The truth about puberty blockers
In order to understand the issues we need to cut through the noise
Recent legislation enacted by Republican governments in red states attacking transgender youth have targeted the use of puberty blockers as a key method of treatment for gender dysphoria. Republican legislators claim puberty blockers are “experimental treatments” that “permanently damage” the bodies of young people yet decades of scientific evidence refutes that argument.
What is the truth about puberty blockers?
The irreversible, slow-motion physiological changes of puberty can be emotionally and mentally disturbing, leading to depression, social withdrawal, self-harm and a risk of suicide. Half of transgender people aged 13 to 24 have seriously considered suicide in the past year, according to a 2023 nationwide survey released on May 1 by the Trevor Project, a nonprofit focused on LGBTQ+ suicide prevention.
Gender-affirming hormone therapy can decrease this risk. A recent study in the New England Journal of Medicine, for example, showed that hormone therapy significantly decreased symptoms of depression and anxiety in transgender youth. Another study found that transgender teenagers who received gender-affirming care were 73 percent less likely to self-harm or have suicidal thoughts than those who didn’t.
Hormonal medications called gonadotropin-releasing hormone agonists (GnRHas), often referred to as puberty blockers, temporarily halt the production of sex hormones testosterone, estrogen and progesterone with minimal side effects. They can pause puberty and buy transgender children and their caregivers time to consider their options.
Puberty blockers have been safely prescribed to children and adolescents suffering from gender dysphoria since the late 1980’s. Originally designed to treat early onset puberty in children, puberty blockers are part of a class of hormonal therapies that include birth control pills, treatments for menopause symptoms, treatments for certain kinds of cancer, and more.
Laws based on lies and propaganda
However despite the evidence for the safety and efficacy of puberty-delaying treatments, some lawmakers across the U.S. have spread false claims about the drugs and other gender-affirming treatments as part of their efforts to ban or severely restrict access to health care for transgender people. Florida, Idaho, Georgia, Indiana, Kentucky, North Dakota, South Dakota, West Virginia, Arkansas, Mississippi, Utah, Iowa and Tennessee have banned gender-affirming care for anyone under 18 years old. The American Civil Liberties Union is tracking the status of 122 health care–related anti-LGBTQ+ bills, which disproportionally target transgender youth.
Medication that pauses puberty, specifically, has the power to prevent a mental health crisis, making the treatment a “profoundly meaningful intervention” for a young person and their family, says Meredithe McNamara, an adolescent medicine physician at the Yale School of Medicine. “Puberty-blocking treatment is probably one of the most compassionate things that a parent can consent to for a transgender child.” It allows transgender children and their families the opportunity to weigh their options carefully, without the constant pressure of physical changes, she says.
A decade of research shows such treatment reduces depression, suicidality and other devastating consequences of trans preteens and teens being forced to undergo puberty in the sex they were assigned at birth).
Yet Republican legislators continue to write laws banning these scientifically proven and life-saving treatments in an attempt to use transgender youth as a wedge issue in order to wage their cruel culture wars and win elections. When Zooey Zephyr claimed “You will have blood on your hands” in the Montana Legislature last month, this is exactly what she was talking about.
The truth is that data from more than a dozen studies of more than 30,000 transgender and gender-diverse young people consistently show that access to gender-affirming care is associated with better mental health outcomes—and that lack of access to such care is associated with higher rates of suicidality, depression and self-harming behavior.
“Most people, within a year [of receiving puberty blockers], decide whether or not they’re going to continue to transition,” says Vin Tangpricha, an adult endocrinologist at Emory University Hospital and Emory University Hospital Midtown and a co-author of some of the foremost clinical guidelines for treating gender dysphoria in the U.S. and worldwide. “You can’t have someone on puberty blockers for a prolonged time.” If a teen decides not to transition and stops taking puberty blockers, the hormones their body produces on its own will cause puberty to resume. If they decide to move forward with a medical gender transition, they may take some combination of hormones—estrogen for feminizing effects or testosterone for masculinizing effects—to experience puberty that aligns with their gender.
“These puberty-pausing medications are widely used in many different populations and safely so,” McNamara says. GnRHas are also used in adolescents to treat endometriosis, a condition in which the cells lining the uterus grow in other parts of the body. These hormonal drugs have provided solutions to a number of hard-to-treat conditions. They adjust hormone levels for people with prostate and breast cancer, pause menstruation for those undergoing chemotherapy and help with in vitro fertilization. This host of beneficial clinical uses and data, stretching back to the 1960s, shows that puberty blockers are not an experimental treatment, as they are sometimes mischaracterized, says Simona Giordano, a bioethicist at the University of Manchester in England. Among patients who have received the treatment, studies have documented vanishingly small regret rates and minimal side effects, as well as benefits to mental and social health.
At every stage, the adolescents, their families and their doctors monitor their development. Each step of their transition is considered independently and carefully by the young people and their families, McNamara says.
A chilling effect
To McNamara, the widespread attempts to take these decisions out of families’ hands by banning care for transgender youth is a clear indication that the goal is not to protect the health of children, as proponents claim. “These bans did not come from a public outcry about concern for trans youth,” she says.
More than 58,000 transgender teenagers who are transitioning are at risk of losing access to their medical care, according to a report from the University of California, Los Angeles, School of Law’s Williams Institute. The effects of these bills and laws would be devastating. A large survey published in Pediatrics in 2018 found that 30 to 50 percent of young trans and nonbinary people reported a previous suicide attempt, compared with less than 9 percent of all adolescents.
Experts hypothesize that this greater suicide risk among trans youth is linked to internalized rejection and shame. In contrast, transgender youth who are supported by their families and receive gender-affirming care have markedly lower rates of depression: gender-affirming care has been associated with a nearly 40 percent reduction in depression and in attempting suicide in the past year. Furthermore, trans youth who have access to puberty suppressants have a much lower risk of lifetime suicide as adults.
All this legislation is at direct odds with the medical guidance of the American Psychiatric Association, the American Medical Association (AMA) and the American Academy of Pediatrics (AAP). These medical organizations recommend these medications and procedures for transgender individuals because there is a corpus of scientific literature affirming their benefits when medically indicated. These treatments are far from new and untested: puberty blockers have been used in medical care since the 1990s.
Numerous bills also propose criminalizing physicians if they offer transgender hormone therapy. In medical school, students had lectures on the importance of providing gender-affirming care, as well as panels specifically on the health-care experiences of transgender patients.
“Politicians deciding what doctors can do puts doctors, not only patients, in a really difficult situation ... of not serving the best interests of the patients,” Says Simona Giordano, a bioethicist at the University of Manchester in England. “‘Alarming’ is, I think, the right word.”