When we discuss trans people’s wellbeing and healthcare, it’s important not to forget issues that concern transgender children and teenagers, especially considering that there are multiple issues exclusive to these ages, such as bullying, dysphoria and mental health issues, the turbulence that puberty brings in the first place. Transgender children and adolescents need all the support they can get from their family, their friends, the law, and the health system. This is why we need to discuss puberty blockers more seriously.
What are puberty blockers?
Puberty blockers are essentially what the name suggests: a method to postpone puberty for transgender children who experience body dysphoria and wish to medically transition in the future.
Puberty can be a hard time for everyone, but especially for trans children, it may trigger intense feelings of dysphoria as secondary sex characteristics such as breasts and body hair start appearing. It is important to remember that not all – adolescent and adult – trans people experience body dysphoria, but for those who do, medical interventions may be a necessity, and puberty blockers is part of this process.
When it comes to trans youth, Harvard researchers found that they face double the risk of mental disorders such as depression, anxiety and suicidal tendencies that cis youth face. It only makes sense that the arrival of puberty and all the physical, hormonal and psychological changes it brings can trigger even more problems to a person experiencing gender dysphoria.
Puberty blockers are drugs prescribed to underaged trans youth with a persisting and intense presence of gender-non-conformity and dysphoria, especially when other psychological issues are present, with the informed consent of the adolescent and of the parents or guardians. This type of therapy is usually prescribed and monitored by an endocrinologist.
How do puberty blockers work?
Puberty starts with the pituitary gland, a gland attached to the base of your brain that send the hormones necessary to produce sex hormones – estrogen or testosterone – to our ovaries or testes.
Puberty blockers – gonadotropin-releasing hormone analogs – block the signaling hormones from being sent out from the pituitary gland, according to Dr. Ralph Vetters, medical director of the Sidney Borum Health Center at Fenway Health in Boston who spoke to Buzzfeed about puberty blockers. The same blockers work for all genders, and they can either be injected in the muscles every month or every three months (the name of the medication is Lupron) by a doctor or nurse, according to Dr. Karin Selva, pediatric endocrinologist at Randall Children’s Hospital at Portland, Oregon. The drug can also be administered via a tiny implant on the arm (Surrelin or Histrilin) every year.
The ideal age to start the blockers is when the first signs of puberty appear, after making sure that the endocrine system is working properly. However, if secondary sex characteristics have already completely developed, this development cannot be reversed, therefore it’s too late to start this treatment. Dr. Vetters says that blocker treatment usually goes on for 5 years, until the patient can begin hormone replacement treatment to develop the desired gender characteristics.
Are hormone blockers harmful?
Hormone blockers are shown to be harmless. First of all, their effect is not permanent, so if someone argues that a child or teenager may change their mind, the answer is that they can stop the treatment if they wish to, and puberty will normally resume from the point where it paused. Still, even if it is possible for some children to change their minds, that is usually not the case. According to the Endocrine Society, almost always trans adolescents grow up to be trans adults.
The same type of treatment has been used safely for decades now, to suppress precocious puberty – children who develop too early – and also to treat endometriosis, uterine fibroids and prostate cancer. Puberty blockers were approved as a treatment for trans adolescents starting from 12 years old by the Endocrine Society in 2008, which has since then declared the intervention safe and effective. In 2011 WPATH (World Professional Association for Transgender Health) included puberty suppression in their Standards of Care for the treatment of patients with gender dysphoria.
The only concerns about which there is no sufficient research yet, are long-term effects such as bone health or effect on brain development. This is why children do not undergo blocker treatment for more than four or five years. A recent study from the Netherlands didn’t find any evidence supporting long-term effects on bone mineral density.
For trans people who were assigned male at birth and consider having bottom surgery in the future, the use of puberty blockers might prevent them from having one type of vaginoplasty, but there are other methods used that can function as an alternative, so it is better to discuss those possibilities beforehand with a doctor.
What’s the cost? Who covers it?
Unfortunately, puberty blockers are quite expensive. The monthly preparation for Lupron costs $1,500, and the equivalent for three-month. As for the Histrelin implant, the whole package might come up to $15,000. Not to mention the tests and doctor appointments that accompany the treatment. Insurance plans are gradually starting to cover puberty blockers, but it’s still far from easy or widespread.
What happens without puberty blockers?
Dr. Aron Janssen, founder and clinical director of the Gender and Sexuality Service at NYU’s Child Study Center, tells Buzzfeed: “I’ve had patients be able to go from being on four different psychiatric medications to none as a result of a successful transition. It is not an exaggeration to say for some kids, these medications are life-saving.”
Without pausing puberty, trans adolescents may experience intense distress when sex hormones start kicking in and they begin experiences the changes in their bodies that might feel foreign or uncomfortable. Blocker treatment makes the process of further transitioning in adulthood easier and smoother, and prevents the aggravation of mental health issues in adolescence. Trans children need to be protected against a transphobic society, so that they can grow into their true selves and live a healthy, happy life.
The support of their parents is obviously vital in this process. With legal recognition and proper medical care, we can help our younger trans siblings grow up without worries and avoiding a darkness they don’t have to go through.