Loading

  • 21 Aug, 2019

  • By, Wikipedia

Puberty Blockers
Puberty blockers (also called puberty inhibitors or hormone blockers) are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens (e.g. testosterone) and estrogens (e.g. estradiol). Puberty blockers are used to delay puberty in children with precocious puberty. They are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

The use of puberty blockers is supported by twelve major American medical associations, including the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics. In Australia four medical organizations support them, as does the Endocrine Society, and the World Professional Association for Transgender Health (WPATH). The United Kingdom has implemented a ban on prescribing puberty blockers to new patients under 18 for the treatment of gender dysphoria except for use in clinical research trials, as of May 2024.

In the 2020s, the provision of puberty blockers for gender dysphoria in children has become the subject of public controversy. A combination of shifts in public opinion, political lobbying, and rising scepticism in the field of medicine has led to the rolling back of the use of puberty blockers for transgender children in some countries, with the United Kingdom stopping the routine prescription of puberty blockers and some states of the United States making their use a criminal offense.

Medical uses

See also: GnRH agonist § Medical uses, and Gender-affirming care

Puberty blockers prevent the development of biological secondary sex characteristics.

Precocious puberty

Puberty blockers are commonly used to delay puberty in children with precocious puberty, a condition that activates the hypothalamic-pituitary-gonadal axis prematurely and initiates puberty at an inappropriate age. The main goal of treatment is to preserve children's adult height potential. Puberty blockers work by stabilizing puberty symptoms, decreasing growth velocity, and slowing skeletal maturation. The outcomes of treatment are assessed in terms of height, reproduction, metabolic, and psychosocial measures. The most pronounced effects on height have been seen in children experiencing the onset of puberty before 6 years of age; however there is variability in height outcomes across studies which can be attributed to varying study designs, time of symptom presentation, and time of treatment termination. A study investigating the effects of puberty blockers on reproductive health showed no significant difference in the number of irregular menstrual cycles, pregnancies, or pregnancy outcomes between women who received treatment for precocious puberty and those who opted out of treatment. In terms of psychosocial markers, preadolescents and adolescents diagnosed with precocious puberty have shown body image concerns and demonstrated poor emotional regulation and high anxiety. Individuals with precocious puberty, early adrenarche, and early normal puberty show less stress after treatment compared to individuals without preexisting developmental conditions.

Moreover, they are utilized in the treatment of central precocious puberty resulting from conditions like hypothalamic hamartomas or congenital adrenal hyperplasia, where early onset of puberty is a symptom. Additionally, puberty blockers can be prescribed for children with severe forms of idiopathic short stature, allowing for more time for growth before the closure of growth plates. These applications illustrate the versatility of puberty blockers in addressing various endocrine and growth-related disorders.

Overall, puberty blockers have demonstrated an excellent safety and efficacy profile in the treatment of precocious puberty. The most common side effects reported include nonspecific headaches, hot flashes, and implant-related skin reactions.

Gender dysphoria

Puberty blockers are sometimes prescribed to young transgender people with gender dysphoria to temporarily halt the development of secondary sex characteristics. Puberty blockers are intended to allow patients more time to solidify their gender identity and give them a smoother transition into their desired gender identity as an adult. If a child later decides not to transition to another gender, the medication can be stopped, allowing puberty to proceed.

The "Dutch Protocol" was the first example of the use puberty blockers to treat gender dysphoria in children. It was developed by Peggy Cohen-Kettenis in the 1990s. The statement was made that the treatment was fully reversible, and that a study of 70 children showed evidence that it had an overall positive outcome for those treated. A number of subsequent studies appeared to support this treatment as safe and effective at delaying development of secondary sexual characteristics, and it became the standard treatment in the field. Since then, the use of puberty blockers has evolved as the result of further medical research and development of opinion within the medical community.

While few studies have examined the effects of puberty blockers for gender non-conforming and transgender adolescents, the studies that have been conducted generally indicate that these treatments are reasonably safe, are reversible, and can improve psychological well-being in these individuals. Puberty blockers are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Puberty blockers have clearly beneficial, lifesaving impacts on a scale of up to six years, but research is lacking beyond that time frame. The World Professional Association for Transgender Health's Standards of Care 8, published in 2022, declared puberty-blocking medication to be medically necessary and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, because longitudinal data shows improved outcomes for transgender patients who receive them.

