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Puberty Blockers: A Comprehensive Introduction for Gender Diverse Adolescents

Medically reviewed by Dr. Scott Mosser on January 11, 2025.

What are puberty blockers?

Puberty blockers are medications that suppress the body’s production of primary sex hormones, either estrogen or testosterone. Also called “blockers”, the effects of these medications are not permanent and can be reversed. The use of puberty blockers for trans and non-binary adolescents is an evidence-based treatment strategy with high rates of success and satisfaction in qualifying and adequately supported patients. Here, we discuss candidacy requirements, benefits, long-term effects, insurance coverage and more.

We know that many trans adolescents and their loved ones have questions and concerns about whether blockers are effective or right for their specific case.  Please note that this page is not meant to be a substitute for professional medical advice. If you are interested in going on puberty blockers yourself or helping a young person with hormone therapy, please consult with a licensed medical expert. Dr. Mosser of the Gender Confirmation Center (GCC) is not an endocrinologist and does not prescribe puberty blockers or other forms of hormone therapy, nor does the GCC provide any of these services. This page is meant to be an informational resource only.

Puberty blockers for gender diverse youth

The most common puberty blockers are gonadotropin-releasing hormone analogues (referred commonly as GnRH), but other types exist. With parental consent and proper psychological evaluation, adolescents can start blockers once they start puberty. Since these medications nearly “press pause” on puberty, if they are suspended before undergoing hormone therapy, you will go back to the puberty you began.

Many trans, non-binary and intersex youth experience gender dysphoria when they go through puberty. More specifically, some, but not all, gender diverse youth experience feelings of discomfort in their bodies with the onset of puberty: most commonly, due to menstruation, breast development, the lowering of the voice, or the growth of facial hair.

Below you can find definitions for some of these key terms:

• Trans: A person who is trans or transgender has a gender identity that transcends the one they were assigned at birth. For example, someone assigned female at birth may identify as a man or boy.
• Non-binary: A person who is non-binary does not identify exclusively as a man or woman.
• Intersex: A person who is intersex was born with ambiguous sex characteristics that neither fell completely into what is typically found in bodies assigned male or female at birth.
• Gender dysphoria: Gender dysphoria describes a persistent sense of discomfort and/or distress caused by a conflict between a person’s gender identity and their gender assigned at birth. Gender dysphoria can be triggered by the use of a name or pronoun that does not align with the person’s identity and/or a part of their body that is not congruent with their internal sense of self. Not all gender diverse youth experience gender dysphoria. According to the DSM V and various professional associations, being trans or non-binary is not a problem that needs treating. Rather, gender-affirming care can help an individual manage the distress that their dysphoria produces.

What is puberty and what might it do to the body?

Puberty is a process wherein the body begins to produce higher amounts of certain hormones, which causes it to change or develop from childhood to adulthood.

Puberty is different for everyone. It starts at different ages, usually in adolescence, often takes several years and its outcomes are variable.

Most commonly, adolescents with testicles will see the following changes in puberty:

• • Primary sex characteristics: the testicles and the penis will increase in size.

• Secondary sex characteristics:

• • Hair will grow on the face, the genitals, in the armpits and other parts of the body.
  • The skin will often produce more oils as well as acne.
  • The voice pitch will deepen and vocal cords elongate.
  • The tracheal cartilage or Adam’s apple will enlarge.
  • The adolescent will often grow taller.

Most commonly, adolescents with ovaries will see the following changes in puberty:

• • Primary sex characteristics: starting to menstruate (having your period)

• Secondary sex characteristics:

• • Breast tissue will develop
  • The hips may become wider as the pelvis bone widens

What do puberty blockers do?

The primary function of GnRH analogues and other puberty blockers is to delay the onset of puberty. Blockers have reversible effects because they simply “press pause” on puberty. In other words, the effects of GnRH analogues are not permanent, meaning that the patient would continue puberty if they stopped taking blockers at any point.

Once puberty is paused, a young person and their parents or guardians can determine if and when it is right for them to start hormone replacement therapy (HRT): taking either estrogen or testosterone. Please note that HRT can produce irreversible effects, which you can consult in the hyperlinks above.

It often takes about a month for patients to see the changes or effects or their puberty slow down. For many young people with testicles, puberty blockers would suppress the growth of body and facial hair, limit the growth of genitalia, and prevent the voice from getting deeper. For many young people with ovaries, GnRH analogues and other blockers would limit breast development and delay or stop the process of menstruation.

How can an adolescent get a prescription for puberty blockers?

Like any medical treatment, gender-affirming puberty blockers can only be given to minors with the consent of their parent(s) or guardian(s). Likewise, other requirements must be met.

