Puberty blockers are chemicals called gonadotropin-releasing hormone (GnRH) agonists. They prevent the ovaries and testes from producing estrogen or testosterone. These hormones increase during puberty, leading to the development of adult sex characteristics.
GnRH agonists treat certain cancers, endometriosis, and fibroids, and are used to chemically castrate sex offenders. They also prevent precocious puberty, a condition when puberty starts abnormally early, causing health issues. Puberty blockers are not FDA-approved for halting normal puberty and are used “off-label” 1 for gender dysphoria. They are used as early as Tanner stage 2 (the onset of puberty)2 when a girl or boy may be only nine or ten years old.
How Did Doctors Start Using Puberty Blockers on Gender Dysphoric Children?
This process started in 1996 under what is called “The Dutch Protocol.” 3 Doctors reasoned that since puberty blockers stopped the development of sex characteristics, they would help those who transition to better pass as the opposite sex as adults. The clinicians thought this may reduce the high rates of mental health problems4 in the trans-identified population. There is currently no solid evidence it does.5 They published a flawed,6 but very influential study7 involving a small number of patients (55). Clinicians in other Western countries rapidly adopted this treatment.
The Marketing of the Use of Puberty Blockers is Propaganda, Not Evidence-Based Medicine
“Puberty blockers are fully reversible.”
For years, health professionals who support the “affirmative model” have claimed that puberty blockers are “fully reversible.”8 We now know there are serious and permanent health consequences to using these drugs.9 As of 2024, there were 63,928 adverse event reports filed with the FDA for the drug leuprolide alone,10 indicating significant side effects for on-label uses of these medications.
“The problems documented in the Kaiser report include extremely brittle bones, anxiety, and seizures.”–Consumer Affairs11
Puberty blockers cause osteopenia (bone weakening).12 Some bone injuries in youth treated in gender clinics have been serious.13
Puberty blockers can cause irreversible sexual function damage in boys who take puberty blockers early (Tanner stage 2) and go onto cross-sex hormones. These drugs stunt male genital growth, may affect cognitive development, and destroy the ability to have orgasms in adulthood. Stunted genital growth means less tissue, making the standard penile inversion surgery impossible. Surgeons must use grafts from the peritoneum or the colon. This happened to Jazz Jennings who required several painful revision surgeries after an experimental procedure failed.14
There are major changes that happen in brain wiring during puberty16 and there is evidence puberty blockers harm this process by reducing intelligence.17 In one case study, the youth experienced a 9 point drop in IQ.18
Puberty blockers may cause the youth to be infertile. They will certainly be infertile if they go on to cross sex hormones (add citation). One study shows that puberty blockers damage development of the testes in boys. (add citation)
“Puberty blockers give the youth time to explore their identity.”
Doctors and mental health professionals who support this medical experimentation on children often claim that puberty blockers give youth time to explore their identity.19 There is no evidence that puberty blockers are beneficial in aiding a young person to make the best decisions that will permanently impact the rest of their lives.
“Carmichael says it’s very important for young people to experience some of their own puberty. ‘The blocker is said to be completely reversible, which is disingenuous because nothing’s completely reversible. It might be that the introduction of natal hormones [those you are born with] at puberty has an impact on the trajectory of gender dysphoria.’ Even though the idea of experiencing any “natural” puberty might horrify the Kings and the Wilsons, by inhibiting it completely, Tom and Julia might be denied the chance to explore fully who they are.”–The Guardian20
“Puberty blockers improve mental health and reduce suicide risk”
There is no reliable evidence that puberty blockers improve mental health.21 Supporters of pediatric transition often circulate poor quality studies to sway public opinion. One of many examples can be found below.22
“Puberty blockers allow them to pass better.”
One of the central reasons doctors do this is for cosmetic results, regardless of whether the youth are improving psychologically or the consequences on their health.23 This is only true for boys who want to be girls. Blockers will not help transitioning girls to pass better. As for boys, male adults who transition still find partners24 and early transition will not necessarily increase their dating pool. Some argue it will reduce it due to the damaging sexual side effects and challenges forming intimate relationships.25
“Trans kids know who they are and should decide.”
