In Italy, a Debate Over Puberty Blockers
The need for data versus the right to grow up
In Italy, the debate surrounding the use of puberty blockers as a treatment for gender dysphoria in children has intensified, in line with the broader shift in international consensus around evidence for their safety and efficacy. Puberty blockers, medically known as gonadotropin-releasing hormone agonists (GnRHa), are medications used to halt the physical changes associated with puberty. Advocates for pediatric transition claim that their off-label use allows young individuals time to explore their gender identity without the pressure of irreversible physical changes. In reality, their use has led to many grave complications for youngsters including osteoporosis, cognitive decline, a worsened psychological state, permanent sexual dysfunction, and sterility.
The Italian Context
Italy has become a focal point following statements from various national bodies. The Italian Psychoanalytic Society (SPI) has expressed "great concern" over the use of these medications, suggesting that they should not be administered without rigorous scientific evaluation. SPI's president, Sarantis Thanopulos, warned in a letter to the Italian government that the diagnosis of gender dysphoria in prepubescent children cannot be thoroughly evaluated while sexual identity development is ongoing and emphasized of both the potential for misdiagnosis and the risks associated with halting psychosexual development.
The Italian National Bioethics Committee (CNB) has recently updated its guidance, recommending that puberty blockers should only be prescribed after mental health interventions have proven ineffective and strictly within the framework of clinical research trials. This more cautious approach reflects the lack of data on long-term effects and outcomes.
These high-profile reevaluations call the stance of Italian Society of Pediatrics, which still supports the use of blockers, under the supervision of a physician, into question.
Scientific and Ethical Considerations
Puberty blockers have been used for decades to treat precocious puberty, but even in such cases, the trade offs are serious. Their application for gender dysphoria is more recent and has sparked considerable debate. The recent Cass Review shows that there is no evidence that their use leads to better mental health outcomes. On the contrary, in most cases they make no difference or lead to a deterioration in mental well-being.
Public and Political Reactions
The issue of puberty blockers is not just a medical debate but has also spilled into the political arena. Posts on X (formerly Twitter) show that the Italian public is increasingly aware of these discussions, with many calling for evidence-based practices, and cautioning against premature medical interventions.
Italy's approach to the medicalization of transgender identity for minors, reflects the growing number of European countries moving towards restricting puberty blockers to research settings. This more cautious approach follows the example of first of countries like Finland and Sweden, which tightened their guidelines due to concerns over the evidence base for these treatments.
The Italian Healthcare System's Response
The Italian healthcare system, like many others, struggles to balance demands for access to care with the need for scientific evidence. The degree to which services for gender distressed youth can access services varies due to regional disparities in healthcare provision and the availability of specialized centers. This lack of uniform coverage across Italy has created a situation, like in the United Kingdom, in which there is pent up demand. Some have turned to online sources or unscrupulous private clinics like the Careggi Hospital in Florence, which was found to be administering puberty blockers to children as young as 9-10 years old. This situation has sparked criminal investigations and discussions about the need for more rigorous scientific evidence and oversight regarding these treatments.
The Ethical Problem of Data
The move toward restricting puberty blockers is welcome, but rather than continuing to prescribe the drugs in a research setting, Italian ethicists and clinicians would be better off ceasing their use altogether. There is no need for Italy to gather its own data. There are already clinical trials for puberty blockers going on in Finland, Norway and Sweden which will provide the information needed. Moreover, the available data shows that puberty blockers are the least promising treatment for gender related distress. While the evidence base for psychological treatments is small, it is impressive and, in contrast to puberty blockers, therapeutic interventions do no harm and are far more effective. Beyond the need for data, there is a more profound ethical need, and that is to recognize the fundamental human right of each child to fully develop as a human being, without chemical impediment. As the growing numbers of detranstioners testify, there is no way back.
A Better Future
The conversation about puberty blockers in Italy is emblematic of a global struggle to reconcile medical innovation with ethical responsibilities. Italy's recent developments signal a shift away from the affirmative approach favored by World Professional Association for Transgender Health (WPATH) towards a more cautious, research-driven approach. This is welcome, but as in the UK, we must balance the desire for the certainty of clinical trials with a realistic assessment of their limitations and the need to ensure that the well-being of young people comes first.
For more information on Italy, please checkout the excellent GenerAzioneD and read about their recent audience with Pope Francis here