{{Short description|Medication used to inhibit puberty}} {{redirect|Hormone blocker|testosterone blockers|Antiandrogen|estrogen blockers|Aromatase inhibitor}} {{protection padlock|small=yes}} <!-- minor edit copyright response --> {{Use dmy dates|date=October 2022}} {{CS1 config|name-list-style=vanc|display-authors=6|mode=cs1}} {{Transgender sidebar|medicine}}
'''Puberty blockers''' (also called '''puberty inhibitors''' or '''hormone blockers''') are medicines used to postpone puberty. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens (e.g. testosterone) and estrogens (e.g. estradiol).<ref name="Hemat2003">{{cite book |vauthors=Hemat RA |title=Andropathy |url=https://books.google.com/books?id=hfwlDwAAQBAJ&pg=PA120 |date=2 March 2003 |publisher=Urotext |isbn=978-1-903737-08-8 |pages=120–}}</ref><ref name="Becker2001">{{cite book |vauthors=Becker KL |title=Principles and Practice of Endocrinology and Metabolism |url=https://books.google.com/books?id=FVfzRvaucq8C&pg=PA973 |year=2001 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-1750-2 |pages=973–}}</ref><ref name="mayo">{{cite web |title=Pubertal blockers for transgender and gender diverse youth |url=https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075 |publisher=Mayo Clinic |access-date=15 December 2020 |language=en |date=16 August 2019 |archive-date=31 December 2022 |archive-url=https://web.archive.org/web/20221231124156/https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075 |url-status=live}}</ref> Puberty blockers are used to delay puberty in children with precocious puberty. They are also used to delay the development of unwanted secondary sex characteristics in transgender youth,<ref name="Stevens_2015">{{cite journal |vauthors=Stevens J, Gomez-Lobo V, Pine-Twaddell E |title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth |journal=Pediatrics |volume=136 |issue=6 |pages=1029–1031 |date=December 2015 |pmid=26527547 |doi=10.1542/peds.2015-2849 |doi-access=free}}</ref> so as to allow them more time to explore their gender identity<ref name="Alegría_2016">{{cite journal |vauthors=Alegría CA |title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice |journal=Journal of the American Association of Nurse Practitioners |volume=28 |issue=10 |pages=521–527 |date=October 2016 |pmid=27031444 |doi=10.1002/2327-6924.12363 |s2cid=22374099}}</ref> under what became known as the Dutch Protocol.<ref name="cassreview2" />
The use of puberty blockers is supported by the Endocrine Society<ref>{{cite web |url=https://www.news-medical.net/news/20210415/Endocrine-Society-opposes-legislative-efforts-to-prevent-access-to-medical-care-for-transgender-youth.aspx |title=Endocrine Society opposes legislative efforts to prevent access to medical care for transgender youth |date=15 April 2021 |work=Endocrine Society |access-date=18 May 2022 |archive-date=23 October 2022 |archive-url=https://web.archive.org/web/20221023125231/https://www.news-medical.net/news/20210415/Endocrine-Society-opposes-legislative-efforts-to-prevent-access-to-medical-care-for-transgender-youth.aspx |url-status=live}}</ref> and the World Professional Association for Transgender Health (WPATH).<ref>{{cite web |title=USPATH Position Statement on Legislative and Executive Actions Regarding the Medical Care of Transgender Youth |date=22 April 2022 |work=US Professional Association for Transgender Health (USPATH) |url=https://www.wpath.org/media/cms/Documents/USPATH/2022/With%20Date%20Position%20Statement%20Anti%20Trans%20Leg%20USPATH%20Apr%2022%202022.pdf?_t=1650665621 |access-date=18 May 2022 |archive-date=10 November 2022 |archive-url=https://web.archive.org/web/20221110095305/https://www.wpath.org/media/cms/Documents/USPATH/2022/With%20Date%20Position%20Statement%20Anti%20Trans%20Leg%20USPATH%20Apr%2022%202022.pdf?_t=1650665621 |url-status=live}}</ref> In the United States, twelve major American medical associations, including the American Medical Association,<ref>{{cite web |url=https://www.ama-assn.org/health-care-advocacy/advocacy-update/march-26-2021-state-advocacy-update |title=State Advocacy Update |date=26 March 2021 |work=American Medical Association |access-date=18 May 2022 |archive-date=2 December 2022 |archive-url=https://web.archive.org/web/20221202203754/https://www.ama-assn.org/health-care-advocacy/advocacy-update/march-26-2021-state-advocacy-update |url-status=live}}</ref> the American Psychological Association,<ref>{{cite web |title=Criminalizing Gender Affirmative Care with Minors |url=https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care |archive-url=https://web.archive.org/web/20220407083327/https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care |archive-date=April 7, 2022 |access-date=2024-06-20 |website=APA}}</ref> and the American Academy of Pediatrics support the use of puberty blockers.<ref>{{cite journal |vauthors=Wyckoff AS |title=AAP continues to support care of transgender youths as more states push restrictions |url=https://publications.aap.org/aapnews/news/19021/AAP-continues-to-support-care-of-transgender |access-date=2024-06-20 |journal=AAP |date=6 January 2022 |archive-date=18 December 2022 |archive-url=https://web.archive.org/web/20221218163549/https://publications.aap.org/aapnews/news/19021/AAP-continues-to-support-care-of-transgender |url-status=live}}</ref> In Australia, four medical organizations support them.<ref name="Parents of Gender Diverse Children" />
In the 2020s, the provision of puberty blockers for gender dysphoria in children has become the subject of public controversy, with the United Kingdom stopping the routine prescription of puberty blockers<ref name="BBC_News_2024" /><ref>{{cite web |title=Ban on puberty blockers to be made indefinite on experts advice |url=https://www.gov.uk/government/news/ban-on-puberty-blockers-to-be-made-indefinite-on-experts-advice |date=2024-12-11 |access-date=2026-01-19 |website=Gov.uk |language=en}}</ref> and some states of the United States making their use a criminal offense.<ref name="Barnes">{{Cite web |last=Barnes |first=Hannah |date=2024-05-30 |title=The government's 11th-hour ban on puberty blockers |url=https://www.newstatesman.com/politics/health/2024/05/government-11th-hour-ban-puberty-blockers-gender |access-date=2024-08-20 |website=New Statesman |language=en-US |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802152433/https://www.newstatesman.com/politics/health/2024/05/government-11th-hour-ban-puberty-blockers-gender |url-status=live}}</ref><ref>{{cite web |vauthors=Choi A, Mullery W |date=2023-06-06 |title=19 states have laws restricting gender-affirming care, some with the possibility of a felony charge |url=https://www.cnn.com/2023/06/06/politics/states-banned-medical-transitioning-for-transgender-youth-dg/index.html |access-date=2023-09-17 |website=CNN |language=en |archive-date=4 August 2023 |archive-url=https://web.archive.org/web/20230804215535/https://www.cnn.com/2023/06/06/politics/states-banned-medical-transitioning-for-transgender-youth-dg/index.html |url-status=live}}</ref><ref>{{cite web |title=Map: Where gender-affirming care is being targeted in the US |vauthors=Alfonseca K |url=https://abcnews.go.com/US/map-gender-affirming-care-targeted-us/story?id=97443087 |date=22 May 2023 |access-date=2023-08-14 |website=ABC News |language=en |archive-date=24 May 2023 |archive-url=https://web.archive.org/web/20230524053447/https://abcnews.go.com/US/map-gender-affirming-care-targeted-us/story?id=97443087 |url-status=live}}</ref> In 2022, Sweden released updated national guidelines stating that puberty blockers should be limited to "exceptional cases".<ref name=":NBHW2"/> However, the guidelines do not constitute a ban.<ref name="politifact"/>
==Medical uses== {{See also|GnRH agonist#Medical uses|Gender-affirming care}}
Puberty blockers prevent the development of biological secondary sex characteristics.<ref name="Boyar_2003">{{cite journal |vauthors=Boyar RM |title=Control of the onset of puberty |journal=Annual Review of Medicine |volume=29 |pages=509–520 |date=November 2003 |pmid=206190 |doi=10.1146/annurev.me.29.020178.002453}}</ref> The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.<ref>{{cite journal |vauthors=Helyar S, Jackson L, Patrick L, Hill A, Ion R |title=Gender Dysphoria in children and young people: The implications for clinical staff of the Bell V's Tavistock Judicial Review and Appeal Ruling |journal=Journal of Clinical Nursing |volume=31 |issue=9–10 |pages=e11–e13 |date=May 2022 |pmid=34888970 |doi=10.1111/jocn.16164 |s2cid=245029743 |doi-access=free}}</ref><ref name="pmid25667370">{{cite journal |vauthors=Watson SE, Greene A, Lewis K, Eugster EA |title=BIRD'S-EYE VIEW OF GnRH ANALOG USE IN A PEDIATRIC ENDOCRINOLOGY REFERRAL CENTER |journal=Endocrine Practice |volume=21 |issue=6 |pages=586–589 |date=June 2015 |pmid=25667370 |pmc=5344188 |doi=10.4158/EP14412.OR}}</ref><ref name="pmid25342997">{{cite journal |vauthors=Panday K, Gona A, Humphrey MB |title=Medication-induced osteoporosis: screening and treatment strategies |journal=Therapeutic Advances in Musculoskeletal Disease |volume=6 |issue=5 |pages=185–202 |date=October 2014 |pmid=25342997 |pmc=4206646 |doi=10.1177/1759720X14546350}}</ref>
===Precocious puberty=== Puberty blockers are commonly used to delay puberty in children with precocious puberty, a condition that activates the hypothalamic-pituitary-gonadal axis prematurely and initiates puberty at an inappropriate age.<ref>{{cite journal |vauthors=Mul D, Hughes IA |title=The use of GnRH agonists in precocious puberty |journal=European Journal of Endocrinology |volume=159 |issue=suppl_1 |pages=S3–S8 |date=December 2008 |pmid=19064674 |doi=10.1530/EJE-08-0814}}</ref> The main goal of treatment is to preserve children's adult height potential.<ref>{{cite journal |vauthors=Aguirre RS, Eugster EA |title=Central precocious puberty: From genetics to treatment |journal=Best Practice & Research. Clinical Endocrinology & Metabolism |volume=32 |issue=4 |pages=343–354 |date=August 2018 |pmid=30086862 |doi=10.1016/j.beem.2018.05.008 |series=Issue Update in paediatric endocrinology |hdl=1805/16522 |hdl-access=free}}</ref>
Puberty blockers work by stabilizing puberty symptoms, decreasing growth velocity, and slowing skeletal maturation.<ref>{{cite journal |vauthors=Latronico AC, Brito VN, Carel JC |title=Causes, diagnosis, and treatment of central precocious puberty |journal=The Lancet. Diabetes & Endocrinology |volume=4 |issue=3 |pages=265–274 |date=March 2016 |pmid=26852255 |doi=10.1016/S2213-8587(15)00380-0}}</ref> The outcomes of treatment are assessed in terms of height, reproduction, metabolic, and psychosocial measures. The most pronounced effects on height have been seen in children experiencing the onset of puberty before 6 years of age; however there is variability in height outcomes across studies which can be attributed to varying study designs, time of symptom presentation, and time of treatment termination.<ref>{{cite journal |vauthors=Fuqua JS |title=Treatment and outcomes of precocious puberty: an update |journal=The Journal of Clinical Endocrinology and Metabolism |volume=98 |issue=6 |pages=2198–2207 |date=June 2013 |pmid=23515450 |doi=10.1210/jc.2013-1024}}</ref>
A study investigating the effects of puberty blockers on reproductive health showed no significant difference in the number of irregular menstrual cycles, pregnancies, or pregnancy outcomes between women who received treatment for precocious puberty and those who opted out of treatment.<ref>{{cite journal |vauthors=Magiakou MA, Manousaki D, Papadaki M, Hadjidakis D, Levidou G, Vakaki M, Papaefstathiou A, Lalioti N, Kanaka-Gantenbein C, Piaditis G, Chrousos GP, Dacou-Voutetakis C |title=The efficacy and safety of gonadotropin-releasing hormone analog treatment in childhood and adolescence: a single center, long-term follow-up study |journal=The Journal of Clinical Endocrinology and Metabolism |volume=95 |issue=1 |pages=109–117 |date=January 2010 |pmid=19897682 |doi=10.1210/jc.2009-0793 |doi-access=free}}</ref> In terms of psychosocial markers, children diagnosed with precocious puberty have shown body image concerns and demonstrated poor emotional regulation and high anxiety.<ref>{{cite journal |vauthors=López-Miralles M, Lacomba-Trejo L, Valero-Moreno S, Benavides G, Pérez-Marín M |title=Psychological aspects of pre-adolescents or adolescents with precocious puberty: A systematic review |journal=Journal of Pediatric Nursing |volume=64 |pages=e61–e68 |date=May 2022 |pmid=35033399 |doi=10.1016/j.pedn.2022.01.002 |doi-access=free|hdl=10550/81423 |hdl-access=free }}</ref> Individuals with precocious puberty, early adrenarche, and early normal puberty show less stress after treatment compared to individuals without preexisting developmental conditions.<ref>{{cite journal |vauthors=Menk TA, Inácio M, Macedo DB, Bessa DS, Latronico AC, Mendonca BB, Brito VN |title=Assessment of stress levels in girls with central precocious puberty before and during long-acting gonadotropin-releasing hormone agonist treatment: a pilot study |journal=Journal of Pediatric Endocrinology & Metabolism |volume=30 |issue=6 |pages=657–662 |date=May 2017 |pmid=28599388 |doi=10.1515/jpem-2016-0425}}</ref>
Overall, puberty blockers have demonstrated an excellent safety and efficacy profile for treating precocious puberty. The most common side effects reported include nonspecific headaches, hot flashes, and implant-related skin reactions.<ref>{{cite journal |vauthors=Lewis KA, Eugster EA |title=Experience with the once-yearly histrelin (GnRHa) subcutaneous implant in the treatment of central precocious puberty |language=English |journal=Drug Design, Development and Therapy |volume=3 |pages=1–5 |date=September 2009 |pmid=19920916 |doi=10.2147/DDDT.S3298 |doi-access=free |pmc=2769233}}</ref>
=== Gender dysphoria === {{anchor|Gender dysphoria|Gender incongruence|Dutch Protocol}} Puberty blockers are sometimes prescribed to young transgender people with gender dysphoria to temporarily halt the development of secondary sex characteristics.<ref name="Rew_2021" /> While there is evidence to suggest transgender youth may benefit from gender-affirming hormone therapy (HRT) even at early puberty,<ref>{{cite journal |vauthors= Chen D, Berona J, Chan YM, Ehrensaft D, Garofalo R, Hidalgo MA, Rosenthal SM, Tishelman AC, Olson-Kennedy J|date= 2023|title= Psychosocial Functioning in Transgender Youth after 2 Years of Hormones|journal= The New England Journal of Medicine|volume= 388|issue= 3|pages= 240–250|doi= 10.1056/NEJMoa2206297|pmid= 36652355|pmc= 10081536}}</ref><ref>{{cite journal |vauthors= Telfer MM, Tollit MA, Pace CC, Pang KC|date= 2023|title= Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents Version 1.4|url= https://auspath.org.au/wp-content/uploads/2024/02/230242-RCH-Gender-Standards-Booklet-1.4_Nov-2023_WEB.final_.pdf|journal= Melbourne: The Royal Children's Hospital|access-date=2025-01-25}}</ref><ref name="SOC8"/> there may be restrictions on prescribing HRT at younger ages.<ref name="SOC8">{{cite journal |vauthors=Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HF, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TL, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BP, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J |year=2022 |title=Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 |journal=International Journal of Transgender Health |volume=23 |issue=Suppl 1 |pages=S1–S259 |doi=10.1080/26895269.2022.2100644 |pmc=9553112 |pmid=36238954}}</ref> Puberty blockers are intended to allow patients more time to solidify their gender identity and give them a smoother transition into their desired gender identity as an adult.<ref name="Alegría_2016" /> If a child later decides not to transition, the medication can be stopped and puberty will proceed.
