When a child questions their gender identity, or when they’re actually experiencing gender dysphoria, the emotional turmoil often extends into family. In the last couple of years, I’ve received so many calls from worried parents that go something like this:

My son who is 11 years old just came out to us, sharing that he’s a girl and is unhappy with his body parts and wants to stop puberty.

Parents are often shocked and never see it coming. Even the most supportive parents echo their child’s questions and — not surprisingly — have many more of their own. Often, they are about puberty blockers, so I attempt to address this curiosity with the information below. However, know that we strongly recommend working with doctors and medical professionals before starting any medicines.

What are puberty blockers and what do they do?

Puberty blockers are medicines that block puberty-related hormones that make your body go through puberty. Starting puberty blockers is a decision that is different for everyone. When taken regularly, gonadotropin-releasing hormone (GnRH) analogues suppress the body’s release of sex hormones, including testosterone and estrogen, during puberty. These hormones affect:

• Primary sex characteristics. These are the sexual organs present at birth, including the penis, scrotum and testicles and the uterus, ovaries and vagina.
• Secondary sex characteristics. These are the physical changes in the body that typically appear during puberty. Examples include breast development and growth of facial hair.

Dr. Stephen Rosenthal, medical director of the child and adolescent gender center for U.C.S.F. Benioff Children’s Hospitals, a co-author of the Endocrine Society’s 2017 guidelines for transgender health care suggests that families should undergo a thorough process of informed consent, during which they are educated about the potential effects of blocking puberty — including adverse ones.

• Medications are rarely without side effects. Blocking puberty can make bones weaker (lower bone density), but this may get better when an adolescent stops the puberty blockers or starts cross-hormone therapy. While on puberty blockers, doctors often recommend taking calcium, vitamin D and doing bone strength-building exercises like walking, jumping and weight lifting to counter possible side-effects.
• Taking puberty blockers should not affect an adolescent’s ability to have a baby in the future (fertility). However, permanent damage to fertility is a concern for people who stay on puberty blockers and then take cross-sex hormones.

The World Professional Association for Transgender Health’s (WPATH) guidelines for medical care suggest that “before any physical interventions are considered for adolescents, extensive exploration of psychological, family and social issues should be undertaken.” Professionals emphasized mental health care as an integral part of the process.

Puberty blockers are approved by the Food and Drug Administration to treat precocious puberty — puberty occurring at an unusually early age.

What’s the difference between puberty blockers and testosterone for AFAB (assigned female at birth) and estrogen for AMAB (assigned male at birth)?

• In those identified as male at birth, GnRH analogues decrease the growth of facial and body hair, prevent voice deepening, and limit the growth of genitalia.
• In those identified as female at birth, treatment limits or stops breast development and delays or stops menstruation.

References
“Puberty Blockers” (Downloadable PDF from Seattle Children’s Hospital)
“Pubertal blockers for transgender and gender diverse youth” (Mayo Clinic)
“What are Puberty Blockers” (New York Times)