Serena Freewomyn

New International Guidelines Recommend Hormone Blockers For Transgender Youth

Filed By Serena Freewomyn | December 09, 2008 10:00 AM | comments

Filed in: Living, Living, Transgender & Intersex
Tags: child care, gender identity disorder, hormone blockers, kids, LGBT youth, teenagers, teens, trans, transgender

A new report from the Endocrine Society issued this week recommends hormone blockers for children and teens diagnosed with gender identity disorder. Hormone blockers would essentially delay puberty and give children and their parents time to decide the best course of action. According to ABC News:

The hope is that by delaying puberty, young teens will be given valuable thinking time in which they can decide if they are sure they want to begin gender reassignment using cross-sex hormones at the age of 16.

Ultimately, this strategy would also make it easier for them to live in their chosen gender. For example, potential male-to-female transsexuals will not have developed the deep voice, facial changes and body hair associated with adult masculinity. Gender-reassignment surgery should be avoided until the age of 18, the guidelines say.

In May I posted about an NPR story that covered this same issue. In the comments section there was quite a bit of debate about whether or not young people should be on hormones or hormone blockers. Some argued that kids are fickle and go through phases. But I say that this is precisely the reason why hormone blockers can be beneficial. If a teenager decides they're happy with their birth gender, they can always stop taking the hormone blockers and start experiencing puberty. All this does is buy the kid time to decide what's right for them.

That seems to be the consensus of the doctors involved in crafting the guidelines:

"We recommend that adolescents who fulfill eligibility and readiness criteria for gender reassignment initially undergo treatment to suppress pubertal development," say the guidelines.

They state that treatment should not begin before Tanner stage 2 or 3: when female breasts have begun to bud, and boys have experienced a slight enlargement of the penis and scrotum. This is because the teenager's emotional reaction to these first physical changes can help predict whether they will persist in wanting to change their sex.

The recommendations are largely based on the experience of a clinic in the Netherlands where doctors have so far prescribed puberty blockers to more than 70 under-16s. The youngest they have treated is 11, although the majority are 12 or over.

"We don't have any patient who has regretted their decision on the treatment," says Henriette Delemarre-van de Waal of Leiden University Medical Centre who has helped treat them.

The biggest downside of the treatment is that young people could become infertile. However, with the option of adoption, this doesn't remove the possibility of people becoming parents in the future. Tons of kids are in foster care who need loving homes.

This is good news. Let's hope doctors in the US take note.


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Giving kids some breathing room, all things being equal, is a good idea. It's the long term effects that I'd be worried about. If infertility has been identified as a possible side effect, what are the others?

Greg, I know Serena mentioned, in her May 26 article, possible infertility as a result of this treatment, but I am not sure if that is true. I'm not an expert, but all the previous articles I've read indicated that the effects of the hormone blockers were completely reversible (aside from taller girls because their bones kept growing).

I think these guidelines are badly needed. They won't help kids whose parents are hostile, but for others they could make all the difference in the world.

One item of concern in this draft report:

Given the high rate of remission of GID after the onset of puberty, we recommend against a complete social role change and hormone treatment in prepubertal children with GID. (Section 1.2, emphasis added)

I cannot but wonder why a society of endocrinologists is making recommendations about social roles. It seems like that should be the province of the psych community. It is becoming more and more common to allow children to make the social role change, given the risks associated with forbidding such change.

One further note: this report addresses treatment of transpeople of all ages, not just children and adolescents.

Thanks for the clarification, Angel.

This is good common sense, plain and simple.

What happens if they do change their mind? Do the treatments wear off and male kids develop the lower voice, etc?

From what I understand, teens who stop taking the hormone blockers revert back to puberty and their body starts to develop as it normally would.

Gerri Ladene | December 9, 2008 11:22 PM

Thanks for the update Serena, it's great to know the Endocrine Society is making thoughtful recommendations as this. But, it's still like Dale stated, there are going to be parents that are Transphobic and will remain hostile toward their own children, I know well how that one goes. On the other hand the medical community is helping to further the education in this still not well know human condition which is just natures way of saying, WTF!

The blockers stall the effects of the body's hormones, this is not a recommended long term treatment on its own due to the adverse effects to which a body requires of hormones. Skeletal effects being the primary known concern at present. The advantage in short term use is that the blocking effect can be reversed on termination of use resorts the body back to its biological pathway, the younger the age the more the reversal due to the fact that the body is still developing. Its the actual introduction of hormones which has some non reversible effects for both FtM and MtF. But this is just singing to the quire in the TS community!

What is needed more for transgender and gay youth in this country is the removal of phobic views that stigmatize them. We are all aware as a community of ABC-LGBT-WXYZ (didn't want to miss anyone there) that the shameful actions and words of the superstitious fairy-tale believing Rome empowered cult followers who hide behind their antiquated book of fables while still trying to deny each and every freedom guaranteed under our Constitution to all but their own followers are the very people that cause many of our hopes to move a snail pace. Of course, until people become aware that looking for the easy answer is not the answer and that reason, research and taking a step into the future rather than into the past will give us all the answers we seek about the truth of humanity. Hiding their heads in the sand and pointing fingers only leaves their asses exposed, and it's a big damn ass too.

People of reason in the AMA and the APA have taken a big step for the treatment of transgender youth and adults in their own recommendations and maybe, just maybe our own new President elect will stick to his word and finally the stop the unfair practices of politics and its use by misguided people in marginalizing any American! I will definitely give a sigh of relief when the Shrub is no longer sitting in the oval orifice!

Anywho, this is just my two cents worth. Still, you have to admire the Medical Society, the majority that is, in how they care for all issues pertaining to the medical field. At least Transgender children will begin to have a better chance in life and just in case they may find themselves questioning themselves later then they do have the safety of medical supervision! All we need do now is get the phobiacs to stop meddling in other peoples lives and mind their won damn business! Whatever that is?

Hormone blockers simply delay the onset of puberty. They don't introduce the "opposite" hormone, like full-blown hormone replacement therapy does. Indeed, teens who discontinue hormone blockers should begin puberty just as they normally would have without the blockers. I'm not sure about the fertility issue, but I think it's covered in the draft guidelines (link is in my previous post).

Thanks, Angel, for posting a link to the draft guidelines. I was too intimidated to read the whole thing, but a search of the document revealed that the guidelines do state:
We recommend that all transsexual individuals be informed and counseled regarding options for fertility prior to initiation of puberty suppression in adolescents and prior to treatment with sex hormones of the desired sex in both adolescents and adults.

However, the discussion (on page 15 of the text) indicates that fertility should be unaffected if the hormone blocking drug is stopped. The only difficulty is in predicting when sperm production, or ovulation, will begin. (And I think most folks have that problem anyways.)

So I am unsure of the need for the caution about fertility in the guideline. Certainly it needs addressing before taking cross-sex hormones, though.

I hope we can start to think of ways to get around the hostile parent situation many of these kids are in. I can imagine that many parents would be opposed to something like this, but that doesn't change their child's needs.