Puberty blockers are medications that temporarily suppress gonadotrophin releasing hormone (GnRH) from the hypothalamus. This results in suppression of luteinising hormone (LH) and follicle-stimulating hormone (FSH) secretion from the pituitary gland and subsequently, testosterone and estrogen are not produced by the testes and ovaries, respectively.
By suppressing the development of secondary sex characteristics, they reduce the distress associated with a spontaneous endogenous puberty and allow a young person to mature emotionally and cognitively to be able to provide informed consent for gender affirming hormone treatment in later adolescence, if sought.
For young trans people wanting access hormonal affirmation, puberty blockers are sometimes the first step. This page aims to provide clinicians with an overview of what puberty blockers are, the international standards of care, and how they might be prescribed or accessed in your State or Territory.
Information and resources for community members, and their families seeking puberty blockers can be found here.
Acknowledgements
This page was created with input from trans writers across each state and territory, and developed in collaboration with Northern Territory AIDS and Hepatitis Council (NTAHC), SHINE SA, Transgender Victoria (TGV), A Gender Agenda, TransFolk of WA, Queensland Council for LGBTI Health (QC), and Working It Out Tasmania (WIC). All content was reviewed by the Inner City Legal Centre.
“Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated, and mental health and wellbeing outcomes can be significantly improved.” – Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents (2018)
Puberty blockers are taken by trans people whose bodies are just started or are about to undergo puberty. For those who are pre-pubertal (i.e. children), gender affirmation is only ever social (source 1 and 2.) Masculinising and feminising hormones are commenced after puberty would have, or did, occur.
For more information about testosterone suppressing medications such as spironolactone or cyproterone acetate, visit our page on Feminising Hormones.
Legal status of prescribing of puberty blockers to trans adolescents
In Australia, trans young people may commence puberty blockers with permission from all carers or guardians, and their doctor. However, there are exceptions to this.
A Family Court ruling (Re Jamie, 2013) overturned existing law that required an adolescent and their family to go to the Family Court of Australia to gain authority to commence puberty blockers prior to 18, provided parents consented. This ruling was further clarified in the judgement of Re Imogen 2020 to mean that treatment can be commenced in Australia with people under 18 when there is no dispute between parents (or those with parental responsibility), the medical practitioner and the young person themselves with regard to:
- The Gillick competence of an adolescent; or
- A diagnosis of gender dysphoria; or
- Proposed treatment for gender dysphoria
Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re Imogen 2020.
Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a child’s parents or legal guardians’ consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers (“Stage 1”), hormones (“Stage 2”) or surgical intervention (“Stage 3”) without court authorisation.
For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court may be involved. However, a recent case (Re CD, 2024) clarified that in some circumstances an individual parent can provide valid consent to stage 1.
Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones or seeking to access them outside of medical care and oversight.
The prescribing of puberty blockers does not currently sit in primary healthcare and can cost $5000+ per year outside of the hospital system. Treatment and care of young trans people is best managed through a multidisciplinary team where available.
Accessing puberty blockers in Australia often involves a referral from a GP or another doctor to a specialist clinic. For eligible adolescents, this is usually coordinated through a multi-disciplinary team, when available.
WPATH Standards of Care 8
“In general, the goal of GnRHa administration in TGD adolescents is to prevent further development of the endogenous secondary sex characteristics corresponding to the sex designated at birth. Since this treatment is fully reversible, it is regarded as an extended time for adolescents to explore their gender identity by means of an early social transition” – Coleman, et al. (2022). Standards of care for the health of transgender and gender diverse people, Version 8
The current SoC (8th ed) for the health of transgender and gender diverse people, published by the World Professional Association for Transgender Health (WPATH) offers guidance to clinicians working with trans patients, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.
These standards were updated from the previous guidelines (7th ed) in 2022 to reflect significant cultural shifts & advances in clinical knowledge. This includes a new chapter dedicated to adolescents and children and expanded discussion about the safety of gonadotropin releasing hormone (GnRH) agonists in youth.
How an ’adolescent’ is defined will differ between countries. In Australia, the legal age of maturity will also differ depending on your State or Territory. For WPATH SoC 8, adolescence refers to the period of time between the start of puberty until legal majority age. This stage of maturity is called ‘Tanner 2’ and can be measured by the Sexual Maturity Rating (SMR).
