Gardasil for boys?
September 15, 2015 3:59 AM   Subscribe

Should we have our 12 year old son immunized against HPV using Gardasil?

So the school immunization schedule came home yesterday, and we're going through the consent form. TDaP booster? Check. Meningitis? Check. Hep B? Check. HPV? Uhhhhh....

We're pro-vax. Our family is fully up to date. We also get the annual flu shot (immuno-compromised grandparent). My wife worked in an autism family support nonprofit fighting against neoMcCarthyism. No concerns there.

We're pro-sexuality. We've had talks with our son on sexual health, discuss positive treatment of all genders (we have a trans relative he's met), and are clear on "anybody you love is all right with us". So no concerns there.

But my wife is concerned about this one, and for a very specific reason. Gardasil has been extensively tested on females (and my wife would be first in line if we were discussing a 12 year old daughter). We haven't been able to determine if it's actually been tested on boys for a significant enough period to reach a scientific conclusion. We've found one study of 4000 boys, but that's it.

I'm relatively satisfied, but my wife is not. She wants more long term information and multiple studies. Does anyone know of more studies that have been done, specifically on boys, and with 5+ years of data?
posted by GhostintheMachine to Health & Fitness (28 answers total) 2 users marked this as a favorite
 
Please dear lord, do not make a medical decision for your child based on an internet discussion board. Call your son's doctor and ask her/him about research studies, and her/his recommendations. The doctor should have the best and most up-to-date information.
posted by Toddles at 4:10 AM on September 15, 2015 [19 favorites]


Best answer: Here's another study that included boys: Safety and persistent immunogenicity of a quadrivalent human papillomavirus types 6, 11, 16, 18 L1 virus-like particle vaccine in preadolescents and adolescents: a randomized controlled trial.

"We haven't been able to determine if it's actually been tested on boys for a significant enough period to reach a scientific conclusion." If you trust the FDA (I do), remember that Gardasil is FDA approved for use in boys. That means that a panel of experts has decided based on available evidence that enough boys have been tested for a significant enough period to reach a scientific conclusion. I would note that what is necessary to reach a "scientific conclusion" is often emotionally insufficient for parents, but if "if the scientific community is behind this" is your bar to clear, the bar has been cleared.

Finally, yes, speak to your son's pediatrician.
posted by telegraph at 4:15 AM on September 15, 2015 [15 favorites]


Response by poster: Sorry, one more point. Consent forms are due Friday. Today being Tuesday, there's no way we can get in touch with our family doctor for her opinion before then. If we don't reach a satisfactory answer before then, we'll likely be skipping this shot at school, and eventually getting it from our doctor when we're able to make an appointment and if she feels it's worthwhile.
posted by GhostintheMachine at 4:33 AM on September 15, 2015 [1 favorite]


I know a man who had throat cancer caused by HPV. The potential benefits of vaccination are pretty huge here.
posted by yarntheory at 4:50 AM on September 15, 2015 [17 favorites]


HPV is the most common cause of anal cancer, a disease which is on the rise, and expected to overtake cervical cancer in a few years. Men are more likely to be affected by anal cancer than women. The vaccine isn't just for women, and the virus doesn't only affect women. Even if you don't care about the herd immunity thing, you're buying the same type of protection for your son with the vaccine that you'd be buying for a daughter. I'm actually not sure how the idea that HPV is only dangerous for women got started, because it's considered a cancer risk factor for men. There are lots of reasons for boys to take the vaccine, care of the CDC.
posted by deathpanels at 5:03 AM on September 15, 2015 [17 favorites]


Agreed. HPV isn’t just about cervical cancer.
posted by mcwetboy at 5:24 AM on September 15, 2015 [3 favorites]


Best answer: One question you can ask your doctor, especially if you find that there has been less testing on boys, is whether or not there's any reason to believe the effects would be different on boys than on girls. My understanding is that vaccines work via/target/affect the immune system (i.e. not the hormonal system), which might mean there's no particular reason to think there could be side effects or risks for boys that do not exist for girls. If you know a curling iron curls girls' hair, there's no reason to think it won't curl boys' hair, right? Hair is hair. Ask your doctor if immune systems are more like hair (immune systems are immune systems) or more like hormonal systems.

One other way to find this out if you don't get to talk to your doctor would be to to look up other vaccines to find out if side effects or risks are different for boys or girls. If immune systems are different for boys and girls, you should see different side effects and risks for all sorts of vaccines, not just HPV.

