Can’t we just let puberty do its job?
Boys will be boys and girls, girls – or perhaps not. Parents may understandably be perplexed as to why, as reported in this paper last week, their children should be interrogated – under the guise of an NHS survey – as to whether they are “comfortable with their gender”.
This is what it is about. Consider the perhaps not unusual situation of a 10-year-old girl who wishes she were more like her brothers playing football, climbing trees and similar stereotypical boyish pastimes. She is vexed at the imminent prospect of developing those secondary female sexual characteristics of monthly periods and burgeoning breasts.
But were she to take drugs to suppress the onset of puberty, this would maintain her in the prepubertal state, “and give her time to explore her gender identity without the distress [sic] of undergoing the physical transformation into womanhood”. Then, come 16, she can make an informed choice. If she decides she does want to be female, she only has to stop the drugs to become so. But if “having explored her gender identity” and she still wishes to be a boy, she can then switch to taking the virilising male sex hormone testosterone and any subsequent sex change operation will be more straightforward without the need for breast reduction surgery. This therapeutic approach, according to an authoritative article in The Lancet this month, “has considerable benefits”. Really? Virtually all (90 per cent) of children ambivalent about their sexual identity (so-called gender dysphoria) becomes less so as puberty progresses and end up identifying with, and indeed embracing, their biological sex. None of those treated with puberty suppressant drugs do so. This is scarcely surprising for, in their essentially neutered state, they have missed out on the flourishing of those natural instincts of mutual attraction between boys and girls that come with the normal physical changes of puberty.
The case for puberty suppressant drugs is thus dangerous nonsense on stilts and, together with the mischief of interrogating 10-yearolds about being comfortable with their gender, should be banned.
Pill popping
The reliable rule of thumb, as featured in this column last week, that pills are much the likeliest cause of unexplained, unusual symptoms has prompted several further reports including a couple of instances of an important variation on this theme.
The first concerns a fit gentleman in his mid-eighties, still playing a couple of rounds of golf a week though taking long-term medication for heart problems with the beta blocker Bisoprolol and a cholesterol-lowering Atorvastatin. During the past six months, and for the first time in his life, he has developed what sounds like an anxiety state, with feelings of apprehension, poor sleeping, early morning waking and a generalised loss of energy. He has consulted a couple of specialists whose investigations have ruled out any possible medical explanation such as an overactive thyroid.
Next, a woman writes on behalf of her husband, who is taking Omeprazole, the acid suppressant, for scarring of the oesophagus. She reports he has had several episodes of dizziness with, on a couple of occasions, an alteration in consciousness warranting an emergency trip to casualty. Again, the usual blood tests and ECGS have not identified what might be amiss.
For both, the longish interval between the initiation of their medical treatment and the onset of these symptoms would suggest they are not related. Still, the possibility needs to be considered on two counts. First, well-tolerated drugs may become less so with time, due to age-related changes in the tissues of the body. Thus, it could be relevant that both Atorvastatin and Omeprazole are reported to cause an anxiety state.
Or, again, it can take several months, or longer, for Omeprazole to lower the levels of magnesium in the blood, as it is known to do, predisposing to disturbances in heart rhythm and a fall in blood pressure that could account for the symptoms of dizziness and altered consciousness. Thus, for both, their unexplained symptoms may be drug-induced. Email medical questions confidentially to Dr James Le Fanu at drjames @telegraph.co.uk
‘Interrogating 10-year-olds about their gender should be banned’