What's the deal with puberty blockers?

Let's talk about one of the most controversial and rarest parts of gender-affirming care

While you might think of a certain surgery when you imagine what somebody goes through during a gender transition, the changes that most impact a trans person’s day-to-day experience of their body and the world come from medications that change the expression of their body. People transitioning before puberty start with something called puberty blockers, but this is uncommon. 

Over the last five years, fewer than 1,000 trans people per year have started treatment with puberty blockers. This is a tiny fraction of the 121,000 youth who were diagnosed with gender dysphoria during that period. Similarly, just 14,000 total of those youth were treated with hormone therapy, underscoring just how rare this situation is. Gender-affirming surgeries are comparatively rare in minors, with 282 mastectomies performed in 2021. By contrast, 20,000 people a year undergo treatment for male breast growth. 

Puberty blockers are safely used in children who start puberty too early, a condition known as “precocious puberty,” and their use in trans patients is not considered experimental by experts.

Opponents of trans healthcare often raise the specter of “off label” medications to make them sound scary, but off label is a misleading label that simply means that the FDA has not explicitly approved a specific drug for a specific treatment in a specific population. Off-label use of medications is particularly common in pediatric medicine. Steroids for croup in toddlers are “off-label,” as is Ondansatron for nausea and SSRIs for youth with major depressive disorder. Wellbutrin for depression is “off-label,” as is Gabapentin for nerve pain.

 Many medications have side effects, and some studies have suggested that long term use of puberty blockers can lead to reductions in bone density, which is why they’re used as a chance to allow families and their doctors more time to decide whether to pursue hormone therapy. In most cases, people who take puberty blockers are actually trans and move on to hormone therapy when it’s developmentally appropriate.