Puberty is a challenging phase in any teenager's life. For those questioning their gender identity or identifying as transgender, it becomes even more complex. This is where puberty blocking therapy can play a critical role. Designed to provide these young people with time to explore their identity, these medical interventions are considered safe and reversible. However, they are not without controversy or misunderstanding, which we aim to address in this blog post.

What is Puberty Blocking Therapy?

Puberty blocking therapy, often referred to as hormone blockers, is a medical intervention used to pause the physical changes of puberty. It's primarily used for transgender or gender-questioning youth who are about to undergo or are in the early stages of puberty.

This therapy involves the administration of medications known as gonadotropin-releasing hormone (GnRH) agonists. These substances act on the pituitary gland in the brain to temporarily stop the production of sex hormones (estrogen and testosterone), thereby halting puberty. It's worth noting that these effects are generally reversible. If the young person stops taking these blockers, puberty will typically resume and progress as per their biological sex.

Why are Puberty Blockers used?

Puberty blockers give adolescents more time to explore their gender identity without the added pressure of undergoing physical changes that might not align with their gender identity. This can significantly reduce psychological and emotional distress, contributing to better mental health outcomes.

Moreover, for transgender teenagers who plan to transition in the future, puberty blockers can prevent the development of secondary sexual characteristics that can be difficult, costly, or impossible to reverse with later treatments.

Are Puberty Blockers Safe?

Puberty blockers have been used for decades to treat precocious puberty (early onset puberty) and are generally considered safe. They are endorsed by major medical organizations such as the Endocrine Society and the American Academy of Pediatrics.

However, like all medications, they do have potential side effects. These can include hot flashes, weight gain, and mood changes. There is also ongoing research on the potential impact of puberty blockers on bone density. It is essential to have these discussions with a knowledgeable healthcare provider to weigh the benefits against potential risks.

The Controversy Surrounding Puberty Blockers

Despite the supportive medical consensus, there is controversy around the use of puberty blockers for transgender youth, primarily arising from social, political, and ethical concerns. Critics argue that adolescents are too young to make such significant decisions about their bodies. Others believe that puberty blocking therapy might encourage young people to identify as transgender.

It is important to note that, according to guidelines from the Endocrine Society and the World Professional Association for Transgender Health (WPATH), the administration of these treatments should always be preceded by thorough psychological evaluation and counseling. The decision to start on puberty blockers is not taken lightly and involves the young person, their family, and a team of medical and mental health professionals.

Conclusion

Puberty blocking therapy can be a vital part of care for transgender and gender-questioning youth, allowing them more time to understand their identity while potentially sparing them from psychological distress. While controversy exists, the consensus among major medical organizations is that when properly administered and supervised, puberty blocking therapy is both safe and beneficial.

If you're a parent, guardian, or educator seeking to understand more about this therapy for the benefit of a young person in your life, remember to foster open, accepting, and knowledgeable conversations about gender identity. Consult with healthcare professionals specializing in transgender health to make informed decisions.

As with all aspects of healthcare, individual experiences can vary, and what works best will depend on the unique circumstances of the person involved. In all cases, understanding, respect, and support are fundamental.

Citations

1. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T'Sjoen, G. G. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903. Link

2. American Academy of Pediatrics. (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 142(4). Link

3. De Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics, 134(4), 696-704. Link

4. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., ... Zucker, K. (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Version 7. International Journal of Transgenderism, 13(4), 165-232. Link

5. Giordano, S. (2013). Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?. Journal of Medical Ethics, 39(8), 559-564. Link

For information about potential side effects, you might find these sources useful:

1. Klink, D., Caris, M., Heijboer, A., van Trotsenburg, M., & Rotteveel, J. (2015). Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. The Journal of Clinical Endocrinology & Metabolism, 100(2), E270-E275. Link

2. Vlot, M. C., Klink, D. T., den Heijer, M., Blankenstein, M. A., Rotteveel, J., & Heijboer, A. C. (2017).