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Puberty Inhibitors

Reviewed by:  Dr. Norman P. Spack, M.D.,
Associate in Endocrinology at Children’s Hospital Boston

What are they and why are they used?
Children whose gender identity differs from their assigned birth sex often suffer from body dysphoria. (An intense dislike of their body)  This stems from the fact that they don’t feel that their body matches their internal experience of themselves. In other words, the body and the brain are not congruent with each other. Puberty brings about unwanted secondary sexual characteristics like breast development and menstruation in natal females and growth of facial hair and an Adam’s apple in natal males.  These secondary sexual characteristics can be devastating to the child. 

Puberty Inhibitors (Puberty Blockers, GnRh Analogues, Puberty Suppressors, Hormone Suppressors) are a group of medications that are prescribed by an endocrinologist to suppress or inhibit puberty.  The medications work by suppressing the production of sex hormones (Testosterone and estrogen). Puberty Inhibitors are reversible and are used to prevent the devastating effects of developing unwanted secondary sexual characteristics in gender dysphoric children.  Suppressing puberty in gender dysphoric children prior to cross gender hormone therapy has several advantages and can often be life saving.  These advantages include: decrease of depression/anxiety, better social integration with their peers, eliminating the need for future surgeries and improved mental well being for the child. 

When are they prescribed and how do they work?The drugs are administered six months to one year into Tanner Stage 2 in children who meet the criteria for prescription. (Psychological evaluation and various other tests) The two main methods of administration are monthly injections and a surgical implant in the arm. The inhibitors (blockers) are used until or if cross gender hormone therapy begins.

If cross gender therapy is to occur, the timetable varies for each individual.  There are several factors that an endocrinologist looks at to determine readiness.  These include, age, maturity, therapist recommendation, physical development of height and weight and other important factors.  Once cross gender hormone therapy begins and optimal levels of the cross gender hormone are achieved, puberty inhibitors are stopped and puberty begins to occur with the correct dominant hormone.

Cost and Insurance Coverage
Most insurance plans will not pay for puberty inhibitors and they can be cost prohibitive.  The implant is effective for approximately one year; however, may last months longer and effectiveness can be checked by blood test. The cost varies from $4,500-$15,000 and must be inserted by a surgeon.  Monthly injections are approximately $1,200 per month.  This will not include the cost of other necessary treatment, such as: blood work, x-rays, office visits with the physician, etc.

What if my child has already reached puberty?
Some families don’t know about puberty inhibitors until their child has surpassed Tanner Stage 2 and some children don’t disclose their gender dysphoria to their families until they have surpassed Tanner Stage 2.  There is still help for some of these children.  Natal females may be prescribed medications to stop menstruation and some children may still receive benefit from puberty inhibitors.  Contact a qualified endocrinologist for an assessment of your child’s situation.

How do I find a qualified endocrinologist?
There are endocrinologists throughout the country who have experience with puberty inhibitors.  For assistance in locating a qualified endocrinologist near you, contact TransYouth Family Allies, Inc. (TYFA).  We may be reached Toll Free at 1-888-IMA-TYFA (462-8932), by email at info@imatyfa.org or on the internet at www.imatyfa.org .