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 blockers 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 hormones from the pituitary gland, thus putting a pause on puberty. More precisely, they suppress luteinizing hormone (LH) and follicle stimulating hormone (FSH), the hormones responsible for triggering the production of estrogen and testosterone. Patients on blockers won’t go through puberty and develop tell-tale signs like breasts, larger testes, more body hair, and fat redistribution.
Here’s the cool thing about blockers: they let you take a developmental time out. 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,” a terminology I don’t favor because, among other reasons, all you’re doing is replacing the hormones your body doesn’t produce naturally). Once you switch to HRT, you’ll start going through puberty.
Like social transition, hormone blockers are fully reversible. A lot of adults seem to think that they know all about trans kids, and that trans kids will experience “regret” later. They are wrong. Researchers at Northwestern University conducted an extensive research review looking at trans kids and hormone blockers, and they found that early intervention is tremendously beneficial for trans youth. Plus, one tremendous advantage of blockers is that you don’t have to go through costly and frustrating transition procedures like top surgery, 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 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.
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!