How can a child suppress puberty & what are the medical considerations?
July 31, 2017 5:51 AM Subscribe
My child is non-binary. They are ten years old, biologically born a female, and told us about a year ago the are unsure which sex they identify with and want to be considered non-binary for the time being. We are of course supportive and have very candid conversation with them about gender identity and let them know that whatever decision they make we support. The problem is their other parent (we are divorced) seems to be pushing them to have puberty suppression therapy.
Does anyone know what this entails, what are the dangers, and any other medical considerations we should know about, especially at this young age of 10? Any information would be greatly appreciated!
This article from the Center of Excellence for Transgender Health explains puberty suppression therapy. Basically, PST is a process that suppresses physical changes that occur during puberty to avoid the emotional trauma those physical changes can cause.
Kids get injections to suppress their body's changes and as they work with their doctors and therapists and mature, they begin receiving gender-affirming hormones.
I've copied a few of their points:
1. Care for transgender and gender non-conforming (TGNC) youth is a rapidly expanding field of medicine, and lends itself to controversy among professionals. It stands to reason that transgender adults started as transgender youth, and if identified in childhood or adolescence may benefit from early access to hormone blockers and/or gender-affirming hormones. While sparse data exist regarding the impact of puberty suppression and gender-affirming hormones administered during adolescence, there have been promising results from the Netherlands indicating that this approach in adolescents results in improved quality of life and diminished gender dysphoria.
2. Youth with gender dysphoria often experience significant trauma at the onset of their endogenous pubertal process.Not uncommonly, gender dysphoria first emerges with the onset of puberty. The development of secondary sexual characteristics can be the solidification of an undesired physical developmental process for those with a gender identity that is incongruent with their assigned sex at birth. With the high frequency among transgender youth of mental health challenges including anxiety, depression, social isolation, self-harm, drug and alcohol misuse, many providers view early treatment as life-saving.
3. A team of experts in the Netherlands at the Gender Identity Clinic at the VU University Medical Center in Amsterdam was the first to develop a protocol that presented the possibility of delaying, or avoiding altogether, the development of undesired secondary sex characteristics resulting from an unwanted endogenous pubertal process. This model of care includes the use of gonadotropin releasing hormone (GnRH) analogues, most commonly in the United States, leuprolide acetate or histrelin, medications that have been used for decades to delay pubertal development in children with central precocious puberty. GnRH analogues offer a reversible intervention that allows youth temporary relief from an undesired, and potentially traumatic endogenous puberty.
The article then discusses the kid getting gender-affirming hormone treatment. It's relatively new information and there aren't a lot of studies to fully understand risks and benefits. I would get in touch with the Center of Excellence for Transgender Health for more support.
posted by yes I said yes I will Yes at 6:11 AM on July 31, 2017 [11 favorites]
Kids get injections to suppress their body's changes and as they work with their doctors and therapists and mature, they begin receiving gender-affirming hormones.
I've copied a few of their points:
1. Care for transgender and gender non-conforming (TGNC) youth is a rapidly expanding field of medicine, and lends itself to controversy among professionals. It stands to reason that transgender adults started as transgender youth, and if identified in childhood or adolescence may benefit from early access to hormone blockers and/or gender-affirming hormones. While sparse data exist regarding the impact of puberty suppression and gender-affirming hormones administered during adolescence, there have been promising results from the Netherlands indicating that this approach in adolescents results in improved quality of life and diminished gender dysphoria.
2. Youth with gender dysphoria often experience significant trauma at the onset of their endogenous pubertal process.Not uncommonly, gender dysphoria first emerges with the onset of puberty. The development of secondary sexual characteristics can be the solidification of an undesired physical developmental process for those with a gender identity that is incongruent with their assigned sex at birth. With the high frequency among transgender youth of mental health challenges including anxiety, depression, social isolation, self-harm, drug and alcohol misuse, many providers view early treatment as life-saving.
3. A team of experts in the Netherlands at the Gender Identity Clinic at the VU University Medical Center in Amsterdam was the first to develop a protocol that presented the possibility of delaying, or avoiding altogether, the development of undesired secondary sex characteristics resulting from an unwanted endogenous pubertal process. This model of care includes the use of gonadotropin releasing hormone (GnRH) analogues, most commonly in the United States, leuprolide acetate or histrelin, medications that have been used for decades to delay pubertal development in children with central precocious puberty. GnRH analogues offer a reversible intervention that allows youth temporary relief from an undesired, and potentially traumatic endogenous puberty.
