Healthy Mind

All Trans and Non-Binary Kids Need and Deserve Access to Puberty Blockers

Graphic: W+G Creative
Whether you get your news from Fox, CNN, or TikTok, there's a chance you've noticed that puberty blockers have been the subject of semi-recent conservative legislation. That legislation, to be clear, is rooted in protecting transphobic ideals and limiting access to identity-affirming health-care options.

Puberty blockers are medications that can be taken by individuals—often teens who are transgender and gender-expansive, which describes people whose gender identity is broader than the traditional gender norms—who have already started puberty in order to suspend its progression. Sometimes called hormone blockers or gonadotropin-releasing hormone agonists (GnRH agonists), these medications have also been the focus of legislation in Arkansas, Alabama, and Tennessee this year, with bills aiming to limit the health-care option for youth under 18 years old.

With deceptive names like Arkansas's Save Adolescents from Experimentation (SAFE) Act (which was temporarily blocked by a federal judge in July), these bills put forth the notion that the risks of puberty-blocking medications outweigh the benefits, which is downright false from a physical and psychological standpoint.

Below, gender advocates, therapists, and endocrinologists explain exactly what puberty blockers are, break down why access to the medication is so important, and why passing transphobic policies that would limit such access could actually be life threatening.

How puberty blockers work

When an individual is going through puberty, the brain (specifically, the hypothalamus) releases a gonadotropin-releasing hormone (GnRE) in pulse-like bursts, says Jennifer Osipoff, MD, a pediatric endocrinologist at Stony Brook Children’s Hospital in New York. “Blockers keep the brain from releasing the gonadotropin-releasing hormone in pulses, and instead lead the brain to release the hormone in a steady-state,” she says. "Without the pulses of GnRE, the brain can’t make the LH and FSH hormones, which are needed to trigger the body to make estrogen or testosterone.” In people assigned female at birth, the pulses of these hormones trigger the ovaries to make estrogen, which leads to breast growth and menstruation. In people assigned male at birth, the hormone pulses signal to the testes that it’s time to make testosterone, which promotes characteristics like facial hair, voice deepening, and the development of the Adam’s apple.

One way to understand the difference between not taking blockers and taking blockers is to consider the difference between a strobe light and a regular lamp. Just as the pulsing strobe light might trigger someone to dance in the way regular yellow light wouldn’t, the pulsing of GnRE triggers production of the sex hormones in the way a constant stream of GnRE cannot.

"The simplest way to imagine puberty blockers is to think of them like a pause button. Using them holds off physical changes that occur during puberty while the person is taking them." —Jesse Kahn LCSW-R, sex therapist

By disrupting production of estrogen and testosterone, puberty blockers—administered either by injection or as an arm implant—effectively stall the production of certain secondary sex characteristics. "The simplest way to imagine puberty blockers is to think of them like a pause button," says Jesse Kahn, LCSW-R, CST, director and sex therapist at The Gender & Sexuality Therapy Center in New York City. "Using them holds off physical changes that occur during puberty while the person is taking them."

The point? To keep teens from going through puberty in a way that does not align with their gender identity, says Jonah DeChants, PhD, a research scientist with The Trevor Project. Kahn agrees, adding that puberty blockers "give individuals the opportunity to explore their own gender before their body forces changes on them, and decide for themselves what that gender is." A boy who was assigned female at birth might take puberty blockers to stall the development of breasts or the onset of a menstrual cycle, for example. "It also allows them time to decide if they want to try other forms of medical transition down the road," Dr. DeChants adds.

For youth who are exploring their gender, or are certain that their assigned gender is not aligned with their sex, puberty blockers can provide a combination of physical, emotional, and mental benefits—as well as the gift of time.

Who are puberty blockers for, exactly?

Puberty blockers aren't intended for young children, but rather individuals who have begun puberty and who are gender expansive or gender questioning (people who are discovering their gender identity and sexual orientation). “The age of a candidate for puberty blockers varies because the age someone starts puberty varies,” says Dr. Osipoff. “For natal girls, puberty typically begins [between ages] 8 and 14 and for natal boys, puberty begins between 9 and 14.”