Many children outgrow gender dysphoria through puberty if not socially or medically transitioned.26 Giving this population drugs that stunt puberty is dangerous for their development. In general, no child or teenager can provide fully informed consent to irreversible side effects.
“The frontal cortex is the most recently evolved part of the human brain. It’s where the sensible mature stuff happens: long-term planning, executive function, impulse control, and emotional regulation. It’s what makes you do the right thing when it’s the harder thing to do. But its neurons are not fully wired up until your mid-20.”–Robert Sapolsky27
Minors Cannot Provide Consent to the Use of Puberty Blockers
We oppose giving puberty blockers to children and teenagers given the severity of the side effects and that their brains are not fully developed. It certainly tracks young people who would have grown out of their desire to transition into a medical pathway, as we see with cases of real-world regret.28 Other European countries are restricting puberty blockers.29 All minors, regardless of how they will feel should be supported with compassionate care, but they need a natural puberty for healthy brain, bone, and sexual health development.
1 Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2012). Ten common questions (and their answers) about off-label drug use. Mayo Clinic Proceedings, 87(10), 982–990. https://doi.org/10.1016/j.mayocp.2012.04.017
2 Professional, C. C. M. (2025, February 18). Puberty. Cleveland Clinic. https://my.clevelandclinic.org/health/body/puberty
3 Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and evidence. Journal of Sex & Marital Therapy, 49(4), 348–368. https://doi.org/10.1080/0092623x.2022.2121238
4 Wanta, J. W., Niforatos, J. D., Durbak, E., Viguera, A., & Altinay, M. (2019). Mental health diagnoses among transgender patients in the clinical setting: an All-Payer Electronic Health Record study. Transgender Health, 4(1), 313–315. https://doi.org/10.1089/trgh.2019.0029
5 Cass, H. (2024) The Cass Review: Independent Review of gender identity services for children and young people
6 Abbruzzese, E., Levine, S. B., & Mason, J. W. (2023). The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed. Journal of Sex & Marital Therapy, 49(6), 673–699. https://doi.org/10.1080/0092623x.2022.2150346
7 De Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young Adult Psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704. https://doi.org/10.1542/peds.2013-2958
8 Gender Health Query. (2019). Unsubstantiated claims it is known that hormone blockers are fully reversible & that they are beneficial to the child’s decision-making process about their gender. https://thehomoarchy.com/trans-youth-ethics-affirmative-doctors [accessed 25 April 2025]
9 Gender Health Query. (2019). Consequences & Permanent Side-Effects That Result from the Use of Hormone Blockers. https://thehomoarchy.com/trans-youth-side-effects-hormone-blockers-surgery [accessed 25 April 2025]
10 Tang, X., Zheng, F., Ma, Z., Shen, H., & Yao, Z. (2024). Comprehensive evaluation of leuprorelin-associated adverse events: insights from FDA adverse event reporting system. Expert Opinion on Drug Safety, 1–10. https://doi.org/10.1080/14740338.2024.2423680
11 Martyn, A. (2017, February 3). New report describes dangers of giving Lupron to kids. Consumer Affiars. https://www.consumeraffairs.com/news/new-report-describes-dangers-of-giving-lupron-to-kids-020317.html
12 Splete, H. (2024, August 26). Hormone agonist therapy disrupts bone density in transgender youth. Medscape. https://www.medscape.com/viewarticle/959101?form=fpf
13 Singal, J. (2022, November 5). A Swedish Investigative Journalist Talks About The Youth Gender Medicine Scandal She Helped Uncover At One Of The World’s Top Hospitals. Singal-Minded. https://jessesingal.substack.com/p/a-swedish-investigative-journalist-dd6 [accessed 25 April 2025]
