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Putting puberty on pause

 
  Thursday, 12 l 05 l 2011  Source: The Straits Times   
By: Andy Ho
     
 

WHAT can a mother do if her autistic son compulsively masturbates in public?

A reader faced with this problem said that offended neighbours have called the police in a few times already. The teenager’s doctors had been quite helpless when it came to this issue. Then she heard about a certain treatment available across the Causeway. She now takes the teen there for an injection once every three months. This has put an end to his inappropriate sexuality. It might even cure his autism, she has been told. The boy is now very docile but the fact that doctors here would not use a drug that clearly works worries her.

The three-monthly injection is a synthetic hormone called leuprolide, that acts on the brain which then tells the gonads to go slow on their sex hormone production. Since testosterone, the male sex hormone, is what gives people their libido, having less of it sees the sex drive curbed accordingly. In fact, leuprolide is used to chemically castrate repeat sex offenders in the United States. But it is not approved for use in treating autism anywhere. The very idea of using it for this condition is based on the disproven idea that a mercury-based preservative called thimerosal found in some childhood vaccines is the cause of autism.

The latter is a dogma held fervently by the anti-vaccination movement. Extending this dogma, an American physician called Dr Mark Geier and his son, David, have been promoting, for over five years now, the notion that autistic boys also have too much testosterone. This, they say, is because the mercury from childhood vaccines binds very tightly to testosterone. This makes the elimination of mercury from the body very difficult, they assert. Since this mercury-testosterone complex tends to remain in the body, there will also be too much of testosterone in the growing child, they say.

That is, the mercury causes autism while the excess testosterone leads to precocious puberty. Thus the need for an anti-testosterone drug, the argument goes.

  • First, the notion that it is mercury in childhood vaccines that causes autism is one that has been roundly discredited. While mercury had been removed from all “baby shots” by the end of 2001, save for some flu jabs, the Geier position continues to attract a lot of support from the anti-vaccination movement. This is why the Geier treatment has garnered much credibility among families with autistic children.

In 2003, the American Academy of Pediatrics condemned a Geier study finding a link between vaccines and autism as being one flawed by “numerous conceptual and scientific flaws, omissions of fact, inaccuracies, and misstatements”.

In 2004, a US Institute of Medicine report on autism and mercury in vaccines noted in particular that the Geiers’ research was “uninterpretable” and shot through with “serious methodological problems”.

In his 2008 book, Autism’s False Prophets, Dr Paul Offit, an infectious disease specialist at the Children’s Hospital of Philadelphia, reviewed some 16 of the best epidemiological studies on the putative link between autism and mercury. There was none to be found.

  • Second, it is true that more boys than girls are autistic. But it has not been shown that elevated testosterone levels in childhood cause autism.

The Geiers cite two Cambridge University studies that found a link between prenatal (before birth) testosterone levels and the severity of autism later on in life. By their very design, however, these studies did not address the issue of how testosterone levels later on in childhood might be related to the development of autism, if at all. Thus the Cambridge data cannot and does not support the Geier argument that reducing the effects of childhood testosterone levels will cure autism. It seems more likely that brain development is largely shaped by the levels of testosterone in the womb. If so, lowering testosterone levels in the childhood years may be too late to impact the course of autism. Weighing in on the debate, the Cambridge dons have called treating autistic children with leuprolide “irresponsible”.

If leuprolide is used to turn off a teen’s testosterone production, his inappropriate sexual behaviour will decrease markedly, of course. But the drug will not improve the autistic teen’s intellectual disability since that is not caused by too much of testosterone (after birth).

Fortunately, leuprolide might not do too much harm before puberty when testosterone production is still minimal. But during puberty, that production is ramped up, which turns a boy into a man with larger muscles, facial and body hair, a deeper voice and sperm production. Given to any teenager, however, it puts puberty on pause. The question is how long to put the autistic male with inappropriate sexual behaviour on it. If chemical castration is for the incorrigibly recidivist sex offender, putting an autistic boy on leuprolide may arguably amount to child abuse. Putting up with any socially embarrassing sexual behaviour of his seems the lesser of two evils.

     
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