Tuesday, September 15, 2020




Emails Show the Meatpacking Industry Drafted an Executive Order to Keep Plants Open

Hundreds of emails offer a rare look at the meat industry’s influence and access to the highest levels of government. The draft was submitted a week before Trump’s executive order, which bore striking similarities.



by Michael Grabell and Bernice Yeung Sept. 14


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In late April, as COVID-19 raced through meatpacking plants sickening and killing workers, President Donald Trump issued a controversial executive order aimed at keeping the plants open to supply food to American consumers.

It was a relief for the nation’s meatpackers who were being urged, or ordered, to suspend production by local health officials worried about the spread of the coronavirus.

But emails obtained by ProPublica show that the meat industry may have had a hand in its own White House rescue: Just a week before the order was issued, the meat industry’s trade group drafted an executive order that bears striking similarities to the one the president signed.

The draft that Julie Anna Potts, the president of the North American Meat Institute, sent to top officials at the U.S. Department of Agriculture was written using the framework of an official executive order and stressed the importance of the food supply chain and how outbreaks had reduced production — themes later addressed in the president’s order.

It invoked the president’s powers under a Korean War-era law known as the Defense Production Act and proposed that the president make a simple and straightforward proclamation: “I hereby order that critical infrastructure food companies continue their operations to the fullest extent possible.”



Highlights added by ProPublica

What happened next within the USDA and White House isn’t clear from the records. The USDA declined to answer questions, and the White House did not respond to requests for comment. But while the final wording wasn’t verbatim, Trump’s order emphasized the points the industry had proposed and furthered the same goal, directing the agriculture secretary to take action “to ensure that meat and poultry processors continue operations.”

The order provided a lifeline for meatpacking companies stressed by dozens of plant closures, severe staffing shortages and supply chain disruptions that would cause fast food restaurants to run out of hamburgers and grocery stores to ration meat purchases.

But it has also generated significant criticism from labor unions and Democratic senators who said it prioritized the bottom line of the nation’s meatpackers over the health of their workers.

The executive order effectively provided a justification, sanctioned by the White House, for meat companies to continue operations even as tens of thousands of the industry’s workers contracted the disease.

“It certainly gives rise to at least the appearance of favoritism that the executive order was done not because the White House thought it was the right thing to do but because they were getting pressure from outside groups that wanted it done,” said Stephen Vladeck, a constitutional law professor at the University of Texas at Austin.

Highlights added by ProPublica

In a statement, Potts said that the meat institute had been working as a liaison between the government and industry on many issues related to COVID-19. “Trade associations of all types routinely suggest legislative language, comment on proposed rules, and other provisions that are shared with the government,” she said.

The documents obtained by ProPublica offer a rare look at the process of drafting an executive order and a glimpse into the meat industry’s influence and access to the highest levels of government. Such political support has been crucial for the industry, which had dismissed years of warnings from the federal government to plan for a pandemic, sowing chaos in rural communities as they battled local health departments over outbreaks in their plants.

The draft executive order was one of hundreds of emails between the companies, industry groups and top officials at the USDA since March. Together, they show that throughout the coronavirus crisis, the meatpacking industry has repeatedly turned to the agency for help beating back local public health orders and loosening regulations to keep processing lines running.

While special interest groups often submit draft legislation and regulations to policymakers, legal experts said executive orders are less common and aren’t subject to the same public scrutiny.

In interviews, former White House lawyers from Democratic and Republican administrations said that there is great latitude in how executive orders are generated and it wasn’t unusual for private interest groups of all types to promote their causes by pushing for an executive order. It is also reasonable for the White House to seek input from outside entities during the process. But there would typically be an effort to consult a range of parties who might be affected by it before the order received legal scrutiny, they said. The quick seven-day turnaround, even amid an emergency like COVID-19, is notable, some said.

