Puberty blocker myths
Apologies for my long absence. The past 8 months have come with a lot of trauma work. Moving because home is unsafe is brutally hard. I had hoped to share that here, but as it turns out, sometimes that kind of trauma makes it more difficult to write. It is always hard to know how and what to share — what is ours alone, what is beneficial to others, what is my story to tell vs the other members of my family, etc.
One thing I’ve continued to come back to are all of the myths (and flat-out lies) that are out there about gender-affirming care. Politicians in states like my home weaponize this lack of understanding to stir up fear and seek votes. The number of times I’ve heard politicians — who HAVE been given facts — continue to tell lies about toddlers receiving surgeries* and being put on “experimental” medications (using scary terms like “chemical castration”) is mind-blowing.
People on social media love to hurl insults at me, claiming that I have done these sorts of things to my child or “can’t wait to.”
So what does this actually look like?
Transition for a young child is nothing more than a haircut, clothing, name, and pronoun change. For kids who may have already been gender-nonconforming in style, it may be that even hair and clothing do not change.
Doctors may update charts to reflect a new name and pronouns. Kiddos who are experiencing distress from dysphoria may begin counseling . . . and . . . that’s it.
As kids get closer to puberty, they may have more regular check-ups — either from their own pediatrician or a pediatric endocrinologist. These check-ups are designed to look for early stages of puberty. Why? Because puberty blockers are not used until puberty begins. One of the main reasons for this is because doctors want to ensure that there isn’t a problem being masked by blockers. Also: there is no need to block hormones until the body begins producing them.
Puberty blockers are either regular injections or a small implant inserted into the arm. Lots of fearmongering has been used about these drugs. It is important to note that puberty blockers are used primarily in cisgender kids (that is, kids who are not trans). They have been used for a long time to stop precocious puberty (puberty that begins at an age deemed too early by the child’s doctors) and in cancer patients for cancers that are fed by hormones. The results are temporary. If puberty blockers are stopped, puberty begins again.
Blockers are used in trans kids as a pause button. They buy time for a few years to allow kids to be clear on which puberty (testosterone-based or estrogen-based) they wish to go through without their bodies facing permanent changes in the meantime.
Are there risks? Like all medications, puberty blockers have risks, but they are small. What are those risks? Delaying puberty may be noticed by peers and may lead to bullying. The mineralization of bones will slow down. In rare cases, high blood pressure, weight gain, seizures, or increased brain pressure can occur.
This is why when any child is on puberty blockers, regular monitoring takes place. They take vitamin D (which most people, regardless of gender identity and medication use, are low in) and get regular bone scans.
So why use blockers? Without them, puberty continues. Trans boys will get periods and grow breasts. Trans girls will develop facial and body hair, lower voice, Adam’s/Eve’s apple, and genital growth. Bones and fat distribution will change. The effects of puberty are permanent. Undoing them will require surgeries, painful and costly procedures. This can be devastating — and even deadly — for those dealing with dysphoria.
Blockers are generally used alone for 2-3 years, then a teen will either discontinue them and resume puberty or use hormone therapy to begin puberty.
I’ve said all of this clinically. But I want to be clear that none of these decisions are clinical. They are full of emotion.
There can be a mix of joy, relief, anger, and sadness. It is amazing that these possibilities exist. As I watched a doctor talk through options with my kiddo, I saw her smile as she contemplated the changes she *wants* in her body as she grows up. My child knew she was trans before learning about puberty, so her education has always included the idea of puberty blockers — so she perhaps did not experience the same sort of relief, as she was never under the impression that certain changes *would* happen. But for kids who believed that their body would change in ways that terrified them? To learn that they can pause puberty and then go through the changes that are right for their gender? Euphoria!
But it is important to note the negative emotions, as well. I have never met anyone who loves being put on medicine and rejoices in needles. This is scary and overwhelming. Like learning about any new medical procedure (even just lifestyle change!) you may need to manage care for a new diagnosis, there is processing time. Needing to visit a doctor every six months (or more), needing meds, going through these changes at a different time than peers? It is a lot to process. It can be angering or depressing to realize how much work it is to be able to be fully yourself. It can be hard as a parent to know that there isn’t just a magic button to press to make everything easier for our kids.
There were a lot of hugs during our appointment as my kid connected to this info more deeply than prior conversations. She said a few times, “I don’t want puberty blockers . . . I just want to go through girl puberty.” (For reference, it is far better to refer to this as estrogen-based puberty, as it is not just girls that go through it — but that is both difficult for a young child to remember and gender-affirming for her to refer to it that way. BUT if you are teaching kids about puberty, I encourage gender-inclusive language like “some people go through testosterone-based puberty. They will experience these changes: ____________. Some people go through estrogen-based puberty. Their bodies change in these ways: ___________”)
If I could do that, I would. Watching my kids — either of them — go through hard things is heartbreaking. I love them, I don’t want life to be hard! But one of the first lessons parents learn is that we can’t take all the hard things away. My kids would love to do away with shots, hair brushing, cleaning, having to eventually leave fun places. If my daughter continues on her current path, we will go through the challenges of puberty blockers together — not because either of us want her to go through medical procedures, but because the benefits and ultimate result are worth it. And trust that if my needle-phobic child believes facing needles is worth it . . . it means everything to her.
*There are some infants having surgery on genitals — intersex kids. Doctors sometimes make decisions and perform procedures to make infants’ appearance fit a gender binary. The general consensus in the trans community is that this is unethical. It is often those who oppose healthcare for trans people who continue to support this practice.