What Are Puberty Blockers, and How Can They Support Teens Through Puberty?
Key takeaways:
Puberty-blocking medications slow down the body changes that come with puberty.
Puberty blockers have been available for many years and are safe for most teens.
For young transgender people who could benefit from puberty blockers, the best time to start them is right after puberty begins.
Puberty is the time when the body changes from that of a child to that of an adult. Everyone goes through puberty, though exactly what puberty looks like depends on the body parts you have.
The changes of puberty can feel awkward for anyone. But for people who are uncomfortable or unhappy with their birth-assigned sex, puberty can be an especially difficult time. Luckily, there are options for young preteens facing puberty before they’re fully ready to embrace their gender identity.
Puberty-blocking medications put on hold the body changes of puberty. This temporary fix can give those who need it more time to decide what they want for the future. For many, these medications can be a lifesaver and have a direct positive impact on mental health.
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Here we’ll cover what you should know about puberty blockers, including benefits, risks, and how they work.
What are puberty blockers?
Puberty blockers are medications that block the hormones that control puberty. This is why puberty blockers are sometimes called “hormone blockers.”
Typically, puberty starts when the brain sends hormones into the bloodstream. These hormones spread throughout the body. The changing pattern of hormones tells the body when it’s time to start going through puberty.
If you have female-typical body parts, you’ll grow breasts and start getting your period during puberty. People with male-typical body parts will develop a lower voice, more hair on their face and body, and larger genitals.
Puberty blockers stop these hormones. Without a signal, body parts that are ready to change will just keep waiting.
Here are some medications used to block puberty:
Leuprolide (Lupron)
Triptorelin (Trelstar)
Goserelin (Zoladex)
Histrelin (Supprelin LA)
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What’s the difference between puberty blockers and hormone treatments?
Puberty blockers are completely different from hormone treatments. Puberty blockers don’t cause long-term changes. In fact, their entire job is to stop things from changing.
On the other hand, hormone treatments used as part of gender-affirming care start puberty. They can be used later, if needed, to tell the body to develop masculine or feminine features.
How do puberty blockers work?
Puberty blockers work by mimicking the actions of gonadotropin-releasing hormone (GnRH).
GnRH is a natural hormone made by the brain starting in late childhood. When it’s time for puberty, the brain releases GnRH in an on-off-on-off pattern — like morse code. The body responds to that pattern and starts maturing.
Puberty blockers muddle the on-off-on-off pattern of GnRH so the message to start puberty doesn’t get through to the rest of the body.
How are puberty blockers administered?
Puberty blockers are given by injection (shot) or a small implant that stays just beneath the skin. They’re designed to deliver the medication at a steady rate over time. Injections need to be repeated every few weeks or months to keep working. Implants need to be replaced over time, too.
What are puberty blockers used for?
Puberty blockers aren’t a new medication. In fact, these hormone blockers have been around for decades. They treat a number of medical conditions, including prostate cancer and endometriosis. But they’re best known for their role in treating medical conditions in children.
Transgender care
Puberty blockers are an important tool for transgender youth. They give young teens more time to navigate their gender identity and create a long-term vision for their future.
Early puberty
Puberty blockers have been safely used for decades to treat early puberty, also called precocious puberty. Early puberty can impact a child’s physical and mental well being. Puberty blockers stop early puberty so children can achieve a full adult height. By pausing puberty, puberty blockers let children develop at the same time as their peers, which helps with mental well-being and self-esteem.
Short stature
Hormone blockers are sometimes used with other medications to treat short stature (height). This is a medical condition in which a child does not grow as they should. Treatment can help these children achieve an adult height that is closer to what would be expected based on their genetics and sex.
What are the side effects of puberty blockers?
Puberty blockers are generally very safe. That said, like any medication, they can have some side effects that a provider needs to monitor.
Possible long-term side effects include:
Lower bone density: This can raise the risk for osteoporosis later on in life.
Less developed genital tissue: This can affect gender-affirming surgery.