“All policy is shaped by people who have a stake in it,” said Rakesh Kilaru, associate counsel and special assistant to President Barack Obama from 2015 to 2017. “But I can’t think of something that was so direct between the stakeholder asking for action and getting it.”

Highlights added by ProPublica

Jonathan Adler, a constitutional and administrative law professor at Case Western Reserve University, said there’s nothing “inherently inappropriate” about the industry helping to draft the order. “The concern is that, in a case like this, if the executive order is slanted to a particular interest rather than the public at large,” he said.

The United Food and Commercial Workers union, which represents workers responsible for the majority of U.S. beef and pork production, said no one from the White House or the USDA sought its input before the executive order was issued.

Mark Lauritsen, the UFCW’s director of food processing, packing and manufacturing, said he believes the Meat Institute “along with some of the other bigger players in the industry pulled every lever they could.”

The order has been effective as a political tool because it is widely perceived to have far more legal force than it actually does. From a legal standpoint, the executive order gave Agriculture Secretary Sonny Perdue additional power to issue his own orders related to the food supply — something he hasn’t done.

But many state and local health officials view the order as superseding their authority or decided to back off in the face of political pressure from the Trump administration. Within a week of the executive order, the USDA was working with companies and local health authorities to reopen shuttered plants. With workers back on the line, operations ramped up again. Pork production, for example, had fallen by more than half by the end of April, causing steep financial losses. But by early June, meatpacking plants were nearly back to capacity.

Since the order, however, COVID-19 infections among meatpacking workers have multiplied. To date, there have been more than 43,000 cases and at least 195 deaths among meatpacking employees, according to data compiled by ProPublica from public health agencies and news reports.

Documents obtained under the Freedom of Information Act show that almost from the start of the crisis, the meatpacking industry and the USDA were largely focused on how to keep workers on the line.

Highlights added by ProPublica

In March, governors across the country tried to stem the spread of COVID-19 with shelter-in-place orders, coming up with their own varied lists of essential industries. Companies were sometimes faced with unclear and conflicting directives. This was especially true in meatpacking, a highly consolidated industry where a handful of companies run multiple operations across the country with hundreds of employees working side by side.

To seek clarity, 60 food and agricultural trade groups sent a letter on March 18 to federal, state and local officials asking for exemptions from curfews and public gathering bans so they could keep their businesses running. Copies of the letter were sent to the White House and members of Congress, and Tyson Foods circulated it among several governors.

The next day, the Department of Homeland Security issued guidance and noted Trump’s previous comments that “if you work in a critical infrastructure industry, as defined by the Department of Homeland Security, such as healthcare services and pharmaceutical and food supply, you have a special responsibility to maintain your normal work schedule.”

But the meatpacking companies soon found themselves facing another hurdle. By April, waves of workers who debone chickens or carve up pork elbow-to-elbow with their co-workers were falling ill from the virus. Some feared coming to work while others walked out of plants to protest the lack of infection control measures.

With plant slowdowns came a backlog of pigs, cows and chickens waiting for slaughter. Millions of animals had to be euthanized.

As some plants partially suspended operations or contemplated closing because of staffing shortages, Potts of the Meat Institute arranged an April 3 call between Perdue and top executives of major meatpacking firms Tyson, Smithfield Foods, Hormel, JBS, Seaboard and Cargill. Before the call, Potts emailed the USDA’s undersecretary for food safety, Mindy Brashears, with a list of discussion topics, including clear messaging that employees who failed to show up for work because they were scared would not qualify for unemployment benefits.

“I want to re-emphasize that the slowdowns and shutdowns you heard described today are significant and getting worse each day,” Potts wrote in a follow-up email. “Hearing a strong and consistent message from the President or Vice President like that delivered by the Governor of Nebraska yesterday is vital: being afraid of COVID-19 is not a reason to quit your job and you are not eligible for unemployment compensation if you do.”

