For decades, medications called puberty blockers have been used to temporarily delay puberty in young children who experience precocious puberty, a rare condition in which physical and sexual maturation starts earlier than it should. In North America, this is defined as before age 8 for girls and age 9 for boys. These medications are also used to treat endometriosis in adult women and prostate cancer in adult men. But now, puberty blockers— also called hormone blockers— are additionally being used to “pause” puberty in adolescents who identify as being a gender different from their biological gender. This is a condition known as gender dysphoria [1].
The exploding trend towards utilizing puberty blockers in the treatment of gender dysphoria is increasingly under scrutiny because these medications are often just the first step in a cascade of medical interventions— such as hormone therapy and surgery— that permanently change a young person’s body to align with their desired or professed gender.
The exploding trend towards utilizing puberty blockers in the treatment of gender dysphoria is increasingly under scrutiny because these medications are often just the first step in a cascade of medical interventions— such as hormone therapy and surgery— that permanently change a young person’s body to align with their desired or professed gender.
And there is a push to start this cascade of interventions even sooner—before puberty has begun—despite evidence showing that gender dysphoria tends to go away once puberty starts and recommendations from the World Professional Association for Transgender Health (WPATH) to use puberty blockers only once puberty has begun [1][2]. Evidence is also starting to show that these medications come with serious, possibly permanent, risks, all while the long-term outcomes remain unclear.
What do puberty blockers do?
The most common puberty blockers are gonadotropin-releasing hormone analogs and include several medications, the best known of which is Lupron. These drugs work by interfering with gonadotropin-releasing hormone (GnRH), a natural hormone made in the brain that regulates the reproductive systems in boys and girls during adolescence and throughout adulthood.
In both boys and girls, GnRH tells an area in the brain to make two hormones critical for reproductive development: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The effects of these hormones differ by sex. In girls, FSH and LH help the ovaries mature and tell the body to produce estrogen and progesterone. In boys, FSH and LH help the testicles mature and tell the body to produce testosterone and other male sex hormones.
By interfering with GnRH, puberty blockers halt the production of estrogen and progesterone in girls and testosterone and other male sex hormones in boys, thereby preventing secondary sex characteristics from developing. For example, breasts stop developing in girls and facial hair stops developing in boys.
Just how “reversible” are the effects of puberty blockers?
While puberty blockers have been touted as “totally reversible”—and it is true that stopping puberty blockers reinstates the flow of previously hindered hormones and puberty resumes—we’re learning that their effects may not be.
For instance, in 2022, The New York Times conducted an investigation and wrote, “there is emerging evidence of potential harm from using blockers, according to reviews of scientific papers and interviews with more than 50 doctors and academic experts around the world.”
Also, the National Health Service (NHS) in the United Kingdom, where puberty blockers are no longer offered to youth with gender dysphoria, has updated its website to state (emphasis added):
“Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although [Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust] advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.”
Amidst growing evidence of the risk of these drugs and uncertainty surrounding their benefits, many other European countries have since similarly restricted access to puberty blockers, as have many states in the United States.
From risks to bones, brains, hearts and more, we’re learning more about the real risks of puberty blockers
Virtually all medications come with unintended effects and puberty blockers are no different. As these medications are studied further, more becomes known about their risk profile. Evidence now shows, for example, that using puberty blockers for adolescent girls interferes with their normal bone development [3]. Whether this could have long-term consequences, such as leading to more bone fractures or developing osteoporosis, still needs to be answered.
Evidence now shows, for example, that using puberty blockers for adolescent girls interferes with their normal bone development [3].
The investigation from The New York Times showed that youth taking puberty blockers are indeed having problems with their bone health. For example, an adolescent in Sweden had such poor bone health after taking puberty blockers for multiple years that a compression fracture formed in the spine, leading to “continued back pain” that’s described as a “permanent disability.”
The problems with puberty blockers aren’t just limited to what they do. There’s also reason for concern about what they don’t do or allow. In our Reasons Women Need Periods series, we’ve extensively covered the health benefits of ovulation and the menstrual cycle for women’s brain, bone, breast, heart, and immune health. As with girls on hormonal birth control, females who take puberty blockers also will not ovulate or menstruate and therefore will miss out on the whole-body positive impacts of these normal bodily processes.
