What Are Puberty Blockers And How Do They Work?

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Puberty blockers are hormone blockers that are available as over-the-counter medications to delay the physical changes of puberty in children. Although these medications do not cause permanent changes to a child’s body, they pause the signs of puberty. With the help of these medications, children dealing with precocious puberty can have a normal growth spurt by delaying puberty. Also, children dealing with gender dysmorphia are allowed enough time to decide their gender identity without affecting their mental health.

Read on as we discuss the types, benefits, and side effects of puberty blockers in children and their working mechanisms.

What Are The Types Of Puberty Blockers?

The following types of puberty blockers are available on prescription (1):

  • Histrelin acetate is a flexible rod that can be implanted in the skin of the arm. Its effects usually last a year, after which the rod is removed or replaced.
  • Leuprolide acetate is an injection given once a month or every three or four months, depending on the requirement.

Puberty blockers are not cross-sex hormones, which means they do not contain female or male sex hormones, like estrogen or testosterone. Puberty blocking medications only prevent pubertal changes in children. In contrast, cross-sex hormones are part of hormone therapy, which helps transition children with gender dysphoria from their biological gender to their desired gender and improve their quality of life (2).

Are Puberty Blockers Safe?

The US Food and Drug Administration approves puberty blockers to treat precocious puberty, where the child reaches puberty at a younger age. Most experts agree that puberty blockers are safe. The Endocrine Society and World Professional Association for Transgender Health also support puberty blockers in children who wish to prevent or delay unwanted physical changes (3).

When Should You Start Taking Puberty Blockers?

The ideal age to start puberty blockers may vary depending on the purpose and other individual factors. Usually, these medications are prescribed when the body begins to show signs of puberty (3). However, children with precocious puberty may only receive prescriptions after diagnosis. The results are evident in a month or two in most children.

Children with gender dysphoria may be examined by various specialists, including psychiatrists, to assess if they fit the criteria to receive puberty blockers. After a detailed assessment, children are referred to hormone therapists for treatment, including counseling and training sessions for the families.

Guardians’ informed consent and a court order are often required to treat children with gender dysphoria. Treatment can be obtained through the Gender Identity Development Service (GIDS) or similar organizations in your area (4). Beginning the treatment early can result in better outcomes and reduces the psychological issues caused by physical puberty changes.

How Do Puberty Blockers Work?

Puberty blockers suppress or prevent puberty by blocking the testosterone and estrogen hormones. Since these hormones are responsible for puberty-related changes, blocking them helps delay the following changes related to sexual maturity in children (1):

  • Breast growth
  • Menstruation
  • Widening of hips
  • Facial hair growth
  • Voice deepening

Children can continue to have normal pubertal changes after stopping the use of puberty blockers. Thus, these effects are reversible and temporary. Puberty blockers do not stop acne, underarm and pubic hair growth, and body odor since estrogen and testosterone hormones do not regulate these changes (3).

What Are The Benefits Of Puberty Blockers?

Puberty blockers can delay puberty in children with precocious puberty, allowing them to have normal growth and development. Additionally, children with gender dysphoria can avoid the stress and discomfort caused by the development of secondary sexual characteristics.

The benefits of puberty blockers in children with gender dysphoria may include (5):

  • Reduction of anxiety and depression
  • Elimination of future surgeries and procedures
  • Decrease of actions or thoughts causing self-harm
  • Improved interpersonal relationships and social interactions
  • Improved mental health

Although puberty blockers suppress puberty, they do not ease gender dysphoria. However, this treatment may also allow children enough time to decide whether to continue with their biological gender or desired gender. If the child prefers their biological gender, they can resume puberty by stopping these medications.

Do Puberty Blockers Have Side Effects?

Although these medications are proven safe and effective, some children may experience side effects. The possible long-term side effects of puberty blockers may include (6)

  • Low bone density may occur in some children, possibly increasing the likelihood of fractures. However, calcium and vitamin D supplements, exercise, and regular monitoring of bone mineral levels can help prevent this.
  • Taller adult height may be seen due to growth spurts caused by delayed growth plate closure. Height may also be monitored in the follow-up visits.
  • Underdeveloped genital organs (secondary sexual characteristics) may be seen in some cases, possibly limiting the options for sex reassignment surgeriesin the future.

Some children may experience the following short-term side effects (6):

  • Headache
  • Muscle aches
  • Fatigue
  • Mood swings
  • Changes in body weight
  • Breast tissue changes
  • Spotting or irregular periods if menstruation has begun and has not been fully repressed by puberty blockers

The mental health benefits of puberty blockers often outweigh these risks. Hence, children who want to prevent or delay physical changes often get prescriptions after assessment. Fertility is not affected by puberty blockers alone. However, children who receive cross-hormone therapy after using puberty blockers could permanently damage their fertility (3).

Frequently Asked Questions

1. Do puberty blockers affect the brain?

Gender dysphoria can also affect the brain due to long-standing mental health problems. Research has shown evidence of brain changes in adolescents undergoing therapy with puberty blockers and replacement hormones. However, the evidence from these studies is limited to whether these brain changes are effects of puberty blockers or the expression of secondary sexual characteristics of the desired gender (7).

2. How much do blockers cost?

The cost of puberty blockers may vary depending on the manufacturer and the place of your residence. In the US, puberty-blocking injections can cause nearly $1,200 per month, and implants can cost around $4,500 to $18,000. Estrogen hormone supplements are the least expensive and cost around $4 to $30; male hormone replacement (testosterone) can cost around $20 to $200. You may seek financial aid for these therapies from various organizations (8).

Puberty blockers allow children and families to take time and discover their preferred gender with careful guidance, possibly avoiding future interventions for gender transitions. Seek medical care from approved institutions and practitioners regarding gender reassignment therapy and puberty blockers. It can help prevent side effects and illegal and inappropriate treatments.

Key Pointers

  • Puberty blockers help delay puberty and treat conditions where children reach puberty early.
  • Usually, they are prescribed when the individual begins to present the signs of puberty.
  • Although proven safe, some children experience side effects such as low bone density and underdeveloped genitals.


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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more

Dr. Jessica Madden

Jessica Madden is a pediatrician, neonatologist, lactation consultant, and mother of four, who has been taking care of newborns since 2001. She works as a neonatologist in the NICU at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and founded Primrose Newborn Care, a newborn medicine and “4th trimester” home-visiting and telemedicine practice, in 2018.  Dr. Madden is a Fellow... more