Highlights added by ProPublica

Two days later, the Labor Department, which had been hearing similar complaints from across the business community, issued guidance clarifying that workers who quit to avoid contracting the disease wouldn’t receive jobless benefits.

As outbreaks overwhelmed hospitals in April, pressure from local public officials grew, leading to the rapid-fire closures of some of the nation’s largest slaughterhouses.

The threat of closure led the meatpacking industry to ramp up its efforts to seek intervention not only from the USDA but from other government officials as well. Emails obtained by ProPublica show that as state and local health officials sought to order JBS to shut down its Greeley, Colorado, plant, the company appealed to Gov. Jared Polis and then to Vice President Mike Pence.

State health director Jill Hunsaker Ryan told the head of the county Health Department that she had received a call from Robert Redfield, the director of the Centers for Disease Control and Prevention.

“JBS was in touch with the VP who had Director Redfield call me,” she wrote in an email, first reported by The Denver Post. “They want us to use CDC’s critical infrastructure guidance, (sending asymptomatic people back to work even if we suspect exposure but they have no symptoms) even with the outbreak at present level.”

JBS said that it reached out to Pence because it was “receiving guidance from local authorities that conflicted with federal CDC guidance,” but that it ultimately agreed to shut down the plant to “stop any potential chain of infection.”

Tyson and National Beef made similar appeals to the Kansas Department of Agriculture when the state Health Department wanted workers to stay off the line for two weeks if they had come in contact with a positive COVID-19 case, public records first reported by The Kansas City Star and The Wichita Eagle show. The state’s secretary of agriculture coordinated with meat companies and the director of the Kansas Department of Health and Environment, who then agreed to follow the less-strict CDC guidance.

Despite these varied efforts to keep plants open, absenteeism and public health orders continued to cripple production lines. Government experts had long predicted a pandemic would cause food shortages. And those worst-case scenarios were now playing out.

The major meat and agriculture trade groups, including the American Farm Bureau Federation, the National Cattlemen’s Beef Association and the Meat Institute, wanted the White House to get directly involved in preventing plant closures.

In an April 17 letter to Trump, they detailed the disruptions caused by plant closures and the inconsistency of health and safety actions from state to state — a point later echoed in the executive order.

“To ensure livestock producers, poultry growers, and all food processors and their workers can continue to feed the nation,” they wrote, “we respectfully request you emphasize the importance of allowing critical infrastructure food companies to responsibly and safely continue their operations to the fullest extent possible without undue disruption.”

For emphasis, Potts of the Meat Institute followed up with an email to Stephen Censky, the USDA’s deputy secretary, who led the American Soybean Association before joining the Trump administration. She attached the letter to Trump and added, “The situation is continuing to get worse and worse at the local level (it’s hard to overstate how dire it is) and I want to explore with you what might be possible as a tool to help.”

Early the next morning, Potts had a call with top officials from the USDA, and shortly after 9 a.m., she sent them an email, writing: “Attached is a draft EO for consideration.”

Highlights added by ProPublica

The records don’t include a reply, and White House and internal deliberative agency conversations are exempt from public records laws, making it difficult to verify how much or little influence the meat industry’s draft had on the final executive order.

But over the next week, the drumbeat for action on behalf of the food and agriculture sector continued. Governors from the poultry producing states of Delaware, Maryland and Virginia wrote to Trump asking for the designation of one federal agency to lead on COVID-19 and poultry workers, access to protective equipment and financial relief for farmers and companies. Industry representatives convened a call with the USDA, the Food and Drug Administration and DHS about the impending disaster facing farmers, who would need to mass euthanize their animals if plants remained shuttered. In that conversation, utilizing the Defense Production Act was discussed, according to an industry representative on the call. Tyson took out a full-page ad in major newspapers to warn that the food supply chain was breaking.

Even on the day the executive order was issued, there was still a flurry of activity to get the White House to help the meat industry. That afternoon, records show, the director of the Washington office for North Carolina Gov. Roy Cooper forwarded a letter from pork producers to his counterparts in Michigan, Illinois, Minnesota, Colorado and Pennsylvania to ask their opinion on it and whether their governors were going to sign on.

