Puberty and puberty blockers

Content warning: discussions of self-harm and suicide attempts.

Puberty is a difficult time during many young people’s lives, but for trans and gender diverse young people it can often be a big challenge for a number of reasons. The young people we spoke to described diverse experiences of puberty and what the changes meant to them. They also spoke about their experiences of puberty blockers, medication that delays puberty. A few of the young people we spoke to had experience of puberty blockers and others talked about the impact puberty blockers would have had on their lives if they had been able to access them at puberty. This summary explores:

  • Discomfort and distress with puberty;
  • Making sense of puberty changes;
  • Managing physical changes such as periods and menstruation;
  • Experiences of puberty blockers and;
  • Missed opportunities with accessing puberty blockers

Discomfort and distress with puberty

Many young people talked about the distress they felt as their bodies changed during puberty. Several described feelings of deep discomfort, fear, and helplessness at the beginning of puberty: Finn said, ‘It’s a panic, like a feeling of being trapped… like visceral disgust… it’s distressing’. He said ‘It’s that feeling of it looks wrong, it is wrong… that shouldn’t be there.’ Ari remembered being age 12 or 13 and being told ‘in the girls locker room about puberty and what changes happen’. They felt ‘absolutely horrified’ and wished they could ‘cryogenically freeze myself and I wouldn’t ever have to go through it.’

Charke talks about the significant negative impact of going through puberty.

Age at interview 17

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Evelyn shares her feelings when she started to hit puberty. She realised I don’t want to be a boy, I am a girl.

Age at interview 14

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Several people said the timing and speed of puberty was important. Some experienced early puberty, which could add to the intensity of these feelings. Jack said that he ‘went through puberty at a very early age, I think I was about six or seven… so very, very young to the point that I probably should have got puberty blockers not even for being trans but [for] being that young.’ Finn said that whilst he was ‘flat-chested’, puberty suddenly hit him ‘like a ton of bricks’ and he immediately began to bind his chest. Several people described becoming very aware of puberty at school, particularly in relation to friends and other pupils, and the challenges of using changing rooms, toilets and doing sport.

Ezio describes their experience of puberty and how it felt like a mistake.

Age at interview 23

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Some young people spoke about how experiencing puberty changes had a negative impact on their mental health. Charke, Reuben and H spoke about experiencing depression as a result of the changes. Charke, Ezio and H shared how the distress of puberty also led to self-harming behaviour. Charke said puberty changes ‘set off a quite a rough time in my life, I became severely depressed, self-harmed, attempting suicide on two occasions and was hospitalised because of it’. Cas described the difficulty of dealing with self-hate and hate of one’s own body during puberty.

N reflects on the onset of puberty as a spanner in the works’ and how their whole relationship with their body shifted.

Age at interview 34

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Making sense of puberty changes

People talked about confusion around puberty and their experiences of changes and many described feeling uncomfortable in their bodies and not knowing why. Patrick said when he started puberty between 12 and 13 and ‘didn’t understand why this feels wrong’ he said, ‘I didn’t have the language to describe it’.

People said that they would try to reassure themselves that their feelings were something everyone goes through, rather than see them as linked to gender identity. Kat said, ‘I kind of knew something was wrong and I didn’t like it, but I’ve been told everyone feels like that which kind of I guess is true but like trans people [feel] worse’. PJ described puberty ‘feeling like crap’ but thinking that there was ‘nothing else’ and he’d ‘just have to get on with it’.

Bay reflects on their understanding of puberty changes as they were taking place and how they tried to rationalise it.

Age at interview 28

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Jacob tried to think of puberty as a ‘natural teenage thing’ and that he was ‘gonna be fine’ and ‘get used to it’. He spoke about trying ‘really, really hard to fit in…pushing myself to be someone I wasn’t’. Cassie talks about waiting for puberty to ‘finally click’. This, she thought, would make her ‘happy’ and ‘able to be like the other boys’. Then she would be able to ‘relate to them’ and puberty ‘will stop feeling so foreign and alien’. However she said ‘that never happened’.

Erion says finally having a word to describe a lot of what I was feeling’ felt like a massive weight off my shoulders.

Age at interview 22

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Managing physical changes such as periods and menstruation

Several people spoke about being very aware of their bodily changes including body hair, breast development, genital changes, skin and voice changes, and starting periods. Evelyn said, ‘I suppose obviously, the first kind of things that was really, like that triggered [gender] dysphoria was obviously like growing hair in my genital area, and then armpit’s as well, also like voice breaks, voice cracking and then getting deeper, that was like a big thing to me as well. Getting a lot taller and shoe size is also a thing.’ Similarly, H spoke about how he found growing breasts ‘quite distressing’. Charke felt that body hair, especially facial hair, ‘was a big part of my dysphoria’.

Declan talks about his experience of puberty changes and his gender identity.

Age at interview 20

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For the trans and gender diverse young people assigned female at birth, one of the most distressing changes at puberty was starting periods. Ezio said he tried to ‘block out the experience’. Declan said that he ‘started periods at eight’. He said it ‘felt wrong’ and would hide it. He went on to say that he ‘didn’t really understand what it was’ and ‘didn’t feel comfortable going to anyone about it.’ Cas felt there wasn’t much information available ‘anywhere …about how to deal with a period if you are trans’. Henry started menstruating at eleven and described feeling ‘horrified’ even though his mum was a nurse and had given him information on what to expect. He said he remembered ‘feeling a sense of horror and a complete lack of control.’

