The information on this site is not meant to replace individual medical consultation with your doctor. Please speak with your medical provider about any medical interventions you are interested in.
How it Works
Puberty blockers (GnRH agonists) mimic a naturally occurring hormone in the brain (GnRH) and halt the production of estrogen or testosterone = PUBERTY PAUSE.
- Estrogen and testosterone are the body’s hormones that cause pubertal development—without them, there will be no development of secondary sex characteristics (broad shoulders, more body hair, erections, bigger hips, thighs, breasts, monthly periods).
- It will not reverse any changes that have already occurred but can be used to prevent pubertal changes.
- The effects of puberty blockers are COMPLETELY REVERSIBLE.
- Puberty blockers are FDA-approved and well-studied for precocious puberty*. Research on their use for gender diverse individuals is ongoing. We will discuss all currently available information about benefits, risks, side effects, and long-term outcomes for all medications or procedures.
*Precocious puberty is a condition where children begin puberty at unusually early age (younger than age 8 or 9 years). These medications are used to delay puberty, sometimes for many years, until these children reach the typical age of puberty.
What to Expect
Overall, the expectation on puberty blockers is that your body will continue to look as it is now in terms of your pubertal development. Full blocking of a person’s hormones takes approximately 4 weeks, during which time puberty may continue and you might experience period bleeding, abdominal cramping, or erections depending on what body parts you have. Some adolescents experience mood changes (specifically lower energy and flattening) and “hot flashes” that tend to improve over time.
While on blockers, pubertal development will stop, but you will continue to group in height because your bone will continue to grow. The biggest influence on height potential is your genetics. Your metabolism and parts of your body composition may not mature while blockers. Pubertal changes, such as more lean-muscle mass and increase metabolism that happens during puberty, will occur once your come off blockers.
People cannot be on just puberty blockers forever because your body will continue to grow, and you need to mature your bones and other body parts to meet the increased demands of a larger body. We use a number of indicators to help in making decisions about how long puberty blockers can be safely used:
- Researched protocols which generally suggest upper limits of 16 years old
- Bone scans and metabolic indicators that help reduce or even eliminate risks of prolonged blocker use.
- Clinical judgement, where we keep up on the latest evolving research and try our best to incorporate it with each patient and family’s medical needs.
Important Considerations
Fertility: Puberty blockers are most effective when started in early puberty. Youth who start puberty blockers before the ovaries or testicles mature, AND, then, start gender affirming hormones while on blockers will likely be unable to have biological children (i.e. they would be infertile). We recognize that fertility and family planning may not be things that a young child is ready to consider. Since blockers are fully reversible, if fertility is desired later, there is the option to come off the blockers and allow necessary development (and fertility consultation) before considering gender affirming hormone options. However, we consider and counsel on this risk early and will continue to check in.
For teens who start blockers later in puberty (with gender affirming hormones or by themselves), after they have had sufficient development of their reproductive parts to support fertility, this consideration is not relevant. The effect of gender affirming hormones on fertility should be considered and is described elsewhere.
Implications for Later Surgery: Surgery options will differ for those youth who never go through the undesired puberty (no need for “top surgery”; no need for tracheal shave or male hair removal). Taking puberty blockers early in puberty may change or reduce the options for transfeminine “bottom surgery” later in life because genital tissues used for reconstruction may limited and not be fully developed.
Bone Health: During puberty, your bones get stronger. While on puberty blockers, bone mineral density is maintained at pre-pubertal levels. From what the research tells us, if current accepted protocols are used, then bone density will catch up when you come off the puberty blockers and puberty is reinitiated (either by your body’s hormones or by gender affirming hormones you are given). In other words, your body needs hormones at some point to develop and be healthy.
How It’s Given
There are two ways to take puberty blockers. Both provide the same type of medicine and are equally effective.
- Intramuscular (IM) injection (leuprolide or Lupron/Eligard) once every three months
- Small under the skin implant (histrelin or Supprelin/Vantas) placed in the upper arm and releasing medicine slowly over year(s). The implant can be placed with sedation, meaning that you are given medicine to make you sleepy so that it is more comfortable to insert. The implant will be removed or replaced when it stops working or when you are ready to stop blockers. Removing the implant may require surgery/general anesthesia or can be done when you have a future surgery.
Choosing between the shot and the implant depends on your personal preference but may also depend on your health insurance coverage. Puberty blockers require insurance preauthorization. If insurance does not cover Lupron or Histrelin, then we will work with you to find medical alternatives.
Follow-up and Labs
You will follow up every three to six months to monitor for suppression of puberty changes. We may use labs or other studies (bone age x-ray or bone density scan) as needed.
Next Steps
Based on your gender goals, you will either start gender affirming hormones or stop puberty blockers and let the puberty of your designated gender continue.
Using Blockers in Late Puberty or After Puberty
There are times when the medications that we use to block puberty may be considered later on in development based on your personal goals for gender affirmation. Although it may not be as effective at stopping development of pubertal effect, it can be used to suppress your body’s hormones allowing for a slower start of gender affirming hormones. This may require special monitoring and considerations that your provider will review with you.
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