When someone makes the decision to transition, part of that
process can be social (changing pronouns, letting people know
what name you prefer, or trying out a new wardrobe) and, for
some, it can also involve medical interventions (surgery or
hormone therapy). While medical interventions may not be part
of everyone’s journey, for those who include it, it’s often
considered medically necessary.
Puberty blockers, which are commonly used to treat children
who begin puberty too early, are a relatively new practice
when it comes to treating trans and gender-nonconforming
children. Understandably, people still have a lot of
questions and concerns about using them.
BuzzFeed LGBT spoke with experts Dr.
Jeremi M. Carswell, the director of the Gender Management
Service Division of Endocrinology at the Children’s Hospital
Dr. Ralph Vetters, medical director of the Sidney Borum
Health Center at Fenway Health in Boston, Dr.
Aron Janssen, founder and clinical director or the Gender
and Sexuality Service at NYU’s Child Study Center, and
Karin Selva, a pediatric endocrinologist at Randall
Children’s Hospital at Legacy Emanuel in Portland, Oregon, to
cut through the misconceptions and get down to the facts.
blockers (also called puberty inhibitors or puberty
suppressors) are a type of medication that essentially hit
pause on the physical changes that would occur during
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“It’s a great way to stop the development of unwanted
secondary sexual characteristics in a trans-identified youth
until they get old enough to [start transitioning],” says
Vetters. Secondary sex characteristics are all those physical
changes you notice popping up during puberty — growth of hair
in some places, the development of breasts, a deepening of
the voice, etc.
Most children who experience gender dysphoria will not
continue to experience it into adolescence, but a portion do
continue to experience those uncomfortable feelings and seek
transitioning later in life, found one one study.
By using blockers, kids are given just a bit more time to
figure things out without also dealing with the discomforts
dysphoria — which often worsens during puberty.
Attached to the base of your brain is a little pea-sized
gland called the pituitary. It’s this gland that sends
signaling hormones to your ovaries or testes so they can
begin producing estrogen or testosterone — the sex hormones
that get puberty going.
Blockers (which are classified as gonadotropin-releasing
hormone analogs if you want to get fancy) work by
short-circuiting the signals to the pituitary gland in the
brain, says Vetters. The medication “blocks” the signaling
hormones from being sent out from the pituitary, stopping the
sex hormones from being produced. No signals? No puberty. And
no puberty means no development of breasts, deepening of
voice, or increase of facial and body hair.
Carswell says the process works the same for any gender.
agents can be administered in two different ways — via an
injection or an implant.
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Medioimages / Getty Images
Lupron is an injectable medication that can be given on a
monthly or trimonthly basis, explains Selva. The
intramuscular injections would be given in a doctor’s office
by trained staff, not at home by a patient or parent.
short video of a patient being given an injection, shared
with their permission, if you’re feeling curious.)
Surellin or Histrelin are two medications that can be
delivered via a tiny implant. The small device, placed under
the skin of the patient’s upper arm, releases medication over
a period of one year, says Selva. The implant is replaced
“The insertion site is so small, they don’t use stitches to
close it, only a medical glue or derma bond.”
The best time to start puberty blockers is along with the
very first signs of puberty — usually in the ballpark of 14
or 15 years old.
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Degrassi / Epitome Pictures
By starting treatment with the first signs of puberty,
doctors can ensure the endocrine system is working properly
while stopping the complete development of unwanted secondary
sexual characteristics that could cause dysphoria later, says
If puberty has already caused the complete development of
secondary sexual characteristics it’s too late to “block”
them, as the job has already been done. “We can never
‘reverse’ what has already occurred, like facial hair, or
deep voice, or breasts,” explains Carswell. In this case, the
best option would be to consider starting hormone replacement
Once a patient begins blockers, the average time to stay on
the treatment is around four to five years. “Just long enough
to get a kid to the point where we can start HRT to support
the development of preferred gender characteristics,”
8. So, how
are blockers different from hormone replacement therapy?
Hormone replacement therapy, or HRT, is the addition of
hormones that the body does not readily produce. HRT in
transgender patients is started when a patient decides to
begin physically transitioning — developing secondary sex
characteristics that match one’s gender identity.
“Sometimes people are on puberty blockers or hormone blockers
and [HRT] all at the same time,” says Vetters. “But it is
only testosterone and estradiol [the hormones administered
during HRT] that will actually cause the changes in the body
that masculinize or feminize the patient.”
study of trans and gender-nonconforming children hasn’t been
a priority in the past, making research-based data hard to
come by — but the current consensus is that blockers are safe
and their effects totally reversible.
The likely immediate side effects are local, such as bleeding
or infection at the implant site, says Carswell. But there
are things we still don’t know much about, like long-term
effects on bone health or effect on brain development.
“We have some concerns about bone density – and we will watch
that fairly closely,” says Vetters. “We don’t generally like
kids to be on puberty blockers for more than four or five
because going through the “wrong puberty” can have clear
long-term negative mental health effects for transgender
youth, medical interventions like blockers can be, quite
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Stockbyte / Getty Images
“Transitioning is a complex process, but at its core, it is a
process defined by allowing one’s internal experience of
gender to be expressed and affirmed,” Janssen says.
With blockers, children are given the immediate relief of
knowing there is a pause placed on the physical changes of
puberty, adds Janssen. When children are allowed to
transition, along with the support of parents or family,
improvement in mental health and functioning usually follow.
“I’ve had patients be able to go from being on four different
psychiatric medications to none as a result of a successful
transition,”Janssen says. “It is not an exaggeration to say
for some kids, these medications are life-saving.”
“Typically Depot-Lupron costs approximately $1,500 a month,
if on the monthly preparation,” says Selva. “The three-month
preparation is equivalent in price.” Meanwhile, the Histrelin
implant can be up to $15,000 (for the device itself and the
procedure to implant it).
And these costs won’t cover the additional blood work and
doctor’s visits that will coincide with treatment. Several
clinics designed specifically to guide children and their
families through the confusing journey of transitioning have
opened up around the country.
Most insurance plans still won’t cover puberty blockers for
trans and gender-nonconforming children, but, according to
Janssen, it’s (slowly) getting better. “It’s still an uphill
battle and for each prescription — it involves typically up
to several hours of time with various claim forms and
13. If a
parent wants to start their child on blockers, they’ll have
to schedule an appointment with an endocrinologist.
“For patients under the age of 18, most programs have a set
protocol involving a physical exam, collection of medical
records, baseline lab tests, a therapist’s recommendation,
and some time with parents and family,” says Vetters.
Due to the fact that anyone using puberty blockers will be a
minor, it will take parent’s consent and cooperation to
obtain a prescription.
World Professional Organization for Transgender Standards of
Care makes recommendations for mental assessments of
transgender youth prior to being prescribed blockers.