For parents and guardians who are worried about permanent effects of hormone replacement therapy for their transgender children there is a fully reversible intervention.
Adolescents may be eligible for puberty suppressing hormones as soon as pubertal changes have begun. It is recommended that your adolescent experience the onset of puberty to at least Tanner Stage 2 (stages shown below).
Boys - development of external genitalia
Girls - breast development
Boys and girls - pubic hair
Stage 1: Prepubertal
Stage 1: Prepubertal
Stage 1: Prepubertal (can see velus hair similar to abdominal wall)
Stage 2: Enlargement of scrotum and testes; scrotum skin reddens and changes in texture
Stage 2: Breast bud stage with elevation of breast and papilla; enlargement of areola
Stage 2: Sparse growth of long, slightly pigmented hair straight or curled at base of penis or along labia
Stage 3: Enlargement of penis (length at first); further growth of testes
Stage 3: Further enlargement of breast and areola; no separation of their contour,
Stage 3: Darker, coarser and more curled hair, spreading sparsely over junction of pubes
Stage 4: Increased size of penis with growth in breadth and development of glans; testes and scrotum larger scrotum skin darker
Stage 4: Areola and papilla form a secondary mound above level of breast,
Stage 4: Hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs,
Stage 5: Adult genitalia
Stage 5: Mature stage: projection of papilla only, related to recession of areola
Stage 5: Adult in type and quantity, with horizontal distribution ("feminine")
Criteria for puberty suppressing hormones
For, adolescents to receive puberty suppressing hormones, the following minimum criteria
must be met:
1. The adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity
or gender dysphoria (whether suppressed or expressed);
2. Gender dysphoria emerged or worsened with the onset of puberty;
3. Any co-existing psychological, medical, or social problems that could interfere with treatment
(e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s
situation and functioning are stable enough to start treatment;
4. The adolescent has given informed consent and, particularly when the adolescent has not
reached the age of medical consent, the parents or other caretakers or guardians have consented
to the treatment and are involved in supporting the adolescent throughout the treatment
Risk for Puberty Suppressants
- During pubertal suppression, your child should be monitored carefully – preferably by a pediatric endocrinologist – so that any necessary interventions can occur.
- Early use of puberty suppressing hormones may avert negative social and emotional consequences of gender dysphoria more effectively than their later use would.
- Youth with male genitalia who start puberty suppressants should be informed that they could have insufficient penile tissue for vaginoplasty.
- Neither puberty suppression nor allowing puberty to occur is a neutral act.
o On one hand function in later life can be compromised by the development of irreversible secondary sex characteristics during puberty and by years spent experiencing intense gender dysphoria.
o On the other hand, there are concerns about negative physical side effects of GnRH analog use. Such as risk for bone development and height.
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