Adolescence is a uniquely painful time for transgender young people, who often experience gender dysphoria. It’s the mismatch between the gender you were assigned at birth and the gender that matches who you are. During this period, hormone levels increase, leading to secondary sexual characteristics such as facial hair and breasts. Irreversible, slow-motion physiological changes can be emotionally and mentally disruptive, leading to depression, social withdrawal, self-harm, and risk of suicide. Hormonal drugs called gonadotropin-releasing hormone agonists (GnRHas), often called pubertal blockers, temporarily stop the production of the sex hormones testosterone, estrogen, and progesterone, minimizing side effects. They can pause puberty and buy time for transgender children and their caregivers to consider their options.
These medications are well-studied and have been used safely to suspend puberty in adolescents with gender dysphoria since the late 1980s. They have long been used routinely in children entering puberty too early and in adults with a variety of other medical conditions. , is part of a class of hormone therapy that includes the treatment of certain types of cancer.
But despite evidence about the safety and effectiveness of treatments that delay puberty, some lawmakers across the country have taken action to ban or severely limit access to health care for transgender people. Spreading false claims about drugs and other gender-affirming treatments. The states of Florida, Idaho, Georgia, Indiana, Kentucky, North Dakota, South Dakota, West Virginia, Arkansas, Mississippi, Utah, Iowa, and Tennessee have prohibited gender-affirming care under the age of 18. The American Civil Liberties Union tracks the status of 122 anti-LGBTQ+ bills related to healthcare. These bills disproportionately target transgender youth.
More than half of transgender people ages 13 to 24 have seriously considered suicide in the past year, according to a recent national survey by The Trevor Project, a nonprofit focused on LGBTQ+ suicide prevention. Gender-conforming hormone therapy can reduce this risk.Recent research in New England Journal of MedicineFor example, hormone therapy has been shown to significantly reduce symptoms of depression and anxiety in transgender youth. They found they were 73% less likely to have self-harm or suicidal thoughts compared to those who didn’t.
Drugs that suspend puberty have the power to prevent mental health crises, among other things, and treatment could be a “very meaningful intervention” for young people and their families, says Meredith, a doctor of adolescent medicine at Yale University School of Medicine. McNamara says “Treatment that stops puberty is probably one of the most compassionate things a parent can agree to for their transgender child.” to give them the opportunity to carefully consider their options, she says.
Puberty has a long natural period, usually occurring between the ages of 8 and 14 and lasting 2 to 5 years. Blockers are usually prescribed after puberty has already begun, and the process involves evaluation by multiple physicians, including mental health practitioners, said a member of the board of directors of the World Association of Transgender Health Professionals and a member of the university’s board of directors. Pediatric endocrinologist Stephen Rosenthal explains. Benioff Children’s Hospital, San Francisco, California.
“Within a year, most people [of receiving puberty blockers]says Vin Tangpricha, an adult endocrinologist at Emory University Hospital and Emory University Hospital Midtown and co-author of several of the leading clinical guidelines for treating gender dysphoria in the United States. and around the world. “You can’t force someone to take puberty blockers for a long period of time.” When a teenager decides not to transition and stops taking puberty blockers, hormones that the body makes on its own force puberty to resume. If they decide to go ahead with a medical sex reassignment, they will undergo gender-conforming puberty by taking a combination of hormones such as estrogen for feminizing effects or testosterone for masculinizing effects. There is likely to be.
Teenagers who were on puberty blockers and hormone therapy had less need for gender reassignment surgery in adulthood. The World Association of Transgender Health Professionals standards of care recommend waiting until adulthood for gender reassignment surgery. Sex reassignment surgery is uncommon under her age of 18 and is usually limited to “upper surgery” or mastectomy. Breast reduction surgery is also one of the most common forms of plastic surgery for cisgender teenagers.
At every stage, adolescents, their families and doctors monitor their development. Each step in the transition is independently and carefully considered by young people and their families, he says McNamara.
“These puberty-suspending drugs are widely used in different populations and are safe to use,” says McNamara. GnRHas are also used in adolescents to treat endometriosis, a condition in which the cells that line the uterus proliferate in other parts of the body. These hormonal agents have provided solutions to many difficult-to-treat conditions. It regulates hormone levels in patients with prostate and breast cancer, suspends menstruation in patients undergoing chemotherapy, and aids in in vitro fertilization. This host of informative clinical uses and data dating back to the 1960s show that puberty blockers are not experimental treatments. Studies of treated patients have demonstrated very low regret rates, minimal side effects, and benefits for mental and social health.
“From an ethical and legal point of view, this is a benign drug,” says Giordano. She is baffled by the extra scrutiny these treatments receive given their benefits and limited risks. “There is no valid clinical, ethical, or legal reason to refuse to provide them to people in need,” she says.
Like other drugs, GnRHas have potential side effects. GnRHas are known to limit the accumulation of bone density when used as pubertal blockers or for endometriosis, raising concerns about fractures. However, bone density often recovers when sex hormones are reintroduced. The effects on bone health depend on many factors, including when GnRHas were started, duration of treatment, sex at birth, and subsequent sex hormone intake.
But these bone density scores may not tell the full story of a person’s long-term health, McNamara explains. An individual’s bone mineral density is assessed at the average of a broader population. This data may not be representative of transgender people. Transgender people often have lower bone density than their cisgender peers to begin with. Less likely.
“The bright side of this whole story is that fractures don’t seem to be increasing. [by GnRHas]That’s what we really care about,” says Tangpricha. The treatment “doesn’t make it really bad health.” On the other hand, increased suicide rates among people who do not receive gender-affirming care are well documented.
“I think patients and their families need to weigh the risk of low bone density against gender issues that are not properly treated,” says Tangpricha.
The families McNamara and Rosenthal work with are aware of the potential risks and benefits of puberty blockers. [physicians] We honestly admit uncertainty to patients and their parents and make informed consent decisions,” says McNamara. “These are personal decisions that parents make for their child’s well-being,” she says. Our conversations are thorough, exhaustive and repetitive,” she adds.
For McNamara, the widespread attempt to put these decisions in the hands of families by banning the care of transgender youth is, as proponents argue, important in protecting children’s health. “These bans did not come from a public outcry over concerns about transgender youth,” she says.
Health care bans for transgender people are increasingly expanding beyond restrictions for minors. Emergency rules last month by the Missouri Attorney General blocked access for people diagnosed with autism and depression It has imposed troubling new restrictions on adults seeking gender-affirming care, such as by taking care of themselves. 1 has autism and depression is a common consequence of gender dysphoria. A state judge temporarily blocked the order hours before it was set to take effect last Thursday.
“When politicians decide what doctors can do, it puts doctors in a very difficult situation, not just patients…it doesn’t serve the patient’s best interests,” says Giordano. “I think ‘sound the alarm’ is the right word.”
if you need help
If you or someone you know is struggling or considering suicide, help is available. Call or text 988 Suicide & Crisis Lifeline 988, or go online. lifeline chat. of trevor project We provide support to LGBTQ+ individuals and can be reached by texting START at 678-678 or calling 1-866-488-7386.