Criteria for Puberty-Suppressing Hormones (Adolescents)
Accessing puberty blockers in Australia often involves a referral from a GP or another doctor to a specialist clinic. In order for adolescents to receive puberty-suppressing hormones, the following minimum criteria must be met:
- The adolescent meets the diagnostic criteria of gender incongruence as per the ICD-11.
- The adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.
- The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed.
- The adolescent has been informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility, and these have been discussed in the context of the adolescent’s stage of pubertal development.
- The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated.
Source: Coleman, et al. (2022). Standards of care for the health of transgender and gender diverse people, Version 8
Once medication has started, adolescents will need regular appointments with their clinicians to monitor the impact of their treatment.
What types of puberty blockers are there?
The puberty blocker that is right for your client will depend on a combination of your age, puberty-stage, preferences, access, existing contraindications, and other factors.
GnRH analogues
Gonadotropin-releasing hormones (GnRH) or gonadotropin-releasing hormone analogues (GnRHa) are drugs suppress the secretion of gonadotropin-releasing hormones and are commonly used to prevent a spontaneous puberty in young trans people.
These include:
- Goserelin (Zoladex) – implant with a cycle of 10-12 weeks
- Leuproein (Lupron, Lucrin) – injection every 3-4 months
- Triptorelin – injection every 5-6 months
What are the effects of puberty blockers?
Studies on puberty blockers have shown that they are an effective and safe part of the hormonal therapy toolkit for young trans people. Puberty blockers are not only prescribed for trans young people but are also freely given to cis children and adolescents for a range of reasons.
WPATH, AusPATH, the RACP, the RACGP, and the Australian Endocrine Society all endorse access to puberty suppression/blockers for trans young people and adolescents.
In 2024 the Sax Institute released an evidence summary into the effectiveness of interventions for children and young people with gender dysphoria.
“Broadly, the newly identified evidence reinforced the previous finding regarding benefits and effectiveness. That is [puberty blockers] were reported to be safe, effective and reversible.” – The Sax Institute (2024) Evidence for effective interventions for children and young people with gender dysphoria – update
GnHRa’s may reduce bone density, however results showing this are mixed. It is recommended to for bone density be continually monitored for trans youth in collaboration with their endocrinologist or paediatrician.
GnHRa’s can affect your final height and could make someone slightly taller if administered without gender affirming hormones and before the first growth spurt of puberty. This is because bones do not stop growing until exposed to estrogen or testosterone. In general, GnHR’s are well-tolerated by the body. In 2024 Transcend Australia and AusPATH also released ‘Living True, Living Better’ evidence briefs & factsheets. These resources provide comprehensive, evidence-based information to guide decision-making for families, caregivers, and health providers. You can read the evidence brief for puberty blockers here.
“Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.” – Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents (2018)
Puberty blockers are taken by trans people whose bodies are just started or are about to undergo puberty. For those who are pre-pubertal (i.e. children), gender affirmation is only ever social (source 1 and 2). Masculinising and feminising hormones are commenced after puberty would have, or did, occur.
For more information about testosterone suppressing medications such as spironolactone or cyproterone acetate, visit our page on Feminising Hormones.
Please note: Under a Health Service Directive (HSD) issued by the Director-General Queensland Health on 28 January 2025, no new public patients under 18 years can be prescribed Stage 1 (puberty blockers) or Stage 2 (gender-affirming hormones) treatment for gender dysphoria.
You can read more about this change and efforts to support trans youth in Queensland through AusPATH’s Project 491 initiative.
Legal status of prescribing of puberty blockers to trans adolescents
In Australia, trans young people may commence puberty blockers with permission from all carers or guardians, and their doctor. However, there are exceptions to this.
A Family Court ruling (Re Jamie, 2013) overturned existing law that required an adolescent and their family to go to the Family Court of Australia to gain authority to commence puberty blockers prior to 18, provided parents consented.
This ruling was further clarified in the judgement of Re Imogen 2020 to mean that treatment can be commenced in Australia with people under 18 when there is no dispute between parents (or those with parental responsibility), the medical practitioner and the young person themselves with regard to:
- The Gillick competence of an adolescent; or
- A diagnosis of gender dysphoria; or
- Proposed treatment for gender dysphoria
Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re Imogen 2020.
Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a child’s parents or legal guardians’ consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers (“Stage 1”), hormones (“Stage 2”) or surgical intervention (“Stage 3”) without court authorisation.
