Views on hormone/puberty blockers

Hormone blockers, also called puberty blockers, pause the physical changes of puberty that can be distressing for many trans or gender diverse young people. Hormone blockers are gonadotrophin-releasing hormone (GnRH) analogues. These synthetic hormones pause puberty and supress naturally occurring hormones (such as oestrogen and testosterone) in the body. According to the Gender Identity Development Service (GIDS, 2020), hormone blockers are a reversible intervention, and the World Professional Association for Transgender Health (WPATH) cite hormone blockers in their established internationally accepted Standards of Care (SOC) guidance. This guidance states that it is more harmful to withhold this intervention that to provide it. For more information on this including possible side effects please see our Resources page.*

Richard talked about what he knows about hormone blockers and the reasons his daughter wanted to take them.

In our interviews, parents and carers spoke about their children’s experiences with hormone blockers both within the Gender Identity Development services (GIDS) and through seeking private healthcare. In this section, you can read, hear and watch what parents and carers said about:
  • Considering hormone blockers;
  • Getting hormone blockers;
  • Combining private care with NHS treatment;
  • Managing hormone blockers;
  • Side effects of hormone blockers; and
  • Parent’s feelings about hormone blockers.

Considering hormone blockers

The parents and carers we spoke to often thought carefully about hormone blockers. They had conversations with their children about the benefits and side effects of hormone blockers. Many parents had researched the topic and looked for information and advice. A conversation about hormone blockers may be had before puberty, but this medication is not introduced before what is known as puberty Tanner Stage 2, which marks the beginning of physical development and hormonal changes.
For parents whose children were taking hormone blockers, the decision was often seen as giving the young person time and space to think, taking some of the puberty related pressures away. Adele’s son wanted to start taking hormone blockers to have ‘space’ to think without having to worry about puberty and physical changes. Lisa felt that when her son started hormone blockers it meant that ‘he didn’t have to worry that he was going to see even more problems created.’ Ali felt hormone blockers would give her daughter ‘breathing space,’ to explore her gender identity, without the pressure of developing an Adam’s apple and growing facial hair.
Some parents viewed hormone blockers as a way to prevent irreversible physical changes and the future need for surgery. Georgina said, ‘Im really hopeful that hes gonna get the blockers in time, to not make him need top surgery, because to me thats one of the huge, huge benefits of blockers is that it takes away the need for another major surgery. And I know that hes gonna feel really, really down if hes made to experience having breasts, basically.’

Adele said she supported her son starting hormone blockers to put his worries about unwanted puberty changes on the back burner.

Lisa talked about the decision to start her son on hormone blockers privately. She felt this gave him peace of mind and was the best decision for him.

Oonagh talked about introducing the idea of hormone blockers to her pre-pubertal daughter. She said her daughter understood that they would give ‘her some time to think about what she wants for the future.’ Similarly, Leigh said that whilst she trusted her foster son 100% to know who he was, she felt hormone blockers gave him extra time and allowed him to take things slow.

Oonagh talks about her daughter’s understanding of hormone blockers and her daughter not wanting to develop the male things.

Georgina’s son found out about hormone blockers from a friend. She explained to him how they work and said that part of the reason they were going to GIDS was to be able to access them, if needed.

Getting hormone blockers

In our interviews, parents and carers had a range of experiences trying to access hormone blockers for their children. Accessing hormone blockers on the NHS requires assessment by the specialist Gender Identity Development Services (GIDS). This service refers the young person to a doctor specialising in hormones called an endocrinologist, who assesses the stage of puberty the young person is at and prescribes the blockers, if appropriate.

Adele talked about the assessment process at the GIDS and the process of getting her son approved for hormone blockers.

Leigh said they had many conversations with her foster son’s therapist at GIDS and social worker before he was cleared for hormone blockers. She felt the clinical process after that was surprisingly smooth.

Some parents we spoke to felt that the assessment process took too long, which resulted in unwanted physical changes for their children. For Josie’s daughter, a delay in getting hormone blockers, meant she felt it was too late. She said: ‘We really wanted her to start on blockers and it took ages for them to agree. And then, by that time we knew that, what she needed ,was oestrogen.’

Ali felt the process to get her daughter hormone blockers took too long. She said that her daughter has experienced unwanted physical changes.

Once a young person was allowed to start hormone blockers, it did not always mean that they would be able to start treatment straight away. For young people in the earliest stages of puberty, it was sometimes necessary to wait.

Richard’s daughter was waiting for puberty to become more advanced to start on hormone blockers. The father felt frustrated and worried in case her puberty accelerates.

Combining private care with NHS treatment

For parents whose children had accessed hormone blockers and hormones privately, it was sometimes difficult for this to fit with NHS treatment plans. For Lesley this meant that her son would have to stop taking hormones and go back to being on hormone blockers, before his hormone treatment could be restarted. She felt this was ‘not an option’ for him.
Trying to integrate private care and NHS treatment, meant that Lisa’s son had to stop taking hormone blockers prescribed privately so that the GIDS could assess his puberty development. Lisa felt that NHS plans ‘prioritised policy’ over her son’s wellbeing, when she was told that her son could not have blockers. Lesley talked about the difficulty of integrating private care with NHS treatment for her son. She shared: ‘We are two sessions into our assessment, because we are on, GIDS child and adolescent pathway, we already know that, we stick to the child and adolescent pathway he’d have to come off hormones. And then, he’d have to be on blockers alone for twelve months before hormones were reinstated, they won’t take into account the twelve months he’s already been on blockers [via private provider]. That would have to start from day dot again.’

Managing hormone blockers

In our interviews, parents and carers spoke about managing hormone blockers. Leigh said hormone blocker injections were being carried out by a nurse at their GP surgery. She said: ‘The nurses are quite happy to do the blockers for injections for him each month. They are keeping the one nurse doing them, so my child does have a relationship with that one nurse.’ She also said the process of getting the prescription at the pharmacy had been straightforward.

Andrew’s daughter takes hormone blockers and oestrogen gel. As a retired healthcare professional he is able to give his daughter the hormone blocker injections himself.

Side effects of hormone blockers

Hormone blockers can cause side effects. Adele thought that the way a young person’s body responds to the blockers ‘varies from child to child, because of their own kind of physiological make-up and their own, mental health.’ Some parents, said their children experienced no side effects with hormone blockers. Other parents talked about a range of side effects their children had (see also our Resources page for further information on possible side effects). Parents whose children have not yet started taking hormone blockers, like Mel, whose stepdaughter has been approved for blockers, were eager to learn more about the side effects of the medicine.

Parent’s feelings about hormone blockers

Parents and carers whose children were not on hormone blockers spoke about concerns they had about starting them. Richard, whose daughter had been approved to start hormone blockers, thought that there were not enough data about long-term effects of blockers. He also felt that the increase in young people coming out as transgender was a positive thing, as for him it meant that it was becoming more socially acceptable. He also thought that would lead to ‘a lot more evidence and research’ on the long-term effects of hormone blockers. Elijah worried that hormone blockers are based on ‘bad science’. He had concerns about his daughter taking them.
One parent felt that the existing NHS protocols for hormone blockers were ‘very rigid and inflexible’ and ‘still about the psychologist checking that, a child knows their gender and checking that there arent external forces forcing a child to pretend to be trans.’ She worried that health professionals didn’t have ‘sufficiently trans positive approach.’

Mel worries about the side effects of hormone blockers and talks about strategies to support her stepdaughter with mindfulness and meditation.

* NHS, 2020. Treatment: Gender dysphoria.

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