How Do We Know When Adolescent’s Bodies Are Ready for Puberty Blockers and/or Gender Affirming Hormones?
Puberty is a gradual process of changes to a person’s body that takes several years. In young humans, puberty often starts during the tween and younger teen years. Currently, we use Tanner Stages to gauge how far a person has proceeded through puberty. We do sometimes use lab work and x-rays to help give us more information about a person’s stage in puberty, but the standard for assessing puberty progress remains the physical exam. The presence or absence of specific bodily changes as described in the chart above help us determine where a person is in puberty.
How do we do this in a video visit?
Don’t worry – no one takes their clothes off on camera! We explore pubertal changes by talking about them. Anytime I start talking about genitals with younger patients, I ask what they would like me to call their genitals, and I talk with them about the importance of consent.
Consent is key.
No one should touch us or our genitals without our permission and coerced permission is NOT consent.
I also review different people with whom younger patients can discuss abuse or potential abuse. Depending on the age and comfort of the youth and family, we do this with or without parents present. When talking with younger patients, the parents are generally present, and parents are often not present when taking with older adolescents.
Then, I ask for consent!
But what if patients say, “No”?
Amazing and awesome! A younger person practicing autonomy over their own body is a fabulous thing. I love it!
“No” is always an acceptable answer at the doctor’s office.
This is your body – you make the decisions. Sometimes “no” might limit our evaluation and treatment options, but a lot of the time creative providers can find alternative solutions. We can review records from their last annual visit with a pediatrician or engage the family to do the exam. We can explore ways the youth might feel safer. Common ways to increase their comfort are to include support people, support animals, or support objects in the visit, use bibliotherapy, or work with a mental health provider to prepare a youth to talk about their genitals.
Great the exam is over!
We have determined a Tanner Stage. As a doctor who focuses on gender affirming care, Tanner Stage 2 is a magic number for me.
Tanner Stage 2 is when we can start puberty blockers. Puberty blockers let us put a pause on puberty. They prevent a younger patient’s endogenous hormones (the hormones coming from their testes or ovaries) from creating physical changes in their bodies.
The other magic Tanner Stage is Tanner Stage 4 – this is usually when people have eggs or sperm that are mature enough to be capable of creating a baby. Currently, most of our fertility preservation interventions cannot occur prior to this stage. However, there is some interesting research coming out of the pediatric oncology field, and as the science progresses, so will our knowledge.
As you can tell from the chart at the top of this page, many physical changes occur between Tanner Stage 2 and Tanner Stage 4. This can be a big bummer for younger patients who want the option for biological kids in the future, but for whom later endogenous Tanner Stage attributes are unwanted. Each person and family has to find their own individual way through the challenges and limitations of our current gender affirming therapies and fertility preservation therapies.
Additionally, people born with ovaries will see no benefits from puberty blockers if they are 2 or more years past the start of their periods. People born with testicles may see benefits from puberty blockers through late adolescent, depending on the start of the puberty, up to the age of 18 even for some.
Doctors like me who focus on gender affirming care can help navigate some of that journey. Social workers and mental health providers also provide priceless guidance.
Let us know if you have more questions about puberty, Tanner Stages, and adolescent gender affirming care by emailing us at firstname.lastname@example.org.