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Puberty blockers: Difference between revisions
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{{content warning|private body parts, puberty, and menstruation}} | {{content warning|private body parts, puberty, and menstruation}} | ||
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'''Puberty blockers''', also called '''puberty inhibitors''', are drugs used to postpone and temporarily suspend puberty in [[children]] and teenagers. These drugs are called gonadotropin-releasing hormone (GnRH) agonists, and they inhibit the action of [[testosterone]]. Delaying or temporarily suspending puberty is a medical treatment for children whose puberty started abnormally early (precocious puberty). The drugs are also commonly used for children with idiopathic short stature, for whom these drugs can be used to promote development of long bones and increase adult height.<ref>Sara E. Watson, Ariana Greene, Katherine Lewis, and Erica A. Eugster (2015). Bird's-eye view of GnRH analog use in a pediatric endocrinology referral center. ''Endocrine Practice:'' June 2015, Vol. 21, No. 6, pp. 586-589.</ref> Additionally, they are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016}}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016}}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> | '''Puberty blockers''', also called '''puberty inhibitors''', are drugs used to postpone and temporarily suspend puberty in [[children]] and teenagers. These drugs are called gonadotropin-releasing hormone (GnRH) agonists, and they inhibit the action of [[testosterone]]. Delaying or temporarily suspending puberty is a medical treatment for children whose puberty started abnormally early (precocious puberty). The drugs are also commonly used for children with idiopathic short stature, for whom these drugs can be used to promote development of long bones and increase adult height.<ref>Sara E. Watson, Ariana Greene, Katherine Lewis, and Erica A. Eugster (2015). Bird's-eye view of GnRH analog use in a pediatric endocrinology referral center. ''Endocrine Practice:'' June 2015, Vol. 21, No. 6, pp. 586-589.</ref> Additionally, they are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free|archive-url=https://web.archive.org/web/20230628170532/http://pediatrics.aappublications.org/content/136/6/1029|archive-date=17 July 2023}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016|archive-url=https://web.archive.org/web/20230617205749/http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |archive-date=17 July 2023 }}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016|archive-url=https://web.archive.org/web/20221211205947/https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |archive-date=17 July 2023 }}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> | ||
In adults, the same drugs are used to treat endometriosis (a menstrual disorder),<ref>Current treatments for endometriosis, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661</ref> prostate cancer, and other conditions.<ref>Smith, M. R. (2006). Treatment-related osteoporosis in men with prostate cancer. ''Clinical Cancer Research, 12''(20 pt 2), 6315-6319.</ref><ref>Panday, K., Gona, A., Humphrey, M. B., (2014). Medication-induced osteoporosis: Screening and treatment strategies. ''Therapeutic Advances in Musculoskeletal Disease, 6,'' 185-202.</ref> | In adults, the same drugs are used to treat endometriosis (a menstrual disorder),<ref>Current treatments for endometriosis, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661 [https://web.archive.org/web/20230216145815/https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661 Archived] on 17 July 2023</ref> prostate cancer, and other conditions.<ref>Smith, M. R. (2006). Treatment-related osteoporosis in men with prostate cancer. ''Clinical Cancer Research, 12''(20 pt 2), 6315-6319.</ref><ref>Panday, K., Gona, A., Humphrey, M. B., (2014). Medication-induced osteoporosis: Screening and treatment strategies. ''Therapeutic Advances in Musculoskeletal Disease, 6,'' 185-202.</ref> | ||
== Medical uses == | == Medical uses == | ||
Puberty blockers prevent the development of biological secondary sex characteristics.<ref name=":2">{{Cite journal|last=Bayar|first=R. M.|date=2003-11-28|title=Control of the Onset of Puberty|url=|journal=Annual Review of Medicine|language=en|volume=29|pages=509–520|doi=10.1146/annurev.me.29.020178.002453|pmid=206190|access-date=}}</ref> They slow the growth of sexual organs and production of hormones. Other effects include the suppression of male features of facial hair, deep voices, and Adam's apples for children and adolescents, and the halting of female features of breast development and menstruation. | Puberty blockers prevent the development of biological secondary sex characteristics.<ref name=":2">{{Cite journal|last=Bayar|first=R. M.|date=2003-11-28|title=Control of the Onset of Puberty|url=|journal=Annual Review of Medicine|language=en|volume=29|pages=509–520|doi=10.1146/annurev.me.29.020178.002453|pmid=206190|access-date=|archive-url=https://web.archive.org/web/20190827211801/http://http:///|archive-date=17 July 2023}}</ref> They slow the growth of sexual organs and production of hormones. Other effects include the suppression of male features of facial hair, deep voices, and Adam's apples for children and adolescents, and the halting of female features of breast development and menstruation. | ||
