At What Age Can You Start Hormone Therapy
For parents of gender-diverse and transgender children, it may make sense to start puberty blockers at the onset of puberty to help prevent the stress and negative feelings their child may experience due to the development of these secondary sex characteristics. Puberty blockers also allow for additional time to explore gender without the further development of secondary sex characteristics. However, the Endocrine Societys 2017 guidelines do not recommend that gender-affirming hormone treatment with puberty blockers begin before puberty.
For youth seeking gender-affirming care, puberty blockers are a treatment that can begin, at the earliest, after a child has signs of puberty, such as chest budding or the enlargement of the testes, said Suzanne E. Kingery, M.D., pediatric endocrinologist with Norton Childrens Endocrinology, affiliated with the UofL School of Medicine. Dr. Kingery serves as director of the Pediatric and Adolescent Gender Education program.
Before starting any kind of hormone therapy, gender-diverse and transgender children need behavioral health evaluation to assess gender dysphoria. Additionally, these children and families need education and support regarding all options for care, Dr. Kingery said. The PAGE program offers children and families the mental and medical care and support these children need.
Puberty Blockers Are Drugs That May Be Given To Young People With Gender Dysphoria To Prevent Them From Going Through A Puberty That Doesnt Match Their Gender Identity Theyre A Physically Reversible Intervention And If A Young Person Stops Taking The Blockers Their Physical Adolescence Will Continue To Develop As It Had Done Previously But The Drugs Have Proven Controversial And Theres A Lot Of Misinformation Out There Chloe Kent Reports
In January, papers were lodged at the British High Court against the Tavistock and Portman NHS Trust, which runs the UKs only gender identity development service .
The claimants against the Trust want to establish a legal minimum age of 18 for puberty blocking hormone therapy for young people diagnosed with gender dysphoria, with their lawyers arguing that it is illegal to prescribe the drugs to anyone younger as they cannot give informed consent to the treatment.
The case has been brought about by the parent of a 15-year-old on the GIDS waiting list known as Mrs A, who does not believe children can understand the ramifications of taking puberty blockers. Alongside her is a 23-year-old woman named Keira Bell, who transitioned to male as a teenager but has since detransitioned and believes she should have been challenged more by GIDS during the process.
So-called puberty blockers, known formally as gonadotropin-releasing hormone antagonists, are medications that cause the body to stop producing sex hormones. They are delivered either as leuprorelin injections, which are administered by a healthcare worker every three months, or via a histrelin implant, which needs to be replaced annually.
Negative Effects Of Puberty Blockers
Studies on puberty blockers have shown that they are an effective and safe part of the hormonal therapy toolkit for young trans people.
GnRH analogues have been used to suppress puberty for the last 20 years and short-mid term studies have found them to be well tolerated by the body when used temporarily. Long term studies are currently underway.
GnHR analogues can affect your final height and could make you slightly taller if administered without gender affirming hormones and before the first growth spurt of puberty. This is because bones do not stop growing until exposed to estrogen or testosterone.
Accessing a Paediatrician or Paediatric Endocrinologist in a timely manner is important, and a GP is the first step to coordinating care.
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Physical Effects Of Estrogen Blockers
The most common use for estrogen blockers for men is to improve performance in the gym and bedroom. Estrogen blockers help boost overall energy levels in most men who take it in the morning before a workout. Testosterone can also improve mood and promote better sleep.
Lets look at how over-the-counter estrogen blockers can help you more in-depth.
Standards Of Care For Trans And Gender Diverse Children And Adolescents
Puberty blockers are medications that temporarily pause the development of physical characteristics from gonadotropin-releasing hormones in the body. Blockers might be taken while making a decision about beginning or waiting to be allowed to begin hormonal affirmation, or before accessing some kinds of gender affirming surgeries.
For young trans people wanting access hormonal affirmation, puberty blockers are sometimes the first step. Transfigurations in the UK write for many families, the question is not whether to intervene with blockers, but how early to start.1
Puberty blockers are taken by trans people whose bodies are just about to undergo puberty. For those who are pre-pubertal, gender affirmation is only ever social. Masculinising and feminising hormones are commenced after puberty would have, or did, occur.
They work by blocking the hormones testosterone and estrogen that lead to puberty-related changes in your body. This stops things like periods and breast growth, or voice-deepening and facial hair growth.
Information and resources to assist clinicians learn more about puberty blockers can be found here.
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Who Can Get Puberty Blockers
Although parents might think they should start puberty blockers very young, so that a child never has to experience any physical changes associated with the unwanted gender, experts say its better to wait at least until the early stages of puberty have started. Dr. Stephen Rosenthal, medical director of the child and adolescent gender center for U.C.S.F. Benioff Childrens Hospitals, was a co-author of the Endocrine Societys 2017 guidelines for transgender health care. He recommended starting puberty blockers when breast budding or the enlargement of the testes has begun, at the earliest.