The "Dutch Protocol" is the first known example of the use of puberty blockers to treat gender dysphoria in children. It was developed by Peggy Cohen-Kettenis in the 1990s.<ref name="cassreview2">{{cite web |vauthors=Cass H |date=2024 |title=Final Report |location=U.K. |work=The Cass Review |publisher=National Health Service |url=https://cass.independent-review.uk/home/publications/final-report/ |access-date=2024-04-20 |archive-date=9 April 2024 |archive-url=https://web.archive.org/web/20240409231432/https://cass.independent-review.uk/home/publications/final-report/ |url-status=live}}</ref> The initial article describing the Dutch Protocol stated that the treatment was reversible and that a study of 54 children showed evidence that it had an overall positive outcome for those treated.<ref name="dutchprot">{{cite journal |last1=Delemarre-van de Waal |first1=Henriette A. |last2=Cohen-Kettenis |first2=Peggy T. |title=Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects |journal=European Journal of Endocrinology |date=November 2006 |volume=155 |pages=S131–S137 |doi=10.1530/eje.1.02231}}</ref><ref name="Biggs2023">{{cite journal |vauthors=Biggs M |title=The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence |journal=Journal of Sex & Marital Therapy |volume=49 |issue=4 |pages=348–368 |date=2023-05-19 |pmid=36120756 |doi=10.1080/0092623X.2022.2121238|doi-access=free }}</ref> A number of subsequent studies supported the treatment as safe and effective at delaying development of secondary sexual characteristics, and it became the standard treatment in the field.<ref name="Clinical management of gender dysph">{{cite journal |vauthors=de Vries AL, Cohen-Kettenis PT |title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach |journal=Journal of Homosexuality |volume=59 |issue=3 |pages=301–320 |date=March 2012 |pmid=22455322 |doi=10.1080/00918369.2012.653300}}</ref>
==== Research ==== Studies examining the effects of puberty blockers for gender non-conforming and transgender adolescents have indicated that these treatments are reasonably safe and reversible.<ref name="Rew_2021">{{cite journal |vauthors=Rew L, Young CC, Monge M, Bogucka R |title=Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature |journal=Child and Adolescent Mental Health |volume=26 |issue=1 |pages=3–14 |date=February 2021 |pmid=33320999 |doi=10.1111/camh.12437 |s2cid=229282305}}</ref><ref name="rafferty_2018">{{cite journal |vauthors=Rafferty J |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |volume=142 |issue=4 |article-number=e20182162 |date=October 2018 |pmid=30224363 |doi=10.1542/peds.2018-2162 |quote=The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood. |doi-access=free}}</ref><ref name="Hembree_quote1">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology and Metabolism |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains. |doi-access=free}}</ref><ref name="Tornese-quote1">{{cite journal |last1=Tornese |first1=Gianluca |last2=Di Mase |first2=Raffaella |last3=Munarin |first3=Jessica |last4=Ciancia |first4=Silvia |last5=Santamaria |first5=Fabiana |last6=Fava |first6=Daniela |last7=Candela |first7=Egidio |last8=Capalbo |first8=Donatella |last9=Ungaro |first9=Carla |last10=Improda |first10=Nicola |last11=Diana |first11=Pierluigi |last12=Matarazzo |first12=Patrizia |last13=Guazzarotti |first13=Laura |last14=Toschetti |first14=Tommaso |last15=Sambati |first15=Vanessa |last16=Tamaro |first16=Gianluca |last17=Bresciani |first17=Giulia |last18=Licenziati |first18=Maria Rosaria |last19=Street |first19=Maria Elisabeth |last20=Aversa |first20=Tommaso |last21=Delvecchio |first21=Maurizio |last22=Faienza |first22=Maria Felicia |last23=Iughetti |first23=Lorenzo |last24=Calcaterra |first24=Valeria |last25=de Sanctis |first25=Luisa |last26=Salerno |first26=Mariacarolina |last27=Franceschi |first27=Roberto |title=Use of gonadotropin-releasing hormone agonists in transgender and gender diverse youth: a systematic review |journal=Frontiers in Endocrinology |date=14 May 2025 |volume=16 |article-number=1555186 |doi=10.3389/fendo.2025.1555186 |pmid=40438403 |pmc=12116301 |doi-access=free |quote=GnRHa is effective in halting puberty and improving mental health in TGD adolescents.}}</ref> While research on long-term effects remains limited,<ref>{{Cite journal |last1=Herrera Jerez |first1=M. J. |last2=Castro-Peraza |first2=M. E. |last3=Delgado Morales |first3=N. M. |last4=Arias Rodriguez |first4=A. |date=2024-12-20 |title=Use of Hormone Blockers in Transgender Teenagers: A Scoping Review |journal=Nursing Reports (Pavia, Italy) |volume=14 |issue=4 |pages=4109–4118 |doi=10.3390/nursrep14040299 |doi-access=free |issn=2039-4403 |pmc=11676889 |pmid=39728660}}</ref><ref name="Taylor_2024" /> especially regarding bone health, cognitive function, and fertility, available evidence supports the use of puberty blockers as part of gender-affirming care, as these treatments can improve psychological well-being in trans individuals.<ref name="Rew_2021">{{cite journal |vauthors=Rew L, Young CC, Monge M, Bogucka R |title=Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature |journal=Child and Adolescent Mental Health |volume=26 |issue=1 |pages=3–14 |date=February 2021 |pmid=33320999 |doi=10.1111/camh.12437 |s2cid=229282305}}</ref><ref name="rafferty_2018">{{cite journal |vauthors=Rafferty J |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |volume=142 |issue=4 |article-number=e20182162 |date=October 2018 |pmid=30224363 |doi=10.1542/peds.2018-2162 |quote=The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood. |doi-access=free}}</ref><ref name="Hembree_quote1">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology and Metabolism |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains. |doi-access=free}}</ref><ref name="Tornese-quote1">{{cite journal |last1=Tornese |first1=Gianluca |last2=Di Mase |first2=Raffaella |last3=Munarin |first3=Jessica |last4=Ciancia |first4=Silvia |last5=Santamaria |first5=Fabiana |last6=Fava |first6=Daniela |last7=Candela |first7=Egidio |last8=Capalbo |first8=Donatella |last9=Ungaro |first9=Carla |last10=Improda |first10=Nicola |last11=Diana |first11=Pierluigi |last12=Matarazzo |first12=Patrizia |last13=Guazzarotti |first13=Laura |last14=Toschetti |first14=Tommaso |last15=Sambati |first15=Vanessa |last16=Tamaro |first16=Gianluca |last17=Bresciani |first17=Giulia |last18=Licenziati |first18=Maria Rosaria |last19=Street |first19=Maria Elisabeth |last20=Aversa |first20=Tommaso |last21=Delvecchio |first21=Maurizio |last22=Faienza |first22=Maria Felicia |last23=Iughetti |first23=Lorenzo |last24=Calcaterra |first24=Valeria |last25=de Sanctis |first25=Luisa |last26=Salerno |first26=Mariacarolina |last27=Franceschi |first27=Roberto |title=Use of gonadotropin-releasing hormone agonists in transgender and gender diverse youth: a systematic review |journal=Frontiers in Endocrinology |date=14 May 2025 |volume=16 |article-number=1555186 |doi=10.3389/fendo.2025.1555186 |pmid=40438403 |pmc=12116301 |doi-access=free |quote=GnRHa is effective in halting puberty and improving mental health in TGD adolescents.}}</ref> Treatment of transgender adolescents with puberty blockers, especially when followed by gender-affirming hormone therapy, has been shown to reduce depression, anxiety, and suicidality.<ref name="Tornese-quote2">{{cite journal |last1=Tornese |first1=Gianluca |last2=Di Mase |first2=Raffaella |last3=Munarin |first3=Jessica |last4=Ciancia |first4=Silvia |last5=Santamaria |first5=Fabiana |last6=Fava |first6=Daniela |last7=Candela |first7=Egidio |last8=Capalbo |first8=Donatella |last9=Ungaro |first9=Carla |last10=Improda |first10=Nicola |last11=Diana |first11=Pierluigi |last12=Matarazzo |first12=Patrizia |last13=Guazzarotti |first13=Laura |last14=Toschetti |first14=Tommaso |last15=Sambati |first15=Vanessa |last16=Tamaro |first16=Gianluca |last17=Bresciani |first17=Giulia |last18=Licenziati |first18=Maria Rosaria |last19=Street |first19=Maria Elisabeth |last20=Aversa |first20=Tommaso |last21=Delvecchio |first21=Maurizio |last22=Faienza |first22=Maria Felicia |last23=Iughetti |first23=Lorenzo |last24=Calcaterra |first24=Valeria |last25=de Sanctis |first25=Luisa |last26=Salerno |first26=Mariacarolina |last27=Franceschi |first27=Roberto |title=Use of gonadotropin-releasing hormone agonists in transgender and gender diverse youth: a systematic review |journal=Frontiers in Endocrinology |date=14 May 2025 |volume=16 |article-number=1555186 |doi=10.3389/fendo.2025.1555186 |pmid=40438403 |doi-access=free |quote=Mental health improved significantly, including reduced depression, anxiety, and suicidality—especially when GnRHa was followed by gender-affirming hormone therapy (GAHT).|pmc=12116301 }}</ref> The World Professional Association for Transgender Health's Standards of Care 8, published in 2022, declared puberty-blocking medication to be medically necessary and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, because longitudinal data shows improved outcomes for transgender patients who receive them.<ref name="SOC8" />
A 2014 longitudinal study followed 55 young transgender adults (22 trans women and 33 trans men) over the entire duration of their puberty. Participants were assessed prior to puberty suppression around mean age 13-14, followed by another assessment at the beginning of gender-affirming hormones being introduced around mean age 16-17 and a post-adolescence review following a year or longer after gender-affirming surgery at a mean age of 20-21. The results of the longitudinal study found that gender dysphoria decreased and psychological health steadily improved and concluded that a multidisciplinary team of mental health professionals working together with physicians and surgeons and informed administration of puberty blockers, followed by cross-sex hormones and gender affirming surgery led to positive health outcomes, mental and physical for study participants.<ref name="SOC8"/><ref>{{cite journal |last1=de Vries |first1=Annelou L. C. |last2=McGuire |first2=Jenifer K. |last3=Steensma |first3=Thomas D. |last4=Wagenaar |first4=Eva C. F. |last5=Doreleijers |first5=Theo A. H. |last6=Cohen-Kettenis |first6=Peggy T. |title=Young adult psychological outcome after puberty suppression and gender reassignment |journal=Pediatrics |date=October 2014 |volume=134 |issue=4 |pages=696–704 |doi=10.1542/peds.2013-2958 |pmid=25201798 |issn=1098-4275}}</ref>
A 2022 study published in the ''Journal of the American Medical Association'' found a 60% reduction in depression and 73% reduction in suicidality in transgender patients prescribed puberty blockers or gender affirming hormones.<ref>{{Cite journal |last1=Tordoff |first1=Diana M. |last2=Wanta |first2=Jonathon W. |last3=Collin |first3=Arin |last4=Stepney |first4=Cesalie |last5=Inwards-Breland |first5=David J. |last6=Ahrens |first6=Kym |date=2022-02-01 |title=Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care |journal=JAMA Network Open |volume=5 |issue=2 |pages=e220978 |doi=10.1001/jamanetworkopen.2022.0978 |issn=2574-3805 |pmc=8881768 |pmid=35212746}}</ref>
In September 2024, the New South Wales government in Australia released an independent review into puberty blockers that they commissioned which found that the benefits of puberty blockers (including positive results relating to body image, gender dysphoria, depression, anxiety, suicide risk, quality of life, and cognitive function) outweigh any possible risks. The review concluded that puberty blockers are "safe, effective and reversible".<ref name="Sax"/><ref name=":6">{{Cite web |title=Puberty blockers are 'safe, effective and reversible', independent study finds |url=https://www.thepinknews.com/2024/09/10/puberty-blockers-safe/ |access-date=September 10, 2024 |website=PinkNews |date=10 September 2024 |language=en |archive-date=10 October 2024 |archive-url=https://web.archive.org/web/20241010042516/https://www.thepinknews.com/2024/09/10/puberty-blockers-safe/ |url-status=live }}</ref>
A multi-year study published in September 2024 found that restrictions to transgender care, including restriction on access to gender-affirming puberty blockers, showed a direct link to negative mental health outcomes for transgender youth. The study followed the enactment of several laws in US states on restricting such access, which led to an increase of suicide attempts of 7-72% in transgender youth within one to two years following the enactment of laws restricting access.<ref name="nature2">{{cite journal |last1=Lee |first1=W.Y. |last2=Hobbs |first2=J.N. |last3=Hobaica |first3=S |last4=DeChants |first4=J.P. |last5=Price |first5=M.N. |last6=Nath |first6=R |date=26 September 2024 |title=State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA |url=https://www.nature.com/articles/s41562-024-01979-5 |url-status=live |journal=Nature Human Behaviour |volume=8 |issue=11 |pages=2096–2106 |doi=10.1038/s41562-024-01979-5 |pmid=39327480 |url-access=subscription |archive-url=https://web.archive.org/web/20240928224220/https://www.nature.com/articles/s41562-024-01979-5 |archive-date=28 September 2024 |access-date=29 September 2024}}</ref><ref name="nprsuicide2">{{cite web |date=26 September 2024 |title=More trans teens attempted suicide after states passed anti-trans laws, a study shows |url=https://www.npr.org/sections/shots-health-news/2024/09/25/nx-s1-5127347/more-trans-teens-attempted-suicide-after-states-passed-anti-trans-laws-a-study-shows |url-status=live |archive-url=https://web.archive.org/web/20240927230731/https://www.npr.org/sections/shots-health-news/2024/09/25/nx-s1-5127347/more-trans-teens-attempted-suicide-after-states-passed-anti-trans-laws-a-study-shows |archive-date=27 September 2024 |access-date=29 September 2024 |website=NPR}}</ref>
A 2024 systematic review, which ranked studies it analyzed into quality buckets, found that synthesis of the available "moderate-quality and high-quality studies showed consistent evidence demonstrating efficacy for suppressing puberty." The review noted that there was limited, or inconsistent evidence in other regards, saying that they could not draw conclusions on the "impact on gender dysphoria, mental and psychosocial health or cognitive development." The review noted a current lack of high-quality research on puberty blockers in adolescence experiencing gender dysphoria and that "large well- designed research is needed" to better inform this area for the future.<ref name="Taylor_2024" />
In January 2025, a systematic review led by Gordon Guyatt found the evidence surrounding puberty blockers to be of low certainty in relation to global function, depression, gender dysphoria, bone mineral density, and progression to cross-sex hormones. Some studies showed improvements while others showed little to no change. Guyatt said that he was worried the results would be misused to justify denying blockers to trans youth seeking them, that banning care based on the evidence being low certainty was "a clear violation of the principles of evidence-based shared decision-making and is unconscionable", and that patient autonomy should be supported.<ref>{{Cite journal |last1=Miroshnychenko |first1=Anna |last2=Roldan |first2=Yetiani |last3=Ibrahim |first3=Sara |last4=Kulatunga-Moruzi |first4=Chan |last5=Montante |first5=Steven |last6=Couban |first6=Rachel |last7=Guyatt |first7=Gordon |last8=Brignardello-Petersen |first8=Romina |date=2025-01-30 |title=Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis |journal=Archives of Disease in Childhood |volume=110 |issue=6 |pages=429–436 |language=en |doi=10.1136/archdischild-2024-327909 |issn=0003-9888 |pmid=39855724|doi-access=free |pmc=12171406 }}</ref><ref>{{Cite news |date=2025-02-28 |title=New Study Finds Evidence on Puberty Blockers Is Uncertain |url=https://www.psychreg.org/new-study-finds-evidence-puberty-blockers-uncertain/ |access-date=2025-04-14 |work=PsychReg |language=en-GB}}</ref>
In May 2025, a systematic review on the use of puberty blockers in adolescents was published in ''Frontiers in Endocrinology''. It found that puberty blockers led to "significantly improved" mental health outcomes, "especially when GnRHa was followed by gender-affirming hormone therapy." The review said that "key clinical and ethical considerations—such as bone health monitoring, fertility counseling, psychological support, and informed decision-making—must guide treatment." The review recommends gender-affirming care such as puberty blockers for adolescents, along with professional mental health support. It also recommended further longitudinal studies to support safe and individualized care, noting the current lack of long-term data and a need for further study, highlighting areas of fertility preservation and skeletal health.<ref>{{Cite journal |last1=Tornese |first1=Gianluca |last2=Di Mase |first2=Raffaella |last3=Munarin |first3=Jessica |last4=Ciancia |first4=Silvia |last5=Santamaria |first5=Fabiana |last6=Fava |first6=Daniela |last7=Candela |first7=Egidio |last8=Capalbo |first8=Donatella |last9=Ungaro |first9=Carla |last10=Improda |first10=Nicola |last11=Diana |first11=Pierluigi |last12=Matarazzo |first12=Patrizia |last13=Guazzarotti |first13=Laura |last14=Toschetti |first14=Tommaso |last15=Sambati |first15=Vanessa |date=2025 |title=Use of gonadotropin-releasing hormone agonists in transgender and gender diverse youth: a systematic review |journal=Frontiers in Endocrinology |volume=16 |article-number=1555186 |doi=10.3389/fendo.2025.1555186 |doi-access=free |issn=1664-2392 |pmc=12116301 |pmid=40438403}}</ref>
==== Informed consent ==== {{main|Informed consent}}
Many medical groups recommend administration of gender-affirming health care under an informed consent model, which helps patients make an informed decision about the benefits and potential risks associated with treatment, such as puberty blockers.<ref name="SOC8"/> Medical researchers continue building on the discussion on informed consent. A 2019 study recommended that a "multidisciplinary approach" is necessary "to ensure meaningful consent" is acquired and treatment is initiated with a strong ethical foundation.<ref name="pmid306552662">{{cite journal |vauthors=Butler G, Wren B, Carmichael P |date=June 2019 |title=Puberty blocking in gender dysphoria: suitable for all? |journal=Archives of Disease in Childhood |volume=104 |issue=6 |pages=509–510 |doi=10.1136/archdischild-2018-315984 |pmid=30655266 |s2cid=58539498}}</ref> A 2021 editorial adds a pragmatic perspective, claiming that "disproportionate emphasis is given to young people's inability to provide medical consent" and that "what matters ethically is whether an individual has a good enough reason for wanting treatment".<ref name="Lancet 2021-05-142">{{cite journal |department=Editorial |date=June 2021 |title=A flawed agenda for trans youth |journal=The Lancet Child & Adolescent Health |volume=5 |issue=6 |page=385 |doi=10.1016/S2352-4642(21)00139-5 |pmid=34000232 |s2cid=234769856 |doi-access=free}}</ref> Bioethicist Maura Priest shares this perspective. She claims that even in the absence of parental permission, the use of puberty blockers could mitigate any adverse effects on familial relationships within the home of a transgender child and that the psychological costs associated with untreated gender dysphoria in children are avoidable.<ref name="Priest_20192" /> Another bioethicist, Florence Ashley, adds that counseling and educating the parents of transgender youth could also be beneficial to familial relationships.<ref name="pmid307843862">{{cite journal |vauthors=Ashley F |date=February 2019 |title=Puberty Blockers Are Necessary, but They Don't Prevent Homelessness: Caring for Transgender Youth by Supporting Unsupportive Parents |journal=The American Journal of Bioethics |volume=19 |issue=2 |pages=87–89 |doi=10.1080/15265161.2018.1557277 |pmid=30784386 |s2cid=73478358}}</ref>
== Types == Puberty blocker medications are used to delay the physical changes associated with puberty. The most common type of puberty blockers are gonadotropin-releasing hormone (GnRH) antagonists, such as leuprolide acetate and histrelin acetate, which suppress the release of sex hormones like testosterone and estrogen. These medications are typically administered via injections or implants. Another type of puberty blocker is progestins, such as medroxyprogesterone acetate, which can be taken orally or by injection and work by reducing the body's production of sex hormones. In some cases, aromatase inhibitors are used off-label to block the conversion of androgens into estrogens, although they are less commonly prescribed. Each type of medication has specific benefits and potential side effects, and the choice of which to use depends on the individual's medical needs and the advice of their healthcare provider.<ref>{{cite journal |vauthors=Chew D, Anderson J, Williams K, May T, Pang K |title=Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review |journal=Pediatrics |volume=141 |issue=4 |date=April 2018 |article-number=e20173742 |pmid=29514975 |doi=10.1542/peds.2017-3742}}</ref><ref name="Hembree2017">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=1 November 2017 |volume=102 |issue=11 |pages=3869–3903 |doi=10.1210/jc.2017-01658 |pmid=28945902 }}</ref>
