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Introduction to
Puberty Blockers

For some TTNB youth, delaying or pausing the progression of puberty can be an important part of a gender-affirming care plan. Puberty blockers are medications that can be prescribed at or after the beginning of puberty (Tanner Stage 2 of adolescent development) to temporarily pause puberty, as a treatment for gender incongruence.1 Puberty blockers work by temporarily blocking the body’s production of sex hormones.1 This means puberty will resume when the medication is stopped.1

Research about Puberty Blockers

The following is a summary of research findings showing that puberty blockers improve TTNB youth well-being and can be safely prescribed to TTNB youth.

Puberty blockers improve TTNB youth well-being

Puberty blockers improve mental health and overall well-being. As a result of receiving puberty blockers, TTNB youth report experiencing better overall well-being.2 Many youth report feeling happier, feeling more comfortable, and experiencing better social relationships after starting puberty blockers.3 Youth report high rates of satisfaction with puberty blockers, both during and after treatment.4–6 Research also shows that access to puberty blockers  reduces suicidality, self-harm, and symptoms of depression.2,7,8

Puberty blockers provide time to make decisions about future gender-affirming care. One of the objectives of puberty suppression is to provide time for youth to make decisions about future gender-affirming care.1 By pausing distressing changes related to puberty this treatment can provide youth with the time they need to explore gender and consider future options.1,9 This may include whether hormone therapy is a desired goal.

For some youth, even though puberty blockers help, gender-related distress continues. Puberty blockers can help with mental health and gender-related distress. However, they may not relieve all forms of distress. Body dissatisfaction may continue throughout treatment with puberty blockers.2 Hormone therapy may be needed in the future to support gender health and embodiment goals.2

Puberty blockers are used safely with TTNB youth

Puberty blockers have been safely used with TTNB youth since the 1990s. For decades, doctors have prescribed puberty blockers for children who started puberty too early (precocious puberty).10 The physiological and psychological safety of puberty blockers are well-established in these patients.11,12 Puberty blockers have been safely and effectively used with TTNB youth to support gender health since the 1990s.4,5,13,14 They became part of routine practice with TTNB in the 2000s.14 Research shows that TTNB youth can use puberty blockers safely, in terms of cardiovascular and metabolic health.15–19

Once a person stops taking puberty blockers or starts hormone therapy, puberty continues. Puberty blockers temporarily pause puberty, so if a person stops taking blockers, puberty will resume from the point it was paused.1 Youth who start hormone therapy treatment during or after taking puberty blockers will experience changes aligned with the hormones they are taking.

As with all medications, there are risks of side effects. Possible side effects of puberty blockers include, but are not limited to, headaches, low energy, mood changes, hot flashes, and reaction at the site of the injection that can cause pain, swelling and redness.1,20

Youth should talk with their healthcare provider about whether puberty blockers are right for them. This includes talking about benefits, risks, and preventative care.  Healthcare providers can support youth in mitigating risks and side-effects. For example, puberty blockers delay the building of bone density that happens during puberty.21 Therefore, healthcare providers may recommend that youth starting puberty blockers take vitamin D and calcium supplements, and take part in weight-bearing exercise while benefiting from puberty blockers.21 Youth considering taking puberty blockers and hormone therapy should discuss potential effects on fertility with their healthcare provider.9

