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None of the known risks or side effects include cognitive impairment, you are attributing to puberty blockers changes to cognitive development without research demonstrating the causal link between limiting puberty hormones and decreased or slowed cognitive development like the known negative effects. I also wouldn’t accept increased cognitive development as a positive effect under puberty blockers without justification either. Until there is sufficient justification for either position we are not justified reaching either conclusion.
I am concerned there is and will be increased public resistance to what the medical consensus supports because of the political scapegoating trans people are under, and wonder if we were talking about transhumanism in general instead focused specifically on transgenderism would the resistance be the same.
The discussions you’ve mentioned would likely start with a child experiencing distress reported to an adult or their parents noticing their distress and working with a medical doctor to identify the causes and treatment plans to consider. In the cases where the distress is related to a lasting pattern of gender dysphoria or gender nonconformity that is one of the criteria for prescribing puberty blockers.
The people in charge of whether they can be bribed are the same people receiving the bribes. The accountability of politicians under elections to prevent this behavior depends on a well informed and educated electorate which the wealth class has undermined for decades.