How do you work?
Typically during puberty, the gonadotropin-releasing hormone helps in the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In people assigned to a woman at birth, these hormones cause the ovaries to produce estrogen, which promotes processes like breast growth and menstruation. In people assigned a male at birth, they cause the testes to make testosterone, which encourages processes like hair growth on the face and deepening of the voice.
Puberty blockers disrupt the production of FSH and LH and thus block the production of estrogen or testosterone. As a result, transgender teens no longer develop undesirable secondary sexual traits – transgender boys no longer develop breasts and transgender girls no longer develop facial hair, for example.
Puberty blockers do not stop an early stage of sexual maturation called adrenarche, which can cause acne, armpit and pubic hair growth, and body odor.
Who Can Get Puberty Blockers?
Although parents may think they should start puberty blockers very young so that a child never experiences physical changes related to the unwanted sex, experts say it is better to wait until at least the onset of puberty. Dr. Stephen Rosenthal, Medical Director of the Gender Center for Children and Adolescents at UCSF Benioff Children’s Hospitals, co-authored the Endocrine Society’s 2017 guidelines for transgender health care. He recommended starting puberty blockers when breast budding or testicular enlargement has started at the earliest.
This is because Dr. Rosenthal does not recommend any puberty blockers for prolonged use outside the normal puberty window. They limit the function of the gonads, which can lead to harmful effects. The longer blockers are used after the typical onset of puberty – usually by the age of 14 at the latest – the greater the possible risk.
When blockers are initiated in the early stages of puberty, Dr. Rosenthal normally suggests that his patients stop using them from the age of 14. At this point, patients with their families and doctors can decide whether to introduce hormones that will help them develop according to their gender identity or return to puberty in the sex assigned at birth.
Dr. Rosenthal also recommended that children be examined by a psychologist before starting blocker treatment and that gender-specific dysphoria be determined. He said families should also undergo a thorough informed consent process of educating them about the potential effects of blocking puberty – including adverse ones.