Finally, if you are a woman, you've been exposed to all sorts of medical treatment based on research conducted primarily on men. Do you/to what extent do you ask the analogous question (how extensively has this drug been tested on women?) when your doctor writes you a prescription? I'm guessing you usually take the risk and take the prescription because the prescription is going to provide some benefit that you need provided. I think the same may be true here (the vaccine will provide a benefit to your son), and with a much smaller risk that there is any reason to believe there's a difference.
posted by If only I had a penguin... at 5:37 AM on September 15, 2015 [23 favorites]


If you're uncomfortable with making a decision by Friday (I assume these consent forms are used for the school to administer the vaccines?) then just don't consent to HPV as administered by the school. You can always get the vaccination through your son's doctor, or even Planned Parenthood after you've taken enough time to be comfortable with your decision. Emotionally speaking, being ready to make the decision is probably more important than finding studies.
posted by telegraph at 5:38 AM on September 15, 2015 [4 favorites]


Sorry, I was sure I read in the question that your husband was concerned, which is why I guessed in the last paragraph that you are were a woman. If that guess was wrong, then the last paragraph applies more to your wife than to you, but the general point is the same.
posted by If only I had a penguin... at 5:39 AM on September 15, 2015


Well, lots of medical decisions your wife will have to make about herself are based upon extensive studies only in men, not women, so.

Here is a report on a Canadian study supporting HPV vaccines in boys for preventing various cancers of the throat, mouth and other cancers (80% of patients with one type of throat cancer are HPV positive). Since the medicine of vaccination generally is well-tested and effective, I would not hesitate to vaccinate my son against HPV because it's insufficient for herd immunity to only vaccinate girls and it's insufficient for boys who will grow up to be men who have sexual contact with other men to only vaccinate girls.

But I don't think your decision to forego the school vaccination and take care of it soon at your doctor's office is terrible.
posted by crush-onastick at 5:48 AM on September 15, 2015 [5 favorites]


We had to arrange it for our boys because it's not offered routinely for teenage boys here yet. It's aimed at younger teens because they're statistically less likely to be sexually active yet, so postponing the decision for a 12 year old on an individual decision when you as parents can make an informed assumption about his risk of exposure is fine. But I was absolutely fine about the data being mostly on girls, because generally the data is mostly on boys and girls just have to lump it, so this time round with a vaccine that was generally safe, it seemed the same decision, just gender-reversed.
posted by dorothyisunderwood at 5:52 AM on September 15, 2015 [6 favorites]


The only reason I might hold off on it right now is that they might be using Gardasil 4 (which protects against the four most nasty strains) rather than the fairly new Gardasil 9 (which protects against those same four plus another five) so waiting another year or two or arranging it with your family doctor might provide better protection.
posted by Candleman at 6:12 AM on September 15, 2015 [3 favorites]


You probably can't get an appointment, but can you reach your doctor through an online patient portal to ask her opinion? Or call and leave a message with a nurse? I agree it's not urgent, but you should have a way to get in touch with your doctor in cases like this.
posted by chaiminda at 6:23 AM on September 15, 2015 [1 favorite]


Yeah, I was hesitating to say it, but I also thought it was weird that you can't call your doctor. Even if you can't get an appointment, you should be able to do a brief phone consult. And even if you end up going in for an appointment next week, doing a phone consult now will give your doc the heads up so that if they're not up on the research on boys and Gardasil they should look it up before the appointment.
posted by If only I had a penguin... at 6:57 AM on September 15, 2015


We made this decision for our 12-year-old son partially based on the fact that when the vaccine time came, a good (male) friend was going through chemo for throat cancer caused by HPV. And yeah, it's sort of awkward to think "Hey, he got an oral cancer from eating pussy, hee hee, and I guess that'll be my son one day" but there you have it. We said yes.
posted by BlahLaLa at 7:04 AM on September 15, 2015 [4 favorites]


Does your local library have access to a research database? Or do you have anyone close that works or attends a college or university? You might be able to find more actual studies and meta-studies than a preliminary Google search will offer.
posted by rubster at 7:35 AM on September 15, 2015


Response by poster: Thanks for the ideas and thoughts, they're all appreciated. I guess I was hoping there were more peer-reviewed studies available that I simply couldn't find. Health Canada, the FDA, and the EU all seem satisfied, which is good enough for me. The WHO only recommends for females, but from my reading that's more due to urgent need/practicality in underdeveloped nations. Hopefully the points raised here will provide my wife with the level of comfort she needs this week.

(A few have mentioned the doctor's visit again... two working parents trying to get in to see an overworked family doctor on very short notice for something less than an emergency is an exercise in frustration where I live. We do have an excellent telephone information service here where we can get personal-but-generic health information and advice from a nurse, which I somehow forgot about. I'll try that as well.)
posted by GhostintheMachine at 9:08 AM on September 15, 2015


For what it's worth, the CDC recommends the vaccine for boys which I'd take as a pretty strong recommendation. They also have resources and a study linked.
posted by mikeh at 11:05 AM on September 15, 2015


I'm unclear on why Gardasil would be unsafe for boys but OK for girls. Male and female physiology just isn't that different.