The draft letter, addressed to Pence, asks for his help in invoking the Defense Production Act to assist in “the humane euthanasia of animals,” to indemnify farmers and pork producers and to “utilize every authority available to keep plants open.”

A representative from Michigan said her state would pass, noting the lack of worker protection language in the letter, while an aide to Pennsylvania’s governor cited the need for “advocacy on behalf of all sectors.”

On April 28, a week after Potts sent the suggested language for an executive order, Trump issued the “Executive Order on Delegating Authority Under the DPA with Respect to Food Supply Chain Resources During the National Emergency Caused by the Outbreak of COVID-19.”

Trump’s final order reflects what the meat industry had been requesting for weeks as the pandemic had unfolded: “It is important that processors of beef, pork, and poultry (‘meat and poultry’) in the food supply chain continue operating and fulfilling orders to ensure a continued supply of protein for Americans.”

It also notes that “recent actions in some States have led to the complete closure of some large processing facilities” and that such closures “threaten the continued functioning of the national meat and poultry supply chain, undermining critical infrastructure during the national emergency.”


Read More


Meatpacking Companies Dismissed Years of Warnings but Now Say Nobody Could Have Prepared for COVID-19

Government officials predicted a pandemic would threaten critical businesses and warned them to prepare. Meatpacking companies largely ignored them.

The order invokes the Defense Production Act and orders the agriculture secretary to “take all appropriate action under that section to ensure that meat and poultry processors continue operations consistent with the guidance for their operations jointly issued by the CDC” and the Occupational Safety and Health Administration.

It had immediate effect.

In June, the Bear River Health Department in northern Utah, where nearly 400 JBS workers have tested positive for COVID-19, told the press it couldn’t shut the plant down because of the executive order.

In Virginia, state health officials had initially recommended that poultry companies close their plants for two weeks, “allowing deep cleaning and allowing symptomatic and asymptomatic infected workers to run their course of disease and recover,” records obtained under a separate public records request show. But the state backed off “to maintain the critical food production infrastructure.”

Meanwhile, meat companies and their trade groups continued to seek help from the USDA when public health officials tried to take action.

The day after the executive order was announced, the National Chicken Council wrote to the USDA with complaints that the county Health Department in Chattanooga, Tennessee, was requiring testing of all employees at poultry plants in the area. This would have the effect of closing down the plants, the trade group warned, because they were already short-staffed and testing could cause fear among the remaining workers.

Weeks later, the Chicken Council wrote that local officials were threatening plant closures and issuing public notices because they believed the plants were “operating with an imminent health hazard.”

“We want to push back on 100% testing and would like your assistance,” the trade group wrote.

The Chicken Council didn’t return calls or emails seeking comment.

Smithfield also went to the USDA for help dealing with a local public Health Department in Kane County, Illinois, which had closed the plant days before Trump’s executive order was issued. “The Kane County Illinois health department continues to be a challenge regarding our St. Charles processing facility,” Michael Skahill, Smithfield’s vice president of government affairs, wrote to Brashears, the USDA’s undersecretary for food safety. “I really did not want to have to get you involved but it has now come to the point where we need you to referee.”

Asked why it had gone to the USDA to intervene, Keira Lombardo, Smithfield’s executive vice president for corporate affairs, said: “We are a leading American agriculture company. Considering that fact, why wouldn’t we engage with the United States Department of Agriculture amid an unprecedented pandemic?”

Two days after Skahill’s plea for help, Smithfield continued to press the issue. Amy McClure, Smithfield’s associate general counsel, wrote to Brashears again, this time citing a central tenet of the executive order. “To reiterate our conversation, our St. Charles plant in Kane County, Illinois is in an urgent situation,” McClure wrote. “We need to reopen to prevent further disruption in the nation’s food supply.”