Types

Puberty blocker medications are used to delay the physical changes associated with puberty, offering individuals more time to explore their gender identity. The most common type of puberty blockers are GnRH (gonadotropin-releasing hormone) analogues, such as leuprolide acetate and histrelin acetate, which suppress the release of sex hormones like testosterone and estrogen. These medications are typically administered via injections or implants. Another type of puberty blocker includes progestins, such as medroxyprogesterone acetate, which can be taken orally or by injection and work by reducing the body's production of sex hormones. In some cases, aromatase inhibitors are used off-label to block the conversion of androgens into estrogens, although they are less commonly prescribed. Each type of medication has specific benefits and potential side effects, and the choice of which to use depends on the individual's medical needs and the advice of their healthcare provider.

A number of different drugs are used as puberty blockers.

In the United States, the main providers of puberty blockers are Endo International and AbbVie. Endo International creates histerelin acetate (Vantas) while AbbVie manufactures leuprolide acetate (Lupron Depot). Other companies within the United States are also in the mix such as Pfizer who distributes histerelin acetate (Supprelin LA) and Tolmar Pharmaceuticals who create their own leuprolide acetate (Fensolvi). Outside of the United States, companies such as Ferring Pharmaceuticals, Ipsen, Takeda Pharmaceutical Company, Astellas Pharma, Sandoz, and Sun Pharmaceutical Industries supply much of the rest of the world with the various puberty blockers. Ferring Pharmaceuticals, based out of Switzerland, generate two separate products of triptorelin (Decapeptyl and Gonapeptyl). Originating in France, Ipsen also produces triptorelin (Decapeptyl). German/Swiss company Sandoz makes leuprorelin (Leuprorelin Acetate, Lucrin, Eligard). In Japan, Takeda Pharmaceutical Company and Astellas Pharma create leuprorelin (Lupron Depot) and goserelin (Zoladex). Indian company Sun Pharmaceutical Industries mainly produces leuprolide acetate generic injectables. AbbVie is also a player internationally.

Adverse effects

Short-term side effects

In the short term, they are generally considered safe and well-tolerated by most individuals. One of the primary effects is the suppression of secondary sexual characteristics, such as breast development in assigned females at birth or deepening of the voice in assigned males at birth. This can significantly alleviate the distress associated with gender dysphoria in transgender youth. Additionally, by halting the rapid growth spurts of puberty, these medications provide more time for growth in stature, particularly beneficial for children diagnosed with idiopathic short stature or central precocious puberty. Common short-term side effects may include injection site reactions, headaches, mood swings, changes in weight or appetite, fatigue, insomnia, muscle aches and changes in breast tissue, but these are usually manageable.

Adverse effects on bone mineralization are a potential risk of pubertal suppression in gender dysphoric youth treated with GnRH agonists. To protect against lower bone density, doctors recommend exercise, calcium, and Vitamin D.

Despite their benefits, there are some considerations regarding the short-term use of puberty blockers. One concern is the potential impact on bone density. Since puberty is a critical period for bone development, delaying it may temporarily reduce bone mineral density, which could be monitored through regular bone density scans. Another consideration is the potential impact on psychological well-being. While many individuals experience relief from gender dysphoria, the delay in physical development might also cause anxiety or social difficulties in some cases, particularly in environments where peers are progressing through puberty. It is crucial for healthcare providers to closely monitor the physical and emotional well-being of individuals on puberty blockers, ensuring that the benefits outweigh any short-term risks or discomforts.

In 2016, the FDA ordered drugmakers to add warning labels to puberty blocker drugs that states: "Psychiatric events have been reported in patients", including symptoms "such as crying, irritability, impatience, anger and aggression." The warning labels were added after the FDA received reports of 10 children who had suicidal thoughts, including one attempt at suicide. One of these children, a 14-year-old, was taking a puberty blocker drug for gender dysphoria.

In 2022, the FDA reported that there have been six cases of idiopathic intracranial hypertension in 5 to 12-year-old children assigned female at birth taking puberty blockers. Five who experienced the side effect were receiving treatment for precocious puberty and one who experienced the side effect was transgender and was receiving treatment for gender dysphoria. Morissa Ladinsky, a pediatrician with University of Alabama-Birmingham who works with transgender youth, said that "[Idiopathic intracranial hypertension] is an inordinately well-known side effect that can happen for many, many different medications, most commonly, oral birth control pills. Referring to the six reported side effects, Ladinsky said that "It doesn't even approach any semblance of what we call in medicine, statistical significance".

