In the room where it happened

Part 2

Humans are so predictable. Put just under 100 adults in a room and for the first few hours, they behave. They sit in the chairs, they keep their questions to the formal Q&A time, they keep their shoes on.

By hour 4 we begin to show our mammalian nature. We begin to sit on the floor in the back of the room, we shout out questions to speakers, and the high heels come off. The afternoon and evening of the first day of the SEGM conference didn’t dissolve into chaos, but our humanity began to show.

Two topics took front and center for the afternoon of October 10: puberty blockers and treatment guidelines.

Michael Biggs, Sallie Baxendale, and Alison Clayton assessed the evidence of the use of puberty blockers.

Ivan Florez, William Malone, Susan Brewley, and Dena Zeraatkar led the audience through the current gender dysphoria treatment guidelines and the assessment of the quality of the evidence.

All four contributed valuable information. But the presentation on puberty blockers’ effects on brain development, by Dr. Sallie Baxendale, a professor of clinical neuropsychology at University College London, was critically impactful.

Photo by Robina Weermeijer on Unsplash

She began by stating that she is not a specialist in the field of gender but rather of the brain. When she heard that puberty blockers were being called “safe and irreversible,” she felt amazed because of what she knows about brain development. So she investigated further.

Baxendale provided detailed explanations of the brain’s developmental pathways over time. In the sad study she cited, kittens eyes were sewn shut. When they missed the critical window to develop sight they never developed sight even after their eyes were opened again. For humans, the development of language is similarly age-specific. At 2 or 3 if you learn a second language, you can speak it without an accent. But if you try as an adult, you will always have an accent.

Using animal studies, Baxendale illustrated that similar key moments are occurring in adolescents and that many of those key developmental moments are occurring in part due to the hormonal cascades in the brain. Puberty blockers stop these processes. Because of this, they have a detrimental impact on learning, social behaviors, and responses to stress in mammals.

Adolescence is a critical stage of neurodevelopment. Having made many connections during childhood, the brain now starts to prune some and strengthen others. We are really looking at the frontal circuits, which have everything to do with executive function. Pruning in adolescents is really important and the key thing is that it does not happen automatically with age. Rather it is driven by puberty: the sex receptors in the prefrontal cortex are responding to various hormones.

Baxendale then reviewed a small number of studies on human patients treated with puberty blockers for gender-related issues. These studies found that the blockers lowered patients’ IQs by 7 to 15 points.

Effects on intellectual function were observed in multiple studies. The impacts are complex and sex-specific. There is no clear evidence, Baxendale reported, that these effects of puberty blockers are reversible.

Baxendale closed by arguing that any gender center currently operating in pediatrics should have a neurologist on the team and that further studies are needed to track these cognitive brain impacts of puberty blockers.

Please send your questions or submissions to LGBTcouragecoalition@gmail.com.