Six hours later, Brashears and her chief of staff received a grateful email from Skahill. “Thank you for your support today with the Smithfield St. Charles Kane County issue,” he wrote. “I think we have a resolution that will allow us to process next week and put protein on America’s table.”

Do you have access to information about COVID-19’s spread in the meatpacking industry or the government’s response that should be public? Email michael.grabell@propublica.org or bernice.yeung@propublica.org. Here’s how to send tips and documents to ProPublica securely.

Mollie Simon and Claire Perlman contributed reporting. Graphics by Moiz Syed.

 

Earth barreling toward 'Hothouse' state not seen in 50 million years, epic new climate record shows

A climate map showing the last 66 million years of Earth's history
A climate map showing the last 66 million years of Earth's history
(Image: © Westerhold et al., CENOGRID)

Sixty-six million years ago, after a massive asteroid hit Earth with the explosive energy of roughly 1 billion nuclear bombs, a shroud of ash, dust and vaporized rock covered the sky and slowly rained down on the planet. As plant and animal species died en masse, tiny undersea amoebas called forams continued to reproduce, building sturdy shells out of calcium and other deep-sea minerals, just as they had for hundreds of millions of years. When each foram inevitably died — pulverized into seabed sediment — they kept a little piece of Earth's ancient history alive in their fossilized shells.

For decades, scientists have studied those shells, finding clues about the ancient Earth's ocean temperatures, its carbon budget and the composition of minerals spilling through the air and seas. Now, in a new study published today (Sept. 10) in the journal Science, researchers have analyzed the chemical elements in thousands of foram samples to build the most detailed climate record of Earth ever — and it reveals just how dire our current climate situation is. 

The new paper, which comprises decades of deep-ocean drilling missions into a single record, details Earth's climate swings across the entire Cenozoic era — the 66 million-year period that began with the death of the dinosaurs and extends to the present epoch of human-induced climate change. The results show how Earth transitioned through four distinct climate states — dubbed the Warmhouse, Hothouse, Coolhouse and Icehouse states — in response to changes in the planet's orbit, greenhouse gas levels and the extent of polar ice sheets.

Related: 10 Signs Earth's climate is off the rails

The zig-zagging chart (shown above) ends with a sobering peak. According to the researchers, the current pace of anthropogenic global warming far exceeds the natural climate fluctuations seen at any other point in the Cenozoic era, and has the potential to hyper-drive our planet out of a long icehouse phase into a searing hothouse state.

"Now that we have succeeded in capturing the natural climate variability, we can see that the projected anthropogenic warming will be much greater than that," study co-author James Zachos, professor of Earth and planetary sciences at the University of California, Santa Cruz, said in a statement. "The Intergovernmental Panel on Climate Change (IPCC) projections for 2300 in the 'business-as-usual' scenario will potentially bring global temperature to a level the planet has not seen in 50 million years." (The IPCC is a United Nations group that assesses the science, risks and impacts of climate change on the planet.)

The JOIDES Resolution Drillship gathered sediment cores for the new study.

The JOIDES Resolution Drillship gathered ocean sediment cores for the new study. (Image credit: Adam Kurtz)

Into the hothouse

To compile their new era-long climate map, the study authors examined fossil foram shells in deep-sea sediment cores — long tubes of rock, sediment and microbes — drilled from the world's oceans over the past several decades. Forams (short for foraminifera) are microscopic plankton whose oldest relatives appeared in the ocean close to a billion years ago; the deeper scientists dig into the seabed, the older the foram specimens they uncover. 

The ratios of carbon and oxygen isotopes (versions of elements) in foram shells hold critical climate information. The ratio between the oxygen isotopes oxygen-18 and oxygen-16, for example, can reveal how warm the surrounding water was when a foram constructed its shell; the higher the ratio, the colder the water. The ratio between carbon-13 and carbon-12 shows how much organic carbon was available for the microbes to eat; here, a higher ratio correlates with more greenhouse gases (like carbon dioxide) in the atmosphere.

