Are puberty blockers reversible?

Dear Reader, 

Puberty blockers do just that, they block puberty from happening! However, this block is more of a pause. Once treatment stops, puberty usually occurs within six months, which is why they’re considered reversible. That said, just like any other drug, they may have some unintended side effects. However, more longitudinal research is needed to fully understand the impact that puberty blockers may have on long-term bone health and fertility.  

What are puberty blockers? 

Puberty blockers are medications that temporarily stop puberty from happening. They halt the body from producing sex hormones (such as testosterone and estrogen) that cause changes like voice deepening, facial hair growth, periods, and breast development.  

Health care providers prescribe puberty blockers for a variety of conditions and reasons. Puberty blockers delay the onset of puberty for children who begin at an unusually early age. For transgender and gender diverse youth, puberty blockers give them more time to weigh their options and continue maturing. Puberty blockers are usually recommended for gender diverse youth who have just begun puberty. For adolescents in later stages of puberty, puberty blockers can help prevent further development. 

What are the different types of puberty blockers? 

Health care providers can administer puberty blockers through an injection or implant. An injection called leuprolide can be given every three to four months. An implant called histrelin can be placed under the skin in the upper arm and lasts for a year. 

How are puberty blockers different from gender-affirming hormones? 

Puberty blockers don’t add hormones, rather, they simply stop the production of hormones in the body. These are different from taking gender-affirming hormones (GAH), which increase the levels of hormones, such as testosterone and estrogen that naturally occur in the body. Health care providers recommend GAH treatment for adolescents in the later stages of puberty. This is because these treatments cause changes such as facial hair, voice deepening, and breast development that may or may not be reversible.  

How are puberty blockers prescribed? 

Most health care providers follow the World Professional Association of Transgender Health (WPATH) and Endocrine Society’s (ES) guidelines for prescribing puberty blockers. In most instances, a mental health professional must diagnose someone with gender dysphoria in order to access puberty blockers. Gender dysphoria refers to a feeling of discomfort caused by a mismatch between a person’s assigned gender at birth and their gender identity. This sense of unease can also be accompanied by a strong desire to be perceived by others as a gender different from the one assigned at birth.  

To make this assessment, WPATH and ES recommend that transgender and gender diverse youth complete a clinical evaluation to assess their understanding of their gender identity and goals. This also helps youth and caregivers make shared, informed decisions about gender-affirming care. For minors under the age of 18, parents or legal guardians must also provide consent.  

What are the benefits and risks of puberty blockers? 

Current research suggests that puberty blockers improve psychological well-being for transgender and gender diverse youth. Compared to their cisgender peers, transgender and gender diverse youth experience higher rates of depression, anxiety, bullying, self-harm, and suicidality. Most studies find that puberty blockers lead to a decrease in depressive symptoms and lower lifetime rates of suicidality. For youths who decide to proceed with GAH, puberty blockers can also help reduce the need for future medical interventions such as mastectomies or surgeries to create features associated with a more feminine or masculine face. 

However, puberty blockers can cause undesired side effects. Common side effects include headaches, hot flashes, fatigue, emotional changes, and changes in body composition.  

Would a child who took puberty blockers have physical or emotional scars? 

In terms of physical scars, puberty blockers that are implanted in the skin may leave a slight scar, though it’s likely to fade with time.  

In terms of emotional scars, that isn’t something that is quantifiable in the same way that a physical scar is. That said, studies show that, for most children, taking puberty blockers improves their mental health, rather than harming it.  

Are the effects of puberty blockers reversible? 

Puberty blockers are considered reversible because their effects on the body are not permanent. Once treatment stops, puberty usually occurs within six months.  

Puberty blockers have been used to treat youth with gender dysphoria for a relatively short period of time. As such, there isn’t much data on their long-term physical and emotional effects. However, long-range studies are currently underway. One such study found that bone mineral acquisition decreases during puberty blocker treatment but catches up in the long run—usually when patients stop puberty blockers and start GAH therapy. The only exception was bone mineral density in the spine in participants assigned male at birth (AMAB), which didn’t catch up over time. This might be because the spine is more affected by physical activity and sex hormones compared to other types of bones. Inadequate bone mineral density can lead to greater risk of fractures and osteoporosis in adulthood. Additionally, there has been concern that puberty blockers could cause long-term fertility issues. 

If someone is interested in using puberty blockers, they can speak with a health care provider to learn more about the effects. Together, they can decide whether the risks outweigh the benefits and if it’s a good fit for them.