Here's the thing about HPV. Most men are carriers, but they tend not to be symptomatic. Vaccinating your son against HPV means he won't get it. Now you might be thinking, "But if all the girls are vaccinated, there will be herd immunity!" However, Gardasil is new enough that women not terribly a lot older than he is are still quite likely to have HPV. So you're basically assuming that your son will never, in his whole life, have sex with someone very much older than he is. Which I'm sure seems like a safe assumption inside the weird chaste fiction we create in nuclear families about how sex works, but it's certainly not a safe assumption in real life.

Also, the school requiring everyone to get the vaccine makes things egalitarian and takes the focus off of sexualizing young girls/getting into the "so you're saying you think my 12 year old is having sex!" stuff that has been a problem with the roll-out of Gardasil for the school-aged set.
posted by Sara C. at 12:02 PM on September 15, 2015


Can you clarify whether the main "scientific conclusion" you're looking for is if the vaccine is safe for boys, or if it actually prevents HPV-related cancers in men? I mean, I assume you want to know both, but safety and effectiveness are different questions which are often investigated in separate studies, so it would be helpful to know what you're most concerned about.
posted by randomnity at 12:57 PM on September 15, 2015


Response by poster: I'm unclear on why Gardasil would be unsafe for boys but OK for girls. Male and female physiology just isn't that different.

Higher rates of adverse effects in females have been found in the MMR vaccine. The H7N9 influenza virus strikes women and men differently. Johns Hopkins has discussed the value of sex specific vaccines due to the different immune system reactions in men and women. I'd say the concern is justified.

The worry is over the safety of the vaccine - whether the level of adverse effects in boys is worth the benefit in preventing HPV-related conditions. Since there has been limited testing of the vaccine in males the risk-reward calculation is difficult to assess.
posted by GhostintheMachine at 3:04 PM on September 15, 2015 [2 favorites]


From what I can remember the team that invented the vaccine have vaccinated their sons.
posted by geek anachronism at 5:31 PM on September 15, 2015 [2 favorites]


"Across 7 phase 3 clinical trials involving more than 29,000 males and females ages 9-45, vaccination was generally well tolerated." I can't get to the full text from home, but the abstract of this 2015 review article is reassuring.

Also very recent is this study of the 9-valent HPV vaccine: participants were enrolled at 72 sites in 17 countries and included 669 boys aged 9-15 years. There is a detailed discussion of safety on pages e32-e34.

Meaning no disrespect to your research and concerns, sex differences in adverse events following immunization are not really a thing that vaccine policymakers even talk about. A person can find one journal article for just about any proposition, and I'm not even sure the MMR formulation in the article you found is the kind used in the US (I've never heard ours described as "high-titer"). The Hopkins newsletter article suggests that males and females may need different doses, but not that there's a difference in safety. Science will probably never know everything there is to know about immunology and so it is not impossible that there is a difference in risk for males vs. females with any vaccine, but this is pretty speculative compared to the known risk of HPV-related cancer. I don't say this to demean your research efforts but rather to encourage you to be comfortable trusting the scientific consensus that this vaccine is a good idea for boys.
posted by lakeroon at 5:53 PM on September 15, 2015 [1 favorite]


Just a solitary data point: my son and my daughter have both had the HPV vaccine. They're both in college now. We have a fairly close relationship, but not close enough that I ask them about their HPV status. However, I'm confident that the vaccine has caused them zero problems.
posted by doctor tough love at 9:59 PM on September 15, 2015


From a completely pragmatic point of view, the gardisal vaccine is three shots on a specific schedule. Given it's a hassle for you to get to your doctor, let the school take care of it.
posted by kjs4 at 4:00 AM on September 16, 2015 [1 favorite]


Wanted to clear up something mentioned above--the Gardasil 9 is pretty widely in use now. You can ask the school nurse, but I would expect that's what they're using, instead of the (old) Gardasil 4.

Also, the vaccine is given in two doses--that's two doctor visits. Not a dealbreaker, of course, but something to consider. [I guess the school is planning to do the follow-up vaccines.]

And FYI, my daughter had one dose of the 4, and then the 9 came out, so her second dose was the 9. So there won't be a problem mixing them, if you're caught in that situation.
posted by Jane Austen at 6:51 PM on September 16, 2015 [1 favorite]


Response by poster: My wife remained unconvinced, so she's consented to three of the four vaccines, but not HPV. Nobody else in our group is concerned, so she's the outlier here. She's going to talk with her doctor about it, and will likely have it done at the clinic later.

Thanks for all the comments.
posted by GhostintheMachine at 5:23 AM on October 17, 2015


Response by poster: Hey, this is still open. OK, my wife was at her doctor's today, on an unrelated matter. They discussed the HPV, and her doctor reassured her as expected. She's set up an appointment for my son to get the vaccine (not until next year, for a variety of reasons).
posted by GhostintheMachine at 12:39 PM on October 19, 2015


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