Brandt Files #4: Side Effects? Haven’t Seen ‘Em

A Cheery Endocrinologist Testifies About Everything and Nothing

This post is part of the Brandt Files, a series on the lawsuit in which “trans kids” successfully challenged Arkansas’ ban on youth gender medicalization. Read the introduction to the series here, along with previous entries. This series is free and available to the public.

The trial documents cited in this piece are available on the ACLU’s website in several files. Witness testimony is in the “trial transcripts.” Volume 1 contains Adkins. 

Photo by Tingey Injury Law Firm on Unsplash

The plaintiffs in Brandt presented a picture of gender transition so myopically focused on kids’ current feelings that I felt like I was reading about hospice care. Doctors halt puberty, for example, to save kids from “having to worry about pubertal changes that will make them feel bad.” Hormone therapy puts girls in a “good mood” because it banishes menstruation; mastectomies put them “over the moon.” Long term consequences? Shrug. 

Those quotes are from Deanna Adkins, a pediatric endocrinologist affiliated with the Duke Child and Adolescent Gender Care Clinic. She testified as an expert for the plaintiffs. While other witnesses also presented a rose-colored view of transition, Adkins fielded the most questions from plaintiffs’ counsel about medicalization’s risks and side effects; she seemed to be playing the role of chief consequence-denier.

Instead of fact-checking Adkins throughout this post, I’ve compiled a list of resources at the bottom. Click those links to learn how medicalization really affects kids.

Puberty Blockers – Strengthen Your Bones Later

Puberty blockers “sit in the pituitary on the receptor so that no signals can come through, so the pituitary can’t tell the ovaries or the testicles to be active,” according to Adkins. They’re administered to gender-dysphoric children from the earliest sign of puberty “if they have distress from those pubertal changes.” The purpose is “to allow them some time to get a better understanding of their gender identity if there is a question, also to relieve the distress of the incongruence of their body to their gender identity.” 

“I really don’t see many side effects at all,” Adkins continued. (She had treated 12 gender-dysphoric children with PBs.) The “most common” side effect, which is “not that common,” is “a little bit of weight gain.” PB users grow in height at the slower rate of a prepubertal child, and “we also slow down their accumulation of calcium” which affects bone density. But once a patient goes off PBs, “none of those [side effects] continue. Puberty restarts and everything catches back up.”

PBs are feared to cause cognitive impairments because they interfere with brain maturation. Adkins addressed that concern by listing five obscure conditions that “prevent someone from undergoing a hormonal puberty.” Then she claimed, “I’ve had patients who went to law school and got their Ph.D., friends that are physicians with all of those different conditions.” To recap: Adkins has friends with all five obscure conditions, none of them took PBs, they’re all doctors, doctors are cognitively perfect (implied), ergo PBs don’t cause cognitive impairments.

But wait, Dr. Adkins: do PBs affect cognitive development? “I haven’t seen any issues with our patients having delay in their cognitive development or their executive function.” She also stated that the “data that’s available doesn’t show [cognitive delay is] occurring,” but of course, the data in this field is scarce. We don’t have long term data (or even much short term data) about kids being treated with PBs over age 11.

Transitioning to “Male” – Stop the Bleeding

Adkins prescribes girls progesterone. The side effects: 

“[O]ccasionally we see some mood changes, so we talk with [female patients] about if there’s any change in your mood to let us know. I’m not seeing that. Most of my patients are very excited to not have a period, so they are actually in a good mood. There is some weight gain, and that’s really it.”

As to testosterone: 

“I’m rarely seeing any side effects. The hemoglobin going up is probably the most common one I see. Again, we’re not seeing any problems with that long term.” 

How long is “long term” for a pediatrician?

Some of Adkins' patients undergo double mastectomies while she is treating them. “When my patients come back after their top surgery, they are all over the moon. … They are able to better participate in school and work, yeah.” 

Are patients able to “retain nipple sensation after top surgery?” 

“So it depends on the technique of the surgeon,” she answered. “Most of my patients have had no issues with that.” 

Adkins was treating 400 patients for gender dysphoria at the time, along with an unspecified number for intersex conditions. She’s neither a surgeon nor a therapist, so it surprises me that she interviewed everyone post-surgery about their nipple sensation. (Also note: another gender doctor testified that most of her teen patients were not sexually active.)

Adkins’ teenage patients won’t be able to breastfeed if they get mastectomies:

For “most of them, [breastfeeding] wasn’t something that they did desire to do, and so it’s not something that they have concerns about.” (How many teens have a desire to breastfeed?)

Transitioning to “Female” – Stop Thinking About Your Penis

Transitioning from male to female likely impairs sexual function. If a boy is started on PBs early and then immediately goes on to take cross-sex hormones, he probably won’t be able to orgasm and he won’t have enough penile tissue to create a pseudo-vagina. Surgeons have used pieces of bowels or stomach lining instead. Adkins testified she counseled patients “that if we stop you earlier rather than later it may just change the technique that’s required for your procedure later on.”

As to the inability to orgasm—and the erectile dysfunction caused by estrogen even in males whose genitals developed normally—Adkins testified:

“A lot of [trans-identified adolescent boys] don’t even want to have erections because they don’t want to look at their genitals or have much to do with it. So it’s not every patient – not every patient wants to orgasm.”

