Jenny with the Axe

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.)

Last night was the first full night with the moon cup. It did not turn out as well as I'd hoped. (Again, here's the place you should stop reading if you don't like talk about periods...)

When I use a tampon on a heavy night, what happens is that it gets full and then the blood sort of trickles out along the threads. The clots still get caught in the tampon. But when I use the cup and it gets full, it trickles out through the little holes, and it doesn't get concentrated along any threads so it runs a bit more. That's what happened last night. I did use a pad, too, but unfortunately not the big night-time pads. So when the cup got full, I some of the blood ended up on my panties rather than in the pad. Fortunately I woke up around 4.30 am and discovered this before it had spread to the bed. So this was the second night of getting up and washing panties (and also the floor towel), and then fixing the cup, and getting clean panties, and putting in a larger pad just in case...

So, after last night, I have to say that I would prefer using a tampon at night. The max size tampons do last almost a full night, and the cup just doesn't, not during the first three or four days of my period. Tonight I'll have to set an alarm to get up about five hours after I empty the cup before bed.

Another downside is that with the tampon I usually feel when it starts to get full. With the cup, I just don't feel it. Of course the upside is that I don't feel it much at all, which is way nicer than the pain I get from the tampons, and it'll be very handy when I go to the gym or if I want to go swimming when on my period. I think it'll be good when I go riding too, though I won't get to try that until next month. But since I don't feel any difference from a full cup or a half-empty one, I tend to go check on it quite often. And taking it out is painful still, though I've gotten better at finding the nub. It's just the final pull when the vacuum lets go that is quite unpleasant. The pain does go away after a few minutes, but it's significant during that time.

Oh, another thing. A friend of mine said that she'd heard that it's bad to use the cup if you have endometriosis, like I have. I checked on that, and as far as I've been able to find, it's based on old science that has since been disproved but that unfortunately some doctors still believe in. There used to be a theory that endometriosis was caused by menstrual blood flowing "backwards" instead of running out through the vagina, and the particles of endometrium that came along with the blood would get stuck and become endometriosis nodes. However, this has been disproved, for two reasons - firstly, that a lot of women have retrograde menstruation without having endometriosis, and second, that people who have never had periods can still get endometriosis (e.g. infants and some men who've gotten it after hormone treatments for other diseases). So that's not an issue.

So my experience of the moon cup so far: It's comfortable, but not quite reliable, especially not when you've got a heavy flow. It's a bit tricky to handle at the start but you learn quickly. It's more of a hassle to change it than to change tampons, so with a heavy flow it might not be useful when you're working or just out and about and maybe can't get into a good place to change and wash it. I'm not going to stop using it, but it can't be my only option.