On Puberty Blockers

On Puberty Blockers

February 2024

“At face value I don’t see a problem with waiting for kids to be age of majority for major surgery or drug treatments.” 

After Ruby came out as trans, I had a few friends and family who were curious and wanted to know my perspective on many issues. I appreciate it when people who have not been through this ask questions because it means that they are becoming informed. They are often reluctant and apologetic with their questions because they are afraid of offending, but unless people can ask questions that they will not be shamed for, they will never develop knowledge, empathy, and understanding. The above statement is from a recent conversation I had with someone I love, a family member who has been supportive and loving despite an admitted lack of understanding of the issues involved in the recent Alberta UCP proposed legislation. It seems like a great starting point for this post. 

When my child first came out as nonbinary, I was relieved that it had not come out as trans. I didn’t realize that NB was, in fact, under the trans umbrella, but somehow it seemed safer because my assumption was that it was synonymous with androgyny so we would never have to deal with puberty blockers or hormone treatment. I had no idea what kind of journey we were in for and I can’t help but laugh at four-years-ago-me, although it is an empathetic laugh rather than mockery.

A few months after it came out, I arrived home to find my child sporting gigantic fake boobs and I almost threw up (https://interrobangmehardbaby.blog/2023/12/23/my-truman-show/). My child told me that it was a demi-girl and I argued, saying that I had never gotten any sort of feminine vibes whatsoever from it. Like that mattered. One of the worst things for me personally was that I had completely missed this; what kind of parent misses something this huge in their child? I was making it all about me and the guilt and shame I felt about not really seeing my child. The truth of the matter is that I HAD seen signs, that my child HAD made comments over the years that I pushed aside because I was deeply uncomfortable with them. That is a difficult thing for me to admit, because I always thought I was such an ally to the 2SLGBTQ+ community. I was in major denial and I had no idea how much internalized transphobia I had. Until it directly affected me through my child, I had no motivation to learn or change. 

Once I finally reached the point where I could think rationally, (https://interrobangmehardbaby.blog/2024/02/05/on-parenting-a-transgender-child/) I started to read memoirs written by trans people. One of the pieces of their stories that drove fear into my heart was their descriptions of the trauma of going through the wrong puberty. This can lead to very serious mental health consequences. At this stage, I was still very against any kind of puberty blockers or hormone treatment in children because I was basing my opinion on absolutely NO information. My child was experiencing more and more serious mental health struggles despite psychological support and I couldn’t figure out why, but I never actually asked why. I was remaining wilfully ignorant so that I could justify my opinion. One evening it had a dissociative episode and was holding a huge knife over it’s forearm and even then I didn’t connect the dots or even consider that it may be experiencing gender dysphoria.

During online school due to covid, my previously vocal child refused to speak or turn on its camera after attendance was taken. I noticed that it had started answering me with nods and gestures rather than speaking. UGH, here we go again! I thought. I was afraid and did not want to ask why, but one night I was furious with it about lack of participation in online class and failing grades and it started to cry. 

“Mom! I waited too long to come out and now I have a MAN voice! I have facial hair! I can’t handle seeing or hearing myself! My brain is trying to kill me!”

My heart broke. All the grief I was experiencing over the different name and pronouns paled in comparison to the pain in my child’s voice. Ruby was terrified after the episode with the knife, because it realized it was not in control. There was a psychological break happening in my child that could have been prevented if it had come out sooner and been able to access puberty blockers. 

I have since learned that going through puberty is permanent, but puberty blockers put it on pause and going off of them causes the paused puberty to happen. They are completely reversible and only used under psychological and medical consultation and care. Long wait times for these services lead to kids experiencing the wrong puberty but there is always an element of hope when you’re on a wait list. Banning the use of puberty blockers takes away any hope of avoiding the very serious psychological consequences of going through the wrong puberty. Trans affirming care for adults and children is based on solid science and ensures the best possible outcomes for this marginalized and (often willfully) misunderstood community. The trauma of watching your child self-harm and become suicidal as a result of gender dysphoria is something I would not wish on anyone. 