Thats because Dr. Rosenthal does not recommend puberty blockers for prolonged use outside of the normal window of puberty. They restrict the functioning of the gonads, which may lead to adverse health effects. The longer blockers are used past the typical start of puberty generally age 14, at the latest the greater the possible risk.
When blockers are initiated in the early stages of puberty, Dr. Rosenthal typically suggests that his patients stop using them by age 14. At that point, patients, with their families and their doctors, can determine whether to introduce hormones that help them develop according to their gender identity or resume puberty in the gender assigned at birth.
What Are Estrogen Blockers And How To Use Them
Estrogen blockers have been gaining more and more popularity.
Over the years, we have seen as more and more men have started believing in their supposed health effects and included them in their daily diet.
Although we still have women who are relying on estrogen blockers for help, there is also a fair share of men as well.
But what exactly do these estrogen blockers do?
What beneficial effects can you gain by using them?
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Are Hormone Blockers Expensive
The cost of puberty blockers is approximately $1,200 per month for injections and can range from $4,500 to $18,000 for an implant. The least expensive form of estrogen, a pill, can cost anywhere between $4 to $30 a month, according to Simons, while testosterone can be anywhere between $20 to $200 a vial.
Do Puberty Blockers Have Any Serious Side Effects
Puberty blockers are safe as far as can be determined from the experience of non-transgender children who take them or women undergoing fertility treatments who take them, says Mount Sinai Center for Transgender Medicine and Surgery executive director Dr Joshua Safer.
Like all medications, the blockers are still known to have some side effects, including weight gain, hot flashes, headaches and swelling at the site of injection. There also may be more long-term effects on bone density, which is part of the reason the drugs arent supposed to be prescribed for too long.
Safer explains: The primary concern is that bones might be at greater risk of osteoporosis because bones depend on sex hormones for maintenance. That need is part of the reason that women typically are at risk for osteoporosis earlier than men, as women go through menopause and suffer a loss of sex hormones while men dont typically have a similar significant hormone change. But the risk is hard to see when only taking puberty blockers for a year or two.
Its also worth noting that there is a relationship between puberty blockers and fertility. Sperm production typically begins between 13 to 14, and egg maturation between 12 to 13, and the vast majority of trans children will begin puberty blocker treatment after these processes have already occurred.
Puberty blockers allow trans teenagers to finally get back to living their lives.
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Who Should Use Estrogen Blockers
You shouldnt only use an estrogen blocker if it has been recommended and prescribed by your doctor. Estrogen blockers are most commonly used for testosterone replacement therapy and cancer therapy and prevention. However not everyone that is receiving these therapies will be a good fit for estrogen blockers. Talking with your doctor about your symptoms and experience is important so that you can take medication that is right for you and will give you the most benefit.
The Side Effects Of Estrogen Blockers
Estrogen blockers directly affect the hormones, so the side effects are very similar to the menopause symptoms when there is a natural reduction of estrogen. They are hot flashes, mood swings, night sweat, osteoporosis, vaginal discharge, and vaginal dryness. Fortunately, the most effective estrogen-blocking supplements appear quite safe.
Studies have stated that commercial DIM supplements didnt report any serious side effects even after six years of regular usage.
The grape seed extract usage in clinical research also observed that even after 14 weeks of its use, no major side effects have come up but you must not use any blood thinners like warfarin with it. Also if you are allergic to grapes, then, of course, its better to steer clear of it.
The safety profile of other estrogen blockers is less clear as they contain some ingredients which havent been studied so much. It is better to take the advice of your doctor before starting one.
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Can You Tell Me More About Dht Blockers
We can! While you can go down an internet rabbit hole and read about all kinds of DHT blockers, theres only one thats proven to work. And that one is finasteride. Finasteride is a prescription tablet that effectively blocks DHT and stops further hair loss, including receding hairlines. It works by binding to the 5-Reductase enzyme, effectively inhibiting your body from producing DHT in the first place.
What Are The Risks
Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings. But doctors do not yet know how the drugs could affect factors like bone mineral density, brain development and fertility in transgender patients.
The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.
A handfulof studies have underscored low bone mineral density as a potential issue, though a 2020 study posited that low bone mineral density may instead be a pre-existing condition in transgender youth. Treatment with gender-affirming hormones may theoretically reverse this effect, according to Endocrine Society guidelines.
The impact of puberty blockers on brain development is similarly hazy. The Endocrine Society guidelines point to two studies: A small one published in 2015 showed that the drugs did not seem to impact executive functioning , while a 2017 study of rams treated with GnRH agonists suggested chronic use could harm long-term spatial memory.
The effects of puberty blockers are often referred to as fully reversible, including in both the Endocrine Society and WPATH guidelines, because of evidence showing that girls treated for precocious puberty were still able to undergo normal puberty and have children later in life.
