On the subject of puberty blockers

There have been some things happening in my life lately that I don't yet feel up to talking about. So instead I'll talk about the video being posted around facebook and other places, where a pediatrician claims that letting trans children receive puberty blockers is tantamount to child abuse.

I have very strong opinions about this. Namely, that those claims are a crock of bullshit. So when a net friend posted and asked about it, I ended up writing a fairly long screed about it. Here it is, somewhat amended to work as a blog post instead of a facebook comment.

TL;DR: puberty blockers aren't a drastic change, taking them doesn't do harm but withholding them does.

Long version (and it turned out to be really long!)
I want to look at this from a practical point of view, and try to figure out what does the least harm to an adolescent/pubescent child and to their future adulthood. This is what I see, and it's informed by what I have learned of how these drugs work, as well as the information I've got from my transgender friends who've talked about it:

• First, puberty blockers do not change the body. What they do is to stop changes that would otherwise happen. They delay onset of puberty as long as the blocker is taken, but they do not in themselves cause any other change to the sexual characteristics of the person taking them. Therefore, giving puberty blockers does not cause any long-term danger (and indeed is indicated for children with extremely precocious puberty!) And it does not cause anybody to transition, either - they still have the same pre-pubertal body.
• Second, if an adult person transitions, the process will be a lot more complicated and difficult if the person has fully gone through puberty - their voice will have changed, they will have beard or breasts, and so on. Therefore, making a trans child go through puberty may cause long-term damage, whereas letting a non-trans child delay onset of puberty doesn't.

So from the principle of least harm, I see far less harm in postponing puberty than in forcing a person to grow up with increasing body dysmorphia and then have a lot more medical intervention be necessary once they are allowed to transition. I also see less harm in allowing a person to postpone puberty even if they then choose to not transition. The two risks and harms are by no means equal even from a purely medical standpoint and looking merely at the direct effects of the puberty blockers.

But the direct medical effects aren't the only basis to use when deciding this. Trans children are at a far greater risk of suicide in their teens. Part of this is because society isn't accepting - there are a number of homeless kids in the world, who have literally been kicked out of their homes by their parents! - but another part is because of increased body dysmorphia as the body develops its secondary sexual characteristics during puberty. Eating disorders are also more prevalent among trans kids, because if you don't eat you won't develop as much, you won't get periods and your breasts won't grow, you won't grow as tall and you won't get as broad shoulders, etc. And an eating disorder or self-harm or suicide attempts are way more dangerous to a teenager than puberty blockers are!

I know trans people who've always known their bodies were wrong and they suffered very much during puberty. I have never met anyone who was convinced of being trans during their childhood and adolescence and who later changed their minds. I won't say that they don't exist, but if they do, still they would not suffer any harm from getting puberty blockers, while the first group do suffer harm from having them denied.

(I also know trans people who endeavored to accept their body during adolescence and only transitioned when they were well into adulthood, as well as non-binary, genderqueer and any other non-cis persons you can think of, but they are not really relevant to this particular discussion.)