Long-term uncertainty

Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although puberty blockers are known to be safe and physically reversible treatment if stopped in the short term, it is also not known whether hormone blockers affect the development of factors like bone mineral density, brain development and fertility in transgender patients. There is limited high-quality research on puberty suppression among adolescents experiencing gender dysphoria or incongruence. No conclusions on impact on gender dysphoria, mental health and cognitive development could be drawn.

The Endocrine Society Guidelines, while endorsing the use of puberty blockers for treatment of gender dysphoria, underscores the need for more rigorous safety and effectiveness evaluations and careful assessment of "the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development)."

The longest follow-up study followed a transgender man who began taking puberty blockers at age 13 in 1998, before later taking hormone treatments and getting gender confirmation surgery as an adult. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers.

Neurological effects

Research on the long-term effects on brain development and cognitive function is limited. According to a 2024 systematic review, no conclusions can be drawn about the effects of puberty blockers on cognitive development. Another 2024 systematic review, using both human and animal studies found some evidence of sex-specific impact on cognitive function in mammals, and no evidence that cognitive effects were fully reversible.

Fertility and sexual function

Research on the long-term effects on fertility and sexual function is limited. The long-term use of puberty blockers presents several uncertainties, particularly concerning fertility and sexual function. Since these medications suppress the production of sex hormones during a critical period of sexual maturation, their extended use may impact the development of reproductive organs and future fertility. For instance, individuals assigned male at birth who take puberty blockers might experience underdeveloped testes, potentially affecting sperm production later in life. Similarly, individuals assigned female at birth might have impaired ovarian function, impacting their ability to conceive. Additionally, there is concern that prolonged suppression of puberty may influence sexual function, including libido and the ability to achieve sexual arousal and satisfaction. These potential effects underscore the importance of careful, individualized medical counseling and consideration of fertility preservation options, such as sperm or egg banking, before initiating long-term puberty blocker treatment. Ongoing research is crucial to better understand these long-term impacts and to provide clearer guidance to patients and their families. Additionally, genital tissue in transgender women may not be optimal for potential vaginoplasty later in life due to underdevelopment of the penis when using penile inversion vaginoplasty. Several other methods such as bowel vaginoplasty, which uses part of the sigmoid colon to form the canal instead, or a peritoneal pull-through vaginoplasty which harvests a skin graft from the peritoneum are not affected by this as they do not require the penile tissue to form the vaginal canal.

Bone health

A systematic review of studies investigating the long-term effects of treating precocious puberty with GnRH agonists found that bone mineral density decreases during treatment but normalizes afterward, with no lasting effects on peak bone mass. A review focused on the treatment of adolescents experiencing gender dysphoria found that bone health may be compromised during treatment, although the long-term outcomes of puberty suppression alone were not possible to determine.

Research status

A multi-year study published in September 2024 found that the restriction to transgender care, including restriction on access to gender-affirming puberty blockers, showed a direct link to negative mental health outcomes for transgender youth. The study followed the enactment of several laws in US states on restricting such access, which led to an increase of suicide attempts of 7-72% in transgender youth within one to two years following the enactment of laws restricting access.

In September 2024, the New South Wales government in Australia released an independent review into puberty blockers that they commissioned which found that the benefits of puberty blockers outweigh any possible risks. The review concluded that puberty blockers are "safe, effective and reversible".

In October 2024, the New York Times reported Olson-Kennedy did not publish a study on puberty blockers which showed that they did not improve mental health of children, and has been withholding its results because she was worried that the results provide evidence for the critics of the currently available healthcare for transgender children. The study was part of a larger NIH-funded project studying the impact of gender-affirming care on transgender youth. There was also 28 other peer-reviewed studies for the project that were published, many of which were co-authored by Olson-Kennedy and showed positive results from puberty blockers.

Concerns about insufficient evidence for gender dysphoria

The use of puberty blockers for gender-affirming care has attracted some criticism, due primarily to the lack of randomized controlled trials within the research base.

A 2020 commissioned review published by the UK's National Institute for Health and Care Excellence (NICE) concluded that the quality of evidence for puberty blocker outcomes (for mental health, quality of life and impact on gender dysphoria) was of very low certainty based on a modified GRADE approach, but that it was plausible that the outcomes would have been worse without treatment. A subsequent systematic review re-affirmed the conclusions of the NICE report, concluding that the currently available studies have "significant conceptual and methodological flaws". A 2024 review of evidence on behalf of the Cass Review came to a similar conclusion.

