For various reasons, people who are receiving gender affirming medical treatment may decide to stop their treatment temporarily and recommence at a later date. Reasons for this may include having side effects or medical complications, or because of other personal circumstances. Whatever the reasons are, respect and support in their decisions should be paramount and goes a long way in helping people's wellbeing.
People who decide to stop gender affirming medical treatment temporarily may wonder how stopping may affect their bodies. This article provides some information on the bodily changes that are likely to occur when stopping different gender affirming medications.
Puberty blockers include gonadotropin releasing hormone analogues, such as nafarelin, triptorelin, and leuprorelin.
The effects of puberty blockers are reversible. If you have not yet completed puberty and are taking puberty blockers to suppress puberty, then puberty will recommence if you stop taking the puberty blockers. After stopping the puberty blockers, your body will begin producing sex hormones again, which will produces the bodily changes associated with puberty.
Key Facts
- There are many reasons why you might stop treatment temporarily or permanently.
- As with all medication, it's important to keep in mind information from the member information leaflet that comes with your medication.
- Some changes caused by hormone therapy will not be reversed by stopping treatment.
- Fertility may be affected even after ceasing some medications. Further information is available by searching our knowledge base. You may want to discuss this with one of our advisors, or by talking with your GP.
- The effects of puberty blockers are reversible.
- Puberty blockers will not reverse the pubertal changes that have already occurred.
The effects of puberty blockers are reversible. This means that puberty will recommence if puberty blockers are stopped. However, it is important to note that pubertal changes do not occur suddenly, but take months to occur. In people who have never taken puberty blockers, puberty is a process that usually lasts five or more years.
A study on puberty blockers in children with precocious puberty found that pubertal changes tended to return 6 to 12 months after stopping the puberty blockers (Kim, 2015). This suggests that pausing puberty blockers for only a few days or a few weeks is unlikely to result in significant pubertal changes, as it usually takes a longer period of time for the hormone levels in the body to rise to the levels associated with puberty. This is especially the case with injectable puberty blockers, which take several weeks to clear from the body.
If puberty blockers are recommenced after puberty has begun but before puberty is completed, then blockers will halt further pubertal changes from occurring. However, they will not reverse the pubertal changes that have already occurred.
Antiandrogens are typically used to suppress testosterone as part of feminising hormone treatment. They include gonadotropin releasing hormone analogues (nafarelin, triptorelin, leuprorelin), 5-alpha reductase inhibitors (finasteride and dutasteride), spironolactone and cyproterone acetate.
Antiandrogens are typically taken with oestrogen. It is important to note that oestrogen also suppresses testosterone production, albeit to a lesser degree than antiandrogens.
If antiandrogens are stopped but oestrogen is continued, then the oestrogen on its own may be sufficient to suppress testosterone. Hence, some people find that oestrogen monotherapy is enough to prevent masculinising effects.
However, other people find that oestrogen on its own is not enough to suppress testosterone. For these people, stopping antiandrogens may result in increased testosterone production. This could lead to masculinising effects, such as facial and bodily hair growth, spontaneous erections and skin changes.
If antiandrogens are recommenced at a later date, then they are likely to be just as effective as before at suppressing testosterone and inhibiting masculinising effects.
If feminising hormone treatment with oestrogen and antiandrogens is stopped, testosterone and oestrogen levels in the body will gradually return to levels seen in adults with testes who have never received feminising hormone treatment.
The increased testosterone and decreased oestrogen are likely to lead to the gradual return of masculinising bodily effects, including facial and bodily hair growth, spontaneous erections, skin changes, increased muscle growth and redistribution of fat away from the hips toward the abdomen.
Importantly, some of the effects of oestrogen are irreversible without surgical intervention, such as breast development and hip widening. Hence, stopping oestrogen will not reverse some of the feminising bodily changes that have already occurred.
If oestrogen and antiandrogens are recommenced at a later date, then the increased oestrogen and decreased testosterone will lead to the return of the feminising bodily changes. These include decreased facial and bodily hair, skin changes, decreased muscle mass and redistribution of fat away from the abdomen toward the hips. However, it is important to note that some of the masculinising effects of testosterone, such as voice deepening, are not straightforwardly reversible. Therefore, recommencing oestrogen will not reverse some of the masculinising bodily changes that might have occurred.
If masculinising hormone treatment with testosterone is stopped, then testosterone and oestrogen levels in the body will gradually return to the levels seen in adults with ovaries who have never received masculinising hormone treatment.
The increased oestrogen and decreased testosterone are likely to lead to the gradual return of feminising bodily changes, including menstruation, breast development, decreased facial and bodily hair, skin changes, decreased muscle growth and redistribution of fat away from the abdomen toward the hips.
Importantly, some of the effects of testosterone, such as voice deepening and some skeletal changes, are not straightforwardly reversible. Hence, stopping testosterone will not reverse some of the masculinising bodily changes that have already occurred.
If testosterone is then recommenced at a later date, the increased testosterone and decreased oestrogen will lead to the return of the masculinising bodily changes. These include facial and bodily hair growth, cessation of menstruation, skin changes, increased muscle growth and redistribution of fat away from the hips toward the abdomen. However, it is important to note that some of the masculinising effects of oestrogen, such as breast development and hip widening, are not straightforwardly reversible. Therefore, recommencing testosterone will not reverse some of the feminising bodily changes that might have occurred.
Deutsch, M. (2020). "Information on Estrogen Hormone Therapy". UCSF Transgender Care. https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy
Deutsch, M. (2020). "Information on Testosterone Hormone Therapy". UCSF Transgender Care. https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy
Guss, C., and Gordon, C. M. (2022). "Pubertal Blockade and Subsequent Gender-Affirming Therapy". JAMA Network Open, 5(11): e2239763.
Kim, E. Y. (2015). "Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty". Korean Journal of Pediatrics, 58 (1): 1–7.
MacKinnon, K. R., Kia, H., and Salway, T., Ashley, F., Lacombe-Duncan, A., Abramovich, A., Enxuga, G., and Ross, L. E. (2022). "Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments". JAMA Network Open, 5(7): e2224717.