Because the team's climate record covers such an incredibly long time period, the researchers also had to consider astronomic impacts on the planet's climate — that is, how Earth's slowly changing orbit and tilt toward the sun impact the amount of sunlight reaching different parts of the planet at different times, also known as Milankovitch cycles. When the team overlaid orbital data with their isotopic climate data, they saw that orbital variations created distinct but relatively small-scale changes to the global climate. Crucially, each big jump between climate states was tied to a massive shift in greenhouse gas levels, the researchers said.

A climate map showing the last 66 million years of Earth's history (and the next 300). (Image credit: Westerhold et al., CENOGRID)

For example, about 10 million years after the dinosaur extinction, Earth jumped from a warmhouse state to a hothouse state. This event, known as the Paleocene-Eocene Thermal Maximum, saw temperatures up to 29 degrees Fahrenheit (16 degrees Celsius) above modern levels, Zachos said, and was driven by a massive release of carbon into the atmosphere, thought to be the result of huge volcanic eruptions in the North Atlantic. Similarly, as carbon dioxide disappeared from the atmosphere over the next 20 million years, ice sheets started to form in Antarctica and the planet entered a coolhouse phase, with surface temperatures averaging about 7 F (4 C) above modern levels.

About 3 million years ago, Earth entered an icehouse phase, driven by waxing and waning ice sheets in the Northern Hemisphere. Now, human greenhouse gas emissions are causing temperatures to rise to an extent not seen in tens of millions of years. This rise is well beyond the natural variations triggered by Earth's changing orbit, the researchers concluded. And if current greenhouse emissions hold steady, the climate could skyrocket back to levels not seen since the Paleocene-Eocene Thermal Maximum. The transition from icehouse to hothouse won't take millions of years, Zachos said — it will take hundreds.

"We now know more accurately when it was warmer or colder on the planet and have a better understanding of the underlying dynamics and the processes that drive them," lead study author Thomas Westerhold, Director of the University of Bremen Center for Marine Environmental Sciences in Germany, said in the statement. "The time from 66 [million] to 34 million years ago, when the planet was significantly warmer than it is today, is of particular interest, as it represents a parallel in the past to what future anthropogenic change could lead to."

Editor's Note: This story was updated on Sept. 11 to fix two Celsius and Fahrenheit conversions.

Originally published on Live Science.munity@space.com.



Analysis
Debunking myths about puberty blockers for transgender children

10 September 2020 (Last Updated August 25th, 2020 17:03)

Puberty blockers are drugs that may be given to young people with gender dysphoria, to prevent them from going through a puberty that doesn’t match their gender identity. They’re a physically reversible intervention, and if a young person stops taking the blockers their physical adolescence will continue to develop as it had done previously – but the drugs have proven controversial and there’s a lot of misinformation out there. Chloe Kent reports.

What are puberty blockers and why might a young person want to be prescribed them? Credit: Shutterstock.

In January, papers were lodged at the British High Court against the Tavistock and Portman NHS Trust, which runs the UK’s only gender identity development service (GIDS).

The claimants against the Trust want to establish a legal minimum age of 18 for puberty blocking hormone therapy for young people diagnosed with gender dysphoria, with their lawyers arguing that it is illegal to prescribe the drugs to anyone younger as they cannot give informed consent to the treatment.

The case has been brought about by the parent of a 15-year-old on the GIDS waiting list known as Mrs A, who does not believe children can understand the ramifications of taking puberty blockers. Alongside her is a 23-year-old woman named Keira Bell, who transitioned to male as a teenager but has since detransitioned and believes she should have been challenged more by GIDS during the process.


So-called puberty blockers, known formally as gonadotropin-releasing hormone (GnRH) antagonists, are medications that cause the body to stop producing sex hormones. They are delivered either as leuprorelin injections, which are administered by a healthcare worker every three months, or via a histrelin implant, which needs to be replaced annually.