For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court may be involved. However, a recent case (Re CD, 2024) clarified that in some circumstances an individual parent can provide valid consent to stage 1.
Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones or seeking to access them outside of medical care and oversight.
The prescribing of puberty blockers does not currently sit in primary healthcare and can cost $5000+ per year outside of the hospital system. Treatment and care of young trans people is best managed through a multidisciplinary team1,2 where available.
Accessing puberty blockers in Australia often involves a referral from a GP or another doctor to a specialist clinic. For eligible adolescents, this is usually coordinated through a multi-disciplinary team, when available.
WPATH Standards of Care 8
“In general, the goal of GnRHa administration in TGD adolescents is to prevent further development of the endogenous secondary sex characteristics corresponding to the sex designated at birth. Since this treatment is fully reversible, it is regarded as an extended time for adolescents to explore their gender identity by means of an early social transition” – Coleman, et al. (2022). Standards of care for the health of transgender and gender diverse people, Version 8
The current SoC (8th ed) for the health of transgender and gender diverse people, published by the World Professional Association for Transgender Health (WPATH) offers guidance to clinicians working with trans patients, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.
These standards were updated from the previous guidelines (7th ed) in 2022 to reflect significant cultural shifts & advances in clinical knowledge. This includes a new chapter dedicated to adolescents and children and expanded discussion about the safety of gonadotropin releasing hormone (GnRH) agonists in youth.
How an ’adolescent’ is defined will differ between countries. In Australia, the legal age of maturity will also differ depending on your State or Territory. For WPATH SoC 8, adolescence refers to the period of time between the start of puberty until legal majority age. This stage of maturity is called ‘Tanner 2’ and can be measured by the Sexual Maturity Rating (SMR).
Criteria for Puberty-Suppressing Hormones (Adolescents)
Accessing puberty blockers in Australia often involves a referral from a GP or another doctor to a specialist clinic. In order for adolescents to receive puberty-suppressing hormones, the following minimum criteria must be met:
- The adolescent meets the diagnostic criteria of gender incongruence as per the ICD-11.
- The adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.
- The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed.
- The adolescent has been informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility, and these have been discussed in the context of the adolescent’s stage of pubertal development.
- The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated. Coleman, et al. (2022). Standards of care for the health of transgender and gender diverse people, Version 8
Once medication has started, adolescents will need regular appointments with their clinicians to monitor the impact of their treatment.
What types of puberty blockers are there?
The puberty blocker that is right for your client will depend on a combination of your age, puberty-stage, preferences, access, existing contraindications, and other factors.
GnRH analogues
Gonadotropin-releasing hormones (GnRH) or gonadotropin-releasing hormone analogues (GnRHa) are drugs suppress the secretion of gonadotropin-releasing
hormones and are commonly used to prevent a spontaneous puberty in young trans people.
These include:
- Goserelin (Zoladex) – implant with a cycle of 10-12 weeks
- Leuproein (Lupron, Lucrin) – injection every 3-4 months
- Triptorelin – injection every 5-6 months
What are the effects of puberty blockers?
Studies on puberty blockers have shown that they are an effective and safe part of the hormonal therapy toolkit for young trans people. Puberty blockers are not only prescribed for trans young people but are also freely given to cis children and adolescents for a range of reasons. WPATH, AusPATH, the RACP, the RACGP, and the Australian Endocrine Society all endorse access to puberty suppression/blockers for trans young people and adolescents.
In 2024 the The Sax Institute6 released an evidence summary into the effectiveness of interventions for children and young people with gender dysphoria.
“Broadly, the newly identified evidence reinforced the previous finding regarding benefits and effectiveness. That is [puberty blockers] were reported to be safe, effective and reversible.” – The Sax Institute (2024) Evidence for effective interventions for children and young people with gender dysphoria—update
GnHRa’s may reduce bone density, however results showing this are mixed. It is recommended to for bone density be continually monitored for trans youth in collaboration with their endocrinologist or paediatrician.
GnHRa’s can affect your final height and could make someone slightly taller if administered without gender affirming hormones and before the first growth spurt of puberty. This is because bones do not stop growing until exposed to estrogen or testosterone. In general, GnHR’s are well-tolerated by the body. In 2024 Transcend Australia and AusPATH also released ‘Living True, Living Better’ evidence briefs & factsheets. These resources provide comprehensive, evidence-based information to guide decision-making for families, caregivers, and health providers. You can read the evidence brief for puberty blockers here.