When Ruby first came out as nonbinary, then a demi-girl, and then full on transgender male to female, I took the fact that it couldn’t seem to make up its mind as proof that it was confused and not truly trans. It seemed to me that if this was real and not some sort of bandwagoning, it would know exactly what it was coming out as and have no need to experiment with different pronouns. Again, I didn’t ask it why this was the case, I just ranted about it to my psychologist who was doing her best to hold space for my fear and rage while sharing resources with me to read once I was ready. It was my child who explained it to me during a huge fight we were having because I had suggested that this trans stuff might just be a phase or the typical teen search for identity rather than actually being real. Ruby shared that it had known for a very long time that it was not cisgender heterosexual but knew that it would be hated and unsafe if it came out, so the first step was to come out as nonbinary to see if changing pronouns and dressing androgynously would stop the panic and dysphoria it lived with. When dysphoria was still present a few months later and we had the knife incident, Ruby decided that maybe being a demi-girl would be enough, that sometimes presenting as its authentic self might be enough. Still, the dysphoria and worsening mental health persisted, and by the time it came out as Ruby, transgender girl, there had been so much trauma and self-hatred that I didn’t know if my child would ever be OK. 

As our journey continued, I finally started to ask questions rather than make assumptions. Even still, I would ask a question assuming that I already knew the answer, but I was surprised by the responses every single time. 

“Ruby, when was the first time you had the feeling that you were a girl and not a boy?” I asked, thinking that the answer would be at the beginning of grade ten just after meeting its first transgender classmate. 

“Grade two.”

My entire core froze and that familiar shot of adrenaline coursed through my body. I would never have suspected that. 

“Are you serious, Ruby?! Grade two?! How do you even remember that it was grade two and not grade one or three or something?!” I had become an expert at the subtle art of questioning my child’s experience and identity under the guise of pointing out that it has clinically poor memory. 

“Mom, we moved and I started a new school in grade two. I thought I could maybe be a girl in the new school because no one knew me yet. I noticed that some girls were allowed to be tomboys and I wondered what the equivalent was, like could boys be tomgirls? Then I realized that I was basically a living slur and figured out that girly boys get beaten up and mocked and killed so I was scared. I decided that I would just pretend to be normal.”

Again, my heart broke, and not just into the regular million pieces, but into jagged bloody splinters that bore the stench and colour of shame and regret. I had failed as a Mom by not seeing this. This is my default, always, to blame myself for my child’s struggles, as it is for many parents. I tried to convince myself that it was just a coincidence that grade two was the first time my child had told me it wanted to die, but clearly I was fooling myself. Suddenly and finally, all this trans bullshit, as I sometimes thought of it, seemed very real. 

My child has a host of health and mental health struggles. Being trans is not one of them; it was removed from the DSM for a reason. The associated mental health struggles are the result of living in a world where you are not allowed to be yourself out of fear of being mocked, harassed, beaten, or even killed. Many of our current struggles may have been avoided if my child had confided in me when it was in grade two, but it felt that its secret was so shameful that it had to keep it locked away. It missed out on the opportunity to go on puberty blockers and it breaks my heart that many of the struggles we now face could have been avoided. 

A blanket ban on puberty blockers will achieve both inflated health care costs and children who are terrified to be themselves with awful consequences. Sometimes I do cost/benefit analysis exercises in my head, adding up the cost of both emergency and ongoing psychological treatment for a person forced to endure the permanence of going through the wrong puberty vs. the cost of trans affirming care in the form of puberty blockers, which are completely reversible. The lives that will be destroyed as a result of this policy can not be overstated, both for the transgender child and for their family who is forced to watch helplessly while their child struggles. The removal of parent choice under the guise of giving power to parents is a machiavellian move of the highest degree. Parents already have the power; unless they ask for puberty blockers and sit on a long wait list, their child will never receive them. This proposed policy will do harm by removing the choice of parents and guardians to seek trans affirming care for their children. If you truly believe in parent choice, it is illogical and nonsensical to support this proposed legislation.