A number of different drugs are used as puberty blockers:<ref name="pmid16634688">{{cite journal |vauthors=Tuvemo T |title=Treatment of central precocious puberty |journal=Expert Opinion on Investigational Drugs |volume=15 |issue=5 |pages=495–505 |date=May 2006 |pmid=16634688 |doi=10.1517/13543784.15.5.495 |s2cid=34018785}}</ref><ref name="pmid31041427">{{cite journal |vauthors=Eugster EA |title=Treatment of Central Precocious Puberty |journal=Journal of the Endocrine Society |volume=3 |issue=5 |pages=965–972 |date=May 2019 |pmid=31041427 |pmc=6486823 |doi=10.1210/js.2019-00036}}</ref> * Gonadotropin-releasing hormone (GnRH) agonists: Specific examples include: buserelin, histrelin, leuprorelin, nafarelin, and triptorelin.<ref name="pmid16634688" /><ref name="pmid31041427" /> GnRH agonists are available and used as daily subcutaneous injections, depot subcutaneous or intramuscular injections lasting 1 to 6 months, implants lasting 12 months, and nasal sprays used multiple times per day.<ref name="pmid16634688" /><ref name="pmid31041427" /> A 2024 review found GnRH agonists to be the most effective treatment for puberty suppression.<ref name="Sax">{{Cite web |title=Evidence for effective interventions for children and young people with gender dysphoria—update |date=1 February 2024 |publisher=Sax Institute |url=https://www.saxinstitute.org.au/resource/evidence-for-effective-interventions-for-children-and-young-people-with-gender-dysphoria-update/ |access-date=2025-07-22 |language=en-US |archive-date=25 July 2025 |archive-url=https://web.archive.org/web/20250725072713/https://www.saxinstitute.org.au/resource/evidence-for-effective-interventions-for-children-and-young-people-with-gender-dysphoria-update |url-status=live }}</ref> * GnRH antagonists are also expected to be effective at delaying puberty but have not yet been widely studied or used for this purpose.<ref name="pmid16634688" /><ref name="pmid12225246">{{cite journal |vauthors=Roth C |title=Therapeutic potential of GnRH antagonists in the treatment of precocious puberty |journal=Expert Opinion on Investigational Drugs |volume=11 |issue=9 |pages=1253–1259 |date=September 2002 |pmid=12225246 |doi=10.1517/13543784.11.9.1253 |s2cid=9146658}}</ref> Examples of GnRh antagonists include ganirelix and cetrorelix, drugs that are typically used to treat infertility. * Progestogens used at high doses such as medroxyprogesterone acetate and cyproterone acetate have been used as puberty blockers in the past or when GnRH agonists are not possible.<ref name="pmid16634688" /> For precocious puberty, they are not as effective as GnRH agonists (especially in avoiding a hit to adult height) and have more side effects.<ref name="pmid16634688" /> They are cheaper than GnRH agonists and potentially have fewer side effects for individuals with gender dysphoria (very small sample size).<ref>{{cite web |title=DOSING STANDARDS FOR PUBERTAL SUPPRESSION AND SEX STEROID HORMONES IN TRANSGENDER YOUTH |url=https://support.endocrine.org/-/media/endocrine/files/practice/gender_dosing_standards_transgender_youth.pdf |website=endocrinesociety.org |access-date=3 March 2025 |archive-date=19 March 2025 |archive-url=https://web.archive.org/web/20250319125158/https://support.endocrine.org/-/media/endocrine/files/practice/gender_dosing_standards_transgender_youth.pdf |url-status=live }}</ref> * Antiandrogens: Bicalutamide has been used as a cheaper alternative puberty blocker in transgender girls for whom GnRH agonists were denied by insurance.<ref name="pmid34376826">{{cite journal |vauthors=Rosenthal SM |title=Challenges in the care of transgender and gender-diverse youth: an endocrinologist's view |journal=Nature Reviews. Endocrinology |volume=17 |issue=10 |pages=581–591 |date=October 2021 |pmid=34376826 |doi=10.1038/s41574-021-00535-9 |s2cid=236972394}}</ref><ref name="pmid30612811">{{cite journal |vauthors=Neyman A, Fuqua JS, Eugster EA |title=Bicalutamide as an Androgen Blocker With Secondary Effect of Promoting Feminization in Male-to-Female Transgender Adolescents |journal=The Journal of Adolescent Health |volume=64 |issue=4 |pages=544–546 |date=April 2019 |pmid=30612811 |pmc=6431559 |doi=10.1016/j.jadohealth.2018.10.296}}</ref> The antiandrogens spironolactone and cyproterone acetate are not as strong.<ref name="pmid30612811" />
=== Medical labelling === Puberty blockers have not received FDA approval for use on children who are transgender, and are instead issued ''off-label''. The practice of off-label prescription is common in children's medicine because many drugs lack pediatric-specific information in their marketing authorisation or approval. Doctors use their professional judgment to decide how to use these drugs, and the term "off-label" itself does not indicate an improper, illegal, or experimental use of medicine.<ref>{{cite journal |last1=Giordano |first1=Simona |last2=Holm |first2=Søren |title=Is puberty delaying treatment 'experimental treatment'? |journal=International Journal of Transgender Health |date=2 April 2020 |volume=21 |issue=2 |pages=113–121 |doi=10.1080/26895269.2020.1747768 |pmid=33015663 |pmc=7430465 }}</ref><ref>{{Cite journal |last1=Boulware |first1=Susan |last2=Kamody |first2=Rebecca |last3=Kuper |first3=Laura |last4=McNamara |first4=Meredithe |last5=Olezeski |first5=Christy |last6=Szilagyi |first6=Nathalie |last7=Alstott |first7=Anne L. |date=16 May 2022 |title=Biased Science: The Texas and Alabama Measures Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims |url=https://www.ssrn.com/abstract=4102374 |journal=SSRN Electronic Journal |language=en |doi=10.2139/ssrn.4102374 |issn=1556-5068}}</ref> According to pediatric endocrinology expert Brad Miller, pharmaceutical companies that make puberty blocker drugs for children with gender dysphoria have refused to submit them for FDA approval because doing so would cost too much money and "because (transgender treatment) was a political hot potato."<ref name="Terhune-2022" />
=== Manufacturers === In the United States, the main providers of puberty blockers are Endo International and AbbVie.<ref name="Terhune-2022">{{cite news |vauthors=Terhune C, Respaut R, Conlin M |date=6 October 2022 |title=As children line up at gender clinics, families confront many unknowns |url=https://www.reuters.com/investigates/special-report/usa-transyouth-care/ |access-date=10 October 2022 |work=Reuters |language=en |archive-date=6 October 2022 |archive-url=https://web.archive.org/web/20221006130806/https://www.reuters.com/investigates/special-report/usa-transyouth-care/ |url-status=live}}</ref> Endo International creates histerelin acetate (Vantas) while AbbVie manufactures leuprolide acetate (Lupron Depot).<ref>{{cite book |vauthors=Volans G, Wiseman H |chapter=Vantas (r) |date=2011 |title=Drugs Handbook 2012–2013 |publisher=Bloomsbury Academic |doi=10.5040/9781350363595.art-3616 |isbn=978-0-2303-5601-6}}</ref><ref name="Biodrug_Delivery Systems_2016">{{cite book |vauthors=Okada H |veditors=Morishita M, Park K |chapter=Depot Injectable Microcapsules of Leuprorelin Acetate (Lupron Depot) |date=2016-04-19 |title=Biodrug Delivery Systems |pages=386–399 |publisher=CRC Press |doi=10.3109/9781420086713-25 |isbn=978-0-429-14228-4}}</ref> Other companies within the United States are also in the mix such as Pfizer who distributes histerelin acetate (Supprelin LA) and Tolmar Pharmaceuticals who create their own leuprolide acetate (Fensolvi).<ref>{{cite journal |vauthors=McNamara D |date=July 2007 |title=Supprelin LA, Xyzal Tablets |journal=Pediatric News |volume=41 |issue=7 |pages=52–53 |doi=10.1016/s0031-398x(07)70462-9 |issn=0031-398X}}</ref><ref>{{cite journal |vauthors=Twardowski P, Henry J, Atkinson S |date=2023-02-20 |title=Major adverse cardiovascular events after androgen deprivation therapy in patients with prostate cancer with hypercholesterolemia. |journal=Journal of Clinical Oncology |volume=41 |issue=6_suppl |page=348 |doi=10.1200/jco.2023.41.6_suppl.348 |issn=0732-183X}}</ref>
Outside of the United States, companies such as Ferring Pharmaceuticals, Ipsen, Takeda Pharmaceutical Company, Astellas Pharma, Sandoz, and Sun Pharmaceutical Industries supply much of the rest of the world with the various puberty blockers. Ferring Pharmaceuticals, based out of Switzerland, generate two separate products of triptorelin (Decapeptyl and Gonapeptyl).<ref>{{cite journal |vauthors=Ginsburg ES, Jellerette-Nolan T, Daftary G, Du Y, Silverberg KM |title=Patient experience in a randomized trial of a weekly progesterone vaginal ring versus a daily progesterone gel for luteal support after in vitro fertilization |journal=Fertility and Sterility |volume=110 |issue=6 |pages=1101–1108.e3 |date=November 2018 |pmid=30396554 |doi=10.1016/j.fertnstert.2018.07.014 |doi-access=free}}</ref> Originating in France, Ipsen also produces triptorelin (Decapeptyl).<ref>{{cite journal |vauthors=Drieu K, Devisague J, Dray F, Ezan E |date=August 1987 |title=Pharmakinetics study in man of D-Trp-6-LHRH (decapeptyl, Ipsen-Biotech) administered as slow release microspheres |journal=European Journal of Cancer and Clinical Oncology |volume=23 |issue=8 |page=1238 |doi=10.1016/0277-5379(87)90191-x |issn=0277-5379}}</ref> German/Swiss company Sandoz makes leuprorelin (Leuprorelin Acetate, Lucrin, Eligard).<ref>{{cite journal |vauthors=Solarić M, Bjartell A, Thyroff-Friesinger U, Meani D |title=Testosterone suppression with a unique form of leuprorelin acetate as a solid biodegradable implant in patients with advanced prostate cancer: results from four trials and comparison with the traditional leuprorelin acetate microspheres formulation |journal=Therapeutic Advances in Urology |volume=9 |issue=6 |pages=127–136 |date=December 2017 |pmid=28588651 |pmc=5444576 |doi=10.1177/1756287217701665}}</ref> In Japan, Takeda Pharmaceutical Company and Astellas Pharma create leuprorelin (Lupron Depot) and goserelin (Zoladex).<ref name="Biodrug_Delivery Systems_2016"/><ref>{{cite journal |vauthors=Okumura H, Ueyama M, Shoji S, English M |title=Cost-effectiveness analysis of fidaxomicin for the treatment of Clostridioides (Clostridium) difficile infection in Japan |journal=Journal of Infection and Chemotherapy |volume=26 |issue=6 |pages=611–618 |date=June 2020 |pmid=32165072 |doi=10.1016/j.jiac.2020.01.018 |doi-access=free}}</ref> Indian company Sun Pharmaceutical Industries mainly produces leuprolide acetate generic injectables.<ref>{{cite book |chapter=Leuprolide Acetate |title=USP Access Point |publisher=U.S. Pharmacopeial Convention |doi=10.31003/uspnf_m44592_03_01}}</ref> AbbVie is also a player internationally.<ref>{{cite journal |vauthors=Kaufmann R, Wade R, Patton G |date=September 2000 |title=Very Low Dose Luteal Lupron and Microdose Lupron Flare Offer Comparable Outcomes in Poor Responders |journal=Fertility and Sterility |volume=74 |issue=3 |page=S232 |doi=10.1016/s0015-0282(00)01408-4 |issn=0015-0282|doi-access=free }}</ref>
== Effects == {{AI-generated|date=October 2025|section}}
=== Short-term === In the short term, they are generally considered safe and well-tolerated by most individuals. One of the primary effects is the suppression of secondary sexual characteristics, such as breast development in those assigned female at birth or deepening of the voice in those assigned male at birth. This can significantly alleviate gender dysphoria in transgender youth.<ref name="rafferty_2018" /><ref name="Bangalore_Krishna_2019">{{cite journal |vauthors=Bangalore Krishna K, Fuqua JS, Rogol AD, Klein KO, Popovic J, Houk CP, Charmandari E, Lee PA, Freire AV, Ropelato MG, Yazid Jalaludin M, Mbogo J, Kanaka-Gantenbein C, Luo X, Eugster EA, Klein KO, Vogiatzi MG, Reifschneider K, Bamba V, Garcia Rudaz C, Kaplowitz P, Backeljauw P, Allen DB, Palmert MR, Harrington J, Guerra-Junior G, Stanley T, Torres Tamayo M, Miranda Lora AL, Bajpai A, Silverman LA, Miller BS, Dayal A, Horikawa R, Oberfield S, Rogol AD, Tajima T, Popovic J, Witchel SF, Rosenthal SM, Finlayson C, Hannema SE, Castilla-Peon MF, Mericq V, Medina Bravo PG |date=2019 |title=Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium |journal=Hormone Research in Paediatrics |volume=91 |issue=6 |pages=357–372 |doi=10.1159/000501336 |pmid=31319416 |quote=GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents. |doi-access=free}}</ref>
Common short-term side effects may include injection site reactions, headaches, mood swings, changes in weight or appetite, fatigue, insomnia, muscle aches and changes in breast tissue, but these are usually manageable.<ref name="Hembree2017"/><ref>{{cite web |title=Puberty Blockers |url=https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |archive-url=https://web.archive.org/web/20220803204006/https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |archive-date=3 August 2022 |access-date=18 August 2022 |website=www.stlouischildrens.org |language=en}}</ref><ref>{{cite journal |url=https://academic.oup.com/jcem/article/100/2/E270/2814818?login=true |title=Bone Mass in Young Adulthood Following Gonadotropin-Releasing Hormone Analog Treatment and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria |doi=10.1210/jc.2014-2439 |access-date=2024-07-31 |journal=The Journal of Clinical Endocrinology & Metabolism |date=2015 |volume=100 |issue=2 |pages=E270–E275 |pmid=25427144 |vauthors=Klink D, Caris M, Heijboer A, Van Trotsenburg M, Rotteveel J |archive-date=24 September 2024 |archive-url=https://web.archive.org/web/20240924230051/https://academic.oup.com/jcem/article/100/2/E270/2814818?login=true |url-status=live}}</ref> Bone mineral density is reduced during treatment, though there is no evidence of long-term effects (see also § Bone health in § Long-term). To protect against this, doctors recommend exercise, calcium, and Vitamin D.<ref>{{cite web |date=16 May 2022 |title=What Are Puberty Blockers? |url=https://www.webmd.com/children/what-are-puberty-blockers |url-status=live |archive-url=https://web.archive.org/web/20221221091100/https://www.webmd.com/children/what-are-puberty-blockers |archive-date=21 December 2022 |access-date=27 August 2022 |publisher=WebMD LLC |vauthors=Benisek A |veditors=Nazario B}}</ref> The American Academy of Pediatrics (AAP) also notes delaying puberty beyond peers may be stressful.<ref>{{cite journal |vauthors=Rafferty J |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |volume=142 |issue=4 |date=October 2018 |article-number=e20182162 |pmid=30224363 |doi=10.1542/peds.2018-2162}}</ref>
In 2016, the FDA ordered drugmakers to add warning labels that state: "Psychiatric events have been reported in patients", including symptoms "such as crying, irritability, impatience, anger and aggression."<ref name="Terhune-2022" />
In 2022, the FDA reported that there have been six cases of idiopathic intracranial hypertension in 5 to 12-year-old children assigned female at birth taking puberty blockers.<ref>{{cite news |title=Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists |work=AAP News |url=https://publications.aap.org/aapnews/news/20636/Risk-of-pseudotumor-cerebri-added-to-labeling-for |date=1 July 2022 |access-date=18 August 2022 |author=U.S. Food and Drug Administration |eissn=1556-3332 |archive-date=27 December 2022 |archive-url=https://web.archive.org/web/20221227150739/https://publications.aap.org/aapnews/news/20636/Risk-of-pseudotumor-cerebri-added-to-labeling-for |url-status=live}}</ref> Five were receiving treatment for precocious puberty and one was transgender and receiving treatment for gender dysphoria.<ref>{{cite web |url=https://www.fda.gov/media/159663/download |date=1 July 2022 |title=Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists |work=U.S. Food and Drug Administration |format=PDF |access-date=12 September 2022 |archive-date=22 October 2022 |archive-url=https://web.archive.org/web/20221022193426/https://www.fda.gov/media/159663/download }}</ref> Morissa Ladinsky, a University of Alabama-Birmingham pediatrician who works with transgender youth, said that it "is an inordinately well-known side effect that can happen for many, many different medications, most commonly, oral birth control pills." Referring to the six reported cases, Ladinsky said that "It doesn't even approach any semblance of what we call in medicine, statistical significance".<ref>{{cite web |vauthors=Davis E |title=FDA issues warning on puberty blockers; some Ala. lawmakers support findings |url=https://www.wsfa.com/2022/07/28/fda-issues-warning-puberty-blockers-some-ala-lawmakers-support-findings/ |access-date=12 September 2022 |location=Montgomery, AL |work=WSFA News |date=27 July 2022 |archive-date=23 October 2022 |archive-url=https://web.archive.org/web/20221023085846/https://www.wsfa.com/2022/07/28/fda-issues-warning-puberty-blockers-some-ala-lawmakers-support-findings/ |url-status=live}}</ref>
=== Long-term === Although puberty blockers are known to be safe and fully reversible if stopped in the short term,<ref name="Rew_2021" /><ref name="aap">{{cite report |url=https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf |title=Supporting and Caring for Transgender Children |date=September 2016 |publisher=American Academy of Pediatrics |page=11 |quote=To prevent the consequences of going through a puberty that doesn't match a transgender child's identity, healthcare providers may use fully reversible medications that put puberty on hold. |vauthors=Murchison G, Adkins D, Conard LA, Elliott T, Hawkins LA, Newby H, Ng H, Vetters R, Wolf-Gould C |access-date=17 September 2018 |archive-date=18 December 2022 |archive-url=https://web.archive.org/web/20221218183525/https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf |url-status=live}}</ref> it is not known whether they affect the development of factors like bone mineral density, brain development and fertility in transgender patients.<ref>{{cite web |date=3 October 2018 |title=Gender dysphoria - Treatment |url=https://www.nhs.uk/conditions/gender-dysphoria/treatment/ |access-date=31 March 2022 |work=National Health Service |location=U.K. |language=en |archive-date=2 November 2013 |archive-url=https://web.archive.org/web/20131102135038/http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx |url-status=live}}</ref>{{obsolete source|reason=Confirmed that NHS mentioned specific concerns back in April 2022, but now just says "there is not enough evidence on their clinical safety and effectiveness. If you're already receiving these medicines for gender dysphoria or incongruence on the NHS, you can continue to access them." Might be better to get a new source for this?|date=October 2025}}<ref>{{cite news |vauthors=Wilson L |date=11 May 2021 |title=What Are Puberty Blockers? |url=https://www.nytimes.com/2021/05/11/well/family/what-are-puberty-blockers.html |access-date=31 March 2022 |work=The New York Times |language=en-US |issn=0362-4331 |archive-date=26 December 2022 |archive-url=https://web.archive.org/web/20221226155028/https://www.nytimes.com/2021/05/11/well/family/what-are-puberty-blockers.html |url-status=live}}</ref>
The Endocrine Society Guidelines, while endorsing the use of puberty blockers for treatment of gender dysphoria, underscores the need for more rigorous safety and effectiveness evaluations and careful assessment of "the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development)."<ref name="Hembree_quote2">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology and Metabolism |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |quote=In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols. Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development); |doi-access=free}}</ref>
The longest follow-up study followed a transgender man who began taking puberty blockers at age 13 in 1998, before later taking hormone treatments and getting gender confirmation surgery as an adult. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers.<ref name=":3">{{cite journal |vauthors=Cohen-Kettenis PT, Schagen SE, Steensma TD, de Vries AL, Delemarre-van de Waal HA |title=Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up |journal=Archives of Sexual Behavior |volume=40 |issue=4 |pages=843–847 |date=August 2011 |pmid=21503817 |pmc=3114100 |doi=10.1007/s10508-011-9758-9}}</ref><ref>{{cite journal |vauthors=Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A |title=Puberty suppression in transgender children and adolescents |journal=The Lancet. Diabetes & Endocrinology |volume=5 |issue=10 |pages=816–826 |date=October 2017 |pmid=28546095 |doi=10.1016/s2213-8587(17)30099-2}}</ref>
==== Neurological ==== Research on the long-term effects on brain development and cognitive function is limited.<ref name="Rosenthal-2016">{{cite journal |vauthors=Rosenthal SM |title=Transgender youth: current concepts |journal=Annals of Pediatric Endocrinology & Metabolism |volume=21 |issue=4 |pages=185–192 |date=December 2016 |pmid=28164070 |pmc=5290172 |doi=10.6065/apem.2016.21.4.185 |quote=The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.}}</ref><ref name="deVries2012">{{cite journal |vauthors=de Vries AL, Cohen-Kettenis PT |title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach |journal=Journal of Homosexuality |volume=59 |issue=3 |pages=301–320 |date=2012 |pmid=22455322 |doi=10.1080/00918369.2012.653300 |s2cid=11731779}}</ref> According to a 2024 systematic review, no conclusions can be drawn about the effects of puberty blockers on cognitive development.<ref name="Taylor_2024" />
==== Fertility ==== Research on the long-term effects on fertility is limited.<ref name="Rosenthal-2016" /><ref name="Tornese2025">{{cite journal |last1=Tornese |first1=Gianluca |last2=Di Mase |first2=Raffaella |last3=Munarin |first3=Jessica |last4=Ciancia |first4=Silvia |last5=Santamaria |first5=Fabiana |last6=Fava |first6=Daniela |last7=Candela |first7=Egidio |last8=Capalbo |first8=Donatella |last9=Ungaro |first9=Carla |last10=Improda |first10=Nicola |last11=Diana |first11=Pierluigi |last12=Matarazzo |first12=Patrizia |last13=Guazzarotti |first13=Laura |last14=Toschetti |first14=Tommaso |last15=Sambati |first15=Vanessa |last16=Tamaro |first16=Gianluca |last17=Bresciani |first17=Giulia |last18=Licenziati |first18=Maria Rosaria |last19=Street |first19=Maria Elisabeth |last20=Aversa |first20=Tommaso |last21=Delvecchio |first21=Maurizio |last22=Faienza |first22=Maria Felicia |last23=Iughetti |first23=Lorenzo |last24=Calcaterra |first24=Valeria |last25=de Sanctis |first25=Luisa |last26=Salerno |first26=Mariacarolina |last27=Franceschi |first27=Roberto |title=Use of gonadotropin-releasing hormone agonists in transgender and gender diverse youth: a systematic review |journal=Frontiers in Endocrinology |date=14 May 2025 |volume=16 |article-number=1555186 |doi=10.3389/fendo.2025.1555186 |pmid=40438403 |pmc=12116301 |doi-access=free}}</ref> In males treated for precocious puberty, sperm production was reported 8 months to 3 years after cessation of puberty blockers.<ref name="Hembree2017"/> However, sperm count may be reduced below normal levels.<ref name="Hembree2017"/> In females, no studies have reported long-term adverse effects on ovarian function after cessation of puberty blockers.<ref name="Hembree2017"/> However, the time from cessation of treatment to spontaneous ovulation is not known.<ref name="Hembree2017"/> Due to limited research on the topic, treatment guidelines often advise counseling on fertility preservation options, such as sperm or egg banking, before initiating long-term puberty blocker treatment.<ref name="Clinical management of gender dysph"/><ref>{{cite journal |vauthors=Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP |title=Low Fertility Preservation Utilization Among Transgender Youth |journal=The Journal of Adolescent Health |volume=61 |issue=1 |pages=40–44 |date=July 2017 |pmid=28161526 |doi=10.1016/j.jadohealth.2016.12.012}}</ref>