The article then discusses the kid getting gender-affirming hormone treatment. It's relatively new information and there aren't a lot of studies to fully understand risks and benefits. I would get in touch with the Center of Excellence for Transgender Health for more support.
posted by yes I said yes I will Yes at 6:11 AM on July 31, 2017 [11 favorites]
This is also a contentious and politicized issue within the medical community itself, so it makes sense to look carefully at the primary research on treatment options (both medical and non-medical) and outcomes for children with gender dysphoria.
PubMed is a good place to start, since that'll list a critical mass of the published research on the subject. For instance, specifically on the subject of whether childhood gender dysphoria is likely to persist into adulthood:
Psychosexual Outcomes of Gender-Dysphoric Children (Journal of the American Academy of Child and Adolescent Psychiatry, 2015)
A follow-up study of girls with gender identity disorder (Developmental Psychology, 2008)
Factors associated with desistence and persistence of childhood gender dysphoria (Journal of the American Academy of Child and Adolescent Psychiatry, 2013)
It's worth noting that all those studies suggest that many/most, but by no means all, cases of childhood gender dysphoria will resolve on their own without medical treatment, and that it may be possible (see last article) to identify risk factors for particular individuals being in one or the other group. You'll want to be careful to get advice tailored to your child's specific situation, seek multiple opinions/alternatives, and ask the clinician to walk you through the evidentiary basis for whatever treatment plan they propose.
posted by Sockinian at 7:04 AM on July 31, 2017 [6 favorites]
PubMed is a good place to start, since that'll list a critical mass of the published research on the subject. For instance, specifically on the subject of whether childhood gender dysphoria is likely to persist into adulthood:
Psychosexual Outcomes of Gender-Dysphoric Children (Journal of the American Academy of Child and Adolescent Psychiatry, 2015)
A follow-up study of girls with gender identity disorder (Developmental Psychology, 2008)
Factors associated with desistence and persistence of childhood gender dysphoria (Journal of the American Academy of Child and Adolescent Psychiatry, 2013)
It's worth noting that all those studies suggest that many/most, but by no means all, cases of childhood gender dysphoria will resolve on their own without medical treatment, and that it may be possible (see last article) to identify risk factors for particular individuals being in one or the other group. You'll want to be careful to get advice tailored to your child's specific situation, seek multiple opinions/alternatives, and ask the clinician to walk you through the evidentiary basis for whatever treatment plan they propose.
posted by Sockinian at 7:04 AM on July 31, 2017 [6 favorites]
As Sockinian says, desistence is a highly contentious issue. The studies they cite have been criticized for failing to distinguish between real dysphoria and gender nonconformance. That was a blog post; but here's a research presentation from the WPATH symposium covering that and other methodological concerns.
In plain language: If you count tomboyish girls-who-still-call-themselves-girls and Barbie-loving boys-who-still-call-themselves-boys as "dysphoric," then yes, most so-called "dysphoric" kids grow up to be cisgender. If you only count kids who meet the clinical standards for being counted as transgender, then trans kids are as persistent and consistent in their gender identity as cis kids, and are likely to grow up to be trans adults.
I am not saying your kid meets those clinical standards. I can't make that determination. (And there is admittedly less research on nonbinary-identified kids.) But if they do meet those standards now, there's a decent chance they'll continue to identify as something other than a woman as an adult.
You also asked about safety. Here, there's actually much less controversy. Puberty blockers are widely used in cis girls with precocious puberty, and are overall considered effective and safe. In particular, that lit review cites studies showing that when cis girls take puberty blockers for a while and then stop, they go through a pretty normal cis-girl puberty afterwards. They have good psychological outcomes. They end up with normal menstrual cycles and fertility, normal pregnancies if they get pregnant, normal breast development, normal bone mass, and slightly-higher-than-average adult height (by a few inches). The research around obesity and PCOS are a bit more complicated. Obesity can cause precocious puberty, so a lot of cis girls are overweight when they go onto puberty blockers, but it doesn't seem like puberty blockers make people more likely to be overweight if they weren't already. PCOS and precocious puberty are also linked. But it's possible that puberty blockers raise the rate of PCOS a bit -- they say more research is needed.
