Puberty blockers are drugs that stop the body from producing estrogen and testosterone. In the clinic, they’re called gonadotropin-releasing hormone agonists (GnRHa).
If teens take these medications during puberty, the physical changes related to puberty are prevented. If these medications are stopped, the physical changes return.
Puberty blockers were used since the starting of the 80s in the treatment of precocious puberty in young children.
Since the Nineteen Nineties.Puberty blockers have also been utilized in transgender adolescents to stop the unwanted development of male or female physical changes that occur during puberty.
What advantages do transgender teens receive?
Many transgender children describe the anxiety about the undesirable physical changes that may occur during puberty, especially as puberty approaches.
For presumed females at birth, these undesirable changes include breast development and early periods. For presumed males at birth, these undesirable changes may include the development of a deeper voice, an Adam’s apple, facial hair, and a masculine construct.
Many of those physical changes are irreversible and cause not only Gender dysphoria but additionally misgendering. This is when transgender persons are mistakenly assigned the gender they were assigned at birth. Misgendering generally is a significant and lifelong the source of suffering.
Some transgender people will seek surgery to handle these unwanted irreversible changes. This may include chest masculinization, facial feminization, voice changes, or Adam’s apple reduction.
For young transgender people and their families, the most blatant advantages of using puberty blockers are: avoid unwanted changes that occur with puberty. It can even reduce misgendering and prevent the need for future surgeries.
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Several studies have evaluated the potential advantages of puberty blockers. Systematic review 2024 studies have provided consistent evidence that they’re effective in inhibiting puberty.
The study, which the review authors described as highest quality significantly improved psychological outcomes. Puberty blockers reduced suicidal thoughts and actions in transgender adolescents compared with those that didn’t use treatment.
When must you start using puberty blockers?
Puberty blockers can only be began once puberty has began. The age at which this happens varies greatly between individuals. To avoid unwanted physical changes, puberty blockers should ideally be began in early or middle adolescence.
However, many transgender adolescents were began on puberty blockers at the end of puberty and even after it had ended.
IN EnglandFor example, at the least 12 months of treatment with puberty blockers was previously mandatory for any transgender teen under 18 who wanted access to estrogen or testosterone. As a result, many young people began using puberty blockers long after puberty had ended.
One potential problem with starting puberty blockers after early or mid-puberty is that unwanted physical changes have already occurred, so no further profit must be expected from this treatment.
The last systematic review of puberty blockers noted that while many studies found improvements in psychological well-being, others found no difference. One possible explanation is that none of those studies considered the stage of adolescence at which treatment began.
Especially, a more recent study conducted at Harvard University evaluation was restricted to puberty blocker treatment in early and middle adolescence. Treatment was found to be related to significant reductions in anxiety, depression, and suicidal ideation.
Risk of Puberty Blockers for Transgender Teens
Puberty blockers are generally well tolerated. However, like every medical intervention, they can even cause undesirable effectsThis includes decreased bone density and fertility, and changes in adult growth.
When they begin after early or middle puberty, they usually tend to cause menopause-like unwanted effects, corresponding to hot flashes. This is as a result of a decrease in sex hormone production.
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There are also potential long-term effects of puberty blockers which are still being researched.
The brain matures significantly during adolescence. However, it’s unclear what effect puberty blockers can have on cognitive development. While the use of puberty blockers in early adolescence has not shown influence cognitive functioning, research on transgender teenagers are in progress.
Where are the randomized controlled trials of puberty blockers?
Randomized controlled trials are widely considered the gold standard for testing the effectiveness of medical interventions.
To date, there have been no randomized controlled trials of puberty blockers in transgender teens, leading some to call the treatment experimental. However, carrying out such hormonal intervention trials in transgender youth is problematic because it might be unethical to withhold treatment for research purposes.
In pediatric care, data from randomized controlled trials are sometimes lacking. more broadlySimilar research gaps apply to the use of puberty blockers in early puberty.
However, the politicization of transgender youth has meant that the use of puberty blockers in transgender adolescents has been judged by a unique standard.
How are puberty blockers accessed in several clinical situations?
IN United KingdomPuberty blockers will now only be available available for transgender teens through the National Health Service (NHS) as a part of a research effort, following the recommendations of the Cass Review, which checked out gender identity services available to children and young people through the NHS.
One of the primary criticisms of the review was that it didn’t consider the likely harms of denying hormone therapy to transgender teenagers.
In Australia, health experts also caution against comparing our healthcare system to the NHS and indicate that a lot of the recommendations in the review are consistent with practices currently utilized in Australian specialist gender equality services.
Puberty blockers in Australia can be found to transgender adolescents as a part of a comprehensive, team-based approach to gender-affirming care. This emphasizes holistic, individualized care that takes under consideration the young person’s stage of puberty while balancing potential advantages and risks.