The NICE review has been criticized by organizations that support the use of puberty blockers such as WPATH and EPATH, and in an WPATH's International Journal of Transgender Health article by Cal Horton for excluding studies combining puberty blockers and hormone therapy, and also by parents of transgender youth for excluding evidence of its safety when used, albeit at a much younger age, by cisgender youth being treated for precocious puberty. Horton criticised the review for prioritizing high-quality evidence according to the GRADE approach, which designates randomized control trials (RCTs) as "high quality", since RCTs are widely considered infeasible and unethical for transgender youth if those in the control group are denied medical treatment. Horton also argued that it had not followed GRADE guidance which states that "low or very low quality evidence can lead to a strong recommendation" by not taking the low-quality studies into account when forming evidence review recommendations.

The Finnish Ministry of Health also concluded that there are no research-based health care methods for minors with gender dysphoria, Their guidelines permit the use of puberty blockers for minors on a case-by-case basis.

Puberty blockers have not received FDA approval for use on children who are transgender, and are instead issued "off-label". The practice of off-label prescription is common in children's medicine because many drugs lack pediatric-specific information in their marketing authorisation or approval. Doctors use their professional judgment to decide how to use these drugs, and the term 'off-label' itself does not indicate an improper, illegal, or experimental use of medicine. According to pediatric endocrinology expert Brad Miller, pharmaceutical companies that make puberty blocker drugs for children with gender dysphoria have refused to submit them for FDA approval because doing so would cost too much money and "because (transgender treatment) was a political hot potato."

Political challenges

The prescription of puberty blockers has been a polarizing issue on an international scale. On the one hand, opponents for the use of puberty blockers argue that minors are unable to provide informed consent, treatment interferes with typical gender identity development, and there are high rates of detransitioning after puberty, rendering treatment ineffective. On the other hand, proponents argue that there are psychological and developmental benefits of puberty blockers which may outweigh the risks associated with treatment, such as a lower risk of depression and reduced behavioral issues. In the United States, the growing disarray between opponents and proponents has led to the dissemination of misinformation and consequently the establishment of anti-transgender ("anti-trans") legislation.

Informed consent:

Groups continue building on the discussion on informed consent. A 2019 study found that a "multidisciplinary approach" is necessary "to ensure meaningful consent" is acquired and treatment is initiated with a strong ethical foundation. A 2021 editorial adds a pragmatic perspective, claiming that "disproportionate emphasis is given to young people's inability to provide medical consent" and that "what matters ethically is whether an individual has a good enough reason for wanting treatment". Bioethicist Maura Priest shares this perspective. She claims that even in the absence of parental permission, the use of puberty blockers could mitigate any adverse effects on familial relationships within the home of a transgender child and that the psychological costs associated with untreated gender dysphoria in children are avoidable. Another bioethicist, Florence Ashley, adds that counseling and educating the parents of transgender youth could also be beneficial to familial relationships.

Puberty blockers in the US:

In April 2021, Arkansas passed a ban on treatment of minors under 18 with puberty blockers, but it was temporarily blocked by a federal judge a week before the law was set to take effect. In April 2022, Alabama passed a ban from minors under 19 from obtaining puberty blockers and made it a felony for a doctor to prescribe puberty blockers to a minor with a punishment of up to ten years in prison. The Alabama law was partially blocked by a federal judge a few days after the law took effect. In August 2022, Florida banned Medicaid from covering gender affirming care, including puberty blockers.

As of July 2024, 26 states have enacted some form of ban on gender-affirming care for minors, but not all of these ban puberty blockers. Currently, only 18 of the 26 states have complete bans which are fully in effect. Six states have only partial bans and two are currently blocked from taking effect. While some states have banned all forms of medical transition, others have banned only specific types such as surgery. Six states have exceptions which allow minors who were already receiving gender affirming care prior to the ban to continue their treatments. Currently, all 26 states make exceptions for puberty blockers, hormones and surgery for cisgender and intersex children. Only one state, West Virginia, makes exceptions in cases of "severe dysphoria". There is also currently only one state, Missouri, that has a ban which is set to expire after a certain period of time. Nearly all states with restrictions include specific provisions with penalties for providers and 4 states include provisions directed at parents or guardians. An additional 4 states include laws/policies that impact school officials such as teachers and counselors, among others.

