Puberty marks a period of maturation, growth and development towards adulthood, alongside significant physical changes. Therefore, transgender or gender-diverse children may choose to temporarily halt puberty through the prescription of puberty blockers, also known as hormone blockers.
These changes, inherent to puberty, can lead to considerable emotional distress for many adolescents who are gender non-conforming. Such discomfort may further compound the psychological stress during a phase of their development that is already notably challenging.
Puberty in transgender adolescents
During puberty, the body releases sex hormones like testosterone and oestrogen, triggering changes in both the primary and secondary sex characteristics of the individual.
Primary sexual characteristics refer to the sexual organs present at birth, including the penis, scrotum, testicles, uterus, ovaries and vagina.
Secondary sexual characteristics encompass the physical changes that emerge during puberty, such as the growth of facial hair or the development of breasts.
The regular administration of hormone blockers, specifically gonadotropin-releasing hormone (GnRH) analogues, can suppress the release of these sex hormones.
Is this treatment exclusive to transgender adolescents? The short answer is no. Pubertal blocking therapy has been employed for over two decades to assist boys and girls experiencing precocious puberty, where the objective is to prevent or delay the premature onset of secondary sexual characteristics.
Puberty hormone blockers
Puberty blockers are hormones that act centrally to block the production of sex hormone precursors. This blockage will result in a lack of stimulation of the primary and secondary sex organs, which is required for their typical pubertal growth and development, meaning that puberty will be delayed or reduced for the person taking the blockers.
The use of puberty blocking in trans children has two possible consequences. On the one hand, it inhibits the development of the secondary sex characteristics of the biological sex. That is, in trans boys the breasts will not develop and menstruation stops. In trans girls, it decreases the growth of facial and body hair, prevents the voice from deepening and limits the growth of the genitalia. The other consequence is body immaturity which can be crucial during adolescence.
It is important to note that delaying or suppressing puberty in trans youth may contribute to their emotional well-being and decrease anxiety, improve their group integration and social interactions, and avoid the need for future surgery.
Delaying puberty would not appear to have long-term consequences, as hormonal puberty blocking is fully reversible. So should an adolescent boy or girl choose to discontinue hormone-blocking treatment, puberty will resume its natural course.
When to start puberty blockers?
Puberty typically commences for most boys and girls between the ages of 10 and 12, though this can vary, with some starting earlier and others later. The effect of puberty blockers on adolescents will depend on when the treatment is started.
Starting the treatment at an earlier age can delay the onset of secondary sexual characteristics. For instance, this may result in a partial or almost complete reduction in the development of mammary glands, a decrease in testicular size and a reduction in facial hair growth. Puberty blockers at an early stage may prevent the deepening of the voice and growth of the Adam’s apple.
If initiated at somewhat later stages, after puberty has begun, the treatment can halt menstruation and erections, as well as the progression of other undesired secondary sexual characteristics.
From the age of 16, it is generally recommended to transition from pubertal blockers to cross-hormone therapy, aligning with the gender the individual identifies with. Therefore, transgender women are advised to follow a regimen of oestrogen and anti-androgens, whereas transgender men should commence testosterone therapy.
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