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, temporarily suppress puberty. They might be given to transgender or gender-diverse children to stop certain changes to their bodies.
Transgender youth have a higher risk for depression, anxiety, and suicide. Along with other gender-nonconforming children, they're diagnosed with mental health conditions more often than those who identify with their gender assigned at birth. There are a number of factors that contribute to these rates being higher in this population. But those who have support tend to have lower rates of suicide and depression.
Treatment with puberty blockers in this population, or pubertal suppression, is known as 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:
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.
In other situations, experts may use puberty blockers to treat prostate cancer, breast cancer, and endometriosis.
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.
How Long Have Puberty Blockers Been Used?
Puberty-blocking medications stop puberty in children who start the process too early -- something called precocious puberty. The FDA approved the drugs in 1993. They are used off-label for gender dysphoria. That means they're not approved for gender dysphoria, but they've been found safe and effective to treat early puberty.
What Are the Benefits of Puberty Blockers?
If your child doesn’t identify with the gender they were assigned 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 suicidality
- Improve their overall mental health , at least in the short term
- 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
Are There Side Effects or Risks With Puberty Blockers?
Like other medications, there are some side effects of GnRH analogue treatment. They include:
Other short-term effects from puberty blockers may include:
- Hot flashes
- Weight gain
- Swelling where the shot went in
- Headaches
- Crying and crankiness
- Restlessness
- Acne
- Rashes
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.
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. Some research says the long-term affects aren't yet clear.
Effects on their future fertility. There's no evidence puberty blockers affect fertility.
Are Puberty Blockers Permanent?
Puberty blockers are reversible. These medications are just a short-term pause. They’ll delay the effects of puberty for as long as your child is on them. If they stop treatment, their body will go through puberty.