The physical changes during and around puberty can cause stressful and unpleasant emotions for children who don’t identify with the gender they were assigned at birth. Puberty blockers, or pubertal blockers, help temporarily suppress puberty. Transgender and gender-diverse children may want to use these to stop certain changes to their bodies.
Treatment with puberty blockers is a part of gender-affirming care. This term refers to the social, psychological, behavioral, and medical care that supports a person if their gender identity conflicts with the one they were assigned at birth.
How Do Puberty Blockers Work?
The most common medication for this process is gonadotropin-releasing hormone (GnRH) analogues. These drugs suppress your child’s sex hormones (testosterone and estrogen) during puberty. The most common puberty blockers include:
- Goserelin (Zoladex)
- Histrelin (Supprelin LA)
- Leuprolide (Lupron Depot-Ped, Fensolvi)
- triptorelin (Trelstar, Triptodur)
If your child was assigned male at birth, as soon as puberty starts, these meds will stop or slow the progress of puberty. These meds slow their facial and body hair growth, stop their voice from deepening, and restrict male genitalia development.
For kids assigned female at birth, puberty blockers will stop or slow down breast growth and stop their menstrual periods.
When Do Children Start Puberty Blocker Meds?
Your child’s doctor will confirm when they’re ready to start puberty blockers. They first need to be evaluated by a trained mental health professional. They’ll also need to:
- Give their doctor an informed consent (or have their parents/caretakers/guardians consent to their treatment and agree to support them through the treatment)
- Have an intense, long-lasting pattern of gender dysphoria or nonconformity
- Show that their gender dysphoria started or got worse at the beginning of puberty
- Look into medical, social, or psychological issues that might interfere with treatment
- Be in the early stages of puberty
For most children, puberty starts around the age of 10 or 11. But some kids may start earlier or later than this. Your child may take GnRH at the beginning of puberty to stop secondary sex characteristics. But they could also start treatment in later stages of puberty to end their periods, stop erections, or avoid continued growth of secondary sex characteristics.
A pediatric endocrinologist will prescribe, give, and monitor GnRH analogue treatment. They’ll usually give this medication to your child as a shot (every month or every 3 months) or through an implant in their arm (which their doctor will replace every 12 months).
During their treatment, your child’s doctor will also give them regular blood tests to see how well the medication works.
Most kids take GnRH for years. But each person may have a different preference. Your child may decide they want to stop puberty-blocking treatment and try other hormone treatments. Others may pursue gender affirmation surgery in the future
What Are the Benefits of Puberty Blockers?
If your child doesn’t identify with the gender they were given at birth, uncomfortable feelings may grow during puberty. Gender dysphoria is the term doctors use to describe the distress and unease that happen when gender identity and designated gender don’t align. If your child has gender dysphoria, puberty blockers may help them:
- Lower depression and anxiety
- Improve their overall mental health
- Have better social interactions and connections with other kids
- Stay away from thoughts or actions linked to self-harm
- Avoid future surgeries for gender confirmation
Puberty blockers are reversible. If your child begins these medications, it doesn’t mean that their puberty stops forever. Instead, these medications are a short-term pause in puberty. They’ll stop the effects of puberty for as long as your kid is on them. If they stop the treatment, their body will go through puberty in the way it was assigned at birth.
Are There Side Effects or Risks With Puberty Blockers?
Like other medications, there are some side effects of GnRH analogue treatment. They include:
- Hot flashes
- Weight gain
- Swelling where they got the shot
- Crying and crankiness
Other short-term effects from puberty blockers may include:
- Insomnia or muscle aches
- Shifts in mood
- Changes in breast tissue
- Irregular period or spotting (for people whose periods aren’t totally suppressed by puberty blockers)
Your child might also notice long-term changes like:
Issues with future surgery. If children with external male genitalia start treatment with GnRH analogues early in puberty, they may not develop the right amount of scrotal or penile skin for gender-affirming surgery. There are other methods you can look into instead, though.
Problems with self-esteem. If your child doesn’t begin puberty around the same time as their peers, they may develop lower self-esteem.
Delayed growth plate closure. This could lead to taller adult height.
Changes to their bone growth and density. Your child may have lower bone density. Because of this, your doctor will want to make sure they get enough exercise, calcium, and vitamin D. They’ll also keep a close watch on their bone density to make sure their bones remain strong and healthy.
Effects on their future fertility. Puberty blockers may lead to changes in your ability to have children in the future. Ask your doctor more about your specific risk.