Some people also shared how they tried to control and manage their periods – always get the advice of a healthcare professional. Declan talked about managing his periods with the contraceptive pill. Ezio spoke about the different methods for stopping periods. The options he was aware of included the contraceptive pill, the implant, and the coil. Cas said that being able to stop periods was a significant first step and had a positive impact.

Cas talks about managing periods with progesterone injections.

Age at interview 16

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Experiences of puberty blockers

Puberty blockers are Gonadotropin-Releasing Hormone (GnRH) agonists, which delay the progression of puberty. They are described by the Gender Identity Development Service (GIDS) as a ‘physically reversible intervention’ that ‘allows the young person to consider their options and to continue to explore their developing gender identity before making [further] decisions’ (GIDS, 2021)*.

Some young people were able to access puberty blockers and talked about their impact and the process of accessing them. One of the main issues was the long delays and waiting list for NHS gender identity services. Those who had gotten puberty blockers did so with the help of private care. Charke described how they ‘waited and worked with GIDS for a number of years’ but felt ‘they were making no progress and was no closer to accessing the intervention.’ They eventually sought help from a private health care provider. Charke said that for them it felt like the GIDS clinic was ‘withholding care’. Tom, Evelyn and Charke all describe some conflict between the GIDS and private healthcare process. Tom says that it was difficult working with both.

Evelyn talks about accessing puberty blockers and feeling helpless’ to the irreversible changes’ of puberty.

Age at interview 14

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The experience of puberty blockers involved dealing with physical and mental changes. The young people described positive impacts as well as the changes and side effects to be aware of when accessing this intervention.

Of the young people we spoke to with no personal experiences, some had heard about others experiences of accessing puberty blockers. Declan spoke about his friend who was ‘actually lucky enough to start them before he started puberty.’ He said his friend has ‘never had a period’, and it ‘stopped his chest from developing further’. He described this being ‘the main two things’ that ‘trans guys want to stop’. Declan also said that his friend ‘was able to start testosterone earlier because of that’.

Tom describes his experience of taking puberty blockers as really good’, reversing changes in breast development.

Age at interview 13

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Charke described how accessing puberty blockers felt ‘really relieving, it was great’. They said ‘I no longer felt like every day I was deteriorating’ and ‘digging further down to a hole I really didn’t want to be in.’ They said they felt like they could finally ‘breathe again’ and ‘things are no longer getting worse every day… for the first time in a long while’. They felt that finally they had time to ‘just work out, okay what do I want to do here’.

People also described some side effects including mood changes, headaches and hot flushes at the start of taking them. Evelyn and Tom said that some of the less positive changes of taking puberty blockers were ‘mood changes’. Evelyn spoke about having occasional ‘headaches’. She also found herself getting ‘more emotional’. She also said she had one occasion of ‘vomiting and sickness’. She said the information on what to expect was ‘drilled’ into her beforehand by the doctors prescribing puberty blockers which helped her feel prepared. She said while at GIDS ‘we were given a big folder… of stuff to look out for which told us what’ll happen, and side effects as well.’

Charke weighed up the costs and benefits and spoke about the risks of ‘low bone density or osteoporosis with prolonged use’. They described that while taking this into account they are ‘happy just taking blockers and seeing where I want to go in the future.’ Tom described receiving puberty blockers as a ‘thinking period’. In his words it ‘just relieves you of all the stress so you can get your head back where you want it to be’. Charke says that ‘it was absolutely the right move to get blockers when I got them, certainly no later’.

Tom responds to critics of puberty blockers and describes the positive impacts they’ve had on his life.

Age at interview 13

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Missed opportunities with accessing puberty blockers

Many of the young people and young adults talked about the important timing of puberty blockers and reflected on missed opportunities of accessing timely intervention. Some young people talked about waiting 2-3 years for their first appointment with GIDS and being too young for hormone therapy and too old for puberty blockers.

Eel talks about reaching GIDS at an age where he had already gone through puberty’ and hormone blockers wouldn’t do anything.

Age at interview 17

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Noelle talks about the waiting period for puberty blockers; ‘if you think about it, you start, you get that first referral at 12 and you’re only getting treatment at 16 like you’re most of the way through like at least the big changes in puberty. She said, ‘the effect that that has on people, it’s just, it’s cruel. It’s just cruel.’ Some young people talked about the opportunity to have puberty blockers at puberty. Declan spoke about learning about puberty blockers and trying to access GIDS but said ‘when I finally got there most of puberty had finished because I started really early’.

Ari who did not access puberty blockers reflected, ‘If I had known they were a thing, I would have leapt at the opportunity because I was so absolutely horrified by the idea of puberty.’ They said, ‘having the time to press pause on that, the time to think and assess, would have been so helpful.’

However not all the young people we spoke to felt this way. Ezio said, ‘I’m really envious of those people [who accessed puberty blockers] because they’ve had the spirit and courage to do that, but I know for me that that’s not who I am at all, you know, I am, I’m very slow I’m like a snail’.

H reflects on transitioning as an adult and the missed opportunity of starting younger.

Age at interview 28

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See also

School

Experiences of Gender Identity Development Service (GIDS)

Journeys to identifying as trans and gender diverse

*The World Professional Association for Transgender Health (WPATH) state that ‘treatment of transgender adolescents involving gender affirming medical interventions (puberty suppression and subsequent gender affirming hormones) are a widely accepted and preferred clinical approach in health services for transgender people around the world’ WPATH, 2020. Statement Regarding Medical Affirming Treatment including Puberty Blockers for Transgender Adolescents. Available at: http://epath.eu/wp-content/uploads/2020/12/FINAL-Statement-Regarding-Informed-Consent-Court-Case_Dec-16-2020.docx.pdf

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