Many experts agree that this age is not too early for a person to know their own gender, rendering this age not too early to take puberty blockers. “The science that we have from children and developmental psychology shows that many people know their gender as early as 2 or 3 years old,” Dr. DeChants says. (To be clear, though, coming out as a different gender is valid at any age).

The idea that 8 to 14 is too young for someone to know if they are experiencing gender-based distress is unfair, says Dr. DeChants: "We don’t assign judgment values to other kinds of distress that kids might be experiencing." So, saying that a kid is too young to recognize their distress dismisses their pain and the harm they are currently enduring, he says. It also disregards what they're telling us about their identity. "Just as you and I are the experts of our own lived experience, so are pre-puberty individuals," says Kahn.

Yes, puberty blockers are safe

"There is no scientific evidence that suggests that puberty blockers are unsafe from a medical or psychological perspective," says Dr. DeChants. On the contrary, puberty blockers have a decades-long history of being administered to cisgender kids experiencing accelerated puberty, and the medications have been deemed as safe by the Food and Drug Administration (FDA) for this use. “Endocrinologists have been using this medication for this use off-label—meaning to help transgender youth—for decades,” says Dr. Osipoff. These are not new medications developed just for transgender youth, but instead have been studied and well documented as being safe for a long time, she says.

Puberty blockers also have no long-lasting side effects, Dr. Osipoff adds. “They are completely reversible.” If a person stops getting the injection or has the implant removed, puberty will resume as it would have before, she adds. Whether someone is on puberty blockers for just a few months or six years (which Dr. Osipoff says tends to be the upper limit of how long teens take them, due to the timeframe between the onset of puberty and the age of medical consent for taking other actions, like gender-affirming surgery), because puberty blockers are reversible and offer no studied long-term side effects, the net benefit of this medication far outweighs any downsides.

When folks stop treatment, Kahn says, "some users may realize they are cisgender and just weren't ready for their body to change in such a huge way. [They] are now ready to go through puberty of their sex assigned at birth, while others may continue to affirm that they are transgender through other interventions."

"There are non-reversible effects of going through the puberty of your sex assigned at birth." —Jonah DeChants, PhD, research scientist

There have been some anecdotal reports (that have not be verified by scientific studies) from individuals who took Lupron, a synthetic gonadotropin-releasing hormone, that the medication led to brittle bones. “The sex hormones that puberty blockers intercept [estrogen and testosterone] allow us to build up bone mineral density,” says Dr. Osipoff. That’s why most doctors put patients who are on a puberty blocker for a prolonged period of time on vitamin D and calcium supplements as well to help ensure bone strength and health, she says. “This risk is extremely preventable so long as patients are supplementing properly.”

In fact, as Dr. DeChants says, the bigger risk with regards to puberty blockers actually comes with denying access to the medications. "There are non-reversible effects of going through the puberty of your sex assigned at birth," he says. These effects include physical changes, like hair-growth patterns and vocal alterations; lasting mental-health challenges; and risk of gender dysphoria as a result of going through puberty as the wrong gender.

Puberty blockers can be a lifesaving intervention

Entering puberty before you've been given time to feel comfortable with your own gender identity and build your own social supports can be traumatic and lead to increased anxiety, depression, and risk of suicidal thoughts, says Kahn. Puberty blockers could offer a way to alleviate that distress and affirm the validity of a young person's feelings and experience. For many people, "it is very distressing to be a transmasculine person and getting your period, or to be a transfeminine person and begin growing facial hair," says Dr. DeChants.

It's not an overstatement to call puberty blockers a matter of life or death, either. One 2020 study found that transgender individuals who wanted to take puberty blockers and who had access to them showed a significant reduction in risk of suicidal ideation, compared to those who did not have access to the medications, Kahn says.

So, state legislators, if you're really as concerned for the children as you claim, it’s time you start listening to the health pros and stop pedaling transphobic legislation.

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