen is a Senior Fellow at the Ethics and Public Policy Center. 


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  • Nobody Specific

    All of this is crazy. Lots of little boys and girls don’t conform at various stages to gender norms. When I was little I liked to play with little horses and spent my time in the kitchen cooking with mom. I made mostly female friends in elementary school. I never thought I *was* anything other than a ‘little boy’ nobody ever suggested to me I might actually be a girl. Nobody made a big deal about me wanting to play with girly things. I continued to develop physically and mentally, during and after puberty my interests shifted. I made friends with other guys, I started to want to work on my dad’s cars with him. I dated girls. I retained some of my interests in some things like cooking and sewing.

    Today I am happily married (to a woman). I really think puberty ‘sorts’ or would sort out most of these issues for most children if we would just let nature take its course according to God’s plan. I won’t worry if our future children (trying) don’t align with expectations. If my young daughters want to hand me tools in the garage rather than participate in my wife’s hobbies that will be fine, as it will be fine if they want sit making crafts with her, same for any boys we might have. Just let them grow and pursue their interests. They are children. When they ask questions you tell them as much of the truth as they are ready for at their given stage. What you don’t do is feed them nonsense like ‘well you might actually be a …’ no I will just patiently correct them and say nope your are ‘little boy’ or nope you are ‘little girl’, ‘…God made you that way but its alright to play with or do any activities that appeal to you.’

    • Dena

      Amen, well said. I went through a similar experience when I was little. My neighbors were boys, so I did boy things with them. They were my friends. I played trucks in the sandbox, sports, loved hiking and fishing. I love my Dad and enjoy spending time with him fishing and playing catch. If I grew up in today’s society would my teachers encourage me to be a boy? That would mess me up and confuse me.

      In all reality I could never be a boy. I don’t have the strength boys have. Sex change surgery and/or hormone therapy can never change who you were born as. Sex change surgery isn’t even true sex change. Doctors try to militate and make something that looks like the opposite sex. It’s not a transplant. It’s mutilation. It’s a lie.

      Instead we should encourage kids to pursue their interest as who they are – biologically. There’s nothing wrong with little girls wanting to go fishing or helping their Dad fix the car. Same with little boys wanting to help their Mom clean the house. It doesn’t make them the opposite sex because they like certain things.

  • Jennifer Hartline

    God bless you, Mona, for this much-needed article. This is a horrifying trend in medicine. Politically protected, all but mandated, child abuse. We are creating mentally and emotionally disturbed children, and then violating their bodies to satisfy a greedy sexual agenda. Where this is heading is truly terrifying.

  • Paul

    Mona, the current events you’re discussing are indeed troubling but I wonder why not address a much more obvious parallel to FGM, that being male circumcision? Where is the outrage over taking razor blades to little boys penises? Or is that a cultural blind spot in the Judaeo Christian community justifying male genital mutilation on their own religious grounds?

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