14 Diaz, J. (2020, January 22). A complication, ‘crazy pain,’ as South Florida trans teen Jazz Jennings gets confirmation surgery. Sun Sentinel. https://www.sun-sentinel.com/2019/01/30/a-complication-crazy-pain-as-south-florida-trans-teen-jazz-jennings-gets-confirmation-surgery/
15 RubbleOfEmpires. (2022, September 16). Puberty blockers are chemical castration. Marci Bowers (WPATH) casually reveals extent of damage. [Video]. YouTube. https://www.youtube.com/watch?v=kuwOx9YdHXY
16 Sharma, S., Arain, N., Mathur, N., Rais, N., Nel, N., Sandhu, N., Haque, N., & Johal, N. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 449. https://doi.org/10.2147/ndt.s39776
17 Gender Health Query. (2019). Puberty blockers & negative effects on mental health, physical health, & IQ. https://thehomoarchy.com/trans-youth-side-effects-hormone-blockers-surgery/#anchor-page2-section-c-puberty [accessed 25 April 2025]
18 Schneider, M. A., Spritzer, P. M., Soll, B. M. B., Fontanari, A. M. V., Carneiro, M., Tovar-Moll, F., Costa, A. B., Da Silva, D. C., Schwarz, K., Anes, M., Tramontina, S., & Lobato, M. I. R. (2017). Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression. Frontiers in Human Neuroscience, 11. https://doi.org/10.3389/fnhum.2017.00528
19 Gender Health Query. (2019). Unsubstantiated claims it is known that hormone blockers are fully reversible & that they are beneficial to the child’s decision-making process about their gender. https://thehomoarchy.com/trans-youth-ethics-affirmative-doctors/#anchor-page4-section-d [accessed 25 April 2025]
20 Kleeman, J. (2017b, December 1). Transgender children: ‘This is who he is – I have to respect that.’ The Guardian. https://www.theguardian.com/society/2015/sep/12/transgender-children-have-to-respect-who-he-is
21 BMJ (2021, 8) Puberty blockers do not alleviate negative thoughts in children with gender dysphoria, finds study.https://doi.org/10.1136/bmj.n356 Proper citation format?
22 Singal, J. (2022, April 6). Researchers found puberty blockers and hormones didn’t improve trans kids’ mental health at their clinic. Then they published a study claiming the opposite. (Updated). Singal-Minded. https://jessesingal.substack.com/p/researchers-found-puberty-blockers [accessed 25 April 2025]
23 Biggs, M. (2019, October 17). The astonishing admission in the Health Research Authority report: The purpose of puberty blockers is to commit children to permanent physical transition. Transgender Trend. https://www.transgendertrend.com/health-research-authority-puberty-blockers-commit-children-permanent-physical-transition/ [accessed 25 April 2025]
24 Rosenthal, A. M., Hsu, K. J., & Bailey, J. M. (2016). Who Are Gynandromorphophilic Men? An Internet Survey of Men with Sexual Interest in Transgender Women. Archives of Sexual Behavior, 46(1), 255–264. https://doi.org/10.1007/s10508-016-0872-6
25 Heterodorx. (2022, January 19). Episode 42: GAMPs, Pr0n, trans, and the Conservation of Evil. https://www.heterodorx.com/podcast/episode-42-gamps-pr0n-trans-and-the-conservation-of-evil/
26 Gender Health Query. (2019). Do children and teens with serious gender dysphoria ever outgrow gender dysphoria? Yes. https://thehomoarchy.com/trans-children-dysphoria-desistance-gay
27 Sapoloski, R. (2014, July 4). Dude, Where’s My Frontal Cortex? Nautilus. http://nautil.us/issue/15/turbulence/dude-wheres-my-frontal-cortex
28 Ryan, B. (2024, December 6). Detransitioner sues Johanna Olson-Kennedy, a top pediatric gender medicine doctor, for medical negligence. Hazard Ratio: Benjamin Ryan. https://benryan.substack.com/p/detransitioner-sues-johanna-olson
29 Davis, E., Jr. (2023, July 12). European countries restrict trans health care for minors. US News & World Report. https://www.usnews.com/news/best-countries/articles/2023-07-12/why-european-countries-are-rethinking-gender-affirming-care-for-minors