There is an international debate going on about appropriate medical care for transgender youth.
We’ll be frank: we believe youths’ gender experiences and we support them accessing the medical care that is right for them. There is no lower age limit for our patients, and QueerDoc prescribes blockers and hormones when appropriate.
"When Appropriate" Is A Big Deal
Adolescence for most people, cis and trans alike, is a time of exploring identity, trying on new social roles, and new styles. It is also a time of incredible stress for many youth:
- school gets more intense
- peer groups change
- bodies change
- sex and consent and sexual identity, OH MY!
- jobs take up precious time
- and new rights and responsibilities need to be figured out.
It all adds up!
Societally, we tend to give cis adolescents a lot support and freedom to explore their identities. Also, cis and heterosexual youth have a lot of positive examples in popular culture and media. Surely LGBTQ+ youth deserve as much support and representation while they figure things out, too.
But It's Irreversable!
So is endogenous puberty, after a certain developmental stage.
And, no, blockers aren’t permanent. Blockers don’t change the body – they put pubertal changes on hold.
Puberty blockers have been used since the 1980s to delay the physical changes that happen during puberty. They take the pressure off during an already stressful time.
Blockers Save Lives
A recent study of over 20,000 transgender young adults found a significant positive difference in lifetime instances of suicidal ideation between individuals who wanted blockers and were able to get them and those who wanted blockers, but could not. (Turban, et al.)
Earlier studies also showed improved mental health outcomes among transgender youth who desired and received blockers. The evidence is clear that access to affirming medical care and social supports improve transgender and gender diverse youths’ mental health and well-being (deVries, et al, Costa, et al, the Trevor Project see our blog Affirming Care and Supportive Actions Benefit LGBTQ+ Youth. )
Of course, not all transgender youth desire blockers. However, for those that experience significant dysphoria, endogenous puberty can be traumatic.
Transgender youth have higher rates of anxiety, depression, and suicidal ideation than their cisgender peers. Current theory indicates that this is at least partially due to minority stress (see our Testosterone and Cardiovascular Disease Risk blog for a discussion on minority stress.)
Transgender and gender diverse youth navigate complex and often un-affirming systems in daily life. Blockers can be immensely helpful to these youth by giving them time to explore what they want for their bodies. If physical transition is wanted, going through endogenous puberty can make later transition more difficult and more expensive. Blockers hit the pause button.
Prescribing For Transgender Youth
We don’t rush.
Our providers do an in-depth medical and gender history, and spend time getting to know the patient and their families. We highly encourage that youth have both a primary care provider and a mental health provider, and we strongly support access to additional support resources including family counseling, support groups, and written resources. Family support is hugely beneficial, and we follow medical consent laws. Our patients have homework on exploring their gender identity (everyone should do a little gender homework!)
We don’t prescribe puberty blockers before Tanner Stage 2 – this is when physical changes in the body start to become noticeable. It is not, however, a deadline – we can prescribe blockers during later puberty, as well. For more information, read our Puberty Blockers FAQ. Blockers can be stopped if the individual decides they wish to proceed with endogenous puberty.
Starting Hormones
Delaying hormones can also be harmful to some youth when they do not go through puberty in the same time frame as their peers. Additionally, patients can start hormones while on a blocker. Just like the body would do on its own, we start with low doses and increase gradually. And, similar to endogenous puberty, physical changes occur slowly and (mostly) predictably.
Read more about Youth and Adolescent Care at QueerDoc.
Citations
Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), Article e20191725. https://doi.org/10.
The Center for Community Practice, “What is Minority Stress” https://www.urccp.org/article.cfm?ArticleNumber=69
de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics.
2014; 134(4):696–704 [PubMed: 25201798]
Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. J Sex Med 2015; 12(11):2206–2214 [PubMed: 26556015]
The Trevor Project. (2021). 2021 National Survey on LGBTQ Youth Mental Health. West Hollywood, California: The Trevor Project.
The Trevor Project. (2019). National Survey on LGBTQ Mental Health. New York, New York: The Trevor Project.
