Trans Summer School: Blockers

Depending on how old you are, where you live, and the specifics of your situation, you may start with “blockers,” also called puberty⁠ (puberty: The process of physical and sexual changes from childhood to adulthood, initiated by hormone signals from the brain to the gonads. ) blockers⁠ (blockers: Also called puberty blockers or puberty inhibitors. They block the release of hormones from the pituitary gland, thus putting a pause on puberty. Used by young trans individuals to prevent elements of puberty that may cause dysphoria.) or puberty inhibitors (or, more formally, GnRH agonists). These drugs do pretty much exactly what it sounds like they do: They block the release of testosterone⁠ (testosterone: A steroid hormone produced in the testes and in the ovaries. Is responsible for sperm production, and influences sexual desire, arousal and bone health. Is also blamed for for a lot of things it isn’t actually responsible for.) or estrogen⁠ (estrogen: A steroid hormone found in the bodies of all people, produced in the ovaries and the adrenal glands.It is involved in puberty, menstruation, pregnancy, mood, bone health, and other things across the body and lifespan .) , thus putting a pause on puberty. Patients on blockers won’t go through puberty and develop tell-tale signs like breasts, larger testes⁠ (testes: Reproductive glands of people with penises. They sit outside the body and are contained within the scrotum.) , more body hair, and fat redistribution. Incidentally, post-pubertal trans people sometimes use blockers too, and they have other applications in cancer care, fertility⁠ (fertility: The ability to become pregnant or other things having to do with becoming pregnant (eg, “the fertility clinic”).) treatment, and the management of estrogen disorders.

Here’s the cool thing about blockers: they let you take a developmental time out⁠ (out: Short for ‘out of the closet’. When someone’s LGBTQ+ identity is known to other people.) . While on blockers, you can get to know your body and get more comfortable in yourself as you decide which steps to take next. At any time, you can go off blockers, and allow your body to progress through puberty. You can also opt to switch from blockers to hormone replacement therapy (sometimes called “cross-sex hormones⁠ (hormones: Chemicals – via our endocrine system – that send messages across our bodies and brains. They both naturally exist and can also be made in a lab.) ,” a terminology I don’t favor because, among other reasons, all you’re doing is changing the balance of hormones in your body). Once you switch to HRT, you’ll start going through puberty.

Like social transition⁠ (transition: In the context of gender the process of exploring, expressing and affirming your gender, particularly if and when it doesn’t align with a sex you were assigned at birth. ) , hormone blockers are fully reversible. A lot of adults⁠ (adults: People whose age in years exceeds the legal age of majority, people considered to be adults by law, or people who a culture or individual considers to have reached an adult stage of life.) seem to think that they know all about trans kids, and that trans kids will experience “regret” later. They are wrong. An extensive 2024 literature reviewexternal link, opens in a new tab looking at trans kids and hormone blockers found that early intervention is tremendously beneficial for trans youth and another 2024 studyexternal link, opens in a new tab showed that trans youth on blockers had “very high” satisfaction and 97% went on to HRT. Plus, one tremendous advantage of blockers is that you don’t have to go through costly and frustrating transition procedures like top surgery⁠ (top surgery: Surgery to change the shape of the chest in order to reduce gender dysphoria and cause gender euphoria. May involve reducing/removing chest tissue, implanting chest tissue, and/or changing the location of the nipples.) , laser therapy, and so forth later on.

If you are under 18, depending on where you seek treatment, blockers may be the only thing available to you. Before prescribing blockers, your physician will want to meet with you and your family to discuss your needs and determine how much support is available to you during what can be a stressful time.

How are they administered?

You have two options, an injection and an implant. The injection (Leuprolide or Depot Lupron), is delivered once every three months, and your doctor may teach your family to do it at home. If you decide to go off blockers, it’s as simple as not taking your injection and letting your body do its own thing, or stopping blockers and going on HRT. The implant (Suprellin or Histrelin) delivers a slow dose of hormones and needs to be changed annually under local anesthesia (unless you like the thought of a doctor digging through your arm without anesthetic). Patients using the implant⁠ (the implant: Usually, a hormonal contraceptive implant, a long-term from of birth control which is inserted beneath the fat layer of the arm.) can have it removed and start HRT or allow their bodies to start producing hormones on their own.

What are the risks?

Administration of blockers in trans youth is what’s known as an “off label” use of these drugs. While they were recognized as safe after rigorous testing and evaluation, they weren’t designed for kids, and they weren’t tested with puberty suppression in mind. Physicians follow standards developed within their community, rather than by the manufacturer. That means we don’t know all the risks—for example, hormone blockers may have an impact on brain development as well as bone density, because testosterone and estrogen have an influence on these things. There’s not enough research available to show us how trans youth react to blockers, though that will change in coming years. But, we do know that blockers are used very safely and effectively in cis kids as well as cis and trans adults, so the risks are very low.

That’s why it’s particularly important to take them under supervision. A doctor can monitor your health and levels of hormones and other indicators in your blood, as well as talk to you about any emotional changes you may be experiencing. This will help keep you healthier and happier, but it will also add to the overall body of experience and research on blockers, to make them safer for future generations. You should always report side effects, even if you’re afraid your doctor may take you off your blockers. It’s possible you won’t need to stop the medication, and if you do, you may be able to work with your doctor to resolve the problem quickly and pursue an alternate medication—you may be reacting badly to one blocker, but could be fine on another one!