Transgender youth are a specific target population of puberty blockers to halt the development of natal secondary sex characteristics.<ref name=":0" /> Puberty blockers allow patients more time to solidify their gender identity, without developing secondary sex characteristics.<ref name=":1" /> If a child later decides not to transition to another gender, the effects of puberty blockers can be fully reversed by stopping the medication.<ref name='aap'>{{cite report|date = September 2016| title = Supporting and Caring for Transgender Children| url = https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf| publisher = American Academy of Pediatrics| page =11| quote = "To prevent the consequences of going through a puberty that doesn’t match a transgender child’s identity, healthcare providers may use fully reversible medications that put puberty on hold."}}</ref> Puberty blockers give a future transgender individual a smoother transition into their desired gender identity as an adult.<ref name=":1" /> | Transgender youth are a specific target population of puberty blockers to halt the development of natal secondary sex characteristics.<ref name=":0" /> Puberty blockers allow patients more time to solidify their gender identity, without developing secondary sex characteristics.<ref name=":1" /> If a child later decides not to transition to another gender, the effects of puberty blockers can be fully reversed by stopping the medication.<ref name='aap'>{{cite report|date = September 2016| title = Supporting and Caring for Transgender Children| url = https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf| publisher = American Academy of Pediatrics| page =11| quote = "To prevent the consequences of going through a puberty that doesn’t match a transgender child’s identity, healthcare providers may use fully reversible medications that put puberty on hold."}}</ref> Puberty blockers give a future transgender individual a smoother transition into their desired gender identity as an adult.<ref name=":1" /> | ||
While few studies have examined the effects of puberty blockers for gender non-conforming or transgender adolescents, the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 }}</ref> | While few studies have examined the effects of puberty blockers for gender non-conforming or transgender adolescents, the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free |archive-url=https://web.archive.org/web/20230614175518/https://pediatrics.aappublications.org/content/142/4/e20182162 |archive-date=17 July 2023 }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 |archive-url=https://web.archive.org/web/20230604181439/https://pediatrics.aappublications.org/content/145/2/e20191725 |archive-date=17 July 2023 }}</ref> | ||
The potential risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists may include adverse effects on bone mineralization.<ref name="rafferty_2018">{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name=autogenerated1>{{cite journal|pmc=5290172 | pmid=28164070 | doi=10.6065/apem.2016.21.4.185 | volume=21 | issue=4 | title=Transgender youth: current concepts | author=Rosenthal SM | journal=Ann Pediatr Endocrinol Metab | pages=185–192| year=2016 }}</ref> | The potential risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists may include adverse effects on bone mineralization.<ref name="rafferty_2018">{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free |archive-url=https://web.archive.org/web/20230614175518/https://pediatrics.aappublications.org/content/142/4/e20182162 |archive-date=17 July 2023 }}</ref><ref name=autogenerated1>{{cite journal|pmc=5290172 | pmid=28164070 | doi=10.6065/apem.2016.21.4.185 | volume=21 | issue=4 | title=Transgender youth: current concepts | author=Rosenthal SM | journal=Ann Pediatr Endocrinol Metab | pages=185–192| year=2016 }}</ref> | ||
Research on the long term effects on brain development is limited, but a 2015 study published in the journal ''Psychoneuroendocrinology'' observed the executive functioning in 20 transgender youth treated with puberty blockers compared to untreated youth with gender dysphoria and found that there was no difference in performance.<ref name=autogenerated1 /><ref name="deVries2012">{{cite journal|last1=de Vries|first1=Annelou L. C.|last2=Cohen-Kettenis|first2=Peggy T.|title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach|journal=Journal of Homosexuality|date=2012|volume=59|issue=3|pages=301–320|doi=10.1080/00918369.2012.653300|issn=1540-3602|pmid=22455322}}</ref><ref>{{cite journal |last1=Staphorsius |first1=Annemieke S. |last2=Kreukels |first2=Baudewijntje P.C. |last3=Cohen-Kettenis |first3=Peggy T. |last4=Veltman |first4=Dick J. |last5=Burke |first5=Sarah M. |last6=Schagen |first6=Sebastian E.E. |last7=Wouters |first7=Femke M. |last8=Delemarre-van de Waal |first8=Henriëtte A. |last9=Bakker |first9=Julie |title=Puberty suppression and executive functioning: An fMRI-study in adolescents with gender dysphoria |journal=Psychoneuroendocrinology |date=June 2015 |volume=56 |pages=190–199 |doi=10.1016/j.psyneuen.2015.03.007 |pmid=25837854}}</ref><ref name=":1" /> | Research on the long term effects on brain development is limited, but a 2015 study published in the journal ''Psychoneuroendocrinology'' observed the executive functioning in 20 transgender youth treated with puberty blockers compared to untreated youth with gender dysphoria and found that there was no difference in performance.<ref name=autogenerated1 /><ref name="deVries2012">{{cite journal|last1=de Vries|first1=Annelou L. C.|last2=Cohen-Kettenis|first2=Peggy T.|title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach|journal=Journal of Homosexuality|date=2012|volume=59|issue=3|pages=301–320|doi=10.1080/00918369.2012.653300|issn=1540-3602|pmid=22455322}}</ref><ref>{{cite journal |last1=Staphorsius |first1=Annemieke S. |last2=Kreukels |first2=Baudewijntje P.C. |last3=Cohen-Kettenis |first3=Peggy T. |last4=Veltman |first4=Dick J. |last5=Burke |first5=Sarah M. |last6=Schagen |first6=Sebastian E.E. |last7=Wouters |first7=Femke M. |last8=Delemarre-van de Waal |first8=Henriëtte A. |last9=Bakker |first9=Julie |title=Puberty suppression and executive functioning: An fMRI-study in adolescents with gender dysphoria |journal=Psychoneuroendocrinology |date=June 2015 |volume=56 |pages=190–199 |doi=10.1016/j.psyneuen.2015.03.007 |pmid=25837854}}</ref><ref name=":1" /> | ||