What Are Puberty Blockers? What Are the Benefits and Risks for Transgender Children?

Puberty blockers are drugs that stop the body from producing estrogen and testosterone. In the clinic, they are called gonadotropin-releasing hormone agonists (GnRHa).

If teens take these medications during puberty, the physical changes associated with puberty are prevented. If these medications are stopped, the physical changes return.

Puberty blockers were used since the beginning of the 80s in the treatment of precocious puberty in youthful children.

Since the 1990s.Puberty blockers have also been used in transgender adolescents to prevent the unwanted development of male or female physical changes that occur during puberty.

What benefits do transgender teens receive?

Many transgender children describe the anxiety about the undesirable physical changes that will 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 build.

Many of these physical changes are irreversible and cause not only Gender dysphoria but also misgendering. This is when transgender people are mistakenly assigned the gender they were assigned at birth. Misgendering can be a significant and lifelong the source of suffering.

Some transgender people will seek surgery to address these unwanted irreversible changes. This may include chest masculinization, facial feminization, voice changes, or Adam’s apple reduction.

For youthful transgender people and their families, the most obvious benefits of using puberty blockers are: avoid unwanted changes that occur with puberty. It can also reduce misgendering and prevent the need for future surgeries.

Several studies have evaluated the potential benefits of puberty blockers. Systematic review 2024 studies have provided consistent evidence that they are 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 who did not employ treatment.

When should you start using puberty blockers?

Puberty blockers can only be started once puberty has started. The age at which this occurs varies greatly between individuals. To avoid unwanted physical changes, puberty blockers should ideally be started in early or middle adolescence.

However, many transgender adolescents were started on puberty blockers at the end of puberty or even after it had ended.

IN EnglandFor example, at 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 youthful 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 benefit should 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 these studies considered the stage of adolescence at which treatment began.

Especially, a newer study conducted at Harvard University analysis was restricted to puberty blocker treatment in early and middle adolescence. Treatment was found to be associated with significant reductions in anxiety, depression, and suicidal ideation.

Risk of Puberty Blockers for Transgender Teens

Puberty blockers are generally well tolerated. However, like any medical intervention, they can also cause undesirable effectsThis includes decreased bone density and fertility, and changes in adult growth.

When they start after early or middle puberty, they are more likely to cause menopause-like side effects, such as heated flashes. This is due to a decrease in sex hormone production.

There are also potential long-term effects of puberty blockers that are still being researched.

The brain matures significantly during adolescence. However, it is unclear what effect puberty blockers may have on cognitive development. While the employ 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 would be unethical to withhold treatment for research purposes.

In pediatric care, data from randomized controlled trials are often lacking. more broadlySimilar research gaps apply to the employ of puberty blockers in early puberty.

However, the politicization of transgender youth has meant that the employ of puberty blockers in transgender adolescents has been judged by a different standard.

How are puberty blockers accessed in different clinical situations?

IN United KingdomPuberty blockers will now only be available available for transgender teens through the National Health Service (NHS) as part of a research effort, following the recommendations of the Cass Review, which looked at gender identity services available to children and youthful people through the NHS.

One of the main criticisms of the review was that it did not 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 point out that many of the recommendations in the review are consistent with practices currently used in Australian specialist gender equality services.

Puberty blockers in Australia are available to transgender adolescents as part of a comprehensive, team-based approach to gender-affirming care. This emphasizes holistic, individualized care that takes into account the youthful person’s stage of puberty while balancing potential benefits and risks.