Say "no" to plastics, but "yes" to puberty blockers? What is going on in the field of endocrinology?

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As any woman who has been pregnant will tell you—the list of foods and activities to avoid during pregnancy is long. In recent decades this list has grown far beyond sushi, smoking, and horseback riding. Pregnant women are frequently warned not to store their food in plastic, to use only a certain kind of paint in their nurseries, and to check the labels of their shampoo and body wash for phthalates. These things are to be avoided because they include endocrine disruptors—chemicals that can impact the development of the body’s sensitive endocrine system.

The National Institute of Environmental Health defines the risks associated with endocrine disruptors this way:

The human body is dependent on hormones for a healthy endocrine system, which controls many biological processes like normal growth, fertility, and reproduction. Hormones act in extremely small amounts, and minor disruptions in those levels may cause significant developmental and biological effects.

The website goes on to point out that even in very small concentrations these chemicals can be harmful to development:

Even low doses of endocrine-disrupting chemicals may be unsafe. The body’s normal endocrine functioning involves very small changes in hormone levels, yet we know even these small changes can cause significant developmental and biological effects. This observation leads scientists to think that endocrine-disrupting chemical exposures, even at low amounts, can alter the body’s sensitive systems and lead to health problems.

Therefore, it’s no wonder that pregnant women would want to avoid endocrine disruptors, and many go to great lengths to do so. (While many other women simply cannot afford the organic paint, glass containers, and handmade soaps and lotions.)

Meanwhile, the same institutions publishing concerns about the endocrine-disrupting chemicals in plastics are also recommending the prescription of puberty blockers for distressed (but otherwise healthy) kids and teenagers. Puberty blockers are not a possible endocrine disruptor, they are literally an endocrine disruptor. That is their entire purpose. And while research into the effects of plastics, pesticides, and phthalates continues to be funded and published (for good reason), research into the long-term effects of puberty blockers is getting, well, blocked.

When Sallie Baxendale, a clinical neuropsychologist in the UK, looked into the research surrounding puberty blockers she found an overwhelming lack of evidence, and even a lack of “curiosity.”

In her recent article for Unherd she states:

There are only five [studies] that have looked at the impact of puberty blockers on cognitive function in children, and only three of these have looked at these effects in adolescents given the medication for gender dysphoria.

Not only were the studies she looked into scarce and inconclusive, but the paper she wrote pointing this out, received unusual push-back during the peer-review process. She writes:

I have never encountered the kinds of concerns that some of the reviewers expressed in response to my review of puberty blockers. In this case, it wasn’t the methods they objected to, it was the actual findings.

None of the reviewers identified any studies that I had missed that demonstrated safe and reversible impacts of puberty blockers on cognitive development, or presented any evidence contrary to my conclusions that the work just hasn’t been done. However, one suggested the evidence may be out there, it just hadn’t been published. They suggested that I trawl through non-peer reviewed conference presentations to look for unpublished studies that might tell a more positive story. The reviewer appeared to be under the naïve apprehension that studies proving that puberty blockers were safe and effective would have difficulty being published. The very low quality of studies in this field, and the positive spin on any results reported by gender clinicians suggest that this is unlikely to be the case.

Another reviewer expressed concerns that publishing the conclusions from these studies risked stigmatising an already stigmatised group. A third suggested that I should focus on the positive things that puberty blockers could do, while a fourth suggested there was no point in publishing a review when there wasn’t enough literature to review. Another sought to diminish an entire field of neuroscience that has established puberty as a critical period of brain development as “my view”.

So, on the one hand, the endocrine system is so delicate that we should avoid trace amounts of plastics lest we compromise it; but on the other hand, when administering drugs powerful enough to literally stop puberty, there is "nothing to see here.”

Questions to the community:

• What is going on in the field of endocrinology?

• Are there any endocrinologists out there willing to speak out, aside from the few we have heard from already?

If you find this topic interesting (or maddening) be sure to tune in Friday to our conversation with Dr. Eithan Haim where we talk about these issues and a whole lot more.