Puberty blocker drugs contain new warning label
Just last year, drug makers for common puberty blockers Fensolv and Lupron Depot added a new warning to their labels—that is, the piece of paper, or papers, that accompanies a prescription picked up at the pharmacy. (Drug labels can also be easily viewed online through a simple Google search.) The labels now warn parents about the possibility of their children developing increased pressure within the skull (idiopathic intracranial hypertension), the symptoms of which include blurred vision and headache. This update came after the complication was reported in six children, of which five had precocious puberty and one had gender dysphoria. Parents who read the drug label for Fensolv will also be warned of other possible neurological issues, including convulsions, peripheral neuropathy, paralysis, insomnia, and psychiatric events, including crying, irritability, impatience, anger, aggression, and suicidal ideation and suicide attempts.
The drug label for Lupron Depot likewise warns of serious risks such as bone pain, increased testosterone, and two potentially fatal complications: spinal cord compression and ureteral obstruction, in which one or both tubes that transport urine to the bladder are blocked. For males taking Lupron Depot, parents are warned of increased risk of diabetes, heart attack, sudden cardiac death, and stroke.
Puberty blockers are only the tip of the iceberg: “Gender-affirming” hormone therapy and surgeries carry even greater risk
Although the known risks that come with puberty blockers are serious, the more concerning risks are those that come with the interventions that come next: hormone therapy and surgery.
Evidence shows that most adolescents who start puberty blockers move on to hormone therapy, the effects of which are known to be permanent, as stated by the Mayo Clinic [4]. Hormone therapy involves taking either synthetic testosterone or estrogen to develop the person’s desired masculine or feminine secondary sex characteristics. We previously covered the health risks of testosterone for females.
Surgery, such as the removal of ovaries and uterus in girls or testicles in boys, permanently alters the body’s physical appearance and hormone production–and permanently harms a person’s fertility, rendering them completely sterile. In other words, individuals who undergo these surgeries to remove their reproductive organs will never be able to conceive children naturally, even if they decide to transition back to their biological gender. And while surgery to remove both breasts in girls may not render them infertile, it will still render them unable to ever breastfeed their future children–a devastating realization for those who later detransition.
The connection between gender dysphoria and other mental health diagnoses
Sadly, mental health issues, including suicide, plague a majority of youth with gender dysphoria, who also tend to exhibit “a high prevalence of mood and anxiety disorders, trauma, eating disorders and autism spectrum conditions, suicidality and self-harm” [5]. Arguably, puberty blockers, synthetic hormones, and mutilative surgeries fail to address the deeper psychological issues potentially at play for many youth with gender dysphoria. As Dr. Kathleen Raviele previously observed in an interview with Natural Womanhood, ” “We don’t treat psychological conditions with surgery.”
It’s obvious why doctors and parents alike are looking for ways to help children struggling with gender dysphoria and, often, other significant mental health issues. But despite growing interest in puberty blockers for the treatment of gender dysphoria, many experts are cautioning against widespread acceptance of the practice until more is known about the side effects and risks (both short- and long-term) of puberty blockers and other forms of “gender-affirming” treatment, such as hormonal therapy and surgery.
Research purporting to show mental health benefits of “gender-affirming” treatment is poor quality
Claims of the mental health benefits of “gender-affirming” treatment, from puberty blockers to more aggressive interventions, are rampant. But researcher Allison Clayton in Australia described the current evidence on how best to care for youth with gender dysphoria as “inconclusive” and having “major knowledge gaps” [6]. She also pointed out that, thus far, studies evaluating whether “gender-affirming” treatment is beneficial for mental health have a “high risk of bias and confounding and, thus, provide very low certainty evidence.”
Adolescents dealing with gender dysphoria and their parents may feel frustrated with the current treatment options, but Dr. Hilary Cass, a pediatrician in charge of an independent review of medical treatments for gender dysphoria offered to youth in the United Kingdom, stated:
“Whenever doctors prescribe a treatment, they want to be as certain as possible that the benefits will outweigh any adverse effects so that when you are older you don’t end up saying ‘Why did no-one tell me that that might happen?’ This includes understanding both the risks and benefits of having treatment and not having treatment.”
The bottom line
With the potential for serious risks and side effects and uncertainty surrounding their benefits (if any), puberty blockers have become a controversial means of treating gender dysphoria, and many doctors and experts all over the world (even ones who once pioneered and championed their use) have thus begun cautioning against their use, especially in children and teens. The reasons for the absolute explosion of children and teens identifying as transgender in the past several years are also unclear, and merit further serious exploration. One thing is certain, however: if the growing numbers of detransitioners–including those suing the very physicians who once prescribed and/or administered them with “gender-affirming” treatments and procedures–are any indication, more caution is warranted when it comes to dealing with the phenomenon of gender dysphoria.