Some short-term side effects include:
Headaches
Mood changes
Muscle aches
Puberty blockers can stop periods. But they don’t completely suppress periods for everyone. Some people still experience spotting and breakthrough bleeding while taking puberty blockers.
Puberty blockers aren’t birth control. This means it’s possible to get pregnant while taking puberty blockers. Experts recommend using contraception if you’re sexually active while taking puberty blockers.
Although puberty blockers have been around for a long time, helping transgender kids delay puberty was not their original purpose. That means there are still many unanswered questions about the long-term effects of puberty blockers.
Here are some things scientists are trying to answer:
Does delaying puberty affect brain development in teens?
Until what age can puberty be paused and still be reversible?
Could taking puberty blockers affect fertility (the ability to have a baby in the future)?
If you’re considering puberty blockers, you’ll want to talk with a healthcare provider about these issues and any other concerns you may have.
What are the benefits of puberty blockers?
These medications have clear benefits for kids and adults with certain medical conditions. For kids who are questioning their gender, these medications can help buy some time.
For children who are unhappy or uncomfortable with the sex they were assigned at birth, puberty blockers can ease their worries — at least for a little while.
Transgender people can face an uphill battle when it comes to being understood in society. The risks of depression and suicide are high. Giving kids who might be transgender a little extra time in their gender-neutral, childhood body offers them a chance to make careful decisions about their future.
There are significant mental health benefits to pausing puberty for transgender kids. By slowing things down, kids gain time to understand and express their wishes. Research has shown that using puberty blockers lowers suicidal thoughts among transgender people in adulthood.
Are puberty blockers reversible?
Yes, puberty blockers are reversible.
Children with early puberty are given puberty blockers right away, sometimes as young as 5 or 6 years old. They take the medication for a while. Then, when they stop taking it, puberty restarts normally.
Although research with transgender kids is slim, specialists believe the same thing will happen for them. In other words, a teen can choose to stop taking puberty blockers and let puberty happen naturally if they decide that’s the best choice for them.
On the other hand, if a teenager chooses to transition to a gender different from their birth-assigned sex, they can talk to a specialist about starting hormone treatments or other gender-affirming therapies.
Who shouldn’t take puberty blockers?
Not all transgender people or people who question their gender need puberty blockers. Transgender people have different feelings about what kind of body they’re comfortable with, so stopping puberty isn’t always the right path.
In general, puberty blockers are not helpful for people who:
Are OK with their changing body
Don’t show any signs of puberty yet
Already have an adult body type
Puberty blockers can’t reverse puberty. So you can’t take hormone blockers after puberty.
How do you get a prescription for puberty blockers?
Puberty-blocking medication requires a prescription. A mental health assessment is not required, but state laws and insurance coverage might limit access to some medications.
Healthcare providers who can prescribe puberty blockers include:
Many gynecologists
Most endocrinologists (hormone specialists)
Some family medicine physicians, nurse practitioners, and physician assistants
Some pediatricians and pediatric primary care providers
Some psychiatrists
Healthcare providers who specialize in adolescent care
Healthcare providers who specialize in gender-affirming care
Cost can be a barrier for accessing puberty blocker medications. Treatment can total thousands of dollars every year without insurance. Although insurance coverage of these therapies seems to be improving, it’s best to check with your specific plan.
The bottom line
Puberty blockers work with your natural body systems to pause puberty. This can give gender-questioning kids a few more years to consider what puberty should look like for them.
These medications can have a long-lasting positive effect on mental health, easing some of the pressures transgender kids might feel as their bodies start to mature. The effects are reversible. So, when they’re ready later on, kids can resume puberty or take the next steps toward transitioning.
Why trust our experts?
References
American College of Obstetricians and Gynecologists. (2022). Health care for transgender and nonbinary teens.
Krishna, K. B., et al. (2019). Use of gonadotropin-releasing hormone analogs in children: Update by an international consortium. Hormone Research in Paediatrics.
Turban, J. L., et al. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics.