The GnRH antagonists bind to receptors in the pituitary gland, blocking the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the anterior pituitary. This leads to suppression of testosterone production in the testes or the suppression of estradiol and progesterone production from the ovaries, depending on the anatomy of the individual taking them.



For young trans people, taking these drugs will prevent things like breast tissue development and periods, or the growth of facial hair and a deepening voice. The effects of drugs are completely reversible, and if a person stops taking them their body will resume sex hormone production as it had done before they started.

As well as being used to suppress puberty in gender-questioning youth, they’re used from the age of six onwards for the management of precocious puberty, when a child’s body enters adolescence too early. GnRH antagonists are also used to treat prostate cancer, as part of IVF fertility treatment and for the management of uterine disorders such as endometriosis or fibroids. They’re even being investigated as a treatment for women with hormone-sensitive breast cancer, as a treatment for benign prostatic hyperplasia and as a potential contraceptive.
Why might a young person want puberty blockers?

Gender dysphoria – the sense of unease arising from one’s physical sex characteristics not aligning with one’s gender identity – can be just as unpleasant for young people as it is for adults.


Pacific University Oregon co-director of child psychology Dr Laura Edwards-Leeper says: “The impact of going through the wrong puberty for a child who is transgender can be devastating, as their body feels as if it is out of their control and changing in a way that is incongruent with their gender identity. This can lead to a host of psychological problems, most often depression, anxiety, low self-esteem, self-harming behaviours and suicidality.”

When puberty blockers are used to delay or prevent these changes, they’re essentially used to buy time. They’re primarily intended to give young gender-questioning people a few years to weigh up their options before going through any permanent bodily changes, whether those are through hormone replacement therapy (HRT) to induce a puberty which corresponds with their gender identity, or discontinuing the blockers altogether and allowing puberty to proceed as it would have done without any intervention.

“It is important that the young person fully understands that they can change course at any time and that no one will be disappointed in them or feel that they made ‘a mistake’ or ‘didn’t know who they were’ when they made the decision to start blockers,” says Edwards-Leeper.

“Parents, other family members, providers, friends and peers and school staff need to understand this as well, so that the young person does not feel boxed in. Just as we do not want trans youth to feel pressured into being cis, we don’t want gender diverse youth to feel pressured into being trans if they ultimately feel that this does not fit for them.”
How are puberty blockers prescribed in the UK?

While many people who oppose the use of blockers maintain that drugs are given out too readily, most patients actually face a lengthy waiting period. In November 2019, doctors in the UK GIDS were beginning initial consultations with patients who had been referred in September 2017, more than two years beforehand. Even then, puberty blockers won’t be prescribed immediately.

Val, a 19-year-old transfeminine student, came out at 13 and had her first appointment with the UK GIDS soon after, but didn’t receive puberty blockers until she was 17.

“I think the thing I find really distasteful is all the things in the media about how they’re fast-tracking trans people,” she says. “I’m like, ‘they’re not!’. During that process you have to put your life on hold. It’s like an axe that’s hanging above your head all the time and you don’t know when it’s going to drop and it’s terrifying. Puberty blockers allow trans teenagers to finally get back to living their lives. They just give you peace of mind.”

More than 5,000 young people are currently on the GIDS waiting list, and according to a BBC investigation only 267 people under the age of 15 started using blockers between 2012 and 2018. While things differ internationally, the UK GIDS will not prescribe HRT to a young trans person unless they have spent 12 months on blockers and are at least 16 years of age.
Related Report



While it’s important to acknowledge that detransition does happen, what’s vital is that cases like Keira Bell’s are rare. Most recent studies estimate the overall detransition rate for trans people to be less than 4%.

“Far more trans kids live with lifelong impacts of decisions that we seem to be making based on one cis kid who gets referred accidentally,” says Val.
Do puberty blockers have any serious side effects?

