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This is Your Brain on Lupron
giving kids hypothalamic hormones b/c adolescence sucks seems like a bad idea
“There are no known irreversible effects of puberty blockers, so if your child were to stop taking them their body would continue through puberty, picking up where it left off.” — Trans Care BC
Let’s unpack that misleading statement from the Trans Care BC website.
First of all, note the language — “puberty blockers”. Puberty is a complex temporal physiologic process. Can we “pause puberty” so the kid can decide whether s/he wants to grow up or not? Is a pubescent child’s neuroendocrine system really like a Netflix show we can pause so we can go to the loo + make popcorn + take the dog out? What if when we try to “pause puberty” it’s the equivalent of shutting down your computer in the middle of an OS upgrade so you can decide whether you want that new OS version or not. If your computer loses power during an OS upgrade you could corrupt your operating system or even brick your computer.
Second, note the reassurance offered by Trans Care BC about the child’s body picking up where it left off, untrue. GnRH neurons are central to sexual + behavioral maturation, wrote Sisk et al 19 years ago in a paper about the neural basis of puberty. What’s that mean? It means that puberty involves far more than development of secondary sex characteristics. It means that the hormone which Lupron blocks has very a important role to play in brain growth and health. Puberty happens because of the temporal activation of the brain’s Hypothalamic-Pituitary-Gonadal axis. The brain has its innate programming and the HPG axis engages as a result of several temporal permission signals throughout the brain. GnRH neurons play a key role in this complex temporal process. Lupron is a GnRH agonist, meaning it blocks production of GnRH in the brain. When you stunt the hypothalamus and desensitise the pituitary of an adolescent, then you have not affirmed her, and that young person’s body will not pick up where it left off — Lupron is not the endocrine equivalent of pausing your Netflix show to get a snack.
Third, note the blatant lie no known irreversible effects of puberty blockers. Lupron has been FDA and Health Canada approved for treatment of prostate cancer, endometriosis, and central precocious puberty since the late 80s and studies dated as early as 1992 document irreversible effects from Lupron, in particular in women with endometriosis. In fact memory impairment and bone density loss featured among the most common enduring effects of Lupron therapy. Beyond the know adverse effects of Lupron in adults for Health Canada approved uses, the frightening truth lurks. Neuroscience barely has an understanding of the neurophysiology pubertal onset, and yet we do have the science knowledge base that points to important functions for GnRH beyond triggering reproductive hormone production — including metabolic and immune.
What are we doing when we give kids puberty blockers? We are giving them a drug that is 20 more potent than endogenous GnRH. We are targeting GnRH neurons — that means the hypothalamus and possibly beyond (recent discovery shows that GnRH neurons exists in the basal ganglia and the forebrain ganglia). We are desensitising the pituitary through our disruption of the HPG axis. Surely this deserves some kind of warning? Surely this qualifies as irreversible effects?
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