This month, Arkansas became the first state to ban physicians from providing certain types of treatment to transgender youth, including puberty blockers, when its legislature overrode Governor Asa Hutchinson’s attempted veto on April 6. Under the law, called the Save Adolescents from Experimentation (SAFE) Act, healthcare professionals who provide these services to minors risk losing their medical license and make them vulnerable to lawsuits.
The legislation has revitalized battles against puberty blockers in 15 other states, including Florida, Texas and Georgia, while vexing medical and civil rights groups who argue this treatment can be life-saving for young people. But what are puberty blockers, how do they impact an adolescent’s body and why has this long-existing medical treatment suddenly become politicized? If you’re a parent or guardian of a trans child or teen, here’s what you need to know:
What are puberty blockers?
Puberty blockers are medications that temporarily stop the body’s production of testosterone and estrogen. For years, the treatment has helped trans, intersex and nonbinary youth halt changes in their bodies that don’t align with their gender identity. There are two main types of puberty blockers, including histrelin acetate, a flexible rod that goes under the skin of the arm for about one year, and leuprolide acetate, a shot that lasts for one to four months at a time.
How do they work?
According to a 2021 article published in Transgender Health, when an adolescent begins puberty, the hypothalamus in their brain starts producing gonadotropin-releasing hormones. These hormones activate the pituitary gland, which triggers the release of hormones like gonadotropins that cause the maturation of the gonads. As a result, testosterone and estrogen are produced and released from the testes and ovaries. As blockers, histrelin acetate and leuprolide acetate both prevent the pituitary gland from producing gonadotropins, which stops the body from producing the sex hormones that cause the physical effects of puberty. As such, puberty blockers can curb periods, breast growth, voice deepening and facial hair.
Are they safe?
A 2017 study in The Lancet found that suppressing puberty through prescribed blockers is safe. Additionally, many medical professionals and associations, including The American Academy of Pediatrics and the Endocrine Society, have called the treatment medically necessary and life-saving for suicidal trans and nonbinary youth experiencing gender dysphoria, distress that occurs in people whose gender identity differs from their sex assigned at birth. According to a nationwide survey by The Trevor Project, 40 percent of transgender adolescents consider suicide. In 2020, a study in the journal Pediatrics found that transgender individuals who received puberty blockers during adolescence have a lower risk of suicidal thoughts as adults than those who wanted the medication but could not access them.
Are they reversible?
Puberty blockers pause the production of testosterone and estrogen hormones. As such, when someone stops taking the medication, their body will produce the hormones and experience bodily changes like breasts, facial hair or a deepening voice. While this process of reversal is easy, forcing a trans adolescent into puberty without their consent can beget permanent changes that can only partially be reversed through pricey and painful medical treatments or surgical procedures later in life.
Why are states banning them?
For decades, blockers have been used to delay puberty in youth who start too early or who are intersex. The recent politicization of the medical treatment, and the growing number of states introducing legislation to ban such treatment to minors, reflects a swelling movement to limit transgender rights throughout the country. Critics of puberty blockers maintain they’re concerned about the health risks of the medication, which has already been deemed safe, and want to protect youth from decisions they will allegedly regret. Medical experts, however, describe these bans as “sabotage.” They argue that puberty blockers are a careful approach that slows the development of sex characteristics and gives youth experiencing gender dysphoria time to consult with doctors, therapists and social workers for months, or even years, so that they can confidently and safely make their own decisions about their bodies and lives.