Puberty blockers are safe as far as can be determined from the experience of non-transgender children who take them or women undergoing fertility treatments who take them,” says Mount Sinai Center for Transgender Medicine and Surgery executive director Dr Joshua Safer.

Like all medications, the blockers are still known to have some side effects, including weight gain, hot flashes, headaches and swelling at the site of injection. There also may be more long-term effects on bone density, which is part of the reason the drugs aren’t supposed to be prescribed for too long.

Safer explains: “The primary concern is that bones might be at greater risk of osteoporosis because bones depend on sex hormones for maintenance. That need is part of the reason that women typically are at risk for osteoporosis earlier than men, as women go through menopause and suffer a loss of sex hormones while men don’t typically have a similar significant hormone change. But the risk is hard to see when only taking puberty blockers for a year or two.”

It’s also worth noting that there is a relationship between puberty blockers and fertility. Sperm production typically begins between 13 to 14, and egg maturation between 12 to 13, and the vast majority of trans children will begin puberty blocker treatment after these processes have already occurred.

In these cases, sperm or eggs can be frozen before treatment and may be used to conceive a child in later life. If a young person decides not to transition after all and ceases puberty blocker treatment, the Endocrine Society advises that no studies have reported long-term, adverse effects on ovarian function. For people with testicles, sperm numbers can fall below the normal range in some cases.

Things are slightly different for the small number of trans children who may undergo puberty blocker therapy before sperm or egg maturation occurs and then immediately begin HRT. As they will be unable to have a sperm or egg sample frozen, they don’t have the same fertility preservation options that children who start taking blockers when they’re slightly older would have.

“The concern is hormone treatment would have to be stopped in order to restore fertility later were it desired – perhaps for many months,” says Safer. “The concern is part of the reason for puberty blockers – to allow time to have the conversations that will allow reasoned choices being made regarding hormone therapy.”

Of course, any medical decision which could have an impact on fertility is one that requires a lot of time and care to consider. However, many trans people find the way the impact on fertility is used to argue about the ethics of trans healthcare inherently problematic.

Val says: “It’s something that gets brought up and is very much rooted in the idea that if you are infertile that is somehow lesser and you are lesser of a person, which is not at all correct.”
Gillick competence and the future of trans healthcare

In England and Wales, the term ‘Gillick competence’ is used in medical law to decide whether a child under the age of 16 is able to consent to their own medical treatment, without the need for parental permission or knowledge.

It means that the legal authority for parents to make medical decisions on behalf of their children is revoked when the child reaches sufficient maturity to make their own decisions. There is no hard-and-fast age at which a child can be considered ‘Gillick competent’, and it is something decided on a case-by-case basis.

The claimants in the ongoing UK court case against Tavistock and Portman believe that Gillick competence should not apply when it comes to gender reassignment, with their solicitor telling The Guardian: “We say it is a leap too far to think that Gillick as a judgment could apply to this type of scenario, where a young person is being offered a treatment with lifelong consequences when they are at a stage of emotional and mental vulnerability. It simply doesn’t compute, and therefore whatever medical professionals say is consent is not valid in law.”

Yet, a study published this year in the journal Pediatrics found that access to puberty blockers can be life-saving, reducing the chances of suicide among young trans people, who are at much greater risk of this than the general population. It’s hard to see how revoking Gillick competence for a reversible, life-saving treatment stands up from a medical ethics standpoint.

While many parents and carers of transgender children understandably worry about what the future holds for their kids in a world that isn’t especially kind to gender nonconforming people, that worry should never be allowed to become so overwhelming that they seek to strip away essential health services out of fear.

A representative of UK trans children’s charity Mermaids says: “The important thing to remember is that all journeys and identities are valid, and by supporting your child, they will be able to continue along this journey knowing you love and care about them, whoever they are and whatever they choose to do.”