As with girls, Adkins was “rarely seeing any side effects” in boys.

Important question: do her treatments work? An attorney for the plaintiffs asked her how “the effectiveness of pubertal suppression and hormone therapy to treat gender dysphoria compare to the effectiveness of other treatments that you might use for other pediatric conditions.” Adkins responded that it’s better than treating a cold with penicillin:

“In general, the efficacy rate [of hormone therapy] is very high. You know, there are other things that certainly aren’t as likely to help in another pediatric condition like antibiotics for an upper respiratory tract infection.”

To be fair, a more precise answer on efficacy isn’t possible since there are no objective measures of success when it comes to gender medicalization.

Transitioning to Adulthood

Adkins didn’t seem to realize that her patients continued to exist after they aged out of her care. For example,  she was asked by Arkansas’ attorney whether there’s a “set point in a person’s life when they ought to completely know their gender identity[.]” She responded, “You know, my clinical practice, most folks [know] by puberty”—as though being a pediatrician gave her a bird’s eye view of the human life cycle. When asked whether she could “know for any given patient whether their understanding of their gender identity … is going to remain that for the rest of their life or change,” Adkins responded: “We’re not seeing a lot of individuals change.”

She let slip something strange toward the end of her testimony. Arkansas’s attorney was grilling her on whether a boy on puberty blockers had the maturity to decide he didn’t want to orgasm for the rest of his life. Adkins responded:

“I mean, I have patients who were [blocked at early-stage puberty] and they are 24, because they have been on puberty blockers. I think they are making their own decisions just fine.”

The Arkansas attorney replied, gingerly, “I hesitate to ask because I don’t know if it’s relevant. But why would you have someone on puberty blockers at 24?”

Adkins:

“As I mentioned in my prior testimony, there are patients who are very bothered by any possible ongoing development of their genitalia, and they do not want to have any of that change. And they still have their testicles. … And some patients choose not to take the chance that coming off of [puberty blockers] their own body may start puberty again.”

Deanna Adkins doesn’t see side effects. She doesn’t see long term consequences. And she doesn’t see her pediatric patients grow up, even when they remain in her care until age 24.

This is the fourth entry in The Brandt Files. Find past entries on the author’s profile page.

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(Real) Information on the Medical Side of Medicalization

Women who were treated with PBs for precocious puberty allege severe long term effects, including deteriorated jaw joints, depression, cracking teeth and osteoporosis.

The long term effects of puberty blockers on bone health has received minimal study. A Swedish patient developed osteoporosis and a spinal fracture after using puberty blockers as an adolescent. Here’s a write-up of one alarming study by the Society for Evidence-Based Gender Medicine. The New York Times has also covered the topic.

In 2022, before the Brandt trial, the FDA linked PBs to dangerous brain swelling. Adkins testified she hadn’t seen it in her patients.

Reuters covered the risks and unknowns of using puberty blockers to treat gender dysphoric children.

Time to Think by Hannah Barnes describes the harms of puberty blockers.

For neutral information about mastectomies, check out cancer websites. Nerve damage is a risk; loss of sensation is typical.

Helena Kirchner started taking testosterone at age 18. She experienced feeling emotionally “numb for months,” frequent “rage,” and “hours of crying and hyperventilating to drive the needles into [her] flesh once a week.”

Women who have taken testosterone even for short periods report "bottom growth," meaning an enlargement of their clitoris. This can cause pain and discomfort as the clitoris chafes against their underwear. Read threads started by X [Twitter] users Watson, Prisha, eXulansic. 

Many women who take testosterone find they lose the ability to sing.

A youth gender clinic in St. Louis was exposed in 2023 by one of its case managers, Jamie Reed. To read her sworn account about patient outcomes, click here (pages 17-21). They include a teenager whose vagina was so desiccated by testosterone that the lining ripped during intercourse and she ended up in the ER with uncontrollable bleeding.

Irreversible Damage by Abigail Shrier details harms of medicalization for girls and women. I was struck by the story of Blake, a successful middle-aged lesbian who was so thrilled by the mood changes caused by testosterone that she embarked on a gory, disabling series of “bottom surgeries.”

Irreversible Damage also discusses Jazz Jennings, a trans-identified young man who stars in the reality show I Am Jazz, which began its run when Jennings was a “trans child.” Among other surgeries, he had the stomach-lining vaginoplasty that Adkins alluded to; afterward he experienced excruciating pain and his doctor “heard something go pop.” The operation has killed at least one teenager. Lisa wrote about Jennings in 2022; here’s more about Jennings’ dating life from the Daily Mail. 

Taking estrogen for two years increases males’ “odds of developing a potentially-dangerous clot” by “5.1 times” compared to men who do not take estrogen. Taking it for at least six years puts them at a risk for “developing a stroke caused by a blood clot” that’s 9.9 times that of a man not taking estrogen.

A detransitioner named Ritchie writes and speaks about his experience with castration and penectomy. “No one told me that the base area of your penis is left, it can't be removed - meaning you're left with a literal stump inside that twitches.” 

Does gender medicalization actually work better than penicillin for colds? Jesse Singal, a journalist who published a book on junk science, criticized studies purporting to show mental health benefits from gender medicalization in youths. In Brandt that literature was presented by Jack Turban, the subject of a future post in this series.