What You Need To Know About Puberty Blockers

Arkansas has become the first state to ban gender affirming care for transgender youth after the Arkansas General Assembly overturned Governor Asa Hutchinson’s veto of the bill. The new law threatens to revoke the license of any physician who provides puberty blockers, cross hormone therapy treatments, or gender-affirming surgery to a minor. At least 17 other states have similar bills on the table. Doctors are being threatened and punished for doing their job and transgender kids are being punished for being kids. These laws are based on myths, fear, religion, and what-ifs and not the studies and science that support transgender youth. These laws also hurt cisgender children because transgender children aren’t the only minors who seek the care that is being banned.

When examining the anti-trans bills that are being passed, it’s hard to know which lie about gender affirming care to tackle first; for the purposes of this article I will focus on puberty blockers because these medications are what our youngest transgender youth often seek if they choose medical care as part of their transition.

The key words to focus on are “choose” and “their.” No one is forcing a child to be transgender. If anything, too many transgender youth don’t have supportive adults who will advocate on their behalf. More parents will force their kids to not be themselves than to follow their lead when it comes to knowing their gender identity and what they need to feel good about the way they express it.

And because this is still a myth, no one is surgically altering a transgender child’s genitalia. Parents of transgender kids aren’t begging doctors to perform procedures their kids are not consenting to either. There are people who circumcise their children or perform nonconsensual surgeries on children’s genitalia so they fit into society’s idea of what gender should look like, however. If you want to direct your anger at someone, you have actual targets.

What Are Puberty Blockers?

Puberty blockers are medications that are given to kids to prevent their bodies from producing hormones (testosterone and estrogen) that produce physical changes in sex characteristics that occur during puberty. For a child assigned female at birth and who has typical female sex organs and hormones, puberty blockers would stop the child from producing estrogen which would lead to breasts and menstruation. Kids will still develop some puberty features like odor, pubic hair, and acne since those aren’t only controlled by estrogen and testosterone.

There are two types of puberty blockers. Histrelin acetate is implanted under the skin in the arm and lasts about a year before it needs to be replaced. The second option is an injectable shot called leuprolide acetate and the person will need to get a shot every 1 to 4 months depending on the form of the medicine. It takes one to two months for the puberty blockers to start working. Puberty blockers are usually used for two to three years.

Puberty blockers are equivalent to a pause button and when no longer in use, puberty progresses from where it was stopped. If cross-hormone therapy is given to a transgender child then their body will experience puberty more in line with their gender identity. For example, a transgender male who chooses to go from puberty blockers to testosterone will develop a deeper voice and more body hair.

Who Needs Puberty Blockers?

Puberty comes in phases and children experience the onset of puberty at different ages, though the range is typically between the ages of 9 and 11. Because we can’t know the exact age a child will begin puberty, doctors use Tanner stages to visually measure where a person is in their stage of puberty.

Tanner stage 2 is usually the best time to introduce puberty blockers because this marks the beginning of changes in sex characteristics—sex characteristics that a transgender child may not desire because those physical changes do not align with their gender identity. Blood work can help guardians know what stage of puberty their kids are in, but the visual formation of breast buds, pubic hair, and testicle growth all indicate Tanner stage 2. Unless puberty is paused here or shortly after, changes in the body can’t be reversed and some can’t be stopped.

For transgender kids, puberty blockers are critical for their mental health and ability to navigate their gender expression in an authentic way. They allow them to eliminate the potential need or want to undo physical changes later in life that occurred during puberty. For transgender males, if they go through typical female puberty and develop breasts, they may need gender affirming top surgery when they are older to remove breasts that cause discomfort and dysphoria.

Puberty blockers are also used for kids who experience precocious puberty, which is when a child’s body starts puberty too soon. When a child starts to develop secondary sex characteristics before the age of 8 for female assigned children and 9 for male assigned children, doctors can recommend puberty blockers to stop the progression of puberty. When they get older, the use of puberty blockers is stopped and their body re-starts the “normal” progression of puberty.

Both cisgender and transgender children benefit from puberty blockers.

Are Puberty Blockers Safe?

Yes. Puberty blockers are safe and reversible. Fertility is not impacted.

Possible side-effects include: pain at the injection site (which is expected with any injectable medication), headache, fatigue, changes in weight or mood, or spotting or irregular periods for youth whose menstruation was not completely stopped by the puberty blockers.

What Are The Risks Vs. Rewards?

The risk of not allowing kids to access puberty blockers is more costly than providing youth with the medication they need. For children with untreated precocious puberty, they are at risk of experiencing detrimental behavioral and emotional issues. They’re at higher risk for substance abuse, social isolation, sexual promiscuity, and self-image concerns.

These risks are true for transgender youth as well. The benefits of using puberty blockers far outweigh the risks. Mental health improves depression and anxiety decrease, social interaction is more appealing and self-harm and suicide ideation decrease.

Puberty blockers improve and save lives, yet when it comes to providing this care to transgender kids “well-meaning” politicians are taking this option away from supportive parents, trained therapists, educated doctors, and a child who is old enough to articulate their wants and needs.

Will these politicians also declare puberty blockers unnecessary for cisgender children? If yes, then that is negligent. If no, then that is transphobia at its finest. Neither is acceptable.

Politicians need to stop policing gender affirming and life-saving care to kids; they aren’t protecting any children when they deny them access to the medication they need. They’re allowing their ignorance, religion, and transphobia to do more harm than the good they tell themselves they are doing.