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Thinking About The Body
On this page, we describe our approach to intervention and provide information about puberty and how to cope with it. We provide a staged approach to physical intervention that takes into account both physical and psychological development.
Many – although not all – adolescents we see consider at some point having physical interventions to change their bodies.
As well as many people who do start physical interventions, there are many people who choose not to do so – or who decide to wait a while.
We are commissioned by NHS England, who set the service specifications for how we work. The specification was updated in 2016 following extensive input from a wide range of stakeholders and the public, plus an independent review of available evidence.
The Recommended Dosage Of Estrogen Blockers
Studies have suggested that 50-300 mg per day of DIM is effective for people who have cancer .
The grape seed extract recommendation is between 100 to 400 mg per day .
Other than that, the estrogen blockers that are available in the market have dosage recommendations in accordance with the ingredients in it, and abiding by them will ensure that you dont go wrong at all.
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They May Improve Cognitive Performance
It has been proved that men with high testosterone and lowestrogen level perform better on cognitive tests compared to men with low testosterone and high estrogen.
One study suggests that cognitive abilities could be enhanced in older men who keep their testosterone levels high and their estrogen levels low. The study, published in 1999 by researchers at the University of California San Diego, looked at testosterone and estrogen levels among a group of over 500 men aged 59 and up .
The men had standard blood tests done to check their hormone levels, then underwent a series of tests of cognitive ability, including tests for memory, visual reasoning, and overall mental state. It was seen that men with higher testosterone ticked all the above-mentioned boxes as compared to the ones with the lower levels.
Summary: Studies have shown that cognitive abilities could be enhanced, in older men, by improving their testosterone levels and lowering estrogen levels.
What Exactly Is Dht
DHT is an androgen which is made from testosterone in the prostate, testes, and certain other tissues. Its needed to develop and maintain male sex characteristics, such as a deep voice, facial hair, and muscles.
Testosterone converts to DHT with the help of 5-reductase , an enzyme that is held in the oil glands of a hair follicle.
If youre genetically prone to male pattern baldness, DHT binds to receptors in your hair follicles, causing the follicle to miniaturize and, eventually, to stop new growth altogether.
While research has proven that genetics plays a big role in male pattern hair loss, we still dont know why this runs in some families and not others.
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When Are Estrogen Blockers Used
According to the American Cancer Association, about 1 in 8 women will develop breast cancer in the United States. Breast cancer cells use estrogen or progesterone for continued growth. Progesterone is another important female sex hormone and provides a balance for estrogen. 2 out of 2 breast cancers are hormone-dependent. If hormones play a role, the cancers either have receptors for estrogen or progesterone. Both make cancer grow and spread.
Medical Effects Of Estrogen Blockers
Pharmaceutical estrogen blockers, aka the type of antiestrogens that require a prescription, are incredibly effective at managing multiple diseases. Estrogen blockers are an effective treatment for breast cancer patients and women with anovulation.
Antiestrogens are also a component of hormone replacement therapy in transgender men. Many transgender men will use both medical antiestrogens and over-the-counter estrogen blockers to improve the effectiveness of their transition.
In men, estrogen blockers are used to treat the following conditions:
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What Do Puberty Blockers Do
During puberty, gonadotropin-releasing hormone promotes the production of follicle-stimulating hormone and luteinizing hormone in the pituitary gland. LH and FSH increase estrogen production in the ovaries, which causes breast development and eventually monthly periods for individuals assigned female at birth. LH and FSH prompt the testes to make testosterone, which causes body and facial hair, deepening of voice, increase in testes and penis size, and Adams apple for individuals assigned male at birth. Puberty blocker medicines suppress the production of LH and FSH, so gender-diverse and transgender youth do not develop the secondary sex characteristics of their assigned gender at birth.
Consequences & Permanent Side
Early studies show significant improvement in the mental health of youth who undergo social transitions and early medical interventions , . This is why these practices have been adopted so quickly. Parents understandably want to help their upset child and make life easier for them.
Preventing suicides is another argument that is often used both by trans activists and some mental health and medical professionals. Suicide ideation is very high in trans youth in all studies. Suicide is a horrific tragedy for the trans person and their family. Any health professional would want to provide relief if that is what will stop it. But suicides are rare in trans youth, and it doesnt appear that just lack of access to medical care is the sole reason for the suicides, as some of these tragedies have occurred with youths receiving full support and healthcare. Also, it is not clear if transition fully solves suicide risk, as adult transitioners still retain high rates of suicide ideation.
Suicide is used as the main justification for what are in reality medical experiments on children involving harsh medical techniques, and thus is critiqued here.
Need for a more complex surgery
A journal article confirms the above examples are in fact a problem.
This is a graphic of the rectosigmoid vaginoplasty that will be necessary in a puberty blocked male.
The disadvantages of this surgery are listed on the mtfsurgery.net website.
Another doctor says this about the skin graft option .
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