References
  1. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. doi:10.1210/jc.2017-01658
  2. de Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. The journal of sexual medicine. 2011;8(8):2276-2283. doi:10.1111/j.1743-6109.2010.01943.x
  3. Carmichael P, Butler G, Masic U, et al. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PloS one. 2021;16(2):e0243894. doi:10.1371/journal.pone.0243894
  4. Cohen-Kettenis PT, van Goozen SH. Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. European child & adolescent psychiatry. 1998;7(4):246-248.
  5. de Vries ALC, McGuire JK, Steensma TD, Wagenaar ECF, Doreleijers TAH, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696-704. doi:10.1542/peds.2013-2958
  6. Nieder TO, Mayer TK, Hinz S, Fahrenkrug S, Herrmann L, Becker-Hebly I. Individual Treatment Progress Predicts Satisfaction with Transition-Related Care for Youth with Gender Dysphoria: A Prospective Clinical Cohort Study. The Journal of Sexual Medicine. 2021;18(3):632-645. doi:10.1016/j.jsxm.2020.12.010
  7. Lavender R, Shaw S, Maninger JK, et al. Impact of Hormone Treatment on Psychosocial Functioning in Gender-Diverse Young People. LGBT health. 2023;(101616707). doi:10.1089/lgbt.2022.0201
  8. Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics. 2020;145(2). doi:10.1542/peds.2019-1725
  9. Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 2022;23(sup1):S1-S259. doi:10.1080/26895269.2022.2100644
  10. Carel J, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Human Reproduction Update. 2004;10(2):135-147. doi:10.1093/humupd/dmh012
  11. Yu R, Yang S, Hwang IT. Psychological effects of gonadotropin-releasing hormone agonist treatment in girls with central precocious puberty. Journal of Pediatric Endocrinology and Metabolism. 2019;32(10):1071-1075. doi:10.1515/jpem-2019-0108
  12. Bangalore Krishna K, Fuqua JS, Rogol AD, et al. Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Hormone research in paediatrics. 2019;91(6):357-372. doi:10.1159/000501336
  13. Olson-Kennedy J, Chan YM, Garofalo R, et al. Impact of Early Medical Treatment for Transgender Youth: Protocol for the Longitudinal, Observational Trans Youth Care Study. JMIR research protocols. 2019;8(7):e14434. doi:10.2196/14434
  14. Carswell JM, Lopez X, Rosenthal SM. The Evolution of Adolescent Gender-Affirming Care: An Historical Perspective. Hormone Research in Paediatrics. 2022;95(6):649-656. doi:10.1159/000526721
  15. Klaver M, de Mutsert R, van der Loos MATC, et al. Hormonal Treatment and Cardiovascular Risk Profile in Transgender Adolescents. Pediatrics. 2020;145(3). doi:10.1542/peds.2019-0741
  16. Perl L, Segev-Becker A, Israeli G, Elkon-Tamir E, Oren A. Blood Pressure Dynamics After Pubertal Suppression with Gonadotropin-Releasing Hormone Analogs Followed by Testosterone Treatment in Transgender Male Adolescents: A Pilot Study. LGBT Health. 2020;7(6):340-344. doi:10.1089/lgbt.2020.0026
  17. Valentine A, Davis S, Furniss A, et al. Multicenter Analysis of Cardiometabolic-related Diagnoses in Transgender and Gender-Diverse Youth: A PEDSnet Study. The Journal of clinical endocrinology and metabolism. 2022;107(10):e4004-e4014. doi:10.1210/clinem/dgac469
  18. Waldner RC, Doulla M, Atallah J, Rathwell S, Grimbly C. Leuprolide Acetate and QTc Interval in Gender-Diverse Youth. Transgender health. 2023;8(1):84-88. doi:10.1089/trgh.2021.0102
  19. Schagen SEE, Cohen-Kettenis PT, Delemarre-van de Waal HA, Hannema SE. Efficacy and Safety of Gonadotropin-Releasing Hormone Agonist Treatment to Suppress Puberty in Gender Dysphoric Adolescents. The journal of sexual medicine. 2016;13(7):1125-1132. doi:10.1016/j.jsxm.2016.05.004
  20. Khatchadourian K, Amed S, Metzger DL. Clinical management of youth with gender dysphoria in Vancouver. The Journal of pediatrics. 2014;164(4):906-911. doi:10.1016/j.jpeds.2013.10.068
  21. Navabi B, Tang K, Khatchadourian K, Lawson ML. Pubertal Suppression, Bone Mass, and Body Composition in Youth With Gender Dysphoria. Pediatrics. 2021;148(4). doi:10.1542/peds.2020-039339

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