One last thought: Whatever medical treatment your kid does or doesn't get, it would probably be helpful for you to join a support group for parents of trans and gender-nonconforming kids. PFLAG is a good organization to contact for that. If there's a trans health clinic in your area, they will also run parents' groups or be able to steer you towards other organizations that do. Having someone you love who's thinking about transitioning is hard, even if you love them and support them with all your heart, and talking to other parents who have been through it will be a big help.
posted by nebulawindphone at 7:45 AM on July 31, 2017 [19 favorites]
In plain language: If you count tomboyish girls-who-still-call-themselves-girls and Barbie-loving boys-who-still-call-themselves-boys as "dysphoric," then yes, most so-called "dysphoric" kids grow up to be cisgender. If you only count kids who meet the clinical standards for being counted as transgender, then trans kids are as persistent and consistent in their gender identity as cis kids, and are likely to grow up to be trans adults.
I am not saying your kid meets those clinical standards. I can't make that determination. (And there is admittedly less research on nonbinary-identified kids.) But if they do meet those standards now, there's a decent chance they'll continue to identify as something other than a woman as an adult.
You also asked about safety. Here, there's actually much less controversy. Puberty blockers are widely used in cis girls with precocious puberty, and are overall considered effective and safe. In particular, that lit review cites studies showing that when cis girls take puberty blockers for a while and then stop, they go through a pretty normal cis-girl puberty afterwards. They have good psychological outcomes. They end up with normal menstrual cycles and fertility, normal pregnancies if they get pregnant, normal breast development, normal bone mass, and slightly-higher-than-average adult height (by a few inches). The research around obesity and PCOS are a bit more complicated. Obesity can cause precocious puberty, so a lot of cis girls are overweight when they go onto puberty blockers, but it doesn't seem like puberty blockers make people more likely to be overweight if they weren't already. PCOS and precocious puberty are also linked. But it's possible that puberty blockers raise the rate of PCOS a bit -- they say more research is needed.
One last thought: Whatever medical treatment your kid does or doesn't get, it would probably be helpful for you to join a support group for parents of trans and gender-nonconforming kids. PFLAG is a good organization to contact for that. If there's a trans health clinic in your area, they will also run parents' groups or be able to steer you towards other organizations that do. Having someone you love who's thinking about transitioning is hard, even if you love them and support them with all your heart, and talking to other parents who have been through it will be a big help.
posted by nebulawindphone at 7:45 AM on July 31, 2017 [19 favorites]
I think your best bet at this point is going to be to find a doctor that specializes in gender-related treatment in adolescents. My understanding is that puberty blockers are totally reversible and buy time. If puberty continues unabated, the changes become irreversible (or less-reversible? This is my lay-person knowledge and why you need to see a good doctor.)
I know one doctor with this area of expertise. We worked at the same adolescent medical clinic, though not at the same time. But at any rate, look for a similarly-specialized medical provider to talk to.
posted by Stewriffic at 9:30 AM on July 31, 2017
I know one doctor with this area of expertise. We worked at the same adolescent medical clinic, though not at the same time. But at any rate, look for a similarly-specialized medical provider to talk to.
posted by Stewriffic at 9:30 AM on July 31, 2017
(Also, thanks for being awesome parents and thinking about things)
posted by Stewriffic at 9:30 AM on July 31, 2017 [2 favorites]
posted by Stewriffic at 9:30 AM on July 31, 2017 [2 favorites]
My kid, who will be 10 in a couple of days, has been cared for by the Lurie Gender and Sex Development Clinic in Chicago since he was four. There are also clinics with specialist physicians in this area in Boston and LA. We drive just under 5 hours to go to Lurie, but one of the resources they offer is helping people find physicians in their local area, and consultations with non-specialist physicians who find themselves caring for gender nonconforming, trans, and gender fluid kids. You could contact them for information and they would be helpful.
Our kid is being watched for signs up puberty, and is currently at Tanner Stage 1. Hormone blockers are generally begun at Tanner Stage 2. The Tanner Stages describe the progression of physical changes in puberty.
Hormone blockers are very safe, and their effects are reversible--kids who take them and then go off them without receiving hormone treatment will proceed with their interrupted puberty. One of their uses is to buy time for young people to continue to think about their gender identity without experiencing irreversible changes like the development of breasts or facial hair growth. Puberty is sometimes delayed until as late as 16.
The medication used for suppression causes the pituitary gland to be less sensitive to hormonal signals from the brain to start sending out the hormones that guide pubertal changes. It does not cause any permanent changes in the body.
