What are puberty inhibitors?

Typically, in puberty, the gonadotropin-releasing hormone helps to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In those assigned to women at birth, these hormones cause the ovaries to produce estrogen, which promotes processes such as breast augmentation and menstruation. In those assigned to the male at birth, they induce the testes to produce testosterone, which promotes processes such as the growth of facial hair and deepening of the voice.

Puberty inhibitors inhibit the production of FSH and LH, therefore blocking the production of estrogen or testosterone. As a result, transgender adolescents do not continue to develop unwanted secondary sexual characteristics – for example, transgender boys do not develop breasts and transgender girls do not have hair on their faces.

Puberty inhibitors do not prevent an early stage in sexual maturation called adrenarche, which can lead to acne, underarm and growth of pubic hair and body odor.

Although parents may think that they should initiate puberty inhibitors at a very early age, so that a child does not experience any physical changes associated with unwanted sex, experts say that at least the early stages of puberty begin It is better to wait till it happens. Dr. Stephen Rosenthal, Medical Director of the Center for Child and Adolescent Gender for UCSF Benioff Children’s Hospitals, was a co-author of the Endocrine Society 2017 guidelines For transgender health care. He recommended introduction of puberty inhibitors when breast budding or testicle expansion began as soon as possible.

This is because Dr. Rosenthal does not recommend puberty inhibitors for long-term use outside the normal window of puberty. They restrict the functioning of gonads, which may adversely affect health. The longer inhibitors are used before the normal onset of puberty – typically 14 years of age, at the latest – the greater the potential risk.

When inhibitors are introduced in the early stages of puberty, Dr. Rosenthal usually suggests that his patients stop using them until they are 14 years old. At that time, patients, along with their families and their doctors, can determine whether to introduce hormones that help them develop their gender identity or to resume puberty in the designated gender at birth.

Dr. Rosenthal further recommended that before starting inhibitors, children should be evaluated by a mental health professional and prescribed Gender dysphoria. He said that families should also go through the entire process of informed consent, during which they are educated about the possible effects of blocking puberty – including adverse ones.

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