Introduction

Blockers play a critical role in gender-affirming care, particularly for transgender and non-binary individuals. These medications, including Gonadotropin-Releasing Hormone Agonists (GnRHa) and Spironolactone, are pivotal in suppressing endogenous hormone production. Understanding when and how to use these blockers, as well as when to consider discontinuing them, is important to manage gender-affirming treatments effectively.

What Are Puberty Blockers?

Puberty blockers, as the name suggests, are medications used to halt the physical changes that occur during puberty. They are especially useful in gender-affirming care to prevent the development of secondary sex characteristics that do not align with an individual’s gender identity.

However, they do not just have a role in suppressing puberty, they give long-term suppression of the natural hormone production from the testicles and ovaries.

Key Types of Puberty Blockers

• GnRHa (Gonadotropin-Releasing Hormone Agonists): These medications work by signaling the pituitary gland to temporarily stop producing sex hormones. This halt can prevent the onset of puberty in adolescents and is also used in adults to suppress the hormones of their assigned sex at birth.
• Spironolactone: Primarily used as an antiandrogen, spironolactone blocks the effects of testosterone. It’s often used in transfeminine hormone therapy to reduce masculine characteristics.

When to Consider Puberty Blockers

• Early Adolescence: For young transgender or non-binary individuals, puberty blockers can be considered at the onset of puberty to pause the development of unwanted secondary sexual characteristics.
• Adults in Transition: Adults also use these blockers to suppress the hormones of their assigned sex while they are on hormone replacement therapy (HRT) with the hormones corresponding to their gender identity.

The Role of Puberty Blockers in Treatment
As well as suppressing pubertal development, puberty blockers can give time for people to explore their gender identity without the pressure of ongoing puberty. In adults, they assist in creating a more affirming hormonal environment for gender transition.

Thinking About Stopping Puberty Blockers

• Adequate Suppression Achieved: If HRT successfully suppresses the endogenous hormones to a satisfactory level, continuing puberty blockers might be unnecessary.
• Post-Surgical Considerations: After gender-affirming surgeries like removal of the testicles, the body’s natural production of sex hormones is significantly reduced or halted, potentially making puberty blockers redundant.

Conclusion
Puberty blockers such as GnRHa and Spironolactone are powerful tools in gender-affirming care. They offer individuals the chance to align their physical selves with their gender identity in a controlled and reversible way. While many young people seem keen to stop them, we must remember that they are excellent at suppressing natural hormone production, which may be a life-long requirement.