Whether you are a parent looking into info for your transgender child, or you yourself are transgender/gender non-conforming/non-binary, all of these medications and options for transitional therapy can be confusing to someone who doesn’t deal with this stuff on a day to day basis. But that’s ok, because that’s my job, and I’m here to break it down for you a bit so you can understand more about the options out there.
Everyone seems reasonably familiar with the idea of transitioning with hormones, right? You take the hormones needed to align yourself better with the way you best identify, and the changes happen over time. But what about those who, for many reasons, aren’t ready for those hormonally induced physical changes? What can we do for them? Sit back, and let’s learn some stuff!
So, I’m going to give you a quick Endocrine system review to help you understand the biological body system we will be affecting. Or you can skip to the next paragraph if this puts you to sleep:
The cute little set of letters “GnRH” stands for Gonadotropin Releasing Hormone. It is one of the many hormones that your Hypothalamus sends to the Pituitary gland. Your Pituitary gland in response releases two of its own hormones, FSH and LH. These two then head down to the ovaries or testes (whichever may be the case). Once there, FSH and LH cause the production of the more well known hormones: testosterone and estrogen. To sum up: That’s how the brain uses the Hypothalamus to notify the Pituitary, which then notifies the ovaries or testes, which then produce testosterone and estrogen. Now….to the fun stuff.
So…..GnRH Analogues. These are commonly called GnRH blockers or “puberty blockers.” And I will called them “blockers” from here on out because “analogues” makes it start to feel more intimidating/boring to those who aren’t total nerds like me. So, GnRH is the beginning link of the system that stimulates the production of estrogen and testosterone from the ovaries and testes. Testosterone and estrogen elevations at puberty cause the progressive physical changes associated with adulthood. So if we wanted to put a pause on puberty, what could we do? Stop that first piece of the process (GnRH release) from happening! In an effort to not get too technical, GnRH blockers essentially muck up the way that the receptors for GnRH react to it. In doing this, it shuts the GnRH receptors down, which then shuts down the whole system that produces estrogen and testosterone in the first place. Cool, right? So how do we use this?
GnRH blockers are given to basically shut down puberty temporarily. As in, stop its progression as much as possible. So instead of developing adult physical characteristics, the person will just stay relatively pre-pubescent in their physical development. This means that their bodies won’t progress into the characteristics more often associated with adults, such as beard growth or breast development. Depending on the age at which the GnRH blockers are started, the person may have already started to have puberty effects. These will stop when put on the blockers. And some puberty effects may reverse to a small degree as well.
In a perfect world, these would be started right at the first sign of the start of puberty. However, it isn’t a perfect world. Many times, the person in question may not realize just how strongly they may desire to transition until the changes of puberty are in full swing. Or they may have unsupportive parents. There are many reasons why these medications miss out on getting started at the onset of puberty, some reasonable and others not.
At any rate, GnRH blockers are ideal for younger trans youth. Say perhaps those under 16, although that number is highly dependent on where one lives, the provider one sees, length of time the person has known and asserted that they are trans, and many other factors. So don’t take that age as an absolute by any means.
In general, if someone is under 16 and presents for transitional care with no immediate need for hormone initiation, they can be placed on blockers for anywhere from 6 months to 2 years. It depends again on many factors as to how long these are taken. The older the person is at the time of starting on blockers, the more likely they will be on them for a shorter period of time.
Puberty blockers are used as a means of putting puberty on hold so that the person will not have to undergo the potentially psychologically harmful physical changes associated with their sex assigned at birth. This gives more time to ascertain goals, plan for transitioning, and arrange for medical care and/or therapy during the transitioning process. It often serves as a bridge into hormone therapy later on. But there are some who go on blockers and then decide to come off once they have been given the time to think over their situation and options. For example, they may decide that social transitioning is all they desire or need. Remember, hormone therapy is not always the end goal. Mostly, it is about allowing the person the time and space to get to know themselves and their identity more fully so that they can then make an educated decision on whether or not to go forward with their own puberty or to move forward with hormone therapy to medically transition.
It is a deeply personal decision making process, and it can be complicated by many outside factors, such as family, friends, and living situation. However, puberty blockers have been used for decades in various medical conditions, so their safety profile is well documented and very positive. If someone goes on blockers and stops their puberty process, the only thing that happens when they come off of them is that their puberty process resumes where it left off. It is exactly like putting puberty on pause. And this pause can be a literal lifesaver for many.
Thanks for reading. If you have any questions, feel free to email me!
Stacie Pace, ACNP/AGNP