In response to these bans, many Democrat-controlled states have gone in the opposite direction and enacted laws protecting access to gender affirming care for minors and adults. These laws, often called "shield" laws, often explicitly combine protections for gender-affirming care and abortion and cover a variety of protections including protecting both providers and patients from being punished, mandating insurance providers to cover the procedures and acting as "sanctuary states" that protect patients traveling to the state from other states that have banned such treatments among other things. As of June 2024, 16 states and the District of Columbia have enacted "shield" laws.

The UK's Cass Review was cited in the Indiana legislation to ban puberty blockers.

Some US state bans on gender affirming care including puberty blockers have been declared unconstitutional. Furthermore, bans on puberty blockers have been criticized as governments interfering with the patient-doctor relationship and taking away healthcare decisions from parents and families for their children. State level bans on gender affirming care, including puberty blockers, in the United States have led some families with transgender children to move out of their states.

Puberty blockers in Italy:

The Italian National Bioethics Committee and the Italian Medicines Agency have demonstrated support for the use of puberty blockers in adolescents with gender dysphoria, expanding coverage by adding them to the list of medications covered by the National Health Service. Still, challenges with accessing puberty blocker medications persist. Specific clinical criteria must be satisfied for treatment including comprehensive medical evaluations, parental consent, and the exhaustion of all other clinical interventions.

Puberty blockers in Canada:

The British Columbia Infants Act of 1996 grants minors legal decision-making authority if they can consent to a clinical intervention and their healthcare provider believes it is in their best interest. As a result, providers are required to evaluate if their patients have a robust and realistic understanding of hormone therapy, risks, benefits, and alternatives. Although some incorporate the gender-affirming care model into practice, others demonstrate reluctance to prescribe puberty blockers.

A qualitative study investigating the experience of trans youth in seeking and receiving gender-affirming care at Canadian specialty clinics shows a mix of positive and negative outcomes. People reported improvements in their well-being, frustrations with treatment protocols and wait lists, and concerns with their transition journey.

Stances of medical organizations

More than a dozen major American and Australian medical associations, as well as the World Professional Association for Transgender Health (WPATH), and the Endocrine Society generally support puberty blockers for transgender youth and have come out against efforts to restrict their use. In Europe, however, some medical groups and countries have taken a more cautionary stance following reviews of the evidence base, discouraging or limiting the use of puberty blockers. However, these countries have not outright banned or criminalized the treatment unlike many US States.

Australia

See also: LGBT rights in Australia § Gender dysphoria treatment

The Royal Australasian College of Physicians, the Royal Australian College of General Practitioners, the Australian Endocrine Society, and AusPATH all support access to puberty blockers for transgender youth.

An independent review into gender-affirming care for minors commissioned by the New South Wales government and released in September 2024 found that puberty blockers are "safe, effective and reversible", while acknowledging that the evidence for this and other interventions "remains weak due to poor study designs, low participant numbers and single-centre recruitment", calling for more long-term research.

Canada

See also: Transgender rights in Canada § Healthcare access

According to the Canadian Pediatric Society, "Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient's mental and psychosocial health."

Chile

See also: LGBTQ rights in Chile § Gender identity and expression

The following medical organizations have expressed their support for puberty blockers for transgender children and adolescents:

  • The Chilean Pediatric Society
  • The Chilean Society of Psychiatry and Neurology of Childhood and Adolescence
  • The Chilean Society of Childhood and Adolescent Gynecology

Finland

See also: LGBT rights in Finland § Access to healthcare

In 2020, Finland revised its guidelines to prioritise psychotherapy over medical transition, but the Council for Choices in Health Care allows the use of puberty blockers in transgender children after a case-by-case assessment if there are no medical contraindications.

France

See also: LGBT rights in France § Healthcare

Transgender children in France are eligible for puberty blockers with parental permission at any age, and usually receive them at age 15 or 16.

In 2022, France's Académie Nationale de Médecine urged caution when considering puberty blockers due to potential side effects, including "impact on growth, bone weakening, [and] risk of infertility". This change to the guidelines has not changed actual practice.

Italy

See also: LGBT rights in Italy § Gender identity and expression

The use of puberty blockers in transgender youth is supported by:

  • The Italian Society of Endocrinology (SIE)
  • The Italian Society of Andrology and Sexual Medicine (SIAMS)
  • The Italian Society of Gender, Identity and Health (SIGIS)

Japan

See also: LGBTQ rights in Japan § Transgender rights

The Japanese Society of Psychiatry and Neurology (JSPN) published its updated guidelines in August 2024 on the treatment of gender dysphoria. The guidelines continued to recommend puberty suppression in trans patients, noting it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in AMAB individuals. They made recommendations that doctors administering such treatment report more detailed information on outcomes going forward.

