Gender Care

Puberty blockers are a type of medicine called a “GnRH agonist.” They pause puberty by stopping your brain from sending signals to your gonads (usually called ovaries or testes) that make your body go through puberty.

Puberty starts when your brain tells your body to start releasing puberty-related hormones. This happens at different ages for different people, but it normally starts between age 8 to 14 years old. This causes testicles to start producing testosterone or ovaries to start producing estrogen.

Puberty changes in people with testicles (without puberty blockers)
• Testicle growth
• Penis growth
• Deeper voice
• Increased muscle mass
• Pubic hair
• Increased acne
• Increased armpit and facial hair
• Growth spurt

Puberty changes in people with ovaries (without puberty blockers)

• Breast changes
• Changes in body shape, including fuller hips
• Menstrual periods start (usually more than 2 years after breast changes begin)
• Pubic hair and armpit hair
• Increased acne
• Growth spurt

Before starting puberty blockers, we will ask if you have noticed any physical changes related to puberty, and we also recommend lab tests to check puberty hormone levels (LH, FSH, testosterone or estradiol).

You begin puberty blockers after your body starts showing signs of puberty. Usually this is after bodies with testicles have started to have increased testicle size and growth of the penis, and bodies with ovaries have started to have breast changes (breast buds). It is not safe to start puberty blockers before puberty.

They may not be able to reverse most puberty changes that have already happened, such as facial hair or deeper voice. However, puberty blockers can stop any further puberty changes.

It can take 1 to 2 months for puberty blockers to start working, but it is different for everyone and hard to predict. In the beginning, your body may actually show more signs of puberty, but this will lessen as you continue to take the blockers.

No, puberty blockers will not stop pubic or armpit hair from growing or improve acne, because these are caused by other hormones from your adrenal glands. Puberty blockers only make a difference for the puberty changes that make you look female or male. For example, in bodies with ovaries, breast size may get smaller if they have already started to develop. In bodies with testicles, testicle size may decrease and penis growth will be halted.

No. If you decide to stop puberty blockers without starting sex hormones (testosterone or estrogen), your body will start going through the puberty of your sex at birth. You can stop the puberty blockers at any time, but let us know so we can work with you on how to safely do that.

It is up to you! Puberty blockers are used until you decide you want to either resume the puberty process, or you are established on your gender affirming hormones. Because puberty blockers can make your bones weaker over time, it is best to not take them alone for more than 4 years.

Depo Lupron or Leuprolide: This medicine is given as an injection (shot) usually once every 3 months (but may be every 1 month or 6 months depending on the medicine you are on). If you use this kind of puberty blocker, you will need to come to the clinic for the injection.

Histrelin: This medicine is a little plastic rod that is placed under the skin (implant) in the upper arm. The implant works for up to 3 years. After it stops working, it needs to be removed and replaced. This can be done in the clinic.

We partner with you to prevent and relieve any pain as completely as possible. If you have pain from an injection or an implant, you can take Tylenol (acetaminophen) or Advil (ibuprofen) to help relieve the pain if your healthcare provider says it is okay. Contact us if the pain from the injection or implant gets worse the next day or you have a rash.

The injection is given in your arm, leg or bottom. The area where you get it may be sore for about 1 day after the injection. Numbing cream (topical lidocaine) reduces pain from injections by numbing the skin before the needle stick. Ask us if you are interested in using numbing cream before your injection.

If you get the implant inserted in the clinic, we will give you an injection to numb your upper arm before the procedure. After the procedure, your arm may be sore for about 2 days where it was inserted.

We can safely and legally recommend puberty blockers for you based on our medical experience and judgment and your specific health needs. The Endocrine Society and the World Professional Association for Transgender Health (WPATH) support the use of puberty blockers. The Food and Drug Administration (FDA) approves puberty blockers for children who start puberty at a very young age, but has not approved puberty blockers for transgender children.

The long-term safety of puberty-blocking medicines is not completely understood. There may be long-term risks that we do not know about yet. 

Blocking puberty can make your bones weaker (lower bone density). This may get better when you stop the puberty blockers or start hormone therapy. While on puberty blockers, we recommend taking calcium, vitamin D and doing bone strength-building exercises like walking, jumping and weight lifting. We may check your bone health every 2 years while on blockers. 

Taking puberty blockers should not affect your ability to have a baby in the future (fertility). If you stop blockers and choose not to start hormones like estrogen or testosterone, then your gonads will start developing again to make eggs or sperm. However, damage to fertility is a concern for people who stay on puberty blockers and then take gender affirming hormones. We recommend talking about this with us to understand the potential impact on your fertility before starting any medicines.

Puberty blocker medicines can be very expensive and the cost can change every year. Currently, it can cost $1,500 to about $40,000 depending on the type of puberty blocker you use. Some insurance companies cover them. How much your insurance covers depends on your insurance plan and requires authorization from your plan. Sometimes insurance companies will only help pay for Depo Lupron (the injection) and not Histrelin (the implant).

Call your insurance plan and ask:
• Are these medicines covered by my insurance plan?
• What is my deductible, copay and coinsurance?
• Have I met my deductible this year?

If you need help navigating the insurance process, we can connect you to one of our Billing Specialists.

We will answer your questions and make sure you have a good understanding of what to expect, as well as potential risks and benefits, before you decide to start. Starting puberty blockers can give you time before making more permanent gender decisions, like the starting hormones.

It can be distressing for transgender or gender-nonconforming people to go through puberty. Puberty blockers can help with this distress by pushing the “pause button” on your puberty, which prevents puberty changes that do not match with your gender identity. For some people, puberty blockers may reduce the need for future surgeries or other treatments. For example, some transgender women may not end up needing hair removal procedures.

There is no age-restriction on starting hormones, the decision depends on what feels right for you. We will work with you and your guardian to help you make the best decision for yourself and your health.

No. We encourage all of our patients to seek support and therapy during their transition journeys, but we also respect that not everyone wants to or needs to. Everyone deserves to feel supported on their journey and we can connect you to a behavioral health provider if you are interested.

MCC does not have mental and behavioral health providers at the Gender Care Clinic site, but we have many providers across our various clinic sites and can connect you to care.

“Informed consent” means that a person has the cognitive ability to make a decision, and also that they have been presented with all of the information and knowledge they need to make that decision.

We will provide you with a lot of information and answer any questions you may have. We will discuss the various effects, benefits, and risks of hormones so you are able to make the best decision for yourself and your body.

If you are under 18, you will need to bring a parent or legal guardian with you to your first appointment as required by law.

Yes, if you are under 18, a parent or legal guardian who can consent to your medical decisions must accompany you. However, for a portion of your visit, the provider will see you alone to ensure they are providing the most comprehensive and confidential care possible.

Absolutely! Your identity matters and we will ensure you feel welcome and respected throughout each step of your care. Our providers will talk with you about your identity and ask specific questions to make sure you have personalized care that meets your needs as much as possible.

Within the medical system, however, there may be times when binary gender categories are enforced. If and when that arises, we will do our best to be transparent and work as closely as possible with you to ensure your identity is appropriately represented.