The suppressors can be given in the form of an implant under the skin, which reduces the number of injections kids need to get (our kid was very very excited to learn about the implants).
A great place to learn about all of these things is at TransHealth, an annual conference for providers, trans people, and the community. Although my parter transitioned female to male 20 years ago, and so our kids were not the first trans people we ever met, and we knew from our own experience and that of many friends and loved ones that good outcomes and happy lives are very possible for trans people, we have still found it helpful to meet other parents of young trans kids. Before our son started at Lurie, we also learned a great deal from presentations by pioneering doctors, psychologists, and others.
The conference is coming up in early September, and "Get to TransHealth if you can" is my #1 piece of advice for families newly dealing with this sort of thing.
In addition to my partner and our ten-year-old, we have a young adult who is gender fluid. I am not always up on the latest news and resources, and often don't have anything useful to say about kids who are not like mine (the 10yo is totally binary male, and socially transitioned at age 4 without any drama and has just been sailing along in boy land ever since, so I don't always have anything helpful to say when people ask me about dealing with kids whose presentation is gender ambiguous or gender creative). Nonetheless, I am always happy to talk with other parents. Please feel free to memail me.
Supportive parents are the #1 factor in the healthy development of trans and gender nonconforming kids. So, good job.
posted by Orlop at 10:01 AM on July 31, 2017 [11 favorites]
Our kid is being watched for signs up puberty, and is currently at Tanner Stage 1. Hormone blockers are generally begun at Tanner Stage 2. The Tanner Stages describe the progression of physical changes in puberty.
Hormone blockers are very safe, and their effects are reversible--kids who take them and then go off them without receiving hormone treatment will proceed with their interrupted puberty. One of their uses is to buy time for young people to continue to think about their gender identity without experiencing irreversible changes like the development of breasts or facial hair growth. Puberty is sometimes delayed until as late as 16.
The medication used for suppression causes the pituitary gland to be less sensitive to hormonal signals from the brain to start sending out the hormones that guide pubertal changes. It does not cause any permanent changes in the body.
The suppressors can be given in the form of an implant under the skin, which reduces the number of injections kids need to get (our kid was very very excited to learn about the implants).
A great place to learn about all of these things is at TransHealth, an annual conference for providers, trans people, and the community. Although my parter transitioned female to male 20 years ago, and so our kids were not the first trans people we ever met, and we knew from our own experience and that of many friends and loved ones that good outcomes and happy lives are very possible for trans people, we have still found it helpful to meet other parents of young trans kids. Before our son started at Lurie, we also learned a great deal from presentations by pioneering doctors, psychologists, and others.
The conference is coming up in early September, and "Get to TransHealth if you can" is my #1 piece of advice for families newly dealing with this sort of thing.
In addition to my partner and our ten-year-old, we have a young adult who is gender fluid. I am not always up on the latest news and resources, and often don't have anything useful to say about kids who are not like mine (the 10yo is totally binary male, and socially transitioned at age 4 without any drama and has just been sailing along in boy land ever since, so I don't always have anything helpful to say when people ask me about dealing with kids whose presentation is gender ambiguous or gender creative). Nonetheless, I am always happy to talk with other parents. Please feel free to memail me.
Supportive parents are the #1 factor in the healthy development of trans and gender nonconforming kids. So, good job.
posted by Orlop at 10:01 AM on July 31, 2017 [11 favorites]
I hope this doesn't go against the mod request, but, asking as the parent of a non-binary teenager, what does your child want to do?
posted by Ruki at 11:34 AM on July 31, 2017 [5 favorites]
posted by Ruki at 11:34 AM on July 31, 2017 [5 favorites]
The medicine used to block puberty is called Lupron. It is used for a number of different things, but it was originally developed as a chemotherapy drug. Some women who have used it for endometriosis and during fertility treatments report severe side effects, such as osteoporosis and serious joint problems. There are also a fair number of women coming forward now who were given Lupron as kids against precocious puberty and are now suffering the same sort of serious side effects (osteoporosis at age 25, etc).
I don't know how all this relates to the way it's used for transgender kids, but I think it's worth knowing that Lupron is a serious drug that sometimes has serious side effects.
posted by colfax at 1:07 PM on July 31, 2017 [8 favorites]
I don't know how all this relates to the way it's used for transgender kids, but I think it's worth knowing that Lupron is a serious drug that sometimes has serious side effects.
posted by colfax at 1:07 PM on July 31, 2017 [8 favorites]
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