==== Sexual function ==== As of 2025, the only known study of the long-term effects of puberty blockers on sexual function and libido in transgender individuals reported no negative effects.<ref>{{cite journal |last1=Finegan |first1=Jamie L |last2=Marinkovic |first2=Maja |last3=Okamuro |first3=Kyle |last4=Newfield |first4=Ron S |last5=Anger |first5=Jennifer T |title=Experience with gender affirming hormones and puberty blockers (gonadotropin releasing hormone agonist): a qualitative analysis of sexual function |journal=The Journal of Sexual Medicine |date=10 May 2025 |volume=22 |issue=5 |pages=945–950 |doi=10.1093/jsxmed/qdaf061|pmid=40192463 |quote=The subgroup of subjects with a history of GnRHa use did not differ in their experiences and responses from the subgroup on GAHT alone, which indicated no negative effect of GnRHa on sexual function... To our knowledge, this has not been previously addressed or reported in the literature.|doi-access=free }}</ref>
According to a 2020 study, genital tissue in transgender women may not be optimal for potential vaginoplasty later in life due to underdevelopment of the penis when using penile inversion vaginoplasty.<ref name="Sax"/><ref name="vandeGrift2020">{{cite journal |last1=van de Grift |first1=Tim C. |last2=van Gelder |first2=Zosha J. |last3=Mullender |first3=Margriet G. |last4=Steensma |first4=Thomas D. |last5=de Vries |first5=Annelou L.C. |last6=Bouman |first6=Mark-Bram |title=Timing of Puberty Suppression and Surgical Options for Transgender Youth |journal=Pediatrics |date=1 November 2020 |volume=146 |issue=5 |article-number=e20193653 |doi=10.1542/peds.2019-3653 |pmid=33106340 }}</ref> Several other methods such as bowel vaginoplasty, which uses part of the sigmoid colon to form the canal instead,<ref>{{cite journal |vauthors=Bizic M, Kojovic V, Duisin D, Stanojevic D, Vujovic S, Milosevic A, Korac G, Djordjevic ML |title=An overview of neovaginal reconstruction options in male to female transsexuals |journal=TheScientificWorldJournal |year=2014 |volume=2014 |pages=1–8 |pmid=24971387 |pmc=4058296 |doi=10.1155/2014/638919 |doi-access=free}}</ref><ref>{{Cite journal |last1=van der Sluis |first1=W B |last2=de Nie |first2=I |last3=Steensma |first3=T D |last4=van Mello |first4=N M |last5=Lissenberg-Witte |first5=B I |last6=Bouman |first6=M -B |date=2021-12-17 |title=Surgical and demographic trends in genital gender-affirming surgery in transgender women: 40 years of experience in Amsterdam |url=https://academic.oup.com/bjs/article/109/1/8/6325337 |journal=British Journal of Surgery |language=en |volume=109 |issue=1 |pages=8–11 |doi=10.1093/bjs/znab213 |issn=0007-1323 |pmc=10364763 |pmid=34291277 |access-date=9 September 2024 |archive-date=7 October 2023 |archive-url=https://web.archive.org/web/20231007213735/https://academic.oup.com/bjs/article/109/1/8/6325337 |url-status=live}}</ref> or a peritoneal pull-through vaginoplasty which harvests a skin graft from the peritoneum are not affected by this as they do not require the penile tissue to form the vaginal canal.<ref>{{Cite web |last=Brandt |first=Ashley K. |date=2023-03-03 |title=Robotic peritoneal vaginoplasty |url=https://www.mdedge.com/obgyn/article/261583/surgery/robotic-peritoneal-vaginoplasty |access-date=2024-02-05 |website=MDedge |language=en |archive-date=6 April 2025 |archive-url=https://web.archive.org/web/20250406042450/https://www.mdedge.com/obgyn/article/261583/surgery/robotic-peritoneal-vaginoplasty |url-status=live }}</ref><ref>{{Cite journal |last1=Li |first1=Joy S. |last2=Crane |first2=Curtis N. |last3=Santucci |first3=Richard A. |date=3 February 2021 |title=Vaginoplasty tips and tricks |journal=International Brazilian Journal of Urology |volume=47 |issue=2 |pages=263–273 |doi=10.1590/s1677-5538.ibju.2020.0338 |issn=1677-6119 |pmc=7857744 |pmid=32840336}}</ref>
==== Bone health ==== A systematic review of studies investigating the long-term effects of treating precocious puberty with GnRH agonists found that bone mineral density decreases during treatment but normalizes afterward, with no lasting effects on peak bone mass.<ref name="Soliman">{{cite journal |last1=Soliman |first1=Ashraf T. |last2=Alaaraj |first2=Nada |last3=De Sanctis |first3=Vincenzo |last4=Hamed |first4=Noor |last5=Alyafei |first5=Fawzia |last6=Ahmed |first6=Shayma |title=Long-term health consequences of central precocious/early puberty (CPP) and treatment with Gn-RH analogue: a short update: Long term consequences of precocious puberty |journal=Acta Biomedica: Atenei Parmensis |date=5 December 2023 |volume=94 |issue=6 |pages=e2023222 |doi=10.23750/abm.v94i6.15316 |pmid=38054666 |pmc=10734238}}</ref> A review focused on the treatment of adolescents experiencing gender dysphoria found that bone health may be compromised during treatment, although the long-term outcomes of puberty suppression alone were not possible to determine.<ref name="Taylor_2024">{{cite journal |vauthors=Taylor J, Mitchell A, Hall R, Heathcote C, Langton T, Fraser L, Hewitt CE |title=Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review |journal=Archives of Disease in Childhood |date=April 2024 |volume=109 |issue=Suppl 2 |pages=s33–s47 |pmid=38594047 |doi=10.1136/archdischild-2023-326669 |url=https://eprints.whiterose.ac.uk/211412/1/archdischild-2023-326669.full.pdf |access-date=29 September 2024 |archive-date=14 August 2024 |archive-url=https://web.archive.org/web/20240814112456/https://eprints.whiterose.ac.uk/211412/1/archdischild-2023-326669.full.pdf |url-status=live}}</ref> A separate review found that gender-affirming hormone therapy was effective at reversing the bone mineral density losses that may occur during puberty suppression.<ref name="Sax"/>
== Access == {{see also|Transgender health care misinformation}} {{anchor|Puberty blocker bans|Bans on puberty blockers}} The prescription of puberty blockers has been a polarizing issue on an international scale. Proponents argue that there are psychological and developmental benefits of puberty blockers which may outweigh the risks associated with treatment. These benefits include lower mental health risks, lower depression, and reduced behavioral issues.<ref name="Priest_20192">{{cite journal |vauthors=Priest M |date=February 2019 |title=Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm |url=https://philarchive.org/rec/PRITCA-7 |journal=The American Journal of Bioethics |volume=19 |issue=2 |pages=45–59 |doi=10.1080/15265161.2018.1557276 |pmid=30784385 |s2cid=73456261}}</ref><ref name="Giovanardi_20172" /> Opponents of the use of puberty blockers argue that minors are unable to provide informed consent.<ref name="Cohen_20192">{{cite journal |vauthors=Cohen D, Barnes H |date=September 2019 |title=Gender dysphoria in children: puberty blockers study draws further criticism |journal=BMJ |volume=366 |article-number=l5647 |doi=10.1136/bmj.l5647 |pmid=31540909 |s2cid=202711942}}</ref><ref name="Giovanardi_20172">{{cite journal |vauthors=Giovanardi G |date=September 2017 |title=Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents |journal=Porto Biomedical Journal |volume=2 |issue=5 |pages=153–156 |doi=10.1016/j.pbj.2017.06.001 |pmc=6806792 |pmid=32258611 |doi-access=free}}</ref>
More than a dozen major American and Australian medical associations, as well as the World Professional Association for Transgender Health (WPATH),<ref name="WPATH-2022">{{cite web |title=USPATH Position Statement on Legislative and Executive Actions Regarding the Medical Care of Transgender Youth |url=https://www.wpath.org/media/cms/Documents/USPATH/2022/With%20Date%20Position%20Statement%20Anti%20Trans%20Leg%20USPATH%20Apr%2022%202022.pdf?_t=1650665621 |access-date=28 August 2022 |date=22 April 2022 |archive-date=10 November 2022 |archive-url=https://web.archive.org/web/20221110095305/https://www.wpath.org/media/cms/Documents/USPATH/2022/With%20Date%20Position%20Statement%20Anti%20Trans%20Leg%20USPATH%20Apr%2022%202022.pdf?_t=1650665621 |url-status=live |website=USPATH}}</ref> and the Endocrine Society<ref name="Endocrine Society opposes legislative efforts to prevent access to medical care for transgender youth-2021">{{cite web |url=https://www.news-medical.net/news/20210415/Endocrine-Society-opposes-legislative-efforts-to-prevent-access-to-medical-care-for-transgender-youth.aspx |title=Endocrine Society opposes legislative efforts to prevent access to medical care for transgender youth |date=15 April 2021 |access-date=18 May 2022 |archive-date=23 October 2022 |archive-url=https://web.archive.org/web/20221023125231/https://www.news-medical.net/news/20210415/Endocrine-Society-opposes-legislative-efforts-to-prevent-access-to-medical-care-for-transgender-youth.aspx |url-status=live}}</ref> generally support puberty blockers for transgender youth and have come out against efforts to restrict their use. In Europe, however, Sweden and the United Kingdom have limited the use of puberty blockers.<ref name="The Economist-2022">{{cite news |date=28 July 2022 |title=Questioning America's approach to transgender health care |newspaper=The Economist |url=https://www.economist.com/united-states/2022/07/28/questioning-americas-approach-to-transgender-health-care |access-date=6 August 2022 |archive-date=4 August 2022 |archive-url=https://web.archive.org/web/20220804010123/https://www.economist.com/united-states/2022/07/28/questioning-americas-approach-to-transgender-health-care |url-status=live}}</ref><ref name="Terhune-2022" /> These countries have not outright banned or criminalized the treatment, however, unlike many US States.<ref>{{cite web |date=8 October 2023 |title=The real story on Europe's transgender debate |website=Politico |url=https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 |access-date=1 October 2024 |archive-date=5 April 2024 |archive-url=https://web.archive.org/web/20240405212623/https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 |url-status=live }}</ref><ref>{{cite web |date=6 September 2023 |title=Gender-affirming surgery is not banned for minors in Europe, but is mostly inaccessible |website=PolitiFact |url=https://www.politifact.com/factchecks/2023/sep/06/instagram-posts/gender-affirming-surgery-is-not-banned-for-minors/ |access-date=1 October 2024 |archive-date=20 March 2024 |archive-url=https://web.archive.org/web/20240320201314/https://www.politifact.com/factchecks/2023/sep/06/instagram-posts/gender-affirming-surgery-is-not-banned-for-minors/ |url-status=live }}</ref><ref>{{cite web |date=25 December 2023 |title=Fact check: Did Sweden 'shut down' gender-affirming surgical care for minors? |website=Houston Chronicle |url=https://www.houstonchronicle.com/politics/texas/politifact/article/fact-check-sweden-transgender-18571187.php |access-date=1 October 2024 | vauthors = Abels G }}</ref><ref>{{cite web |date=8 June 2023 |title=Norway didn't ban gender-affirming care for minors, as headline falsely claims |website=Associated Press |url=https://apnews.com/article/fact-check-norway-not-ban-gender-affirming-care-956221436313 |access-date=1 October 2024 |archive-date=17 March 2024 |archive-url=https://web.archive.org/web/20240317012417/https://apnews.com/article/fact-check-norway-not-ban-gender-affirming-care-956221436313 |url-status=live }}</ref><ref>{{cite news |date=9 April 2024 |title=Youth Gender Medications Limited in England, Part of Big Shift in Europe |newspaper=The New York Times |url=https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |url-access=subscription |access-date=1 October 2024}}</ref>
According to Transgender Europe, as of late 2024, two-thirds of European Union member states allow trans youth to access puberty blockers. Additionally, they noted that member states of the European Union were not moving towards bans and there was "significant disinformation around the real state of affairs" of trans-specific care, though transgender people were still often pathologized and mandated to undergo psychiatric diagnosis.<ref>{{Cite web |date=2024-10-29 |title=Trans Health Map 2024: As WHO guidelines approach, healthcare for trans people in the EU still hindered by stigma and long delays – TGEU – Transgender EuropeTGEU – Transgender Europe |url=https://tgeu.org/trans-health-map-2024-as-who-guidelines-approach-healthcare-for-trans-people-in-the-eu-still-hindered-by-stigma-and-long-delays/ |access-date=2024-12-21 |website=Transgender Europe |language=en-US }}</ref>
===Guidelines by country=== ==== Australia ==== {{see also|LGBT rights in Australia#Gender dysphoria treatment}} Access to puberty blockers for transgender youth in Australia is supported by: * The Royal Australasian College of Physicians, * The Royal Australian College of General Practitioners, * The Australian Endocrine Society, * AusPATH.<ref name="Parents of Gender Diverse Children">{{cite web |url=https://www.pgdc.org.au/legal |work=Parents of Gender Diverse Children |location=Australia |title=Legal |date=15 November 2023 |access-date=21 August 2022 |archive-date=24 October 2022 |archive-url=https://web.archive.org/web/20221024220321/https://www.pgdc.org.au/legal |url-status=live}}</ref>
An independent review into gender-affirming care for minors commissioned by the New South Wales government and released in September 2024 found that puberty blockers are "safe, effective and reversible", while acknowledging that the evidence for this and other interventions "remains weak due to poor study designs, low participant numbers and single-centre recruitment", calling for more long-term research.<ref>{{cite web |date=6 September 2024 |title=Puberty blockers a 'safe, effective and reversible' form of gender-affirming care, finds review triggered by Westmead Hospital investigation |website=Australian Broadcasting Corporation |url=https://www.abc.net.au/news/2024-09-06/gender-affirming-care-still-safe-effective-and-reversible-review/104322428 |access-date=23 September 2024 |archive-date=23 September 2024 |archive-url=https://web.archive.org/web/20240923064430/https://www.abc.net.au/news/2024-09-06/gender-affirming-care-still-safe-effective-and-reversible-review/104322428 |url-status=live}}</ref><ref>{{cite web |title=Evidence for effective interventions for children and young people with gender dysphoria—update |url=https://www.saxinstitute.org.au/wp-content/uploads/Evidence-for-effective-interventions-for-children-and-young-people-with-gender-dysphoria-update.pdf |website=Sax Institute |access-date=23 September 2024 |archive-date=17 September 2024 |archive-url=https://web.archive.org/web/20240917184703/https://saxinstitute.org.au/wp-content/uploads/Evidence-for-effective-interventions-for-children-and-young-people-with-gender-dysphoria-update.pdf |url-status=live }}</ref>
===== Queensland ban ===== {{see also|LGBTQ rights in Queensland#Gender-affirming care}} In January 2025, shortly after assuming office, Queensland Health Minister Tim Nicholls under the right-wing Queensland Liberal Party announced an immediate pause on the prescription of puberty blockers (Stage 1 treatment) and cross-sex hormones (Stage 2 treatment) for new patients under 18 with gender dysphoria in Queensland's public health services, pending an independent review of evidence and best practices.<ref>{{cite news |last=Robertson |first=Joshua |title=Queensland halts prescription of puberty blockers and hormones for children with gender dysphoria |url=https://www.theguardian.com/australia-news/2025/jan/28/queensland-halts-prescription-of-puberty-blockers-and-hormones-for-children-with-gender-dysphoria |work=The Guardian |date=28 January 2025 |access-date=29 October 2025}}</ref><ref>{{cite web |title=MEDIA STATEMENT: Independent Review into puberty blockers |url=https://statements.qld.gov.au/statements/101903 |publisher=Queensland Government |date=28 January 2025 |access-date=29 October 2025}}</ref> The directive, issued by Queensland Health Director-General David Rosengren, exempted existing patients and allowed non-pharmacological support such as counselling, citing "contested evidence" on benefits and risks, including reports of treatments provided to children as young as 12 without adequate oversight.<ref name="brisbane-court"/> In November 2025, the opposition left-wing Queensland Labor Party passed a motion opposing the ban.<ref name="Queensland Labor">{{cite news |last=Brewster |first=Alex |title=Queensland Labor conference passes motion calling on Commonwealth to take CFMEU out of administration |url=https://www.abc.net.au/news/2025-11-30/qld-cfmeu-motion-labor-conference-brisbane/106083862 |work=ABC News |date=29 November 2025 |access-date=12 December 2025}}</ref>
The policy, the first such ban in an Australian state, faced legal challenge from a parent of a transgender teenager, who argued it was procedurally flawed and politically motivated.<ref name="abc-court">{{cite news |last=Brockwell |first=Ruby |title=Supreme Court in Brisbane overturns controversial freeze on puberty blockers for adolescents |url=https://www.abc.net.au/news/2025-10-28/qld-puberty-blockers-ban-overturned-by-court/105942094 |work=ABC News |date=28 October 2025 |access-date=29 October 2025}}</ref> On 27 October 2025, the Queensland Supreme Court ruled the directive unlawful, finding Rosengren had failed to conduct required consultations with Hospital and Health Service executives (limited to a 22-minute Microsoft Teams meeting concurrent with Nicholls's media announcement) under the ''Hospital and Health Boards Act 2011''.<ref name="guardian-court">{{cite news |last=Sandeman |first=Sophie |title=Queensland puberty blocker ban reinstated by health minister hours after supreme court overturned it |url=https://www.theguardian.com/australia-news/2025/oct/28/queenslands-controversial-puberty-blocker-ban-overturned-by-supreme-court |work=The Guardian |date=28 October 2025 |access-date=29 October 2025}}</ref><ref name="qnews-court">{{cite news |title=BREAKING: Supreme Court overturns Queensland's puberty blocker ban |url=https://qnews.com.au/breaking-supreme-court-overturns-queenslands-puberty-blocker-ban/ |work=QNews |date=28 October 2025 |access-date=29 October 2025}}</ref> Justice Peter Callaghan set aside the order, describing it as an improper exercise of power, though he did not rule on its substantive merits.<ref name="brisbane-court">{{cite news |last=Calligeros |first=Marianne |title=Queensland government's gender blocker ban overturned in court |url=https://www.brisbanetimes.com.au/national/queensland/unlawful-lnp-government-s-gender-blocker-ban-overturned-in-court-20251028-p5n5sc.html |work=Brisbane Times |date=28 October 2025 |access-date=29 October 2025}}</ref>
Hours later, on 28 October 2025, Nicholls exercised his ministerial discretion under section 44 of the Act to issue a new directive reinstating the restrictions in substantially the same terms, applying immediately to all public Hospital and Health Services.<ref name="abc-reinstate">{{cite news |last=Brockwell |first=Ruby |title=Snap new Queensland ban on puberty blockers for transgender adolescents |url=https://www.abc.net.au/news/2025-10-29/qld-health-minister-puberty-blockers-youth-supreme-court/105944876 |work=ABC News |date=29 October 2025 |access-date=29 October 2025}}</ref><ref name="qldhealth">{{cite web |title=Ministerial Direction – Treatment of gender dysphoria in children and adolescents with hormone therapy |url=https://www.health.qld.gov.au/system-governance/legislation/ministerial-direction-treatment-of-gender-dysphoria-in-children-and-adolescents-with-hormone-therapy |publisher=Queensland Health |date=28 October 2025 |access-date=29 October 2025}}</ref> It mandates multidisciplinary panel approval for any exceptions and prioritises psychological interventions, pending the review's completion (expected November 2025) and a further evidence assessment by January 2026.<ref name="guardian-court" /> Nicholls justified the action as necessary "in the public interest" to protect children amid ongoing debates over treatment efficacy.<ref name="abc-reinstate" /> A legal challenge against the new directive was filed in December 2025.<ref>{{cite news |last=Miles |first=Janelle |title=Queensland government facing fresh legal challenge over controversial puberty blocker ban |url=https://www.abc.net.au/news/2025-12-08/qld-puberty-blocker-ban-legal-action/106113504 |work=ABC News |date=7 December 2025 |access-date=12 December 2025}}</ref>
The move has drawn criticism from medical bodies like the Australian Medical Association, left-wing political parties<ref name="Queensland Labor"/> and LGBTQ+ advocates, who contend it undermines clinical autonomy, evidence-based care, and access for vulnerable youth, potentially exacerbating inequities by pushing families toward private services.<ref name="qnews-court" /><ref>{{cite news |title=Queensland Minister signals new puberty blocker ban despite court defeat |url=https://qnews.com.au/queensland-minister-signals-new-puberty-blocker-ban-despite-court-defeat/ |work=QNews |date=28 October 2025 |access-date=29 October 2025}}</ref>
==== Austria ==== {{see also|LGBTQ rights in Austria#Gender identity and expression}}
In Austria, puberty blockers may be recommended for transgender adolescents once they begin showing the first physical signs of puberty. To be eligible, they must have a stable, long-term experience of gender identity that differs from their assigned sex.
This requires a formal diagnosis of gender incongruence (ICD-11 HA60) from a medical professional, and the adolescent must have reached at least Tanner stage 2 of pubertal development.<ref name="awmf"/>
The use of puberty blockers in youth experiencing gender dysphoria has been endorsed by the following organizations:<ref name="awmf"/> * Österreichische Gesellschaft für Kinder- und Jugendpsychiatrie (Austrian Society for Child and Adolescent Psychiatry) (ÖGKJP) * Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (Austrian Society of Gynecology and Obstetrics) (OEGGG)
====Canada==== {{see also|Transgender rights in Canada#Healthcare access}} The British Columbia Infants Act of 1996 grants minors legal decision-making authority if they can consent to a clinical intervention and their healthcare provider believes it is in their best interest.<ref>{{cite journal |vauthors=Clark BA, Virani A |title=This Wasn't a Split-Second Decision": An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy |journal=Journal of Bioethical Inquiry |volume=18 |issue=1 |pages=151–164 |date=March 2021 |pmid=33502682 |pmc=8043901 |doi=10.1007/s11673-020-10086-9}}</ref> As a result, providers are required to evaluate if their patients have a robust and realistic understanding of hormone therapy, risks, benefits, and alternatives. Although some incorporate the gender-affirming care model into practice, others demonstrate reluctance to prescribe puberty blockers.<ref>{{cite journal |vauthors=Kreukels BP, Cohen-Kettenis PT |title=Puberty suppression in gender identity disorder: the Amsterdam experience |journal=Nature Reviews. Endocrinology |volume=7 |issue=8 |pages=466–472 |date=May 2011 |pmid=21587245 |doi=10.1038/nrendo.2011.78}}</ref>
A qualitative study investigating the experience of trans youth in seeking and receiving gender-affirming care at Canadian specialty clinics shows a mix of positive and negative outcomes.<ref name="Pullen_Sansfaçon_2019">{{cite journal |vauthors=Pullen Sansfaçon A, Temple-Newhook J, Suerich-Gulick F, Feder S, Lawson ML, Ducharme J, Ghosh S, Holmes C |title=The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics |journal=The International Journal of Transgenderism |volume=20 |issue=4 |pages=371–387 |date=2019-10-02 |pmid=32999623 |pmc=6913674 |doi=10.1080/15532739.2019.1652129}}</ref> People reported improvements in their well-being, frustrations with treatment protocols and wait lists, and concerns with their transition journey.<ref name="Pullen_Sansfaçon_2019" />
According to the Canadian Pediatric Society in 2024, "Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient's mental and psychosocial health."<ref name=CBC>{{cite news |work=CBC |url=https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920 |title=What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth |vauthors=Johnson L |date=15 April 2024 |access-date=17 April 2024 |archive-date=16 April 2024 |archive-url=https://web.archive.org/web/20240416185549/https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920 |url-status=live}}</ref>
====Chile==== {{see also|LGBTQ rights in Chile#Gender identity and expression}} The following medical organizations have expressed their support for puberty blockers for transgender children and adolescents: * The Chilean Pediatric Society * The Chilean Society of Psychiatry and Neurology of Childhood and Adolescence * The Chilean Society of Childhood and Adolescent Gynecology<ref>{{cite web |title=Sociedad Chilena de Pediatría respalda terapia afirmativa y de bloqueo hormonal en niñez y adolescencia trans |url=https://www.adnradio.cl/2024/06/19/sociedad-chilena-de-pediatria-respalda-terapia-afirmativa-y-de-bloqueo-hormonal-en-ninez-y-adolescencia-trans/ |website=ADN Radio Chile |date=19 June 2024 |language=es |access-date=23 September 2024 |archive-date=23 September 2024 |archive-url=https://web.archive.org/web/20240923054605/https://www.adnradio.cl/2024/06/19/sociedad-chilena-de-pediatria-respalda-terapia-afirmativa-y-de-bloqueo-hormonal-en-ninez-y-adolescencia-trans/ |url-status=live}}</ref>
==== China ==== {{see also|LGBTQ rights in China#Transgender rights}} The 2022 'Chinese expert consensus on multidisciplinary treatment of gender identity disorder' recommends puberty blockers as a treatment for transgender youth.<ref name=":2">{{Cite journal |last1=Zhu |first1=Wenxin |last2=Xu |first2=Ni |last3=Zhang |first3=Yunbo |last4=Pan |first4=Bailin |last5=Liu |first5=Ye |last6=Yu |first6=Xin |date=2025-08-04 |title=Review: Mental Health and Health Care Needs in Transgender and Gender Diverse Youth in China |url=https://www.jaacapopen.org/article/S2949-7329(25)00082-1/fulltext |journal=JAACAP Open |issue=2 |pages=206–219 |language=English |volume=4 |doi=10.1016/j.jaacop.2025.07.002 |doi-access=free|issn=2949-7329}}</ref><ref>{{Cite journal |last1=陆峥 |last2=刘娜 |last3=陈发展 |last4=丛中 |last5=刘阳 |last6=陶林 |last7=邸晓兰 |last8=刘华清 |last9=过斌 |last10=禹海航 |last11=赵烨德 |last12=潘柏林 |last13=刘烨 |last14=李革临 |last15=杨卫敏 |date=2022 |script-title=zh:中国易性症多学科诊疗专家共识 |url=https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_lcjsyxzz2022z1001&dbid=WF_QK |script-journal=zh:临床精神医学杂志 |issue=Z1 |pages=1–15 |doi=10.3969/j.issn.1005-3220.2022.z1.001 |doi-broken-date=11 November 2025}}</ref> As of 2025, there are 7 medical centers that provide treatment to transgender youth and 3 of those offer puberty suppression as a treatment option.<ref name=":2" />
==== Denmark ==== {{see also|LGBTQ rights in Denmark#Access to healthcare}} Danish guidelines published in 2023 recommend the use of puberty blockers on transgender patients at either Tanner stage two or three, as a means of buying time for patients to consider their gender more fully before making a decision.<ref>{{Cite web |title=Sundhedsfaglige tilbud til børn og unge med kønsubehag |url=https://ugeskriftet.dk/videnskab/sundhedsfaglige-tilbud-til-born-og-unge-med-konsubehag |access-date=2024-12-04 |website=Ugeskriftet.dk |language=da |archive-date=4 December 2024 |archive-url=https://web.archive.org/web/20241204160057/https://ugeskriftet.dk/videnskab/sundhedsfaglige-tilbud-til-born-og-unge-med-konsubehag |url-status=live }}</ref>
==== Finland ==== {{see also|LGBT rights in Finland#Access to healthcare}} In 2020, Finland revised its guidelines to prioritise psychotherapy over medical transition.<ref>{{cite news |title=Doubts are growing about therapy for gender-dysphoric children |url=https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children |newspaper=The Economist |access-date=19 March 2024 |archive-date=3 December 2022 |archive-url=https://web.archive.org/web/20221203134018/https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children |url-status=live}}</ref> However, these guidelines are a recommendation, not a mandate.<ref name="Medscape1">{{cite web |title=Europe and the Puberty Blocker Debate |url=https://www.medscape.com/viewarticle/europe-and-puberty-blocker-debate-2024a1000831 |website=Medscape |access-date=31 July 2025 |archive-date=23 May 2025 |archive-url=https://web.archive.org/web/20250523043051/https://www.medscape.com/viewarticle/europe-and-puberty-blocker-debate-2024a1000831 |url-status=live }}</ref><ref name="politifact">{{cite web |date=September 6, 2023 |title=Gender-affirming surgery is not banned for minors in Europe, but is mostly inaccessible |url=https://www.politifact.com/factchecks/2023/sep/06/instagram-posts/gender-affirming-surgery-is-not-banned-for-minors/ |access-date=October 16, 2024 |website=PolitiFact |archive-url=https://web.archive.org/web/20240320201314/https://www.politifact.com/factchecks/2023/sep/06/instagram-posts/gender-affirming-surgery-is-not-banned-for-minors/ |archive-date=March 20, 2024 |url-status=live }}</ref> The Council for Choices in Health Care allows the use of puberty blockers in transgender children after a case-by-case assessment if there are no medical contraindications.<ref name=":COHERE1">{{cite web |date=16 June 2020 |title=Medical treatment methods for dysphoria associated with variations in gender identity in minors – recommendation |url=https://palveluvalikoima.fi/documents/1237350/22895008/Summary_minors_en.pdf/aaf9a6e7-b970-9de9-165c-abedfae46f2e/Summary_minors_en.pdf |access-date=4 May 2023 |website=Council for Choices in Health Care in Finland (Palveluvalikoima) |language=en-GB |archive-date=15 March 2023 |archive-url=https://web.archive.org/web/20230315041312/https://palveluvalikoima.fi/documents/1237350/22895008/Summary_minors_en.pdf/aaf9a6e7-b970-9de9-165c-abedfae46f2e/Summary_minors_en.pdf |url-status=live}}</ref><ref>{{cite news |vauthors=Karjaralainen J |date=2020-06-26 |title="Jos olisin lääkäri, minua pelottaisi ihan hirveästi antaa diagnooseja", sanoo transmies Susi Nousiainen – transsukupuolisten uusista hoitosuosituksista nousi kohu, tästä siinä on kyse |url=https://yle.fi/a/3-11419004 |access-date=2024-03-17 |language=fi |archive-date=25 February 2024 |archive-url=https://web.archive.org/web/20240225080233/https://yle.fi/a/3-11419004 |url-status=live}}</ref>
==== France ==== {{see also|LGBT rights in France#Healthcare}} Transgender children in France are eligible for puberty blockers with parental permission at any age.<ref name="Politico1023">{{cite web |title=The real story on Europe's transgender debate |vauthors=Klapsa K |work=POLITICO |date=8 October 2023 |access-date=9 April 2024 |url=https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 |archive-date=5 April 2024 |archive-url=https://web.archive.org/web/20240405212623/https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 |url-status=live}}</ref>
In 2022, France's Académie Nationale de Médecine urged caution when considering puberty blockers due to potential side effects, including "impact on growth, bone weakening, [and] risk of infertility".<ref>{{cite news |vauthors=Davis Jr E |date=July 12, 2023 |title=European Countries Restrict Trans Health Care for Minors |work=U.S. News |url=https://www.usnews.com/news/best-countries/articles/2023-07-12/why-european-countries-are-rethinking-gender-affirming-care-for-minors |access-date=8 August 2023 |archive-date=8 August 2023 |archive-url=https://web.archive.org/web/20230808004650/https://www.usnews.com/news/best-countries/articles/2023-07-12/why-european-countries-are-rethinking-gender-affirming-care-for-minors |url-status=live}}</ref><ref name="Politico1023"/> This change to the guidelines has not changed actual practice.<ref name="Politico1023"/>
In late 2024, the French Society of Pediatric Endocrinology and Diabetology released the country's first ever guidelines for medical care of trans youth, in which they recommended patients who have hit at least Tanner stage 2 to receive puberty blockers along with calcium and vitamin D supplements.<ref>{{Cite journal |last1=Brezin |first1=François |last2=Busiah |first2=Kanetee |last3=Leroy |first3=Clara |last4=Fiot |first4=Elodie |last5=Bensignor |first5=Candace |last6=Amouroux |first6=Cyril |last7=Caquard |first7=Marylène |last8=Cartault |first8=Audrey |last9=Castets |first9=Sarah |last10=Delcour |first10=Clémence |last11=Devernay |first11=Marie |last12=Feigerlova |first12=Eva |last13=Hoarau |first13=Marie |last14=Lebon-Labich |first14=Béatrice |last15=Lambert |first15=Anne-Sophie |date=2024-11-17 |title=Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group |url=https://www.sciencedirect.com/science/article/pii/S0929693X24001763 |journal=Archives de Pédiatrie |doi=10.1016/j.arcped.2024.08.003 |pmid=39551654 |issn=0929-693X |doi-access=free |url-access=subscription |archive-date=3 December 2024 |access-date=3 December 2024 |archive-url=https://web.archive.org/web/20241203234850/https://www.sciencedirect.com/science/article/pii/S0929693X24001763 |url-status=live }}</ref>
==== Germany ==== {{see also|LGBTQ rights in Germany#Transgender and intersex rights}} Transgender healthcare guidelines published by the Association of the Scientific Medical Societies in Germany recommend that the use of puberty-suppressing medication be considered for young individuals who have attained at least Tanner stage 2 of pubertal development. A prerequisite is a diagnosis of persistent gender incongruence (as per ICD-11 HA60).<ref name="awmf">{{Cite web |date=2025 |title=Geschlechtsinkongruenz und Geschlechtsdysphorie im Kindes- und Jugendalter – Diagnostik und Behandlung (S2k) |url=https://register.awmf.org/assets/guidelines/028-014l_S2k_Geschlechtsinkongruenz-Geschlechtsdysphorie-Kinder-Jugendliche_2025-06.pdf |website=AWMF Online |page=17 |archive-url=https://web.archive.org/web/20250914102314/https://register.awmf.org/assets/guidelines/028-014l_S2k_Geschlechtsinkongruenz-Geschlechtsdysphorie-Kinder-Jugendliche_2025-06.pdf |archive-date=14 September 2025}}</ref>
The use of puberty blockers has been endorsed by numerous medical organizations:<ref name="awmf"/> * {{Interlanguage link|Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie|de}} (German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy) (DGKJP) * {{Interlanguage link|Akademie für Ethik in der Medizin|de}} (Academy for Ethics in Medicine) (AEM) * {{Interlanguage link|Deutsche Ärztliche Gesellschaft für Verhaltenstherapie|de}} (German Medical Society for Behavioral Therapy) (DÄVT) * {{Interlanguage link|Deutsche Gesellschaft für Endokrinologie|de}} (German Society for Endocrinology) (DGE) * {{Interlanguage link|Deutsche Gesellschaft für Gynäkologie und Geburtshilfe|de}} (German Society for Gynecology and Obstetrics) (DGGG) * {{Interlanguage link|Deutsche Gesellschaft für Kinder- und Jugendmedizin|de}} (German Society for Pediatric and Adolescent Medicine) (DGKJ) * {{Interlanguage link|Deutsche Gesellschaft für pädiatrische und adoleszente Endokrinologie und Diabetologie|de}} (German Society for Pediatric and Adolescent Endocrinology and Diabetology) (DGPAED) * {{Interlanguage link|Deutsche Gesellschaft für Medizinische Psychologie|de}} (German Society for Medical Psychology) (DGMP) * {{Interlanguage link|Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde|de}} (German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology) (DGPPN) * {{Interlanguage link|Deutsche Gesellschaft für Psychoanalyse, Psychotherapie, Psychosomatik und Tiefenpsychologie|de}} (German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology) (DGPT) * {{Interlanguage link|Deutsche Gesellschaft für Sexualforschung|de}} (German Society for Sex Research) (DGfS) * {{Interlanguage link|Deutsches Kollegium für Psychosomatische Medizin|de}} (German College for Psychosomatic Medicine) (DKPM) * Bundesverband für Kinder- und Jugendlichenpsychotherapie e.V. (Federal Association for Child and Adolescent Psychotherapy) (bkj) * {{Interlanguage link|Berufsverband Deutscher Psychologinnen und Psychologen|de}} (Professional Association of German Psychologists) (BDP) * Berufsverband für Kinder und Jugendpsychiatrie, Psychosomatik und Psychotherapie (Professional Association for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy) (BKJPP) * Bundesarbeitsgemeinschaft der Leitenden Klinikärzte für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie (Federal Association of Senior Clinicians for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy) (BAG) * {{Interlanguage link|Bundespsychotherapeutenkammer|de}} (Federal Chamber of Psychotherapists) (BPtK) * {{Interlanguage link|Deutsche Psychoanalytische Gesellschaft|de}} (German Psychoanalytic Society) (DPG) * {{Interlanguage link|Deutsche Gesellschaft für Systemische Therapie, Beratung und Familientherapie|de}} (German Society for Systemic Therapy, Counseling, and Family Therapy) (DGSF) * Gesellschaft für Sexualwissenschaft (Society for Sexology) (GSW) * {{Interlanguage link|Kinder- und Jugendlichenpsychotherapie Verhaltenstherapie|de}} (Child and Adolescent Psychotherapy and Behavioral Therapy) (KJPVT) * {{Interlanguage link|Verband für lesbische, schwule, bisexuelle, trans*, intersexuelle und queere Menschen in der Psychologie|de}} (Association for Lesbian, Gay, Bisexual, Trans*, Intersex, and Queer People in Psychology) (VLSP) * Vereinigung Analytischer Kinder- und Jugendlichenpsychotherapeuten in Deutschland (Association of Analytical Child and Adolescent Psychotherapists in Germany) (VAKJP)
==== Italy ==== {{see also|LGBT rights in Italy#Gender identity and expression}} In 2018, the Italian National Bioethics Committee and the Italian Medicines Agency released an opinion that was supportive of the use of puberty blockers in adolescents with gender dysphoria on a case-by-case basis and with some safeguards.<ref name="NBC2018">{{Cite web|url=https://bioetica.governo.it/media/3738/132_2018_triptorelin-gender-dysphoria_en.pdf|title=On The Question Of AIFA'S Request Regarding The Ethicality Of The Use Of The Drug Triptorelin In The Treatment Of Adolescents With Gender Dysphoria|date=July 13, 2018|website=National Bioethics Committee|access-date=31 December 2024|archive-date=31 December 2024|archive-url=https://web.archive.org/web/20241231114836/https://bioetica.governo.it/media/3738/132_2018_triptorelin-gender-dysphoria_en.pdf|url-status=live}}</ref><ref>{{Cite web|url=https://www.medscape.com/viewarticle/988330#vp_2|title=Italian Psychoanalysts Oppose the Use of Puberty Blockers for Gender Dysphoria|date=February 15, 2023|website=Medscape|access-date=31 December 2024|archive-date=31 December 2024|archive-url=https://web.archive.org/web/20241231123209/https://www.medscape.com/viewarticle/988330#vp_2|url-status=live}}</ref> However, they also called for more research to better understand its effects.<ref name="NBC2018" /> As of February 2019, puberty blockers and cross sex hormones are provided free of charge in Italy and are covered by the National Health Service.<ref name="BarbiL2023">{{cite journal | vauthors = Barbi L, Tornese G | title = Ethical dilemmas of gonadotropin-releasing hormone analogs for the treatment of gender dysphoria | journal = Minerva Endocrinology | volume = 48 | issue = 1 | pages = 1–3 | date = March 2023 | pmid = 33880896 | doi = 10.23736/S2724-6507.21.03452-7 | hdl-access = free | hdl = 11368/2988571 }}</ref><ref>{{Cite journal|title=How do Italian pediatric endocrinologists approach gender incongruence?|date=14 June 2023|doi=10.1186/s13052-023-01471-2 |doi-access=free |journal=Italian Journal of Pediatrics |volume=49 |pmid=37316939 | vauthors = Ciancia S, Iughetti L |issue=1 |article-number=70 |hdl=11380/1313446 |hdl-access=free |pmc=10268452 }}</ref> Still, challenges with accessing puberty blocker medications persist. Specific clinical criteria must be satisfied for treatment including comprehensive medical evaluations, parental consent, and the exhaustion of all other clinical interventions.<ref name="BarbiL2023" />
Additionally, the use of puberty blockers in transgender youth is supported by: * The Italian Society of Endocrinology (SIE) * The Italian Society of Andrology and Sexual Medicine (SIAMS) * The Italian Society of Gender, Identity and Health (SIGIS)<ref>{{cite journal |vauthors=Ristori J, Motta G, Meriggiola MC, Bettocchi C, Crespi C, Falcone M, Lombardo F, Maggi M, Morelli G, Colao AM, Isidori AM, Fisher AD |title=A comment from SIGIS, SIE and SIAMS: "Puberty blockers in transgender adolescents-a matter of growing evidence and not of ideology" |journal=Journal of Endocrinological Investigation |volume=47 |issue=2 |pages=479–481 |date=February 2024 |pmid=37695460 |doi=10.1007/s40618-023-02173-6 |hdl-access=free |hdl=2158/1328245}}</ref> * The Italian Academy of Pediatrics<ref name="NIH1"/> * The Italian Society of Pediatrics<ref name="NIH1"/> * The Italian Society for Pediatric Endocrinology and Diabetes<ref name="NIH1"/> * The Italian Society of Adolescent Medicine<ref name="NIH1"/> * The Italian Society of Child and Adolescent Neuropsychiatry<ref name="NIH1">{{Cite journal|title=Adolescent gender dysphoria management: position paper from the Italian Academy of Pediatrics, the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, the Italian Society of Adolescent Medicine and the Italian Society of Child and Adolescent Neuropsychiatry|journal=Italian Journal of Pediatrics |date=April 18, 2024 |volume=50 |issue=1 |article-number=73 |doi=10.1186/s13052-024-01644-7 |doi-access=free |pmid=38637868 |pmc=11025175 | vauthors = Calcaterra V, Tornese G, Zuccotti G, Staiano A, Cherubini V, Gaudino R, Fazzi EM, Barbi E, Chiarelli F, Corsello G, Esposito SM, Ferrara P, Iughetti L, Laforgia N, Maghnie M, Marseglia G, Perilongo G, Pettoello-Mantovani M, Ruggieri M, Russo G, Salerno M, Striano P, Valerio G, Wasniewska M }}</ref> In October 2025, the Italian Medicines Agency (AIFA) reported they found no evidence to alter their evaluation of the risk-benefit ratio for puberty blockers.<ref>{{Cite web |title=Disforia di genere, Aifa: nessun nuovo dato per modificare l'uso della triptorelina negli adolescenti {{!}} Sanità33 |url=https://www.sanita33.it//governo-e-parlamento/6415/disforia-di-genere-aifa-nessun-nuovo-dato-per-modificare-l-uso-della-triptorelina-negli-adolescenti.html |access-date=2025-11-13 |website=www.sanita33.it |language=it}}</ref>
==== Japan ==== {{see also|LGBTQ rights in Japan#Transgender rights}} The Japanese Society of Psychiatry and Neurology (JSPN) published its updated guidelines in August 2024 on the treatment of gender dysphoria. The guidelines continued to recommend puberty suppression in trans patients, noting it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in people who were assigned male at birth. They made recommendations that doctors administering such treatment report more detailed information on outcomes going forward.<ref>{{Cite web |date=August 2024 |title=性別不合に関する診断と治療のガイドライン (第 5 版) |url=https://www.jspn.or.jp/uploads/uploads/files/activity/gid_guideline_no5.pdf |website=The Japanese Society of Psychiatry and Neurology |pages=16–18 |access-date=29 September 2024 |archive-date=1 October 2024 |archive-url=https://web.archive.org/web/20241001004744/https://www.jspn.or.jp/uploads/uploads/files/activity/gid_guideline_no5.pdf |url-status=live}}</ref><ref>{{Cite web |title=性別不合に関する診断と治療のガイドライン｜公益社団法人 日本精神神経学会 |url=https://www.jspn.or.jp/modules/advocacy/index.php?content_id=23 |access-date=2024-09-28 |website=www.jspn.or.jp |archive-date=1 October 2024 |archive-url=https://web.archive.org/web/20241001004731/https://www.jspn.or.jp/modules/advocacy/index.php?content_id=23 |url-status=live}}</ref>
==== Mexico ==== {{see also|LGBTQ rights in Mexico#Healthcare access}} In June 2020, the Mexican federal government released "The Protocol for Access without Discrimination to Health Care Services for Lesbian, Gay, Bisexual, Transsexual, Transvestite, Transgender, and Intersex Persons and Specific Care Guidelines." The guidelines are used in healthcare facilities administered by the government. The guidelines state that the process of identifying one's sexual orientation, gender identity and/or expression can occur at early ages. Thus, the guidelines recommend that medical facilities and doctors consider the use of puberty blockers and cross-sex hormones as a treatment for transgender minors when appropriate. In addition to the guidelines, multiple Mexican states have modified their civil codes to recognize gender-affirming healthcare as a right for transgender people under the age of eighteen.<ref>{{Cite web |title=Protocolo para el Acceso sin Discriminación a los Servicios de Salud para Personas Lesbianas, Gays, Bisexuales, Transexuales, Travestis, Transgénero e Intersex y Lineamientos Específicos de Atención |url=https://www.gob.mx/cms/uploads/attachment/file/558167/Versi_n_15_DE_JUNIO_2020_Protocolo_Comunidad_LGBTTI_DT_Versi_n_V_20.pdf |access-date=2024-09-29 |website=Government of Mexico |date=June 2020 |language=es |archive-date=10 September 2024 |archive-url=https://web.archive.org/web/20240910233257/https://www.gob.mx/cms/uploads/attachment/file/558167/Versi_n_15_DE_JUNIO_2020_Protocolo_Comunidad_LGBTTI_DT_Versi_n_V_20.pdf |url-status=live}}</ref>
==== Netherlands ==== {{see also|LGBT rights in the Netherlands#Transgender and intersex rights}} The Dutch Ministry of Health, Welfare and Sport publishes guidelines recommending the use of puberty blockers in transgender adolescents of at least Tanner Stage II with informed consent and approval of an endocrinologist.<ref name="DutchMinistry2016">{{cite web |url=https://richtlijnendatabase.nl/gerelateerde_documenten/f/19927/Kwaliteitsstandaard%20Transgenderzorg%20-%20Somatisch.pdf |title=Kwaliteitsstandaard Transgenderzorg -Somatisch |access-date=10 April 2024 |archive-date=1 April 2024 |archive-url=https://web.archive.org/web/20240401073534/https://richtlijnendatabase.nl/gerelateerde_documenten/f/19927/Kwaliteitsstandaard%20Transgenderzorg%20-%20Somatisch.pdf }}</ref> This guideline, published in 2016, is endorsed by the following Dutch medical organizations: * Nederlands Internisten Vereniging (Dutch Internists Association)<ref name="DutchMinistry2016"/> * Nederlands Huisartsen Genootschap (Dutch Society of General Practitioners)<ref name="DutchMinistry2016"/> * Nederlands Instituut van Psychologen (Dutch Institute of Psychologists)<ref name="DutchMinistry2016"/> * Nederlandse Vereniging voor Kindergeneeskunde (Dutch Association for Pediatrics)<ref name="DutchMinistry2016"/> * Nederlandse Vereniging voor Obstetrie & Gynaecologie (Dutch Association for Obstetrics & Gynaecology)<ref name="DutchMinistry2016"/> * Nederlandse Vereniging voor Plastische Chirurgie (Dutch Association for Plastic Surgery)<ref name="DutchMinistry2016"/> * Nederlandse Vereniging voor Psychiatrie (Dutch Psychiatry Association)<ref name="DutchMinistry2016"/> * Transvisie (Transvision, a patient organization for transgender patients)<ref name="DutchMinistry2016"/>
==== New Zealand ==== {{see also|Transgender rights in New Zealand#Gender identity and youth}}
The use of puberty blockers for transgender people is supported by: * The Professional Association for Transgender Health Aotearoa (PATHA)<ref>{{cite web |title=PATHA's vision for transgender healthcare under the current health reforms |url=https://nzmj.org.nz/journal/vol-136-no-1574/pathas-vision-for-transgender-healthcare-under-the-current-health-reforms |access-date=29 September 2024 |website=The New Zealand Medical Journal |date=28 April 2023}}</ref> * The Royal Australian and New Zealand College of Psychiatrists (RANZCP)<ref>{{cite web |title=The role of psychiatrists in working with Trans and Gender Diverse people |url=https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/role-of-psychiatrists-working-with-trans-gender-diverse-people |access-date=29 September 2024 |website=The New Zealand Medical Journal |date=December 2023 |archive-date=4 October 2024 |archive-url=https://web.archive.org/web/20241004064835/https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/role-of-psychiatrists-working-with-trans-gender-diverse-people |url-status=live }}</ref> * The Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ){{Citation needed|date=January 2025}} * The New Zealand Sexual Health Society<ref name=":4" /> * The New Zealand Society of Endocrinology<ref name=":4">{{cite web |title=Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand |url=https://researchcommons.waikato.ac.nz/server/api/core/bitstreams/2051b399-ffd9-4826-8f20-dcdb895add83/content |access-date=29 September 2024 |website=Society of Youth Health Professionals Aotearoa New Zealand |date=October 2018}}</ref> * The College of Child and Youth Nurses<ref name=":5">{{Cite web |title=PATHA - Professional Association for Transgender Health Aotearoa - Health Professional Bodies Oppose Restrictions on Puberty Blockers |url=https://patha.nz/News/13484154 |archive-url=https://web.archive.org/web/20250406201429/https://patha.nz/News/13484154 |archive-date=6 April 2025 |access-date=2025-04-06 |website=patha.nz}}</ref> * The New Zealand College of Clinical Psychologists <ref name=":5" /> * The New Zealand Pediatrics Society<ref name=":5" /> * The New Zealand Psychological Society<ref name=":5" /> * The Auckland Sexual Health Service<ref name=":5" />
In November 2024, the Ministry of Health released an evidence brief on puberty blockers. The brief found there to be a lack of evidence for both the efficacy and harms of puberty blockers and recommended "a more precautionary approach".<ref>{{Cite web |date=21 November 2024 |title=Position Statement on the Use of Puberty Blockers in Gender-Affirming Care |url=https://www.health.govt.nz/publications/position-statement-on-the-use-of-puberty-blockers-in-gender-affirming-care |access-date=21 November 2024 |archive-date=21 November 2024 |archive-url=https://web.archive.org/web/20241121012516/https://www.health.govt.nz/publications/position-statement-on-the-use-of-puberty-blockers-in-gender-affirming-care |url-status=live }}</ref> The country did not ban puberty blockers and one doctor who provides the treatments in New Zealand said it "would not change the way in which he practiced".<ref>{{Cite web|url=https://www.nzherald.co.nz/nz/puberty-blockers-to-be-prescribed-more-cautiously-in-new-zealand-after-review/UTYF74GEOBE5FL5UVDSSZJJQGM/|title=Puberty blockers to be prescribed more cautiously in New Zealand after review|website=The New Zealand Herald|date=2024-11-20|language=en|access-date=2024-11-20|archive-date=21 November 2024|archive-url=https://web.archive.org/web/20241121043339/https://www.nzherald.co.nz/nz/puberty-blockers-to-be-prescribed-more-cautiously-in-new-zealand-after-review/UTYF74GEOBE5FL5UVDSSZJJQGM/|url-status=live}}</ref><ref>{{Cite web|url=https://www.rnz.co.nz/news/national/534431/puberty-blockers-ministry-of-health-releases-long-awaited-evidence-brief|title=Puberty blockers: Ministry of Health releases long-awaited evidence brief|website=RNZ|date=2024-11-20|language=en|access-date=2024-11-20|archive-date=21 November 2024|archive-url=https://web.archive.org/web/20241121020159/https://www.rnz.co.nz/news/national/534431/puberty-blockers-ministry-of-health-releases-long-awaited-evidence-brief|url-status=live}}</ref><ref>{{Cite web|url=https://www.thepost.co.nz/politics/360494770/health-ministry-urges-caution-over-prescribing-puberty-blockers|title=Health Ministry urges caution over prescribing puberty blockers|website=The Post|date=2024-11-20|language=en|access-date=2024-11-20|archive-date=2 December 2024|archive-url=https://web.archive.org/web/20241202185354/https://www.thepost.co.nz/politics/360494770/health-ministry-urges-caution-over-prescribing-puberty-blockers|url-status=live}}</ref> In April 2025, potential further restrictions on access to puberty blockers proposed by the ministry were met with backlash by a number of New Zealand medical bodies.<ref name=":5" /> On November 19, 2025, the Ministry of Health under the right-wing New Zealand First and ACT party coalition and led by Simeon Brown, announced a ban on puberty blockers for minors with gender dysphoria set to take effect on December 19, 2025. Minors with gender dysphoria already on puberty blockers will be able to continue them and the drug will also remain available for other uses like early onset puberty. Brown cited the Cass Review in his decision and said the ban will remain in place until the completion of the United Kingdom's clinical trial on puberty blockers. The ban was strongly condemned by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the Professional Association for Transgender Health Aotearoa (PATHA) and multiple other doctors in New Zealand. The ban was also condemned by the opposition centre-left Labour Party as well as members of the Green Party.<ref>{{Cite web |title='Shockingly inappropriate overreach of politics': Doctors slam puberty blocker pause |url=https://www.thepress.co.nz/nz-news/360893490/shockingly-inappropriate-overreach-politics-doctors-slam-puberty-blocker-pause |access-date=2025-11-20 |website=The Press}}</ref><ref>{{Cite web |title=New Zealand bans puberty blockers for young transgender people |url=https://www.theguardian.com/world/2025/nov/19/new-zealand-bans-new-prescriptions-of-puberty-blockers-for-young-transgender-people |date=2025-11-19 |access-date=2025-11-20 |website=The Guardian}}</ref><ref>{{Cite web |title=Government halts new puberty blockers prescriptions for gender-affirming care |url=https://www.stuff.co.nz/politics/360892840/government-halts-new-puberty-blockers-prescriptions-gender-affirming-care |date=2025-11-19 |access-date=2025-11-20 |website=Stuff}}</ref><ref>{{Cite web |title=New Zealand pushes pause on puberty blockers pending UK trial |url=https://www.rnz.co.nz/news/political/579385/new-zealand-pushes-pause-on-puberty-blockers-pending-uk-trial |date=2025-11-19 |access-date=2025-11-20 |website=Radio New Zealand}}</ref><ref>{{cite web|access-date=19 November 2025 |date=19 November 2025 |title=New Safeguards For Puberty Blocker Prescribing |url=https://www.scoop.co.nz/stories/PA2511/S00161/new-safeguards-for-puberty-blocker-prescribing.htm |website=Scoop}}</ref> On December 17, 2025, the Wellington High Court granted an injunction preventing the ban from being enforced while a full judicial review is pending.<ref>{{Cite web |date=2025-12-17 |title=Puberty blockers ban delayed by judicial review |url=https://www.rnz.co.nz/news/national/582090/puberty-blockers-ban-delayed-by-judicial-review |access-date=2026-02-18 |website=RNZ |language=en-nz}}</ref>
==== Norway ==== {{see also|LGBT rights in Norway#Healthcare}}
In 2020, the Norwegian Directorate for Health, the governmental body that develops health guidelines, released one for gender incongruence recommending puberty blockers between Tanner stage 2 and the age of 16 following an interdisciplinary assessment, stating they were reversible and there is no reliable evidence of adverse long-term effects.<ref name="Phan">{{cite news |date=2023-06-08 |title=Norway didn't ban gender-affirming care for minors, as headline falsely claims |url=https://apnews.com/article/fact-check-norway-not-ban-gender-affirming-care-956221436313 |url-status=live |archive-url=https://web.archive.org/web/20240317012417/https://apnews.com/article/fact-check-norway-not-ban-gender-affirming-care-956221436313 |archive-date=17 March 2024 |access-date=2024-03-17 |work=AP News |language=en |vauthors=Phan K}}</ref><ref>{{cite web |title=Utredning, behandling og oppfølging |url=https://www.helsedirektoratet.no/retningslinjer/kjonnsinkongruens/utredning-behandling-og-oppfolging |url-status=live |archive-url=https://web.archive.org/web/20240317012418/https://www.helsedirektoratet.no/retningslinjer/kjonnsinkongruens/utredning-behandling-og-oppfolging |archive-date=17 March 2024 |access-date=2024-03-17 |website=Helsedirektoratet |language=no}}</ref><ref name="Politico1023" />
In 2023, the Norwegian Healthcare Investigation Board, an independent non-governmental organization, issued a non-binding report finding "there is insufficient evidence for the use of puberty blockers and cross sex hormone treatments in young people" and recommending changing to a cautious approach.<ref name="Block">{{cite journal |vauthors=Block J |date=March 2023 |title=Norway's guidance on paediatric gender treatment is unsafe, says review |journal=BMJ |volume=380 |page=697 |doi=10.1136/bmj.p697 |pmid=36958723 |s2cid=257666327 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Taylor J, Hall R, Heathcote C, Hewitt CE, Langton T, Fraser L |date=April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2) |url=https://eprints.whiterose.ac.uk/211590/1/archdischild-2023-326499.full.pdf |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s73–s82 |doi=10.1136/archdischild-2023-326500 |pmid=38594048 |archive-url=https://web.archive.org/web/20240921192521/https://eprints.whiterose.ac.uk/211590/1/archdischild-2023-326499.full.pdf |archive-date=21 September 2024 |access-date=29 September 2024}}</ref> The Norwegian Healthcare Investigation Board is not responsible for setting healthcare policy, and the Directorate, which is, has not implemented the recommendations, though they have said they are considering them.<ref name="Block" /><ref name="Phan" /><ref name="Politico1023" /> Misinformation that Norway had banned gender affirming care proliferated on social media.<ref name="Phan" />
==== Sweden ==== {{see also|LGBT rights in Sweden#Access to healthcare}} Sweden's Karolinska Institute, administrator of the second-largest hospital system in the country, announced in March 2021 that it would discontinue providing puberty blockers or cross-sex hormones to children under 16. Additionally, the Karolinska Institute changed its policy to cease providing puberty blockers or cross-sex hormones to teenagers 16–18, outside of approved clinical trials.<ref name="economist">{{cite news |date=13 May 2021 |title=Doubts are growing about therapy for gender-dysphoric children |newspaper=The Economist |url=https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children |archive-url=https://web.archive.org/web/20230810003011/https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children |archive-date=2023-08-10 |access-date=2 November 2021}}</ref> On February 22, 2022, Sweden's National Board of Health and Welfare released updated national guidelines that state puberty blockers should be limited to "exceptional cases".<ref name=":NBHW1">{{cite web |date=2015 |title=Care of children and adolescents with gender dysphoria: Summary |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf |access-date=4 May 2023 |website=The National Board of Health and Welfare (Socialstyrelsen) |language=en-GB |archive-date=19 May 2023 |archive-url=https://web.archive.org/web/20230519163625/https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf }}</ref><ref name=":NBHW2">{{cite web |date=22 February 2022 |title=Uppdaterade rekommendationer för hormonbehandling vid könsdysfori hos unga |url=https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/ |archive-url=https://web.archive.org/web/20230803230704/https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/ |archive-date=2023-08-03 |access-date=4 May 2023 |website=The National Board of Health and Welfare (Socialstyrelsen) |language=sv}}</ref> According to PolitiFact, these are recommendations and do not equate to a ban on the treatment as physicians and clinics such as Karolinska have latitude deciding which cases qualify.<ref name="politifact"/> Youth in Sweden are still able to access the treatment at other providers when doctors deem it medically necessary, albeit with long wait times. The treatment is not banned in Sweden and is offered as part of its national healthcare service.<ref name=":NBHW2" /><ref>{{cite journal |vauthors=Linander I, Alm E |date=20 April 2022 |title=Waiting for and in gender-confirming healthcare in Sweden: An analysis of young trans people's experiences |url=https://www.diva-portal.org/smash/get/diva2:1657703/FULLTEXT01.pdf |url-status=live |journal=European Journal of Social Work |volume=25 |issue=6 |publisher=Routledge |pages=995–1006 |doi=10.1080/13691457.2022.2063799 |archive-url=https://web.archive.org/web/20220926195755/https://www.diva-portal.org/smash/get/diva2:1657703/FULLTEXT01.pdf |archive-date=26 September 2022 |access-date=11 October 2022 |s2cid=248314474}}</ref><ref>{{cite journal |vauthors=Linander I, Lauri M, Alm E, Goicolea I |date=June 2021 |title=Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare |journal=Sexuality Research and Social Policy |volume=18 |issue=2 |pages=309–320 |doi=10.1007/s13178-020-00459-5 |s2cid=219733261 |doi-access=free}}</ref><ref name="politiceu">{{cite web |title=The real story on Europe's transgender debate |vauthors=Klapsa K |work=POLITICO |date=8 October 2023 |access-date=9 April 2024 |url=https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 |archive-date=5 April 2024 |archive-url=https://web.archive.org/web/20240405212623/https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 |url-status=live}}</ref> However, misinformation that Sweden banned puberty blockers has proliferated on social media and some Republican politicians in the United States have used this misinformation to justify banning puberty blockers outright.<ref name="politiceu"/><ref name="HC">{{cite web |last1=Abels |first1=Grace |date=Dec 25, 2023 |title=Fact check: Did Sweden 'shut down' gender-affirming surgical care for minors? |url=https://www.houstonchronicle.com/politics/texas/politifact/article/fact-check-sweden-transgender-18571187.php |access-date=23 October 2024 |website=The Houston Chronicle}}</ref><ref>{{cite web |date=April 9, 2024 |title=Youth Gender Medications Limited in England, Part of Big Shift in Europe |url=https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |access-date=16 October 2024 |website=New York Times}}</ref><ref name="politifact"/>
==== United Kingdom ==== {{see also|Transgender rights in the United Kingdom#Medical treatment for young people|Cass Review#Puberty Blockers}} As of May 2024, prescription of puberty blockers to new patients under 18 for the treatment of gender dysphoria is banned for both private medical practices (by a law in parliament in May<ref name="Barnes"/>) and the official state healthcare National Health Service (NHS) which stopped their use earlier, in the aftermath of the Cass Review except for use in clinical research trials.<ref>{{cite web |title=New restrictions on puberty blockers |url=https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers |website=GOV.UK |publisher=Department of Health and Social Care: Government of the United Kingdom |access-date=20 August 2024 |language=en |date=29 May 2024 |archive-date=20 August 2024 |archive-url=https://web.archive.org/web/20240820015327/https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers |url-status=live}}</ref>
Previously, on 30 June 2020, the NHS changed its website, replacing the statement that puberty blockers were "fully reversible" and that "treatment can usually be stopped at any time"; with "little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.<ref name="BBC Woman's Hour">{{cite news |date=30 June 2020 |title=Women and Gaming; ICU nurse Dawn Bilbrough; Poulomi Basu; Puberty blockers |work=Woman's Hour |url=https://www.bbc.co.uk/programmes/m000kgsj |access-date=1 November 2021 |archive-date=10 November 2022 |archive-url=https://web.archive.org/web/20221110235425/https://www.bbc.co.uk/programmes/m000kgsj |url-status=live}}</ref>
A 2020 commissioned review published by the UK's National Institute for Health and Care Excellence (NICE) concluded that the quality of evidence for puberty blocker outcomes (for mental health, quality of life and impact on gender dysphoria) was of very low certainty based on a modified GRADE approach, but that it was plausible that the outcomes would have been worse without treatment.<ref>{{cite web |date=2020 |title=Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria |work=National Institute for Health and Care Excellence (NICE) |url=https://arms.nice.org.uk/resources/hub/1070905/attachment |archive-url=https://web.archive.org/web/20210422130502/https://arms.nice.org.uk/resources/hub/1070905/attachment |archive-date=2021-04-22 |access-date=1 April 2021 |quote=It is plausible, however, that a lack of difference in scores from baseline to follow-up is the effect of GnRH analogues in children and adolescents with gender dysphoria, in whom the development of secondary sexual characteristics might be expected to be associated with an increased impact on gender dysphoria, depression, anxiety, anger and distress over time without treatment.}}</ref> A subsequent systematic review re-affirmed the conclusions of the NICE report, concluding that the currently available studies have "significant conceptual and methodological flaws".<ref>{{cite journal |vauthors=von der Gönna U |date=27 February 2024 |title=Trans identity in minors: Review evaluates current evidence on use of puberty blockers and cross-sex-hormones |url=https://medicalxpress.com/news/2024-02-trans-identity-minors-current-evidence.html |newspaper=Medical Xpress |archive-date=7 March 2024 |access-date=6 March 2024 |archive-url=https://web.archive.org/web/20240307013147/https://medicalxpress.com/news/2024-02-trans-identity-minors-current-evidence.html |url-status=live }}</ref><ref name=":0">{{cite journal |vauthors=Zepf FD, König L, Kaiser A, Ligges C, Ligges M, Roessner V, Banaschewski T, Holtmann M |title=[Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria] |journal=Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie |volume=52 |issue=3 |pages=167–187 |year=2024 |pmid=38410090 |doi=10.1024/1422-4917/a000972 |doi-access=free}}</ref> A 2024 review of evidence on behalf of the Cass Review came to a similar conclusion.<ref name="york">{{cite journal |vauthors=Taylor J, Mitchell A, Hall R, Heathcote C, Langton T, Fraser L, Hewitt CE |title=Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review |journal=Archives of Disease in Childhood |date=April 2024 |volume=109 |issue=Suppl 2 |pages=s33–s47 |pmid=38594047 |doi=10.1136/archdischild-2023-326669 |doi-access=free}}</ref>
The NICE review has been criticized by organizations that support the use of puberty blockers such as WPATH and EPATH, and in a WPATH ''International Journal of Transgender Health'' article by Cal Horton for excluding studies combining puberty blockers and hormone therapy, and also by parents of transgender youth for excluding evidence of its safety when used, albeit at a much younger age, by cisgender youth being treated for precocious puberty.<ref name="Horton">{{cite journal |vauthors=Horton C |author-link=Cal Horton |date=2024-03-14 |title=The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children |journal=International Journal of Transgender Health |volume=26 |issue=4 |language=en |pages=1120–1144 |doi=10.1080/26895269.2024.2328249 |issn=2689-5269 |doi-access=free |pmid=41180936 |pmc=12573551 }}</ref><ref name="WPATH-NHS">{{cite web |date=October 30, 2023 |title=Joint statement EPATH and WPATH |url=https://www.wpath.org/media/cms/Documents/Public%20Policies/2023/30.10.23%20EPATH%20-%20WPATH%20Joint%20NHS%20Statement%20Final.pdf |publisher=World Professional Association for Transgender Health, European Professional Association for Transgender Health |access-date=16 March 2024 |archive-date=11 April 2024 |archive-url=https://web.archive.org/web/20240411012336/https://patha.nz/News/13341582 |url-status=live}}</ref> Horton criticised the review for prioritizing high-quality evidence according to the GRADE approach, which designates randomized control trials (RCTs) as "high quality", since RCTs are widely considered infeasible and unethical for transgender youth if those in the control group are denied medical treatment.<ref name="Horton" /> Horton also argued that it had not followed GRADE guidance which states that "low or very low quality evidence can lead to a strong recommendation" by not taking the low-quality studies into account when forming evidence review recommendations.<ref name="Horton" />
The ''Bell v Tavistock'' decision by the High Court of Justice for England and Wales ruled children under 16 were not competent to give informed consent to puberty blockers, but this was overturned by the Court of Appeal in September 2021.
In 2022, the British Medical Association opposed restrictions on puberty blockers,<ref name="ReutersBMA">{{cite web |title=UK doctors back trans self-ID rules and treatment for under-18s |vauthors=Savage R |work=U.S. |date=16 September 2020 |access-date=17 May 2023 |url=https://www.reuters.com/article/britain-lgbt-health-idINL8N2GD35H |quote=The BMA called for trans people to receive healthcare "in settings appropriate to their gender identity" and for under-18s to be able to get treatment "in line with existing principles of consent", which requires they fully understand what is involved. |archive-date=18 May 2023 |archive-url=https://web.archive.org/web/20230518025054/https://www.reuters.com/article/britain-lgbt-health-idINL8N2GD35H |url-status=live}}</ref> and the NHS restricted their use for children under 16 years of age to centrally administered clinical research.<ref>{{cite web |date=20 October 2022 |title=Interim service specification for specialist gender dysphoria services for children and young people – public consultation |url=https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/ |access-date=31 December 2022 |website=NHS UK |language=en-GB |archive-date=31 May 2023 |archive-url=https://web.archive.org/web/20230531102932/https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/ |url-status=live}}</ref><ref name=":NHS1">{{cite web |date=2022 |title=Implementing advice from the Cass Review |url=https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/ |access-date=4 May 2023 |website=NHS UK |language=en-GB |archive-date=4 June 2023 |archive-url=https://web.archive.org/web/20230604080758/https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/ |url-status=live}}</ref>
The April 2024, Cass Review stated that there was inadequate evidence to justify the widespread use of puberty blockers for gender dysphoria, and that more research was needed to provide evidence as to the effectiveness of this treatment, in terms of reducing distress and improving psychological functioning.<ref name="cassreview">{{cite web |vauthors=Cass H |date=2024 |title=Final Report – Cass Review |url=https://cass.independent-review.uk/home/publications/final-report/ |access-date=2024-04-20 |website=cass.independent-review.uk |language=en |archive-date=9 April 2024 |archive-url=https://web.archive.org/web/20240409231432/https://cass.independent-review.uk/home/publications/final-report/ |url-status=live}}</ref> This led to a ''de facto'' moratorium of the routine provision of puberty blockers for gender dysphoria within NHS England and NHS Scotland outside of clinical trials,<ref>{{cite web |vauthors=Alfonseca K |title=What the trans care recommendations from the NHS England report mean |url=https://abcnews.go.com/Health/trans-care-recommendations-nhs-england-report/story?id=109081565 |access-date=2024-04-20 |website=ABC News |archive-date=23 April 2024 |archive-url=https://web.archive.org/web/20240423232304/https://abcnews.go.com/Health/trans-care-recommendations-nhs-england-report/story?id=109081565 |url-status=live}}</ref><ref name="BBC_News_2024">{{cite news |vauthors=Parry J |date=2024-03-12 |title=NHS England to stop prescribing puberty blockers |url=https://www.bbc.com/news/health-68549091 |access-date=2024-04-20 |work=BBC News |archive-date=21 April 2024 |archive-url=https://web.archive.org/web/20240421030249/https://www.bbc.com/news/health-68549091 |url-status=live}}</ref><ref name=":1">{{cite web |date=19 April 2024 |title=Scotland's under-18s gender clinic pauses puberty blockers |url=https://www.bbc.co.uk/news/uk-scotland-68844119 |access-date=21 April 2024 |website=bbc.co.uk |publisher=BBC |vauthors=McCool M |archive-date=21 April 2024 |archive-url=https://web.archive.org/web/20240421043445/https://www.bbc.co.uk/news/uk-scotland-68844119 |url-status=live}}</ref> and a subsequent ban on private prescription of puberty blockers in the United Kingdom.<ref>{{cite news |vauthors=Smyth C, Beal J |date=2024-04-20 |title=Private doctors who give children puberty blockers may be struck off |newspaper=The Times |url=https://www.thetimes.com/uk/article/private-doctors-who-give-children-puberty-blockers-may-be-struck-off-nf97p73l0 |access-date=2024-04-20 |language=en |issn=0140-0460 |archive-date=20 April 2024 |archive-url=https://web.archive.org/web/20240420105107/https://www.thetimes.co.uk/article/private-doctors-who-give-children-puberty-blockers-may-be-struck-off-nf97p73l0 |url-status=live}}</ref><ref>{{cite news |date=7 April 2024 |title=NHS loophole allows puberty blockers for children |url=https://www.telegraph.co.uk/news/2024/04/07/puberty-blockers-nhs-loophole-liz-truss-dr-hilary-cass/ |work=The Telegraph |vauthors=Searle M |access-date=8 April 2024 |archive-date=8 April 2024 |archive-url=https://web.archive.org/web/20240408090851/https://www.telegraph.co.uk/news/2024/04/07/puberty-blockers-nhs-loophole-liz-truss-dr-hilary-cass/ |url-status=live}}</ref><ref>{{cite magazine |title=Children Will No Longer Be Able to Access Puberty Blockers at England Clinics |url=https://time.com/6900330/nhs-bans-puberty-blockers-england-clinics/ |magazine=Time |access-date=16 March 2024 |archive-date=16 March 2024 |archive-url=https://web.archive.org/web/20240316040825/https://time.com/6900330/nhs-bans-puberty-blockers-england-clinics/ |url-status=live}}</ref>
Children already receiving puberty blockers via NHS England will be able to continue their treatment.<ref name="cnn_march_2024">{{cite news |vauthors=John T |date=12 March 2024 |work=CNN |url=https://www.cnn.com/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr/index.html |title=England's health service to stop prescribing puberty blockers to transgender kids |access-date=16 March 2024 |archive-date=16 March 2024 |archive-url=https://web.archive.org/web/20240316040825/https://amp.cnn.com/cnn/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr/index.html |url-status=live}}</ref> In England, a clinical trial into puberty blockers is planned for early 2025.<ref name="Guardian20240807">{{cite news |last1=Campbell |first1=Denis |date=7 August 2024 |title=Delayed puberty blocker clinical trial to start next year in England |url=https://www.theguardian.com/society/article/2024/aug/07/delayed-puberty-blocker-clinical-trial-to-start-next-year-in-england |access-date=8 August 2024 |work=The Guardian |archive-date=1 October 2024 |archive-url=https://web.archive.org/web/20241001004823/https://www.theguardian.com/society/article/2024/aug/07/delayed-puberty-blocker-clinical-trial-to-start-next-year-in-england |url-status=live}}</ref>
In July 2024, the Royal College of General Practitioners stated that for patients under 18, no general practitioner should prescribe puberty blockers outside of a clinical trial, and the prescription of gender-affirming hormones should be left to specialists. They affirmed they will fully implement the Cass Review recommendations.<ref name="RCGP">{{Cite web |last=RCGP |title=Transgender care |url=https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care |access-date=2024-08-16 |website=www.rcgp.org.uk |language=en |archive-date=29 July 2024 |archive-url=https://web.archive.org/web/20240729180836/https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care |url-status=live}}</ref>
===== Bans in the United Kingdom ===== {{anchor|Bans in the United Kingdom|Puberty blocker bans in the United Kingdom}} {{see also|Anti-transgender movement in the United Kingdom|Cass Review}} The United Kingdom has seen a rise of misinformation related to transgender health care being advanced by anti-transgender groups as part of a wider anti-transgender movement in the United Kingdom.<ref>{{cite web |title=The Anti-Trans 'Gender-Critical' Movement Is Overflowing with Bullshit |url=https://www.vice.com/en/article/gender-critical-movement-misinformation/ |website=VICE |date=17 November 2021}}</ref> The Lemkin Institute for Genocide Prevention issued a red-flag alerts for the UK in April 2025 due to the regression of rights of transgender individuals, including a ban on puberty blockers. <ref name="PNLemkinUK">{{cite web |last1=Hansford |first1=Amelia |title=Genocide prevention group issues 'red flag' over UK's treatment of trans people |url=https://www.thepinknews.com/2025/07/02/lemkin-institute-trans-red-flag/ |website=PinkNews |access-date=14 September 2025 |date=2 July 2025 |archive-date=25 August 2025 |archive-url=https://web.archive.org/web/20250825172845/https://www.thepinknews.com/2025/07/02/lemkin-institute-trans-red-flag/ |url-status=live }}</ref><ref name="LemkinUK">{{cite web |title=Red Flag Alert on Anti-Trans and Intersex Rights in the UK |url=https://www.lemkininstitute.com/red-flag-alerts/red-flag-alert-on-anti-trans-and-intersex-rights-in-the-uk |website=Lemkin Institute for Genocide Prevention |access-date=14 September 2025 |language=en |date=30 June 2025 |archive-date=3 September 2025 |archive-url=https://web.archive.org/web/20250903221056/https://www.lemkininstitute.com/red-flag-alerts/red-flag-alert-on-anti-trans-and-intersex-rights-in-the-uk |url-status=live }}</ref>
In December 2024, the Northern Ireland Executive announced a permanent ban on puberty blockers for under-18s, with the Executive's Deputy First Minister, Emma Little-Pengelly, saying it was "the right approach, informed by medical and scientific advice. The protection and safety of our young people must be paramount."<ref>{{Cite web |last=Dalton |first=Eoghan |date=2024-12-11 |title=Parties in Northern Ireland executive agree to extend Britain's ban on puberty blockers |url=https://www.thejournal.ie/puberty-blockers-northern-ireland-6568777-Dec2024/ |access-date=2024-12-11 |website=TheJournal.ie |language=en |archive-date=12 December 2024 |archive-url=https://web.archive.org/web/20241212073132/https://www.thejournal.ie/puberty-blockers-northern-ireland-6568777-Dec2024/ |url-status=live }}</ref><ref>{{Cite web |date=2024-12-10 |title=Puberty blockers set for indefinite ban in Northern Ireland |url=https://www.bbc.co.uk/news/articles/clyxr43e2m7o |access-date=2024-12-11 |website=BBC News |language=en-GB |archive-date=11 December 2024 |archive-url=https://web.archive.org/web/20241211162634/https://www.bbc.co.uk/news/articles/clyxr43e2m7o |url-status=live }}</ref><ref>{{Cite news |last=Searles |first=Michael |date=2024-12-10 |title=Puberty blockers permanently banned in Northern Ireland to block supply loophole |url=https://www.telegraph.co.uk/news/2024/12/10/puberty-blockers-permanent-ban-northern-ireland-loophole/ |access-date=2024-12-11 |work=The Telegraph |language=en-GB |issn=0307-1235 |archive-date=10 December 2024 |archive-url=https://web.archive.org/web/20241210201941/https://www.telegraph.co.uk/news/2024/12/10/puberty-blockers-permanent-ban-northern-ireland-loophole/ |url-status=live }}</ref> The following day, the Health Secretary, Wes Streeting, announced in the House of Commons that the previously enacted ban on puberty blockers in England would be made indefinite and would be reviewed in 2027.<ref>{{Cite news |date=2024-12-11 |title=Health Secretary Wes Streeting announces ‘indefinite’ ban on puberty blockers for children |url=https://www.independent.co.uk/news/health/puberty-blockers-ban-wes-streeting-health-children-b2662590.html |access-date=2024-12-11 |newspaper=The Independent |language=en}}</ref><ref>{{Cite web |title=Ban on puberty blockers to be made indefinite on experts' advice |url=https://www.gov.uk/government/news/ban-on-puberty-blockers-to-be-made-indefinite-on-experts-advice |access-date=2024-12-11 |website=Gov.uk |language=en}}</ref><ref>{{cite news |url=https://www.nytimes.com/2024/12/11/world/europe/uk-bans-puberty-blockers-under-18.html |url-access=subscription | title=U.K. Bans Puberty Blockers for Teens Indefinitely | first=Stephen | last=Castle |newspaper=The New York Times | date=December 11, 2024 | access-date=December 12, 2024}}</ref>
==== United States ==== {{see also|Transgender rights in the United States#Healthcare}}
Since 1993 the US Food and Drug Administration (FDA) has supported the use of puberty blockers to treat precocious puberty.<ref>{{cite web |last=Benisek |first=Alexandra |title=What Are Puberty Blockers? |url=https://www.webmd.com/children/what-are-puberty-blockers |access-date=2024-08-01 |website=WebMD |language=en |archive-date=21 December 2022 |archive-url=https://web.archive.org/web/20221221091100/https://www.webmd.com/children/what-are-puberty-blockers |url-status=live}}</ref> Currently under FDA regulation the use of puberty blockers is considered on-label for the treatment of central precocious puberty.<ref name="Lopez_2018">{{cite journal |vauthors=Lopez CM, Solomon D, Boulware SD, Christison-Lagay E |title=Trends in the "Off-Label" Use of GnRH Agonists Among Pediatric Patients in the United States |journal=Clinical Pediatrics |volume=57 |issue=12 |pages=1432–1435 |date=October 2018 |pmid=30003804 |doi=10.1177/0009922818787260}}</ref><ref name="apa.org" />
For years, the FDA, Endocrine Society, American Academy of Pediatrics (AAP) and many other pediatric associations have supported the use of Gonadotropin-releasing hormone analogs (GnRHas) in central precocious puberty (CPP).<ref>{{cite journal |vauthors=Kletter GB, Klein KO, Wong YY |title=A pediatrician's guide to central precocious puberty |journal=Clinical Pediatrics |volume=54 |issue=5 |pages=414–424 |date=May 2015 |pmid=25022947 |doi=10.1177/0009922814541807}}</ref> Access to treatment depends on the classification of precocious puberty as well as other guidelines implemented by the Endocrine Society.<ref>{{cite journal |vauthors=Klein KO |title=Precocious puberty: who has it? Who should be treated? |journal=The Journal of Clinical Endocrinology and Metabolism |volume=84 |issue=2 |pages=411–414 |date=February 1999 |pmid=10022393 |doi=10.1210/jcem.84.2.5533}}</ref> To determine if a patient is experiencing precocious puberty and should receive treatment, a physical exam, blood test, and x-rays are required.<ref>{{cite journal |vauthors=Eugster EA, Palmert MR |date=September 2006 |title=Precocious Puberty |url=https://academic.oup.com/jcem/article/91/9/E1/2656237 |journal=The Journal of Clinical Endocrinology & Metabolism |language=en |volume=91 |issue=9 |pages=E1 |doi=10.1210/jcem.91.9.9997 |issn=0021-972X |access-date=1 October 2024 |archive-date=1 October 2024 |archive-url=https://web.archive.org/web/20241001005602/https://academic.oup.com/jcem/article/91/9/E1/2656237 |url-status=live|url-access=subscription }}</ref>
In 2009, the Lawson Wilkins Pediatric Endocrine Society and European Society for Pediatric Endocrinology published a consensus statement highlighting the effectiveness of Gonadotropin-releasing hormone analogs (GnRHas) in early onset central precocious puberty.<ref name="Carel_2009">{{cite journal |vauthors=Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, Antoniazzi F, Berenbaum S, Bourguignon JP, Chrousos GP, Coste J, Deal S, de Vries L, Foster C, Heger S, Holland J, Jahnukainen K, Juul A, Kaplowitz P, Lahlou N, Lee MM, Lee P, Merke DP, Neely EK, Oostdijk W, Phillip M, Rosenfield RL, Shulman D, Styne D, Tauber M, Wit JM |title=Consensus statement on the use of gonadotropin-releasing hormone analogs in children |journal=Pediatrics |volume=123 |issue=4 |pages=e752–e762 |date=April 2009 |pmid=19332438 |doi=10.1542/peds.2008-1783 |url=http://orbi.ulg.ac.be/handle/2268/109500 |access-date=8 August 2024 |archive-date=1 October 2024 |archive-url=https://web.archive.org/web/20241001005608/https://orbi.uliege.be/handle/2268/109500 |url-status=live}}</ref> They confirmed that the use of Gonadotropin-releasing hormone analogs (GnRHas) has had a positive effect on increasing adult height.<ref name="Carel_2009" /><ref>{{cite journal |vauthors=Chen M, Eugster EA |title=Central Precocious Puberty: Update on Diagnosis and Treatment |journal=Paediatric Drugs |volume=17 |issue=4 |pages=273–281 |date=August 2015 |pmid=25911294 |pmc=5870137 |doi=10.1007/s40272-015-0130-8}}</ref> However these Endocrine Societies believe additional research should be conducted before routinely suggesting GnRHAs for other conditions.<ref name="Carel_2009" /> There is still some uncertainty surrounding the effectiveness of GnRHas when utilized for other conditions.
Currently under FDA regulation, the use of puberty blockers in pediatrics with gender dysphoria is considered off-label.<ref name="AACAP Statement Responding to Efforts to ban Evidence-2019" />
The use of puberty blockers in youth experiencing gender dysphoria has been supported by the following organizations: * The American Medical Association<ref name="American Medical Association-2021">{{cite web |url=https://www.ama-assn.org/health-care-advocacy/advocacy-update/march-26-2021-state-advocacy-update |title=March 26, 2021: State Advocacy Update |website=American Medical Association |date=26 March 2021 |access-date=18 May 2022 |archive-date=2 December 2022 |archive-url=https://web.archive.org/web/20221202203754/https://www.ama-assn.org/health-care-advocacy/advocacy-update/march-26-2021-state-advocacy-update |url-status=live}}</ref><ref name="AMA Letter">{{cite web |url=https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-26-Bill-McBride-opposing-anti-trans-bills-Final.pdf |title=AMA Letter to Bill McBride |website=American Medical Association |date=26 April 2021 |access-date=10 April 2024 |archive-date=16 May 2024 |archive-url=https://web.archive.org/web/20240516111140/https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-26-Bill-McBride-opposing-anti-trans-bills-Final.pdf |url-status=live}}</ref> * The American Psychological Association<ref name="apa.org">{{cite web |title=Proposed Talking Points to Oppose Gender-Affirming Care Criminalization Bills |url=https://www.apa.org/topics/lgbtq/gender-affirmative-care |website=apa.org |publisher=American Psychological Association |access-date=26 January 2025 |archive-url=https://web.archive.org/web/20210505180900/https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care |archive-date=5 May 2021 |language=en-US |url-status=live}}</ref> * The American Academy of Pediatrics<ref name="Wyckoff-2022">{{cite journal |url=https://publications.aap.org/aapnews/news/19021/AAP-continues-to-support-care-of-transgender |title=AAP continues to support care of transgender youths as more states push restrictions |date=6 January 2022 |vauthors=Wyckoff AS |journal=American Academy of Pediatrics |eissn=1556-3332 |access-date=18 May 2022 |archive-date=18 December 2022 |archive-url=https://web.archive.org/web/20221218163549/https://publications.aap.org/aapnews/news/19021/AAP-continues-to-support-care-of-transgender |url-status=live}}</ref> * The American Academy of Child and Adolescent Psychiatry (AACAP)<ref name="AACAP Statement Responding to Efforts to ban Evidence-2019">{{cite web |date=8 November 2019 |title=AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth |url=https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx |access-date=18 May 2022 |archive-date=7 June 2021 |archive-url=https://web.archive.org/web/20210607005936/https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx |url-status=live}}</ref> * The American Psychiatric Association<ref name="psychiatry.org-2020">{{cite web |date=July 2020 |title=Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth |url=https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf |access-date=28 August 2022 |work=American Psychiatric Association |archive-date=7 December 2020 |archive-url=https://web.archive.org/web/20201207160233/https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf |url-status=live}}</ref> * The Endocrine Society<ref>{{cite web |date=December 16, 2020 |title=Transgender Health |url=https://www.endocrine.org/advocacy/position-statements/transgender-health |work=Endocrine Society |access-date=14 October 2024 |archive-date=10 October 2022 |archive-url=https://web.archive.org/web/20221010143844/https://www.endocrine.org/advocacy/position-statements/transgender-health |url-status=live }}</ref> * The Pediatric Endocrine Society<ref name="Endocrine Society">{{cite web |date=16 December 2020 |title=Discriminatory policies threaten care for transgender, gender diverse individuals |url=https://www.endocrine.org/news-and-advocacy/news-room/2020/discriminatory-policies-threaten-care-for-transgender-gender-diverse-individuals |work=Endocrine Society |access-date=7 October 2022 |archive-date=18 December 2022 |archive-url=https://web.archive.org/web/20221218152316/https://www.endocrine.org/news-and-advocacy/news-room/2020/discriminatory-policies-threaten-care-for-transgender-gender-diverse-individuals |url-status=live}}</ref> * The American Association of Clinical Endocrinologists<ref name="pro.aace.com">{{cite web |title=AACE Position Statement: Transgender and Gender Diverse Patients and the Endocrine Community |url=https://pro.aace.com/recent-news-and-updates/aace-position-statement-transgender-and-gender-diverse-patients |work=American Association of Clinical Endocrinology (AACE) |access-date=29 November 2022 |archive-date=29 November 2022 |archive-url=https://web.archive.org/web/20221129070003/https://pro.aace.com/recent-news-and-updates/aace-position-statement-transgender-and-gender-diverse-patients |url-status=live}}</ref> * The American College of Obstetricians and Gynecologists<ref>{{cite web |url=https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/03/health-care-for-transgender-and-gender-diverse-individuals |title=Health Care for Transgender and Gender Diverse Individuals |author=<!--Not stated--> |date=18 February 2021 |access-date=9 April 2024 |work=American College of Obstetricians and Gynecologists (ACOG) |archive-date=16 April 2024 |archive-url=https://web.archive.org/web/20240416201024/https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/03/health-care-for-transgender-and-gender-diverse-individuals |url-status=live}}</ref> * The American College of Physicians<ref>{{cite web |url=https://www.acponline.org/advocacy/acp-advocate/archive/may-19-2023/acp-advocates-against-restrictions-on-gender-affirming-care |title=ACP Advocates Against Restrictions on Gender-Affirming Care |work=American College of Physicians (ACP) |author=<!--Not stated--> |date=19 May 2023 |access-date=9 April 2024 |archive-date=18 April 2024 |archive-url=https://web.archive.org/web/20240418002647/https://www.acponline.org/advocacy/acp-advocate/archive/may-19-2023/acp-advocates-against-restrictions-on-gender-affirming-care |url-status=live}}</ref>
There has been an increase in youth requesting treatment for gender affirming medical care.<ref name="Salas-Humara_2019">{{cite journal |vauthors=Salas-Humara C, Sequeira GM, Rossi W, Dhar CP |date=September 2019 |title=Gender affirming medical care of transgender youth |journal=Current Problems in Pediatric and Adolescent Health Care |volume=49 |issue=9 |article-number=100683 |doi=10.1016/j.cppeds.2019.100683 |pmc=8496167 |pmid=31735692}}</ref><ref>{{cite journal |vauthors=Lee JY, Rosenthal SM |title=Gender-Affirming Care of Transgender and Gender-Diverse Youth: Current Concepts |journal=Annual Review of Medicine |volume=74 |issue=1 |pages=107–116 |date=January 2023 |pmid=36260812 |pmc=11045042 |doi=10.1146/annurev-med-043021-032007}}</ref> The increased medical coverage and societal awareness of transgender youth may be shifting accessibility to care.<ref name="Stevens_2015" />
=====Second Trump presidency (2025–present)===== {{Main|Persecution of transgender people under the second Trump administration}}
Following a January 2025 executive order, United States Department of Health and Human Services (HHS) issued a declaration in December 2025 stating that gender‑affirming care for minors, including puberty blockers, is "neither safe nor effective" and does not meet recognized standards of care, and it announced steps to eliminate such care for individuals under 19 in federal programs.<ref>{{cite web |last=Redfield |first=Elana |title=Impact of Ban on Gender-Affirming Care on Transgender Minors |website=Williams Institute |publisher=UCLA School of Law |date=January 2025 |url=https://williamsinstitute.law.ucla.edu/publications/impact-gac-ban-eo/ |access-date=15 January 2026}}</ref> HHS guidance now promotes psychotherapy and psychosocial support instead of puberty blockers, hormones, or surgeries for pediatric gender dysphoria.<ref>{{cite web |last1=Fosheim |first1=Gregory E. |last2=Jackson |first2=Travis |last3=O'Brien |first3=Kristen |title=Federal government continues efforts to prohibit gender-affirming care for minors |website=McDermott |publisher=McDermott Will & Schulte |date=23 December 2025 |url=https://www.mwe.com/insights/federal-government-continues-efforts-to-prohibit-gender-affirming-care-for-minors/ |access-date=15 January 2026}}</ref>
===== Bans in the United States ===== {{anchor|Bans in the United States|Puberty blocker bans in the United States}} {{see also|Disenfranchisement of transgender people in the United States|Persecution of transgender people in the United States}} Misinformation spread by anti-trans groups related to puberty blockers has been used by several states in the U.S. to support the creation of bans on puberty blockers.<ref>{{cite journal |vauthors=Lepore C, Alstott A, McNamara M |date=October 2022 |title=Scientific Misinformation Is Criminalizing the Standard of Care for Transgender Youth |journal=JAMA Pediatrics |volume=176 |issue=10 |pages=965–966 |doi=10.1001/jamapediatrics.2022.2959 |pmid=35994256 |s2cid=251721068}}</ref><ref>{{cite web |date=27 September 2019 |title=A viral fake news story linked trans health care to 'thousands' of deaths |url=https://www.nbcnews.com/feature/nbc-out/viral-fake-news-story-linked-trans-healthcare-thousands-deaths-n1059831 |website=NBC News |vauthors=Fitzsimons T |access-date=19 September 2023 |archive-date=28 September 2023 |archive-url=https://web.archive.org/web/20230928022647/https://www.nbcnews.com/news/amp/ncna1059831 |url-status=live}}</ref><ref>{{cite journal |vauthors=McNamara M, Abdul-Latif H, Boulware SD, Kamody R, Kuper LE, Olezeski CL, Szilagyi N, Alstott A |date=September 2023 |title=Combating Scientific Disinformation on Gender-Affirming Care |journal=Pediatrics |volume=152 |issue=3 |article-number=e2022060943 |doi=10.1542/peds.2022-060943 |pmid=37605864 |s2cid=261062959}}</ref><ref>{{cite web |date=29 June 2022 |title=Calling Out Scientific Misinformation and Protecting Transgender Youth |url=https://www.amsa.org/calling-out-scientific-misinformation-and-protecting-transgender-youth/ |work=American Medical Student Association (AMSA) |vauthors=Gavulic K, Bhat S, Shanab B}}</ref> The Southern Poverty Law Center is tracking anti-trans hate groups involved in the spread of misinformation around the use of puberty blockers, and has highlighted several organization, such as Genspect and the Society for Evidence-Based Gender Medicine (SEGM), who are principal actors involved in these efforts and members of the groups are heavily interlinked within the U.S. and with related groups in the UK and other countries, producing pseudo-scientific papers to support their opposition to gender-affirming care.<ref>{{cite web|url=https://www.lgbtqnation.com/2024/06/anti-trans-organizations-genspect-segm-are-now-listed-as-hate-groups-by-the-splc/|title=Anti-trans organizations Genspect & SEGM are now listed as hate groups by the SPLC|date=6 June 2024|website=LGBTQ Nation|access-date=September 9, 2024|archive-date=September 7, 2024|archive-url=https://web.archive.org/web/20240907221725/https://www.lgbtqnation.com/2024/06/anti-trans-organizations-genspect-segm-are-now-listed-as-hate-groups-by-the-splc/|url-status=live}}</ref><ref>{{cite web|url=https://www.splcenter.org/presscenter/splc-releases-annual-year-hate-extremism-report-decodes-far-rights-plan-undo-democracy|title=SPLC Releases Annual Year in Hate & Extremism Report, Decodes the Far-Right's Plan to Undo Democracy|date=5 June 2024|website=SPLC|access-date=September 9, 2024|archive-date=July 22, 2024|archive-url=https://web.archive.org/web/20240722120855/https://www.splcenter.org/presscenter/splc-releases-annual-year-hate-extremism-report-decodes-far-rights-plan-undo-democracy|url-status=live}}</ref><ref>{{cite web|url=https://www.thepinknews.com/2024/06/10/anti-trans-organisations-hate-groups-southern-poverty-law-center/|title=Two anti-trans organisations listed as 'hate groups' by civil rights charity|date=10 June 2024|website=Pinknews|access-date=September 9, 2024|archive-date=September 9, 2024|archive-url=https://web.archive.org/web/20240909042057/https://www.thepinknews.com/2024/06/10/anti-trans-organisations-hate-groups-southern-poverty-law-center/|url-status=live}}</ref><ref>{{cite web|url=https://www.splcenter.org/captain/defining-pseudoscience-network|title=Group dynamics and division of labor within the anti-LGBTQ+ pseudoscience network|date=12 December 2023|website=SPLC}}</ref><ref>{{cite web|url=https://www.them.us/story/splc-report-exposes-anti-trans-extremist-network|title=A New Report Exposes the Network of Extremist Groups Behind the Anti-Trans PR Machine|date=15 December 2023|website=them}}</ref>
In April 2021, Arkansas passed a ban on treatment of minors under 18 with puberty blockers, but it was temporarily blocked by a federal judge a week before the law was set to take effect.<ref name="ual">{{cite web |date=6 April 2021 |title=Arkansas Lawmakers Override Veto, Enact Transgender Youth Treatment Ban |url=https://www.ualrpublicradio.org/post/arkansas-lawmakers-override-veto-enact-transgender-youth-treatment-ban |access-date=12 March 2022 |archive-date=31 July 2021 |archive-url=https://web.archive.org/web/20210731220458/https://www.ualrpublicradio.org/post/arkansas-lawmakers-override-veto-enact-transgender-youth-treatment-ban |url-status=live}}</ref><ref>{{cite news |agency=Associated Press |date=21 July 2021 |title=A Federal Judge Blocks Arkansas Ban On Trans Youth Treatments |language=en |work=NPR |url=https://www.npr.org/2021/07/21/1018867391/arkansas-trans-gender-confirming-treatment-judge-lawsuit |access-date=17 July 2022 |archive-date=18 December 2022 |archive-url=https://web.archive.org/web/20221218191905/https://www.npr.org/2021/07/21/1018867391/arkansas-trans-gender-confirming-treatment-judge-lawsuit |url-status=live}}</ref> In April 2022, Alabama passed a ban from minors under 19 from obtaining puberty blockers and made it a felony for a doctor to prescribe puberty blockers to a minor with a punishment of up to ten years in prison.<ref>{{cite web |vauthors=Yurcaba J |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/judge-blocks-alabamas-felony-ban-transgender-medication-minors-rcna28607 |title=Judge blocks Alabama's felony ban on transgender medication for minors |website=NBC News |date=14 May 2022 |access-date=20 August 2022 |archive-date=2 December 2022 |archive-url=https://web.archive.org/web/20221202034456/https://www.nbcnews.com/news/amp/rcna28607 |url-status=live}}</ref> The Alabama law was partially blocked by a federal judge a few days after the law took effect.<ref>{{cite news |vauthors=Rojas R |date=8 April 2022 |title=Alabama Governor Signs Ban on Transition Care for Transgender Youth |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/04/08/us/alabama-transgender-law-ivey.html |access-date=17 July 2022 |issn=0362-4331 |archive-date=26 December 2022 |archive-url=https://web.archive.org/web/20221226155033/https://www.nytimes.com/2022/04/08/us/alabama-transgender-law-ivey.html |url-status=live}}</ref><ref>{{cite web |vauthors=Sneed T |title=Judge blocks Alabama restrictions on certain gender-affirming treatments for transgender youth |url=https://www.cnn.com/2022/05/14/politics/judge-blocks-alabama-transgender-law/index.html |access-date=17 July 2022 |website=CNN |date=14 May 2022 |archive-date=20 December 2022 |archive-url=https://web.archive.org/web/20221220211428/https://www.cnn.com/2022/05/14/politics/judge-blocks-alabama-transgender-law/index.html |url-status=live}}</ref> In August 2022, Florida banned Medicaid from covering gender affirming care, including puberty blockers.<ref>{{cite web |vauthors=Sarkissian A |url=https://www.politico.com/news/2022/08/11/florida-finalizes-ban-medicaid-transgender-treatments-00051259 |title=Florida bans Medicaid from covering gender-affirming treatments |website=Politico |date=11 August 2022 |access-date=23 August 2022 |archive-date=29 December 2022 |archive-url=https://web.archive.org/web/20221229100627/https://www.politico.com/news/2022/08/11/florida-finalizes-ban-medicaid-transgender-treatments-00051259 |url-status=live}}</ref> Medical experts criticized the report for citing pseudo-scientific sources and repeatedly dismissing legitimate medical studies as "low quality", which they said showed a flawed understanding of statistics, medical regulation, and scientific research.<ref>{{cite web |date=2022-07-13 |title=Team of Experts Provides Critical Review of Florida Medical Report on Transgender Care |work=Yale Law School |url=https://law.yale.edu/yls-today/news/team-experts-provides-critical-review-florida-medical-report-transgender-care |access-date=2024-03-20 |language=en |archive-date=20 March 2024 |archive-url=https://web.archive.org/web/20240320201313/https://law.yale.edu/yls-today/news/team-experts-provides-critical-review-florida-medical-report-transgender-care |url-status=live }}</ref>
As of July 2024, 26 states have enacted some form of ban on gender-affirming care for minors, but not all of these ban puberty blockers. Currently, only 18 of the 26 states have complete bans which are fully in effect. Six states have only partial bans and two are currently blocked from taking effect. While some states have banned all forms of medical transition, others have banned only specific types such as surgery. Six states have exceptions which allow minors who were already receiving gender affirming care prior to the ban to continue their treatments.<ref name="KFF">{{Cite web |title=The Proliferation of State Actions Limiting Youth Access to Gender Affirming Care |url=https://www.kff.org/policy-watch/the-proliferation-of-state-actions-limiting-youth-access-to-gender-affirming-care/ |date=January 31, 2024 |access-date=February 5, 2024 |website=KFF |language=en-US |archive-date=5 February 2024 |archive-url=https://web.archive.org/web/20240205072326/https://www.kff.org/policy-watch/the-proliferation-of-state-actions-limiting-youth-access-to-gender-affirming-care/ |url-status=live}}</ref> Currently, all 26 states make exceptions for puberty blockers, hormones and surgery for cisgender and intersex children.<ref name="KFF"/> Only one state, West Virginia, makes exceptions in cases of "severe dysphoria". There is also currently only one state, Missouri, that has a ban which is set to expire after a certain period of time. Nearly all states with restrictions include specific provisions with penalties for providers and 4 states include provisions directed at parents or guardians.<ref name="KFF"/> An additional 4 states include laws/policies that impact school officials such as teachers and counselors, among others.<ref name="KFF"/>
In response to these bans, many Democrat-controlled states have gone in the opposite direction and enacted laws protecting access to gender affirming care for minors and adults. These laws, often called "shield" laws, often explicitly combine protections for gender-affirming care and abortion and cover a variety of protections including protecting both providers and patients from being punished, mandating insurance providers to cover the procedures and acting as "sanctuary states" that protect patients traveling to the state from other states that have banned such treatments among other things.<ref>{{Cite web |last=Panetta |first=Grace |title=Lawmakers in blue states are linking protections for abortion and gender-affirming care |url=https://19thnews.org/2023/06/abortion-trans-health-care-shield-laws/ |access-date=2024-01-01 |website=The 19th |date=June 9, 2023 |language=en-US |archive-date=5 February 2024 |archive-url=https://web.archive.org/web/20240205155546/https://19thnews.org/2023/06/abortion-trans-health-care-shield-laws/ |url-status=live}}</ref> As of June 2024, 16 states and the District of Columbia have enacted "shield" laws.
Some US state bans on gender affirming care including puberty blockers have been declared unconstitutional.<ref>{{cite web |vauthors=Breen D |date=June 21, 2023 |title=Federal judge blocks the country's first ban on gender-affirming care for minors |url=https://www.npr.org/2023/06/21/1183578244/federal-judge-blocks-the-countrys-first-ban-on-gender-affirming-care-for-minors |website=NPR |access-date=11 August 2023 |archive-date=11 August 2023 |archive-url=https://web.archive.org/web/20230811084546/https://www.npr.org/2023/06/21/1183578244/federal-judge-blocks-the-countrys-first-ban-on-gender-affirming-care-for-minors |url-status=live}}</ref> Furthermore, bans on puberty blockers have been criticized as governments interfering with the patient-doctor relationship and taking away healthcare decisions from parents and families for their children.<ref>{{cite web |title=Parents raise concerns as Florida bans gender-affirming care for trans kids |vauthors=Block M |website=NPR |date=20 February 2023 |url=https://www.npr.org/2023/02/20/1157493433/florida-bans-gender-affirming-care-trans-kids |access-date=11 June 2023 |archive-date=11 June 2023 |archive-url=https://web.archive.org/web/20230611072637/https://www.npr.org/2023/02/20/1157493433/florida-bans-gender-affirming-care-trans-kids |url-status=live}}</ref><ref>{{cite web |title=Why GOP lawmakers want to stop doctors from prescribing gender-affirming care for Utah's youth |vauthors=Schott B |url=https://www.sltrib.com/news/politics/2023/01/18/why-gop-lawmakers-want-stop/ |access-date=2023-08-14 |website=The Salt Lake Tribune |language=en-US |archive-date=11 June 2023 |archive-url=https://web.archive.org/web/20230611072640/https://www.sltrib.com/news/politics/2023/01/18/why-gop-lawmakers-want-stop/ |url-status=live}}</ref> State level bans on gender affirming care, including puberty blockers, in the United States have led some families with transgender children to move out of their states.<ref>{{cite web |date=27 November 2022 |title=Conservative states are blocking trans medical care. Families are fleeing |vauthors=Connell-Bryan A, Kenen J, Holzman J |url=https://www.politico.com/news/2022/11/27/trans-medical-care-red-states-families-00064394 |website=Politico |access-date=30 November 2022 |archive-date=30 November 2022 |archive-url=https://web.archive.org/web/20221130110753/https://www.politico.com/news/2022/11/27/trans-medical-care-red-states-families-00064394 |url-status=live}}</ref><ref>{{cite web |title=As state laws target transgender children, families flee and become 'political refugees' |vauthors=Ramirez M |url=https://www.usatoday.com/story/news/nation/2022/10/29/transgender-children-families-flee-states-restricting-rights/10547110002/ |website=USA Today |access-date=30 November 2022 |archive-date=30 November 2022 |archive-url=https://web.archive.org/web/20221130110753/https://www.usatoday.com/story/news/nation/2022/10/29/transgender-children-families-flee-states-restricting-rights/10547110002/ |url-status=live}}</ref><ref>{{cite web |date=19 April 2021 |title='It's not safe': Parents of trans kids plan to flee their states as GOP bills loom |vauthors=Yurcaba J |url=https://www.nbcnews.com/feature/nbc-out/it-s-not-safe-parents-transgender-kids-plan-flee-their-n1264506 |website=NBC News |access-date=30 November 2022 |archive-date=30 November 2022 |archive-url=https://web.archive.org/web/20221130110753/https://www.nbcnews.com/feature/nbc-out/it-s-not-safe-parents-transgender-kids-plan-flee-their-n1264506 |url-status=live}}</ref>
In June 2025, the United States Supreme Court upheld a Tennessee law banning hormone treatments and puberty blockers for transgender minors. In ''United States v. Skrmetti'', the Supreme Court ruled 6-3 that the law does not violate the equal protection clause of the 14th Amendment.<ref>{{cite news |last=Totenberg |first=Nina |date=June 18, 2025 |title=Supreme Court upholds state bans on transgender care for minors |url=https://www.npr.org/2025/06/18/nx-s1-5421276/scotus-transgender-kids-decision |publisher=NPR |access-date=June 21, 2025 |archive-date=22 June 2025 |archive-url=https://web.archive.org/web/20250622165346/https://www.npr.org/2025/06/18/nx-s1-5421276/scotus-transgender-kids-decision |url-status=live }}</ref><ref>{{cite news |last=Groppe |first=Maureen |date=June 18, 2025 |title=Supreme Court upholds state ban on transgender minors using puberty blockers, hormone therapy |url=https://www.usatoday.com/story/news/politics/2025/06/18/supreme-court-transgender-minors-gender-affirming-care/77693917007/ |publisher=USA Today |access-date=June 21, 2025 |archive-date=19 June 2025 |archive-url=https://web.archive.org/web/20250619053819/https://www.usatoday.com/story/news/politics/2025/06/18/supreme-court-transgender-minors-gender-affirming-care/77693917007/ |url-status=live }}</ref>
== References == {{Reflist}} * {{CCBYSA4Source|revision=1236581834|sourcepath=https://en.wikipedia.org/w/index.php?title=Puberty_blocker&oldid=1235698644|sourcearticle=Puberty blocker|author(s)=https://en.wikipedia.org/w/index.php?title=Puberty_blocker&action=history}}
{{Antigonadotropins}} {{Transgender topics}} {{Authority control}}
Category:Gender transition and medicine Category:Puberty Category:Puberty blockers Category:Cultural politics Category:Precocious puberty and pregnancy