Young people who want to start blockers must work with an endocrinologist and/or primary care doctor, alongside a licensed mental health professional. The patient must have documented proof of gender dysphoria or gender non-conformity that started or worsened at the onset of puberty. Blockers such as GnRH analogues are only prescribed to youth who have begun to show signs of the onset of puberty.

What are the benefits of puberty blockers?

For qualifying adolescents who receive ongoing emotional or mental health support, there are a litany of peer-reviewed medical studies that demonstrate treatment has high success and satisfaction rates. Some of the benefits of gender-affirming puberty blocker treatment in these adolescents are:

• Reduce incidence of self-harm
• Decreased rates of suicidality generally.
  • Adults who were able to access gender-affirming hormonal blockers and therapy in their adolescence experience lower instances of suicidality compared to those who waited until adulthood to do so.
• Make age-appropriate developmental transitions in-line with their gender-identity
• Decrease the need for future gender-affirming surgeries
• Greater psychological functioning
  • The increase in psychological functioning is not only seen over time in patients after treatment, but is also often greater than that of their cisgender peers.
• Improved body image
• Decreased instance of anxiety and depression
  • Please note that puberty blockers will likely not resolve psychological issues that are not tied to gender dysphoria.

Complications and Side Effects

Possible side effects and complications from using puberty blockers include:

• Temporary pain and inflammation in the site of the injection or implant
• Weight gain, hot flashes & headaches
• Risk of bone density loss
• Impacts on mental health vary from patient to patient
• Potential long-term effects on bone growth and density. Frequent testing and/or supplements may be recommended to help counteract these effects.

Puberty Blockers and Surgery

Getting on puberty blockers and accessing gender-affirming surgery are different processes. For adolescents, both processes require parental/guardian consent, the accompaniment of a multidisciplinary team (medical and psychological) and assessments that prove persistent gender dysphoria. Top surgery, also called chest-reconstruction surgery, is the only kind of surgery that can be performed on minors with parental consent.

Being on puberty blockers may affect your eligibility for certain kinds of gender-affirming surgery. Most commonly, trans feminine patients interested in undergoing a vaginoplasty may not qualify for a standard penile-inversion procedure depending on how much skin grows on the scrotum and penis. In this case, patients can undergo a vulvoplasty (aka., zero-depth vaginoplasty) or other vaginoplasty techniques to still have a vaginal canal. For more information on these procedures, click here.

Gender-affirming surgery can help those who would like de-transition or re-transition reverse the effects of gender-affirming hormone therapy or a previous surgery. For example, though very rare, a breast reconstruction may be appropriate for someone who would like to reverse the effects of flattening their chest from an initial top surgery.

Insurance coverage by provider and state

Puberty blockers can be a costly medical treatment for many families. Not all insurance plans cover this treatment. The Transgender Legal Defense & Education Fund (TLDEF) provides a list of insurance companies that cover gender-affirming care.

In the state of California, all private insurance providers are legally obligated to cover gender-affirming care for trans, non-binary and gender non-conforming individuals. However, this is not the case in every state in the country. Despite the fact that gender-affirming care for qualifying minors is an evidence-based practice, 26 states in the U.S. have instituted legal restrictions on gender-affirming care for minors. Almost 40% of trans youth in the U.S. live in states with gender-affirming care bans for minors, of which six have made providing this type of care a felony.

As of late 2024, 14 states and Washington D.C. have passed laws protecting access to gender-affirming medical care for trans, non-binary and gender diverse patients. Often called “shield laws,” they offer legal protection for individuals and their families that travel to other states to receive this care so they cannot be criminalized for doing so in their home state. It is estimated that only 38% of trans youth–children and adolescents–live in states with these “shield laws.”

Financial assistance for gender-affirming care

Even with insurance coverage, many patients and their families will still have to pay a deductible for their plan and a co-pay for specific treatments like puberty blockers and HRT. We understand some families face difficulties meeting these costs. Since the GCC does not provide any kind of gender-affirming blocker or hormonal treatment, we recommend that parents and guardians of gender diverse adolescents reach out to their provider’s insurance team for help. The insurance team, meaning those who submit a claim to insurance for coverage, can help you get cost estimates for care and may be able to provide resources on financial assistance.

In Summary

• Young people experiencing gender dysphoria or expressing gender non-conformity may benefit from puberty blockers like GnRH and other medications.
• Children must work with a licensed mental health professional and an endocrinologist or primary care doctor in order to be prescribed puberty blockers.
• The effects of puberty blockers are not permanent. Blockers are usually accompanied by a hormone replacement therapy regimen, which can have irreversible effects.
• The benefits of puberty blockers include a reduction in gender dysphoria and an overall improvement in mental and social health.

Sources

• Oregon Health and Science University: “About Puberty Blockers”
• World Professional Association for Transgender Health’s (WPATH) Standards of Care, 8th Edition (SOC-8): “Chapter 6: Adolescents”
• Mayo Clinic: “Puberty Blockers”