An onslaught of legislation banning gender-affirming care for transgender youth has pushed puberty blockers into the spotlight. Puberty blockers, or simply “blockers,” are one of the main forms of gender-affirming treatment available to trans kids. These medications put a pause on puberty, giving trans and other gender-diverse children more time to consider their options instead of forcing them to go through the physical changes associated with the sex they were assigned at birth. When trans youth don’t have access to puberty blockers, they experience changes to their bodies that can cause intense gender dysphoria. A 2020 study found that trans people who had wanted to receive pubertal suppression but did not were 70% more likely to experience suicidal ideation in their lifetime than those who did receive it.
The medical consensus is that puberty blockers are safe and effective for trans youth. In a February 23 statement, the Endocrine Society noted that it, along with the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics, as well as clinical practice guidelines, supports “evidence-based medical care” for trans kids, which includes puberty blockers.
Without gender-affirming treatment, trans and gender-diverse kids suffer, often tremendously. Children with gender dysphoria experience anxiety and depression, according to the Mayo Clinic. This distress can be so profound that some children self-harm or attempt suicide. More than half of all teenage trans boys have attempted suicide, according to a 2018 Pediatrics study. Additionally, 42% of teenagers who identify as neither male nor female and 30% of teenage trans girls have attempted suicide. Researchers report that trans adults who had access to puberty blockers as children had a lower lifetime risk of suicidal thoughts and better mental health. And without puberty blockers, trans people are more likely to need surgeries and other intensive medical procedures later in life.
Despite the medical consensus, many people feel unsure about puberty blockers. The science of puberty is surprisingly complex and hard for laypeople to grasp. That’s not to mention the emotional complexities involved with a kid coming out as trans. The larger cultural wars only add to the anxieties surrounding this treatment.
There is a lot of misinformation and myths floating around — some spread by the anti-trans bills themselves. Here, we debunk them.
Myth 1: Puberty Blockers Are Experimental
“We have a long history of experience with these medications,” says Stephanie Roberts, M.D., a pediatric endocrinologist in the gender multi-specialty clinic at Boston Children’s Hospital. “We have used puberty blockers actually for several decades in cisgender children who develop something called central precocious puberty,” which leads to kids “developing puberty abnormally early,” Roberts says. These blockers “are extremely safe and effective,” she notes.
Puberty blockers do come with a risk of lower bone density, according to the gender clinic at the Oregon Health and Science University’s Doernbecher Children’s Hospital. But this side effect is manageable. The Doernbecher’s gender clinic recommends that children only take blockers for two to three years. It also recommends that they take calcium and vitamin D supplements and consider doing certain types of exercise (walking, jumping, and weightlifting) to strengthen bones.
Myth 2: Puberty Blockers Have Similar Effects on Estrogen and Testosterone
When people talk about puberty blockers, they’re usually using a shorthand for a type of medications called gonadotropin-releasing hormone (GnRH) agonists, Roberts explains. These are technically a type of hormone, Roberts says.
A GnRH agonist “works by altering some of the hormone signals in an area of the brain called the hypothalamus, which makes the hormone GnRH,” she says. These blockers are “very effectively taking away the hormone signals in the brain that normally travel to the ovaries or the testes and tell them to make hormones,” she adds. In other words, these medications let kids press pause on puberty.
On the other hand, when trans and other gender-diverse folks receive gender-affirming hormone therapy, the situation is completely different. Taking estrogen brings on pubertal changes such as breast development, and taking testosterone brings on changes such as increased body and facial hair growth. In other words, puberty blockers temporarily stop these types of bodily changes from occurring, and hormone therapy actively causes these changes.
Myth 3: Puberty Blockers Are Given to Very Young Kids
“We do not use puberty blockers in children who have not yet entered puberty,” Roberts says. Since puberty begins at different ages for different children, kids who use this medication will start it at different ages.
For people assigned female at birth, puberty typically begins between ages 8 and 12 (with early signs being chest budding and an increased growth rate), Roberts says.
For people assigned male at birth, puberty typically begins between ages 9 and 14. Pinpointing the age of puberty onset for these kids can be trickier. The first sign in someone assigned male at birth is testicular enlargement,” she notes. Unlike say, shooting up inches in height or a deepening voice — obvious physical changes that would typically happen later in puberty — this one likely wouldn’t be noticed by others when someone is dressed, and children experiencing this change might not realize it’s important to mention. “In someone assigned male at birth, puberty can be going on for some time before the family is aware,” Roberts says.
Myth 4: Puberty Blockers Cause Infertility, Sterility, and Other Irreversible Changes
“The really wonderful feature of puberty blockers is that they are a fully reversible medication,” Roberts says. When it’s time for kids to finish going through puberty, there is a decision to be made between them, their families, and their medical teams. One option is that they start hormone therapy (estrogen or testosterone) to finish going through puberty typical of a sex differing from the one they were assigned at birth. If they stop the blockers and don’t start receiving hormone therapy, they will go through the puberty of the sex they were assigned at birth — no harm, no foul.
Myth 5: Kids Are Too Young to Be Involved in These Decisions
It’s critical that children be involved in these decisions, Roberts says. Although kids who take puberty blockers are too young to provide consent and their parents or guardians must do so on their behalf, most children who are in the early stages of puberty can assent. This means they’re “developmentally ready to participate and be part of that shared decision-making,” with their families and medical team, Roberts says. They’re able to clearly express their wishes for or against certain treatments and consider — with help — the possible benefits and downsides of those treatments.