This article was originally published by the Star Observer. You can find the original article here.
As the name suggests, puberty blockers stop puberty from happening. These medications were originally invented to treat children who start puberty at an abnormally early age. They have been used this way for over thirty years.
However, over the past few decades, they have also been used by another group of patients – children whose internal sense of gender doesn’t line up with their body’s biological sex. Medical evidence shows that the best way to treat this distressing incongruence is by affirming the person’s knowledge of their own gender, and puberty blockers can be a part of this treatment for a small number of people.
How do puberty blockers work?
Puberty blockers act on the pituitary gland, a chickpea-sized structure located just below the brain. This gland is responsible for communicating with and regulating the other hormone-producing glands in the body, like the adrenal glands, thyroid gland, testicles and ovaries.
Normally, around the age of 10 to 13, the pituitary gland releases hormones to tell the testicles and ovaries to start making more testosterone and oestrogen. The increase of these hormones result in the physical changes of puberty, like breast development, hair growth, libido, voice deepening, and growth spurts.
Puberty blockers temporarily pause this process by suppressing the pituitary gland’s messages to the gonads. This means the child remains in a prepubescent state for as long as the medication is taken.
However, once the medication is stopped, puberty resumes straight away.
Why are puberty blockers prescribed to trans children?
For trans children, the onset of puberty can be a source of profound distress. This is because the physical changes of puberty – like breast growth or facial hair – can feel deeply wrong for them, like most people would feel if their body suddenly started transitioning to a different sex all on its own.
Puberty blockers let children put off these changes so they have time to mature before making a decision. It buys them some time to consider the consequences of hormones on their bodies, and avoid changes they might be dreading.
For adult trans people, much of the time, expense and stress of transition comes from reversing the changes that puberty brought about. This means that puberty blockers can potentially save people from going through more intense treatments in the future. For example, a trans girl who was assigned male at birth might use blockers to stop her voice from deepening, a trait that can take years of expensive voice training and surgery to reverse. Similarly, a trans boy who was assigned female at birth might use puberty blockers to stop his breasts developing, so he doesn’t have to go through top surgery in the future.
What does the research say?
An independent review commissioned by the NSW government in response to debates around gender-affirming care confirmed that puberty blockers are “safe, effective and reversible.”
The Sax Institute’s report, published in the wake of a Four Corners investigation, highlighted the need for more high-quality, long-term studies, but noted that the existing evidence supports the use of blockers for managing gender dysphoria in children.
An independent review into Queensland’s Children’s Gender Service, which provides puberty blockers to some of its patients, found that they provide safe and effective medical treatment, consistent with the best available evidence.
A more recent study from Harvard University found puberty blockers were associated with significant reductions in anxiety, depression, and suicidal thoughts.
However, a study published a few days ago found that in the US, only a very tiny minority of trans children ever take any gender-affirming medication at all, suggesting that the discussion about the use of blockers for trans kids has been blown out of proportion.
Research also shows that only a small number of children in Australia have ever used puberty blockers. Over 10 years, only 29% of those attending Royal Children’s Hospital Gender Service started puberty blockers, and a national survey of LGBTQIA+ people found a 4.7% of trans people had ever received puberty blockers.
Future research is being done in this area: the Australian Research Consortium for Trans Youth and Children (ARCYTC) has been funded by the Medical Research Future Fund to collate data from children’s gender clinics around Australia. This dataset will be the largest in the world and will be used to look into the physical and mental health impacts of puberty blockers for trans kids.
Standards of care in Australia
For people under 16, puberty blockers and hormone replacement therapy only ever happens in a hospital, with consent from both parents (with some exceptions in cases of estrangement). However, it can take a very long time to get into one of these hospital clinics, with wait times of one to two years.
Doctors in Australia follow The Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents. Written by over 40 experts in collaboration with patients, these guidelines outline the criteria needed for prescribing puberty blockers. These include a diagnosis of gender dysphoria, a medical assessment that includes fertility preservation counselling, the child having reached Tanner stage 2 pubertal status, consent from the young person, and informed consent from their legal guardians.
There is no minimum age requirement, but treatment is very individual. Each child is assessed by a multidisciplinary team based on their cognitive, emotional, and physical development, and treatment is personalised to them and their needs.
If they do go on puberty blockers, they’ll be given the choice of three sorts: an implant under the skin every 3 months or so, an injection every 3-4 months, or an injection every 5-6 months.
What are the risks?
Puberty blockers usually don’t have too many side effects besides blocking puberty. But like any medication, they can have unexpected or bad effects. These include reductions in bone density and fertility (which resolve once the puberty blockers are stopped), and a taller adult height.
Brains change a lot during the teenage years, but it’s unclear what effect blockers might have on brain development, if any. People who experience delayed puberty due to genetics or diseases don’t seem to experience cognitive differences, except for the mental health effects of feeling different to their peers.
Critics often claim that puberty blockers are drastic or experimental. However, for trans kids, puberty is also drastic and experimental.
Puberty blockers have been safely used for decades in children with other conditions. There’s no real reason the evidence supporting their safety doesn’t also apply to trans kids.
