What are puberty blockers and what do they do? – Cleveland Clinic


Imagine being trapped in a very uncomfortable space.

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You don’t feel good to be there, you can’t relate to anything that is going on, and nothing reflects who you really are.

What if this space is your own body? What would you do and how would you cope?

Some transgender and non-binary youth live with these feelings every day. Puberty can make these feelings worse. These children may feel like their bodies are betraying them because the developmental changes they are going through do not match how they identify with themselves. It is frustrating and can be quite overwhelming.

Fortunately, there are medical interventions that can help eliminate these feelings of frustration and betrayal. One of these interventions comes in the form of prescription drugs known as ‘puberty blockers’.

“Puberty blockers are drugs that we give to children to pause puberty,” says pediatric endocrinologist Julia Cartaya, MD. “The medicine usually contains analogues of gonadotropin releasing drugs (GnRH), a hormone that your body makes naturally. It is considered the main hormone of puberty and the body produces it in cycles.

How do puberty blockers work?

Dr Cartaya says that puberty blockers have been given to children who experience precocious puberty (puberty that begins much earlier than usual) for about 40 years.

During puberty, certain hormone levels tend to rise and fall throughout the day. These ups and downs produce changes in the body such as facial hair growth, deepening of the voice, size changes, breast development, and menstruation.

Puberty medications contain stable amounts of gonadotropin releasing hormones (GnRH), which help suppress sex hormones like testosterone and estrogen. Once these hormones are “blocked”, the physical changes that would occur during puberty are interrupted.

Common puberty blockers include:

The protocol always begins with puberty

Puberty blockers are only given to children who have started puberty. For a child who was assigned to a girl at birth, Dr Cartaya says puberty typically begins between the ages of 8 and 13. For a child who was assigned to a boy at birth, the range is between 9 and 14 years old.

“This threshold exists because there is evidence that children who question their gender before the onset of puberty often decide that they agree with the sex assigned to them at birth after the onset of puberty. the puberty. The most recent data shows that about two-thirds of children will.

But if a child has entered puberty and suffers from gender dysphoria, puberty blockers can help them adjust.

Gender dysphoria occurs when a person experiences psychological distress because the sex assigned to them at birth does not match what they are feeling on the inside. A child with gender dysphoria may say that they feel like they were born in the wrong body or ask to be treated like the gender they identify with.

“One third of children will have an exacerbation of their gender dysphoria during puberty. These children often feel that their bodies betray them in several ways, ”explains Dr Cartaya. “It can also be an indication that gender dysphoria will last throughout their lives. This is the reason we wait until puberty to start children with gender dysphoria on puberty blockers.

However, gender dysphoria is not always the result of a person’s gender identity not matching the evolution of their body. It can also stem from stress related to societal norms, as well as the possibility of being rejected or bullied. It’s also important to note that not all transgender or non-binary people experience gender dysphoria.

How do children receive puberty blockers?

Puberty blockers are given by a healthcare professional through injections or an implant placed under the skin. In order for puberty blockers to continue to work, injections must be received every month or every few months, and implants must be replaced every year.

Are puberty blockers reversible?

When a child starts a puberty blocker, it does not mean that their body’s puberty changes are permanently on hold. A puberty blocker is more like a short-term fix. It stops the process for as long as a child is using the medicine. Once use is stopped, puberty will resume.

“It’s more like a break. If we stop the drug, puberty can start again, ”says Dr Cartaya. She adds that once she does it again, the body will go through puberty associated with the sex assigned at birth.

What are the pros and cons of puberty blockers?

Puberty blockers are generally safe when used short-term. They have even been used to treat diseases like prostate cancer, breast cancer, and endometriosis.

Puberty blockers may improve mental health

Puberty blockers can help maintain the mental health of young people who are establishing their gender identity. One study found that transgender teens who could receive puberty blockers had “superior mental health outcomes” compared to those who wanted the drug but did not receive it. This shows that puberty blockers play an important role in gender-affirming care.

Puberty blockers can affect bone mineral density

As for the downsides, bone mineral density is one thing that should be monitored while using a puberty blocker.

“Puberty is an important time for the development of strong bones,” warns Dr. Cartaya. “Because we put it on hold, the decrease in bone mineral density that we’re seeing is probably due to the lack of puberty encouragement for bone growth. Once a child stops a puberty blocker, bone mineral density increases, but it does not return to what it was before. To help maintain healthy bones, we closely monitor vitamin D levels and make sure children are getting enough calcium. ”

If started early, puberty blockers could complicate some gender-affirming surgeries

Another word of caution: If a child with male genitals begins administering puberty blockers at the onset of puberty and later wants to have gender affirming surgery, they may not be developing enough skin. on his penis and scrotum for the most common genital surgeries. However, if this does happen, Dr Cartaya says other options are available and should be discussed with a surgeon after the age of 18.

Puberty blockers aren’t for everyone

Puberty blockers are not intended for children who are willing to change bodies or for children who have completed puberty. They are also not for children who show no signs of puberty.

Side effects of puberty blockers

Finally, the side effects. Depending on the type of puberty blocker, they could include:

  • Crying and irritability.
  • Restlessness.
  • Reactions at the injection site or pain near the site.
  • Acne.
  • Skin rashes.
  • Headache.
  • Weight gain.

Why family support is important

While we’ve heard plenty of stories about transgender or heterosexual children being rejected by loved ones, friends, or members of their community, Dr Cartaya says most of the interactions she’s seen have been quite positive.

“There is evidence to show that when families support gender identity, their children have standard developmental levels of mental health problems like depression and anxiety,” says Dr. Cartaya. “When transgender or non-binary children are truly seen and respected, they can thrive.”

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