We are midwives, doulas and breastfeeding counsellors concerned about the use of puberty blockers and mastectomies for girls experiencing gender dysphoria. We care for women in their reproductive cycles and understand women’s sexuality and sexual activity as important; therefore we are concerned about the impact of these treatment pathways on their future lives.
We support healthy expressions of sexuality and reproductive choice and think teenagers should be allowed to go through puberty, and develop sexual feelings, expression and behaviour including homosexuality and gender non-conformity. In most cases it is in fact going through puberty and coming to terms with your sexuality and adult body that resolves gender dysphoria, if allowed space to happen and supported by those around them.
With regard to puberty blockers for teenagers with gender dysphoria it is well documented and by now indisputable that:
- Taking puberty blockers (PB) almost always (98%) leads to taking cross sex hormones (CSH). .
- CSH lead to a lack of sexual function, possible inability to orgasm, and lack of fertility. .
- PB themselves taken over a long period may lead to lack of fertility. .
- PB lead to a lack of normal development of sexual urges and feelings.
- CHS have negative health effects such an increased chance of heart disease, liver and kidney disorders, atrophy of reproductive organs, and increased depression and anxiety.
- People who do go on to have genital plastic surgery, will never have fully functional genitalia.
There were no demonstrable improvements of health or wellbeing , a lack of transparency with the young people and their parents, and serious issues around consent and follow-up in most clinics.
Offering mastectomies as a treatment for hatred or disgust of your breasts has such tragic long-term consequences. We see women unable to breastfeed, some due to mastectomies for medical reasons, and this can create feelings of loss or regret. Women given mastectomies for mental distress at a young age, means a number of them will go to have babies, and may suffer further distress at not being able to breastfeed. In fact for the young women, the problem never did reside in the breast tissue, but in the feelings and emotions. As feminists we think much of this distress and unease stems from patriarchy. From growing up in a society influenced by the sexist imagery all around us, and the accessibility of porn; a society that does not allow for a full range of possibilities for girls.
PB supressing sexual feelings is particularly relevant if the young person with gender dysphoria might have ended up to be gay if left to develop. Blocking this stage removes the chance of them really discovering and embracing their full sexuality. We do not know the long term affects on arresting the more general cognitive development happening during puberty.
We do not know the proportion of those on CSH who go on to have surgery. Of course sex is more than genitals, but as adults we can all appreciate that those without normal functioning genitalia may find sex less satisfying for themselves and their partners. We stand for the idea that fulfilling and healthy sex lives are a ‘good thing’. Is ‘passing’ to be valued so highly as to be worth sacrificing an adult sex life for? We are move by stories of detransitioners developing self-acceptance.
The gains of the gay rights movement were to not pathologise and not medicalise gay people, and now we are back to using potent and unproven medication with life-long consequences and severe side effects on often these very same young people. How can a known permanent reduction in sexual function and reproductive choices be compatible with be a full realisation of sexual and reproductive health and rights including the right to safe, enjoyable relationships for gender dysphoric and gender non-conforming young people?
As midwives we see the heartbreak infertility and problems of sexual function can cause women, and couples. When these problems are caused, unintentionally, by medical processes such as through childbirth complications it is hard enough. But that they might be deliberately undertaken by health care professionals to teenagers is hard to justify.
The judgement in the Bell / Tavistock case was that young people were unable to consent to such profound and permanent changes that affect parts of their life they cannot know about. How can a 13 year old understand the importance of orgasm or fertility in later life? As feminist midwives, doulas and breastfeeding supporters, we cannot support the sterilisation of teenagers thereby restricting their reproductive choices.