Providers treating transgender children must strike a balance between the patient’s need to express their true identity against potential long-term harm from the very medication that can help them do that.
Puberty blockers are a medication given to children approaching the hormonal surge that will cause their bodies to express their gender at birth. It is a way to suppress those hormones and allow the child to create their own identity until they are old enough to transition to sex hormones.
Emerging evidence, however, suggests puberty blockers disrupt growth in bone density, which could lead to fractures earlier than in their peers.
“Yes, we know that while on blockers adolescents can fall behind regarding bone density. Providers are aware of that and should be discussing that with adolescents and families if they are not. But, once the adolescent stops the blocker or begins gender-affirming hormones, the bone density starts to increase again,” said Derek Fenwick, PsyD, clinical coordinator of The Right Track – LGBTQ Specialty at the Institute of Living, part of the Hartford HealthCare Behavioral Health Network.
Research underway
While Great Britain and other countries have moved to allow puberty blockers only in a research setting, four American gender clinics are seven years into an investigation of the effect of the medication on transgender youth, promising answers soon.
Until then, Dr. Fenwick stressed that “it’s always important to point out that each person has a unique journey and there is no one size fits all. As a psychologist, I think you always have to weigh the pros and cons of a treatment and determine what is the best option for you.”
Blockers also address the psychological symptoms transgender youth face, including:
- Depression
- Gender dysphoria
- Suicidal ideation
“When they go through puberty, the amount of distress that alone can cause can take a toll of them,” Dr. Fenwick said. “I see it every day in the young adults I work with who are not on blockers for various reasons. In short, we know that gender-affirming care saves lives.”