< All about hormones

Puberty blockers

On this page:

Legal status of prescribing of puberty blockers to trans adolescents Standards of care Downloads

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.
Standards of Care for trans and gender diverse children and adolescents 3

Puberty blockers are medications that temporarily suppress gonadotrophin releasing hormone (GnRH) from the hypothalamus. This results in suppression of lutenizing hormone (LH) and follicle-stiumlating 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 allows 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 many young trans or gender diverse people who want to access hormonal affirmation, puberty blockers are the first step towards that path. Transfigurations in the UK write “for many families, the question is not whether to intervene with blockers, but how early to start1.”

For more information about testosterone suppressing medications such as spironolactone or cyproterone acetate, visit our page on Feminising Hormones.

Information and resources for community members, and their families seeking puberty blockade can be found here.

Legal status of prescribing of puberty blockers to trans adolescents

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.

People aged under 18 can commence treatment only 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 3.

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 must be involved. 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 team4, where available.

Currently puberty blockers are only available in NSW through some public hospitals, but there are a limited number of places that often have waiting lists. It is recommended that a patient makes a long appointment with their GP to discuss options, refer to your local Primary Health Network’s HealthPathways if applicable. Gender affirming HealthPathways have been localised across most of NSW.

WPATH Standards of Care

Puberty suppression may continue for a few years, at which time a decision is made to either discontinue all hormone therapy or transition to a feminizing/masculinizing hormone regimen. Pubertal suppression does not inevitably lead to social transition or to [further medical gender affirmation].
WPATH

The current SoC (7th ed) for the Health of Transsexual, Transgender, and Gender Nonconforming 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.

WPATH states that the two goals of puberty-suppressing hormones are “(i) their use gives adolescents more time to explore their gender nonconformity and other developmental issues; and (ii) their use may facilitate transition by preventing the development of sex characteristics that are difficult or impossible to reverse if adolescents continue on to pursue sex reassignment.”

Criteria for Puberty-Suppressing Hormones

In order 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 coexisting 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 process.

WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People V7

GnRH analogues

GnRH analogues prevent progression of endogenous puberty in trans adolescents. They are most beneficial in those who are Tanner stage 2-3 of development.

These include: