puberty blocker

{{See also|GnRH agonist#Medical uses|Gender-affirming care}}

Puberty blockers prevent the development of biological secondary sex characteristics.{{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}}

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.{{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}} The main goal of treatment is to preserve children's adult height potential.{{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}} Puberty blockers work by stabilizing puberty symptoms, decreasing growth velocity, and slowing skeletal maturation.{{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}} 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.{{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}} 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.{{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}} In terms of psychosocial markers, preadolescents and adolescents diagnosed with precocious puberty have shown body image concerns and demonstrated poor emotional regulation and high anxiety.{{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 }} Individuals with precocious puberty, early adrenarche, and early normal puberty show less stress after treatment compared to individuals without preexisting developmental conditions.{{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}}

Moreover, they are utilized in the treatment of central precocious puberty resulting from conditions like hypothalamic hamartomas or congenital adrenal hyperplasia, where early onset of puberty is a symptom. Additionally, puberty blockers can be prescribed for children with severe forms of idiopathic short stature, allowing for more time for growth before the closure of growth plates. These applications illustrate the versatility of puberty blockers in addressing various endocrine and growth-related disorders.{{cite journal |url=https://academic.oup.com/ejendo/article/176/3/323/6654996 |access-date=2024-07-31 |journal=European Journal of Endocrinology |doi=10.1530/eje-16-0897 |title=MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment |date=2017 |volume=176 |issue=3 |pages=323–328 |vauthors=Eroukhmanoff J, Tejedor I, Potorac I, Cuny T, Bonneville JF, Dufour H, Weryha G, Beckers A, Touraine P, Brue T, Castinetti F |pmid=28073906 |archive-date=3 June 2024 |archive-url=https://web.archive.org/web/20240603100136/https://academic.oup.com/ejendo/article/176/3/323/6654996 |url-status=live}}{{cite journal |vauthors=Carel JC, Léger J |title=Clinical practice. Precocious puberty |journal=The New England Journal of Medicine |volume=358 |issue=22 |pages=2366–2377 |date=May 2008 |pmid=18509122 |doi=10.1056/NEJMcp0800459}}

Overall, puberty blockers have demonstrated an excellent safety and efficacy profile in the treatment of precocious puberty. The most common side effects reported include nonspecific headaches, hot flashes, and implant-related skin reactions.{{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}}

Puberty blockers are sometimes prescribed to young transgender people with gender dysphoria to temporarily halt the development of secondary sex characteristics. While there is evidence to suggest transgender youth may benefit from gender-affirming hormone therapy (HRT) even at early puberty,{{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}}{{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}} there may be restrictions on prescribing HRT at younger ages.{{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}} 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. If a child later decides not to transition, the medication can be stopped and puberty will proceed.

{{anchor|Dutch Protocol}}

The "Dutch Protocol" is the first known example of the use puberty blockers to treat gender dysphoria in children. It was developed by Peggy Cohen-Kettenis in the 1990s.{{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}} 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.{{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}}{{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 }} 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.{{cite journal |last1=de Vries |first1=Annelou L.C. |last2=Steensma |first2=Thomas D. |last3=Doreleijers |first3=Theo A.H. |last4=Cohen-Kettenis |first4=Peggy T. |title=Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study |journal=The Journal of Sexual Medicine |date=1 August 2011 |volume=8 |issue=8 |pages=2276–2283 |doi=10.1111/j.1743-6109.2010.01943.x}}{{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}}

Studies examining the effects of puberty blockers for gender non-conforming and transgender adolescents have generally indicated that these treatments are reasonably safe, are reversible, and can improve psychological well-being in these individuals.{{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 |quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits. |s2cid=10690853}}{{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 |pages=e20182162 |date=October 2018 |pmid=30224363 |doi=10.1542/peds.2018-2162 |quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam's apple, male pattern baldness, voice change, breast growth, etc) are prevented. 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}}{{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", "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}} 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. Puberty blockers are associated with such positive outcomes as decreased suicidality, improved affect and psychological functioning, and improved social life.{{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}}

Puberty blocker medications are used to delay the physical changes associated with puberty, offering individuals more time to explore their gender identity. The most common type of puberty blockers are GnRH (gonadotropin-releasing hormone) analogues, 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 includes 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.{{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 |pmid=29514975 |doi=10.1542/peds.2017-3742}}{{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}}

A number of different drugs are used as puberty blockers.{{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}}{{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}}

• Gonadotropin-releasing hormone (GnRH) agonists: Specific examples include: buserelin, histrelin, leuprorelin, nafarelin, and triptorelin. 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.
• GnRH antagonists are also expected to be effective at delaying puberty but have not yet been widely studied or used for this purpose.{{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}} 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. For precocious puberty, they are not as effective as GnRH agonists (especially in avoiding a hit to adult height) and have more side effects. They are cheaper than GnRH agonists and potentially have fewer side effects for individuals with gender dysphoria (very small sample size).{{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}}
• Antiandrogens: Bicalutamide has been used as a cheaper alternative puberty blocker in transgender girls for whom GnRH agonists were denied by insurance.{{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}}{{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}} The antiandrogens spironolactone and cyproterone acetate are not as strong.

In the United States, the main providers of puberty blockers are Endo International and AbbVie.{{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}} Endo International creates histerelin acetate (Vantas) while AbbVie manufactures leuprolide acetate (Lupron Depot).{{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}}{{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}} 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).{{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}}{{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 |pages=348 |doi=10.1200/jco.2023.41.6_suppl.348 |issn=0732-183X}} 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).{{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}} Originating in France, Ipsen also produces triptorelin (Decapeptyl).{{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}} German/Swiss company Sandoz makes leuprorelin (Leuprorelin Acetate, Lucrin, Eligard).{{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}} In Japan, Takeda Pharmaceutical Company and Astellas Pharma create leuprorelin (Lupron Depot) and goserelin (Zoladex).{{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}} Indian company Sun Pharmaceutical Industries mainly produces leuprolide acetate generic injectables.{{cite book |chapter=Leuprolide Acetate |title=USP Access Point |publisher=U.S. Pharmacopeial Convention |doi=10.31003/uspnf_m44592_03_01}} AbbVie is also a player internationally.{{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 }}

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 assigned females at birth or deepening of the voice in assigned males at birth. This can significantly alleviate the distress associated with gender dysphoria in transgender youth.{{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}} Additionally, by halting the rapid growth spurts of puberty, these medications provide more time for growth in stature, particularly beneficial for children diagnosed with idiopathic short stature or central precocious puberty. 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.{{cite web |title=Puberty Blockers |url=https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |url-status=dead |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}}{{cite journal |url=https://academic.oup.com/jcem/article/102/11/3869/4157558?login=true |access-date=2024-07-31 |doi=10.1210/jc.2017-01658 |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=2017 |volume=102 |issue=11 |pages=3869–3903 |pmid=28945902 |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, t'Sjoen GG |archive-date=28 August 2024 |archive-url=https://web.archive.org/web/20240828143801/https://academic.oup.com/jcem/article/102/11/3869/4157558?login=true |url-status=live}}{{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}}

Despite their benefits, there are some considerations regarding the short-term use of puberty blockers. One concern is the potential impact on bone density. Since puberty is a critical period for bone development, delaying it may temporarily reduce bone mineral density, which could be monitored through regular bone density scans. To protect against lower bone density, doctors recommend exercise, calcium, and Vitamin D.{{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}} Another consideration is the potential impact on psychological well-being. While many individuals experience relief from gender dysphoria, the delay in physical development might also cause anxiety or social difficulties in some cases, particularly in environments where peers are progressing through puberty. It is crucial for healthcare providers to closely monitor the physical and emotional well-being of individuals on puberty blockers, ensuring that the benefits outweigh any short-term risks or discomforts.{{cite journal |vauthors=Reid BM, Miller BS, Dorn LD, Desjardins C, Donzella B, Gunnar M |title=Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development |journal=Pediatric Research |volume=82 |issue=2 |pages=278–284 |date=August 2017 |pmid=28170387 |pmc=5552432 |doi=10.1038/pr.2017.35}}{{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 |pmid=30224363 |doi=10.1542/peds.2018-2162}}{{cite journal |vauthors=de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT |title=Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study |journal=The Journal of Sexual Medicine |volume=8 |issue=8 |pages=2276–2283 |date=August 2011 |pmid=20646177 |doi=10.1111/j.1743-6109.2010.01943.x}}

In 2016, the FDA ordered drugmakers to add warning labels to puberty blocker drugs that states: "Psychiatric events have been reported in patients", including symptoms "such as crying, irritability, impatience, anger and aggression."

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.{{cite web |title=Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists |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 |vauthors=((U.S. Food and Drug Administration)) |publisher=American Academy of Pediatrics |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}} Five who experienced the side effect were receiving treatment for precocious puberty and one who experienced the side effect was transgender and was receiving treatment for gender dysphoria.{{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 |url-status=dead}} Morissa Ladinsky, a pediatrician with University of Alabama-Birmingham who works with transgender youth, said that "[Idiopathic intracranial hypertension] is an inordinately well-known side effect that can happen for many, many different medications, most commonly, oral birth control pills.{{cite journal |title=Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth |date=2023 |pmid=37810940 |journal=Transgender Health |volume=8 |issue=5 |pages=420–428 |doi=10.1089/trgh.2021.0116 |pmc=10551760 |vauthors=Tordoff DM, Sequeira GM, Shook AG, Williams F, Hayden L, Kasenic A, Inwards-Breland D, Ahrens K}} Referring to the six reported side effects, Ladinsky said that "It doesn't even approach any semblance of what we call in medicine, statistical significance".{{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/?outputType=amp |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/?outputType=amp |url-status=live}}

Little is known about the long-term side effects of puberty blockers in children with gender dysphoria. Although puberty blockers are known to be safe and are a fully reversible treatment if stopped in the short term, it is not known whether puberty blockers affect the development of factors like bone mineral density, brain development and fertility in transgender patients.{{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}}{{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}}{{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}} There is limited high-quality research on puberty suppression among adolescents experiencing gender dysphoria or incongruence. No conclusions on impact on gender dysphoria, mental health and cognitive development could be drawn.

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)."

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.{{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}}{{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}}

Research on the long-term effects on brain development and cognitive function is limited.{{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.}}{{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}} According to a 2024 systematic review, no conclusions can be drawn about the effects of puberty blockers on cognitive development. Another 2024 systematic review, using both human and animal studies found some evidence of sex-specific impact on cognitive function in mammals, and no evidence that cognitive effects were fully reversible.{{cite journal |vauthors=Baxendale S |title=The impact of suppressing puberty on neuropsychological function: A review |journal=Acta Paediatrica |volume=113 |issue=6 |pages=1156–1167 |date=June 2024 |pmid=38334046 |doi=10.1111/apa.17150 |quote=While there is some evidence that indicates pubertal suppression may impact cognitive function, there is no evidence to date to support the oft cited assertion that the effects of puberty blockers are fully reversible. |doi-access=free}}

Research on the long-term effects on fertility and sexual function is limited. The long-term use of puberty blockers presents several uncertainties, particularly concerning fertility and sexual function. Since these medications suppress the production of sex hormones during a critical period of sexual maturation, their extended use may impact the development of reproductive organs and future fertility. For instance, individuals assigned male at birth who take puberty blockers might experience underdeveloped testes, potentially affecting sperm production later in life. Similarly, individuals assigned female at birth might have impaired ovarian function, impacting their ability to conceive. Additionally, there is concern that prolonged suppression of puberty may influence sexual function, including libido and the ability to achieve sexual arousal and satisfaction. These potential effects underscore the importance of careful, individualized medical counseling and consideration of fertility preservation options, such as sperm or egg banking, before initiating long-term puberty blocker treatment. Ongoing research is crucial to better understand these long-term impacts and to provide clearer guidance to patients and their families.{{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}} Additionally, 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.{{cite journal |vauthors=Giovanardi G |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 |date=September 2017 |pmid=32258611 |pmc=6806792 |doi=10.1016/j.pbj.2017.06.001 |doi-access=free}} Several other methods such as bowel vaginoplasty, which uses part of the sigmoid colon to form the canal instead,{{cite journal |vauthors=Bizic M, Kojovic V, Duisin D, Stanojevic D, Vujovic S, Milosevic A, Korac G, Djordjevic ML |display-authors=6 |title=An overview of neovaginal reconstruction options in male to female transsexuals |journal=TheScientificWorldJournal |year=2014 |volume=2014 |pages=638919 |pmid=24971387 |pmc=4058296 |doi=10.1155/2014/638919 |doi-access=free}}{{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}} 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.{{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}}{{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}}

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.{{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}} 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.{{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}}

A study published in the Journal of the American Medical Association in 2022 found a 60% reduction in moderate to severe depression and a 73% reduction in suicidality in trans and nonbinary youth prescribed puberty blockers.

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.{{cite journal |url=https://www.nature.com/articles/s41562-024-01979-5 |last1=Lee |first1=W.Y. |last2=Hobbs |first2=J.N. |last3=Hobaica |first3=S |first4=J.P. |last4=DeChants |first5=M.N. |last5=Price |first6=R |last6=Nath |display-authors=3 |journal=Nature Human Behaviour |title=State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA |doi=10.1038/s41562-024-01979-5 |date=26 September 2024 |volume=8 |issue=11 |pages=2096–2106 |pmid=39327480 |access-date=29 September 2024 |archive-date=28 September 2024 |archive-url=https://web.archive.org/web/20240928224220/https://www.nature.com/articles/s41562-024-01979-5 |url-status=live|url-access=subscription }}{{cite web |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 |title=More trans teens attempted suicide after states passed anti-trans laws, a study shows |date=26 September 2024 |access-date=29 September 2024 |website=NPR |archive-date=27 September 2024 |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 |url-status=live}}

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 outweigh any possible risks. The review concluded that puberty blockers are "safe, effective and reversible".{{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}}

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.{{Cite journal |last=Miroshnychenko |first=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 |url=https://adc.bmj.com/content/early/2025/01/29/archdischild-2024-327909 |journal=Archives of Disease in Childhood |language=en |doi=10.1136/archdischild-2024-327909 |issn=0003-9888 |pmid=39855724|url-access=subscription |doi-access=free }}{{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}}

The use of puberty blockers for gender-affirming care has attracted some criticism, due primarily to the lack of randomized controlled trials within the research base.{{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}}{{cite journal |vauthors=O'Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC |title=Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents |journal=The Journal of Clinical Endocrinology and Metabolism |volume=107 |issue=1 |pages=241–257 |date=January 2022 |pmid=34476487 |pmc=8684462 |doi=10.1210/clinem/dgab634}}{{cite journal |vauthors=Rosenthal SM |title=Approach to the patient: transgender youth: endocrine considerations |journal=The Journal of Clinical Endocrinology and Metabolism |volume=99 |issue=12 |pages=4379–4389 |date=December 2014 |pmid=25140398 |doi=10.1210/jc.2014-1919}}

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.{{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.}} A subsequent systematic review re-affirmed the conclusions of the NICE report, concluding that the currently available studies have "significant conceptual and methodological flaws".{{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}}{{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}} A 2024 review of evidence on behalf of the Cass Review came to a similar conclusion.{{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}}

The NICE review has been criticized by organizations that support the use of puberty blockers such as WPATH and EPATH, and in an WPATH's 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.{{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 |language=en |pages=1–25 |doi=10.1080/26895269.2024.2328249 |issn=2689-5269 |doi-access=free}}{{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}} 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. 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.

The Finnish Ministry of Health also concluded that there are no research-based health care methods for minors with gender dysphoria.{{cite web |date=March 2021 |title=Finnish guidelines for treatment of child and adolescent gender dysphoria |url=https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf |url-status=live |archive-url=https://web.archive.org/web/20201203061437/https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf |archive-date=3 December 2020 |access-date=22 April 2021 |work=Council for Choices in Health Care (COHERE) |quote=Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole. |trans-quote=According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors. |quote-page=6}} Their guidelines permit the use of puberty blockers for minors on a case-by-case basis.{{cite web |vauthors=Abels G |title=Trans surgery for minors limited in Europe, not banned |url=https://www.politifact.com/factchecks/2023/sep/06/instagram-posts/gender-affirming-surgery-is-not-banned-for-minors/ |access-date=2024-03-20 |website=@politifact |language=en-US |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}}

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.{{cite journal |vauthors=Frattarelli DA, Galinkin JL, Green TP, Johnson TD, Neville KA, Paul IM, Van Den Anker JN |title=Off-label use of drugs in children |journal=Pediatrics |volume=133 |issue=3 |pages=563–567 |date=March 2014 |pmid=24567009 |doi=10.1542/peds.2013-4060 |s2cid=227262172 |author1-link=American Academy of Pediatrics}} 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."

{{Globalize|section|2=USA|date=March 2024}}

The prescription of puberty blockers has been a polarizing issue on an international scale. On the one hand, opponents for the use of puberty blockers argue that minors are unable to provide informed consent, treatment interferes with typical gender identity development, and there are high rates of detransitioning after puberty, rendering treatment ineffective.{{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 |issue= |pages=l5647 |doi=10.1136/bmj.l5647 |pmid=31540909 |s2cid=202711942}}{{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}}{{cite journal |vauthors=Jorgensen SC, Hunter PK, Regenstreif L, Sinai J, Malone WJ |date=September 2022 |title=Puberty blockers for gender dysphoric youth: A lack of sound science |journal=Journal of the American College of Clinical Pharmacy |language=en |volume=5 |issue=9 |pages=1005–1007 |doi=10.1002/jac5.1691 |issn=2574-9870 |doi-access=free}} On the other hand, proponents argue that there are psychological and developmental benefits of puberty blockers which may outweigh the risks associated with treatment, such as a lower risk of depression and reduced behavioral issues.{{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}} In the United States, the growing disarray between opponents and proponents has led to the dissemination of misinformation and consequently the establishment of anti-transgender ("anti-trans") legislation.{{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}}{{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}}{{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 |doi=10.1542/peds.2022-060943 |pmid=37605864 |s2cid=261062959}}{{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}}

Groups continue building on the discussion on informed consent. A 2019 study found that a "multidisciplinary approach" is necessary "to ensure meaningful consent" is acquired and treatment is initiated with a strong ethical foundation.{{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}} 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".{{cite journal |vauthors=((The Lancet Child & Adolescent Health)) |date=June 2021 |title=A flawed agenda for trans youth |journal=The Lancet. Child & Adolescent Health |volume=5 |issue=6 |pages=385 |doi=10.1016/S2352-4642(21)00139-5 |pmid=34000232 |s2cid=234769856 |doi-access=}} 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. Another bioethicist, Florence Ashley, adds that counseling and educating the parents of transgender youth could also be beneficial to familial relationships.{{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}}

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.{{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}}{{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}} 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.{{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}} The Alabama law was partially blocked by a federal judge a few days after the law took effect.{{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}}{{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}} In August 2022, Florida banned Medicaid from covering gender affirming care, including puberty blockers.{{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}}

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.{{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}} Currently, all 26 states make exceptions for puberty blockers, hormones and surgery for cisgender and intersex children. 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. An additional 4 states include laws/policies that impact school officials such as teachers and counselors, among others.

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.{{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}} As of June 2024, 16 states and the District of Columbia have enacted "shield" laws.

The UK's Cass Review was cited in the Indiana legislation to ban puberty blockers.{{cite web |date=2024-07-09 |title=New report critiques UK transgender youth care research study |url=https://abcnews.go.com/Health/yale-releases-report-critical-uk-transgender-youth-care/story?id=111639373 |access-date=2024-07-17 |website=ABC News |language=en |archive-date=11 July 2024 |archive-url=https://web.archive.org/web/20240711230053/https://abcnews.go.com/Health/yale-releases-report-critical-uk-transgender-youth-care/story?id=111639373 |url-status=live}}

Some US state bans on gender affirming care including puberty blockers have been declared unconstitutional.{{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}} 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.{{cite web |title=Parents raise concerns as Florida bans gender-affirming care for trans kids |vauthors=Block M |website=NPR |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}}{{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}} 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.{{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}}{{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}}{{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}}

The Italian National Bioethics Committee and the Italian Medicines Agency have demonstrated support for the use of puberty blockers in adolescents with gender dysphoria, expanding coverage by adding them to the list of medications covered by the National Health Service.{{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}} 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.

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.{{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}} 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.{{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}}

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.{{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}} People reported improvements in their well-being, frustrations with treatment protocols and wait lists, and concerns with their transition journey.

More than a dozen major American and Australian medical associations, as well as the World Professional Association for Transgender Health (WPATH),{{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}} and the Endocrine Society{{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}} generally support puberty blockers for transgender youth and have come out against efforts to restrict their use. In Europe, however, some medical groups and countries have taken a more cautionary stance, discouraging or limiting the use of puberty blockers.{{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}} However, these countries have not outright banned or criminalized the treatment unlike many US States.{{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}}{{cite web |date=6 September 2023 |title="Norway, Finland, Sweden, Holland, and the UK have now banned gender transition surgery for minors." |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}}{{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 }}{{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}}{{cite web |date=9 April 2024 |title=Youth Gender Medications Limited in England, Part of Big Shift in Europe |website=New York Times |url=https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |access-date=1 October 2024}}

{{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.{{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}}

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.{{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}}{{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}}

{{see also|LGBTQ rights in Austria#Gender identity and expression}}

The use of puberty blockers in youth experiencing gender dysphoria has been endorsed by the following organizations:

• 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)

{{see also|Transgender rights in Canada#Healthcare access}}

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."{{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}}

{{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{{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}}

{{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.{{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}}

{{see also|LGBT rights in Finland#Access to healthcare}}

In 2020, Finland revised its guidelines to prioritise psychotherapy over medical transition,{{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}} but 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.{{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}}{{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}}

{{see also|LGBT rights in France#Healthcare}}

Transgender children in France are eligible for puberty blockers with parental permission at any age, and usually receive them at age 15 or 16.{{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}}

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".{{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}} This change to the guidelines has not changed actual practice.

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.{{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 }}

{{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 immediate access to puberty blockers and other gender affirming medical treatments as quickly as possible for patients in which the progression of puberty would lead to irreversible bodily changes.{{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-Diagnostik-Behandlung_2025-03.pdf |website=AWMF Online |pages=17}}

The use of puberty blockers in youth experiencing gender dysphoria has been endorsed by numerous medical organizations:

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• {{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)

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{{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.{{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}}{{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}} However, they also called for more research to better understand its effects. 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.{{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 }}{{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 |hdl=11380/1313446 |hdl-access=free }} 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.

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){{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}}

{{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 AMAB individuals. They made recommendations that doctors administering such treatment report more detailed information on outcomes going forward.{{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}}{{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}}

{{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.{{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}}

{{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.{{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 |url-status=dead}} This guideline, published in 2016, is endorsed by the following Dutch medical organizations:

• Nederlands Internisten Vereniging (Dutch Internists Association)
• Nederlands Huisartsen Genootschap (Dutch Society of General Practitioners)
• Nederlands Instituut van Psychologen (Dutch Institute of Psychologists)
• Nederlandse Vereniging voor Kindergeneeskunde (Dutch Association for Pediatrics)
• Nederlandse Vereniging voor Obstetrie & Gynaecologie (Dutch Association for Obstetrics & Gynaecology)
• Nederlandse Vereniging voor Plastische Chirurgie (Dutch Association for Plastic Surgery)
• Nederlandse Vereniging voor Psychiatrie (Dutch Psychiatry Association)
• Transvisie (Transvision, a patient organization for transgender patients)

{{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){{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}}
• The Royal Australian and New Zealand College of Psychiatrists (RANZCP){{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}}
• The Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ){{Citation needed|date=January 2025}}
• The New Zealand Sexual Health Society
• The New Zealand Society of Endocrinology{{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}}
• The College of Child and Youth Nurses{{Cite web |title=PATHA - Professional Association for Transgender Health Aotearoa - Health Professional Bodies Oppose Restrictions on Puberty Blockers |url=https://patha.nz/News/13484154 |access-date=2025-04-06 |website=patha.nz}}
• The New Zealand College of Clinical Psychologists
• The New Zealand Pediatrics Society
• The New Zealand Psychological Society
• The Auckland Sexual Health Service

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".{{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}} 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".{{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}}{{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}}{{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}} 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.

{{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.{{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}}{{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}}

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.{{cite journal |vauthors=Block J |date=March 2023 |title=Norway's guidance on paediatric gender treatment is unsafe, says review |journal=BMJ |volume=380 |pages=697 |doi=10.1136/bmj.p697 |pmid=36958723 |s2cid=257666327 |doi-access=free}}{{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}} 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. Misinformation that Norway had banned gender affirming care proliferated on social media.

{{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.{{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}} On 22 February 2022, Sweden's National Board of Health and Welfare said that puberty blockers should only be used in "exceptional cases" and said that their use is backed by "uncertain science".{{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 |url-status=dead}}{{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}}

However, other providers in Sweden continue to provide puberty blockers, and a clinician's professional judgment determines what treatments are recommended or not recommended. Youth are able to access gender-affirming care when doctors deem it medically necessary. The treatment is not banned in Sweden and is offered as part of its national healthcare service.{{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}}{{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}}

{{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) 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.{{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}}

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.{{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}}

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,{{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}} and the NHS restricted their use for children under 16 years of age to centrally administered clinical research.{{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}}{{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}}

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.{{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}} 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,{{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}}{{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}}{{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}} and a subsequent ban on private prescription of puberty blockers in the United Kingdom.{{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}}{{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}}{{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}}

Children already receiving puberty blockers via NHS England will be able to continue their treatment.{{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}} In England, a clinical trial into puberty blockers is planned for early 2025.{{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}}

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.{{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}}

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."{{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}}{{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}}{{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}} 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.{{Cite web |date=2024-12-11 |title=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 |website=The Independent |language=en}}{{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}}{{cite web | url=https://www.nytimes.com/2024/12/11/world/europe/uk-bans-puberty-blockers-under-18.html#:~:text=Britain%20is%20to%20ban%20indefinitely,in%20place%20earlier%20this%20year. | title= U.K. Bans Puberty Blockers for Teens Indefinitely | first=Stephen | last=Castle | website=New York Times| date=December 11, 2024 | access-date=December 12, 2024 }}

{{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.{{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}} Currently under FDA regulation the use of puberty blockers is considered on-label for the treatment of central precocious puberty.{{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}}

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).{{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}} Access to treatment depends on the classification of precocious puberty as well as other guidelines implemented by the Endocrine Society.{{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}} To determine if you are experiencing precocious puberty and should receive treatment it is required your doctor take a medical history, physical exam, blood test, and x-rays.{{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 }}

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.{{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}} They confirmed that the use of Gonadotropin-releasing hormone analogs (GnRHas) has had a positive effect on increasing adult height.{{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}} However these Endocrine Societies believe additional research should be conducted before routinely suggesting GnRHAs for other conditions. 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.

The use of puberty blockers in youth experiencing gender dysphoria has been supported by the following organizations:

• The American Medical Association{{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}}{{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}}
• The American Psychological Association{{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}}
• The American Academy of Pediatrics{{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}}
• The American Academy of Child and Adolescent Psychiatry (AACAP){{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}}
• The American Psychiatric Association{{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}}
• The Endocrine Society{{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}}
• The Pediatric 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}}
• The American Association of Clinical Endocrinologists{{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}}
• The American College of Obstetricians and Gynecologists{{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= |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}}
• The American College of Physicians{{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= |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}}

There has been an increase in youth requesting treatment for gender affirming medical care.{{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 |pages=100683 |doi=10.1016/j.cppeds.2019.100683 |pmc=8496167 |pmid=31735692}}{{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}} The increased medical coverage and societal awareness of transgender youth may be shifting accessibility to care.

{{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:Cultural politics