Thread by @AlexPetrovnia

Today, let's talk about puberty blockers. What they do, what they don't do, what risks they pose, what risks they alleviate, and more. 🧵
TW for anatomical and medical discussion.

To understand puberty blockers, we first must understand what puberty is.
Puberty is the uptick in levels of various hormones in the body that allows for the development of secondary sex characteristics, usually occurring between the ages of 9-15.

"Puberty blockers" themselves are slightly misleadingly named. They don't block all aspects of puberty, just those related to estrogen and testosterone.

This temporarily prevents development of certain secondary sex characteristics, such as breast development, voice deepening, facial hair growth, enlargement of the testes and penis, menstrual cycles and more.

For the cis (not trans) people reading along with me here, I want to propose an exercise. Do your best to remember what puberty felt like. Now I want you to imagine you are developing a different set of secondary sex characteristics than the ones you actually developed.

Cis men, I want you to imagine getting your first period, your chest aching with breast tissue growth. Cis women, I want you to imagine growing facial hair, and your voice deepening. I want you to imagine it viscerally, for as long as you can stand it.

This is the reality trans children face. This is the reality every trans adult has faced, and survived.
This is a taste of what dysphoria feels like.
Dysphoria, especially over long periods of time, has dramatic negative effects on mental health and life outcomes.

When children realize they're trans early enough, we have the medical technology to intervene. But a lot can change for people as young as that. How do we protect children from making irreversible medical decisions too rashly?
The answer is puberty blockers.

Puberty blockers allow traditional puberty to be delayed, preventing irreversible secondary sex characteristics from taking hold. This gives the child, and their loved ones, time to evaluate the best options for them going forwards.

If the child and their loved ones decide that the best option is to continue with traditional puberty, the puberty blockers are stopped, and traditional puberty picks up where it left off.

If they decide to proceed with more trans-related healthcare, the child can begin hormone replacement therapy (HRT) and undergo the secondary sex characteristics more aligned with their internal self.

Puberty blockers are most commonly gonadotropin-releasing hormone analogues, or GnRHs. When taken regularly, these suppress estrogen and testosterone production in the body, allowing these hormones to remain at low levels as they were pre-puberty.

These medications are usually administered in one of two ways, either through a small implant that lasts up to a year (similar to certain forms of hormonal birth control), or through regular injections that can last between one and four months per dosage.

At any time during the administration of these medications, the medication can be stopped, and traditional puberty will resume. The vast majority of children who decide to go on puberty blockers will choose to pursue HRT to reduce their dysphoria.

A slight side note here. There is often discussion in gender critical circles of a phenomena called "desistence". Studies of "desistence" include children who are gender non conforming in many ways, the majority of whom turn out not to be trans, as being trans is uncommon.

The overwhelming majority of peer reviewed evidence shows that children who experience dysphoria will continue to experience dysphoria throughout their lives. We have the medical technology to effectively treat dysphoria, and in children, it starts with puberty blockers.

Puberty blockers were not developed with transgender people in mind. They were developed to treat what is called "precocious puberty", which is a condition some children experience, wherein they experience puberty much earlier than is typical.

In cases of precocious puberty, the medical standard is to administer puberty blockers until the child is the typical age of puberty onset, at which point the child stops blockers and puberty progresses normally. This has been the primary use of puberty blockers for decades.

The FDA has approved puberty blockers as a safe and effective form of treatment for precocious puberty. The majority of experts, The Endocrine Society and The World Professional Association for Transgender Health, also support the usage of puberty blockers for treating dysphoria.

Many studies, linked below, support the usage of puberty blockers for the treatment of dysphoria on the basis that they are shown to dramatically reduce depression, anxiety, behavioral problems and suicidality and increase self image, life satisfaction and global functioning.

"But what about the side effects?" you would be right to ask. Let's talk about them.
Like all medications, puberty blockers can have side effects. In the short term, possible side effects can include weight gain, hot flashes and headaches.

Long term, there is much hand-wringing about potential effects on fertility and bone density.
We'll address each of these in turn.

Puberty blockers don't impact fertility in the long term, as when they are stopped, puberty continues normally. What can impact fertility in the long term is HRT. HRT, when administered to TPAM (trans people assigned male at birth), does cause infertility.

Possible effects on bone density have been observed, although the data on this are still unclear, and there is some data that indicates that low bone density may be a previously existing trait of transgender children. academic.oup.com/jes/article/4/…

Other miscellaneous effects include delayed growth plate closure, leading to a slightly larger adult height and less development of genital tissue, especially in TPAM, which can limit options for gender affirming surgeries later in life.

Considering the wealth of evidence that shows us that puberty blockers can have immense benefit to transgender and intersex children, including being a lifesaving measure in many cases, these side effects are minimal.

As Dr. Jessica Kremen, a pediatric endocrinologist for Boston Children's Hospital's Gender Multispecialty Service, says, "Medications are rarely without side effects. That is usually not enough of a reason to allow a child, who is telling you that they are extremely distressed...

...by the pubertal changes that they're seeing, to continue going through puberty."

Currently puberty blockers, which in many cases are lifesaving medication for trans youth, are quite difficult to be prescribed. The criteria for usage of puberty blockers for dysphoria are very narrow.

According to the Mayo Clinic, it is required that a child, 1) "Show a long-lasting and intense pattern of gender nonconformity or gender dysphoria"
2) "Have gender dysphoria that began or worsened at the start of puberty"

3) "Address any psychological, medical or social problems that could interfere with treatment"
4) "Provide informed consent"
Considering this medication is completely reversible and has minimal side effects, these criteria are extremely stringent.

During treatment, children are also monitored with regular blood testing for any side effects and to keep a record of blood hormone levels. Many children also receive yearly bone density and bone age tests.

Overall, this thread is a very brief overview of puberty blockers, their benefits, their risks, and their administration. I hope it has done some good to cut through the immense amounts of misinformation on this topic.

A full list of sources used for this thread can be found here:
plannedparenthood.org/learn/teens/pu…
mayoclinic.org/diseases-condi…
stlouischildrens.org/conditions-tre…
nytimes.com/2021/05/11/wel…
jahonline.org/article/S1054-…
ijpeonline.biomedcentral.com/track/pdf/10.1…
publications.aap.org/pediatrics/art…
academic.oup.com/jes/article/4/…
seattlechildrens.org/pdf/PE2572.pdf

pharma.nridigital.com/pharma_sept20/…
impactprogram.org/wp-content/upl…

Currently, bills are pending to prevent the administration of puberty blockers to children under age 18 in the following US States:
Arizona, Florida, Georgia, Indiana, Iowa, Kansas, North Carolina, Ohio, South Carolina, Tennessee and Texas.

To learn more about these bills and contact representatives related to these issues, please visit this site to #StepUpForTransKids!
…ansformationsproject.ue.r.appspot.com/how-to-step-up…

As always, writing like this is my job! If you've learned something and feel I've earned it, please consider dropping a tip to my Venmo, @AlexPetrovnia, or supporting me through my etsy shop, here:
etsy.com/shop/MascMasks