Puberty suppression and blockers | Transgender, non-binary and gender diverse children

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This blog post is a part of the resource – Supporting Transgender, Non-binary and Gender diverse Children & Young People, created by Felicity St John and Felicity’s collaborator and fellow Master of Sexology student Lindsay SmithFelicity, during a placement with Sex Ed Rescue in 2024.

Felicity St John has a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She currently works for an NGO as a supervisor of four practitioners, coaching and case managing families facing complex challenges. Felicity also offers professional development and consultancy. Her professional interest areas are sex education, puberty, LGBTQI+ people, child development, transgender/non-binary/gender-diverse people, relationship coaching, family coaching, and parenting psychoeducation. Felicity has a passion for supporting people to step into their capacity. When she’s not working Felicity loves to laugh, play, be with loves ones, rock climb, SUP board, explore nature, read, write, hike, cycle, swim, and laze about like a cat. You can contact Felicity via email.

Before a child is in Tanner stage two of puberty, SOC 8 outlines that they are ineligible for puberty blockers. Suppose a child is engaged in gender-affirming medical care when the first outward signs of puberty begin. In that case, SOC 8 recommends reviewing the child every four months to monitor their puberty stage.

The SOC 8 recommends supporting prepubertal children by openly talking to them in an age-appropriate way about how bodies change at puberty. Before puberty, social affirmation/transition is a positive, evidence-based intervention for transgender children.

Puberty blockers are a medication that pauses puberty by stopping puberty hormones from being secreted. This means the secondary sex characteristics that typically develop in line with a person’s sex assigned at birth are put on hold. According to the Pediatric Endocrine Society (2019),

  • ‘For those assigned female at birth, these medications prevent breast development and menstrual cycles. 
  • For those assigned male at birth, these medications prevent enlargement of the testes and the penis, voice deepening, facial hair growth, masculine facial features and bone structures.’ 

The medication is called gonadotropin-releasing hormone analogues (GnRHa). Colloquially, they are called puberty blockers or hormone blockers. It is administered either by injection, nasal spray, or implant.

Puberty blockers aren’t permanent. If you stop taking them, puberty starts up again and progresses. 

Puberty blockers are not just used in trans health care. They are used as a treatment when children enter puberty much earlier than is typical—sometimes referred to as precocious puberty. Puberty blockers have been in use for the past two decades.

Commencing puberty blockers earlier in Tanner stage two can reduce the number of surgeries the person may need later to move their body more in line with their gender. For example, they are eradicating the need for top surgery for a trans man. This can reduce the future costs of surgery, reduce time off work for surgery, and reduce pain. 

If puberty blockers are started in later Tanner stages, they are unable to reverse the pubertal changes that have already occurred, but they can pause further changes. 

The takeaway for parents of TGD children is that there are real timeframes to consider which impact lifelong outcomes of what is possible for TGD children. 

Despite puberty blockers being a recommended medical intervention, this doesn’t mean the trans adolescent would like to access them, can. Factors vary across geographical locations and can be impacted by the resources and attitudes of a young person’s family and support system. An adolescent would need to have access to a medical provider who would support access to puberty blockers. Public gender health clinics can be limited in number and not able to service the number of youths wanting to access the clinics. Waiting lists can be long. The medication can be expensive, not be subsidised by an insurer, or may not come under a government prescription subsidy program. Minors may be required to have consent for puberty blockers from both parents/legal guardians. Minors may have to go through a court system to access puberty blockers without parental consent. Government decisions and regulations in some locations can limit access to minors.

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Resources

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References

  • Bone Mineral Density in Transgender Adolescents Treated With Puberty Suppression and Subsequent Gender-Affirming Hormones by van der Loos et al., 2023.
  • FAQ- Puberty Blockers by Gender GP 2024.
  • Pubertal Suppression for Youth with Gender Dysphoria by the Pediatric Endocrine Society 2019.
  • Puberty Blockers by Trans Hub 2021.
  • The Effect of Early Puberty Suppression on Treatment Options and Outcomes in Transgender Patients by Panagiotakopoulos et al., 2020.
  • Cass Review – Pre-Release Resource for Media, Commentators and Advocates by Trans Justice Project 2024.
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Felicity St John holds a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She supervises a team in an NGO, coaching and supporting families with complex needs, and offers professional development and consultancy. Her interests include sex education, puberty, LGBTQI+ inclusion, child development, and family coaching. Outside work, Felicity enjoys time with loved ones, outdoor adventures, and creative pursuits.
You can find Felicity at LinkedIn - https://www.linkedin.com/in/felicity-st-john-726365256/