A: Current evidence suggests that puberty blockers, which hit the pause button on puberty and are reversible, significantly improve the mental health of trans youth while reducing the risk of needing future surgeries.
(Note: This post was updated by Those Nerdy Girls from the original published on January 23, 2024.)
A recent study showed that trans teens who were treated with puberty blockers had significantly less anxiety, depression, and stress compared to trans kids who did not receive such treatment. This is one of the largest studies yet to show significant benefit associated with puberty blockers.
Puberty blockers are medications that can (reversibly) pause puberty for a period of time. With them, trans kids can avoid (or delay) irreversible physical changes that are out of line with their gender identity.
For example, for a trans girl, developing a deepened voice, large Adam’s apple, and facial hair can be very distressing. It is also permanent – no amount of future hormone therapy will change those characteristics. Puberty blockers can prevent that.
For a trans boy, breast development, once it occurs, is often very distressing and is also permanent – the only future option is surgery. This distress, called gender dysphoria, is associated with significantly increased risks of depression, anxiety, and suicidality, and poor social functioning in trans youth.
đź’ˇUsing puberty blockers gives trans youth a span of time (up to a few years) before any irreversible changes happen to their bodies, either from the puberty their body was planning to do, or from taking hormone therapy right away. This window of time can be very helpful in working with their counselor, medical team, and families to figure out what future interventions, if any, are right for them.
For those who go on to start hormone therapy, prior use of puberty blockers gives the advantage of not having as many body characteristics that are out of line with their gender. This can alleviate a lot of personal distress (e.g. gender dysphoria) and make it much easier to navigate the world.
In the recent study, researchers looked at the mental health of 438 trans youth aged 13-17 who were coming in for a hormone readiness assessment visit. They found that patients who’d received treatment with puberty blockers had significantly fewer symptoms than those who hadn’t. This study used the Youth Self Report, an extensively validated and widely used survey in pediatrics, on which a score of 50 is the population average and above 70 indicates clinical severity. Youth who’d had puberty blockers scored lower (better), by about 5 points in each category, for symptoms of anxiety, depression, stress, and overall problems.
There are some limitations to this study. The groups were not randomized, so there could be other differences between the two groups that resulted in the different outcomes. For example, it’s possible that youth who received puberty blockers had an even higher level of family support than those who didn’t. Because family support has been shown to be a significant factor in the mental health of trans youth, that could explain some of the lower symptoms scores.
To randomize this study in a research setting, we would have to deny access to a treatment that has shown to help kids. We don’t do that anymore in science because we have learned to do better, more ethical research. (See our post on medical ethics here.)
Another limitation of this study is that all of these subjects were attending a comprehensive specialty gender clinic in a major city. Therefore, they all had very high levels of family support and tended to be majority white and affluent. Therefore, this study does not reflect the general population of trans youth.
A strength of this study is that its findings of improved mental health are in line with several other studies (See here, and here, and here.) that show decreased self-harm, depression, and/or thinking about suicide in youth who receive puberty blockers. This is important, as trans youth have a 2-3 times higher risk of thinking about suicide than non-trans youth. Use of puberty blockers, therefore, does seem to help prevent suffering and increase the likelihood of a happy and healthy adolescence and adulthood. It may even be life-saving.
Puberty blockers have been in use for several decades for a variety of health conditions and seem to be quite safe. There is a risk of loss of bone density (that is reversible when the medication is stopped), so many patients take Vitamin D and calcium, get weight-bearing exercise, and have routine bone scans to make sure things are ok. Research shows no impact on final adult height, fracture risk, or future fertility. Even so, the decision to start puberty blockers is usually made only after careful and extensive evaluation of the patient and discussion with their family.
In sum, puberty blockers appear to be helpful for trans kids. They are associated with significantly improved well-being and decreased need for future surgeries. There is no evidence of significant harm. Therefore, all major medical organizations in the U.S. support their use when they are deemed appropriate by the clinician, patient, and family.
2026 Update: Although a randomized control trial withholding treatment that works would not be done because it is unethical, in many places in the U.S. kids are now being subjected to a realtime social experiment without their, their parents’ or their clinicians’ consent, by being denied access to this treatment. We are now, unethical as it may be, able to collect more data on the impacts of withholding the standard of care.
⚖️ Health Equity Alert: UCLA Williams Institute reports 362,900 trans kids—half of transgender youth in the U.S.—live in 27 states that have enacted bans against accessing gender-affirming care. According to a 2023 study in Nature, when states passed laws targeting transgender youth, suicide attempt rates went up among trans and nonbinary young people in those states compared to states without such laws. The majority (95%) of trans kids in the South and half (51%) of trans kids in the Midwest live in a state with at least one restrictive law or policy. It is a health equity concern when people from one group have worse health outcomes than people from another group. In this case, trans kids living in some southern and some midwestern states, have a higher risk for attempting suicide.
✨ Action Alert: Two proposed rule changes being considered now by the executive branch would further restrict trans kids from receiving evidenced-based care. There is an open commenting period for both proposed rules here and here. (Note: the rules use misleading language calling treatment such as puberty blockers “sex-rejecting procedures.” As we have explored in this post, puberty blockers are gender affirming, not “sex-rejecting” and are associated with better health outcomes.) Everyone in the country, regardless of where you live, can comment by February 17, 2026. Even if comments are not considered by today’s decision makers, they are an important part of the public record. Please consider going to the comment section and letting your voice be heard. If you have questions, let us know.
Stay safe, stay curious,
Those Nerdy Girls &+
Resources:
Info on puberty blockers from Mayo Clinic
Medical organizations that support gender affirming care of trans youth
American Academy of Pediatrics policy supporting care for transgender youth
Systematic Medical Evidence Review of Hormonal Transgender Treatment Report