Mexico

See also: LGBTQ rights in Mexico § Healthcare access

In June of 2020, the Mexican federal government released "The Protocol for Access without Discrimination to Health Care Services for Lesbian, Gay, Bisexual, Transsexual, Transvestite, Transgender, and Intersex Persons and Specific Care Guidelines." The guidelines are used in healthcare facilities administered by the government. The guidelines state that the process of identifying one's sexual orientation, gender identify and/or expression can occur at early ages. Thus, the guidelines recommend that medical facilities and doctors consider the use of puberty blockers and cross-sex hormones as a treatment for transgender minors when appropriate. In addition to the guidelines, multiple Mexican states have modified their civil codes to recognize gender-affirming healthcare as a right for transgender people under the age of eighteen.

The Netherlands

See also: LGBT rights in the Netherlands § Transgender and intersex rights

The Dutch Ministry of Health, Welfare and Sport publishes guidelines recommending the use of puberty blockers in transgender adolescents of at least Tanner Stage II with informed consent and approval of an endocrinologist. This guideline, published in 2016, is endorsed by the following Dutch medical organizations:

  • Nederlands Internisten Vereniging (Dutch Internists Association)
  • Nederlands Huisartsen Genootschap (Dutch Society of General Practitioners)
  • Nederlands Instituut van Psychologen (Dutch Institute of Psychologists)
  • Nederlandse Vereniging voor Kindergeneeskunde (Dutch Association for Pediatrics)
  • Nederlandse Vereniging voor Obstetrie & Gynaecologie (Dutch Association for Obstetrics & Gynaecology)
  • Nederlandse Vereniging voor Plastische Chirurgie (Dutch Association for Plastic Surgery)
  • Nederlandse Vereniging voor Psychiatrie (Dutch Psychiatry Association)
  • Transvisie (Transvision, a patient organization for transgender patients)

New Zealand

See also: Transgender rights in New Zealand § Gender identity and youth

The use of puberty blockers for transgender people is supported by The Professional Association for Transgender Health Aotearoa (PATHA), The Royal Australian and New Zealand College of Psychiatrists (RANZCP), The Australian and New Zealand Professional Association for Transgender Health (ANZPATH), the Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ), the New Zealand Sexual Health Society and the New Zealand Society of Endocrinology.

Norway

See also: LGBT rights in Norway § Healthcare

In 2020, the Norwegian Directorate for Health, the governmental body that develops health guidelines, released one for gender incongruence recommending puberty blockers between Tanner stage 2 and the age of 16 following an interdisciplinary assessment, stating they were reversible and there is no reliable evidence of adverse long-term effects.

In 2023, the Norwegian Healthcare Investigation Board, an independent non-governmental organization, issued a non-binding report finding "there is insufficient evidence for the use of puberty blockers and cross sex hormone treatments in young people" and recommending changing to a cautious approach. The Norwegian Healthcare Investigation Board is not responsible for setting healthcare policy, and the Directorate, which is, has not implemented the recommendations, though they have said they are considering them. Misinformation that Norway had banned gender affirming care proliferated on social media.

Sweden

See also: LGBT rights in Sweden § Access to healthcare

Sweden's Karolinska Institute, administrator of the second-largest hospital system in the country, announced in March 2021 that it would discontinue providing puberty blockers or cross-sex hormones to children under 16. Additionally, the Karolinska Institute changed its policy to cease providing puberty blockers or cross-sex hormones to teenagers 16–18, outside of approved clinical trials. On 22 February 2022, Sweden's National Board of Health and Welfare said that puberty blockers should only be used in "exceptional cases" and said that their use is backed by "uncertain science".

However, other providers in Sweden continue to provide puberty blockers, and a clinician's professional judgment determines what treatments are recommended or not recommended. Youth are able to access gender-affirming care when doctors deem it medically necessary. The treatment is not banned in Sweden and is offered as part of its national healthcare service.

United Kingdom

See also: Transgender rights in the United Kingdom § Medical treatment for young people, and Cass Review § Puberty Blockers

As of May 2024, prescription of puberty blockers to new patients under 18 for the treatment of gender dysphoria is banned for both private medical practices (by a law in parliament in May) and the official state healthcare National Health Service (NHS) which stopped their use earlier, in the aftermath of the Cass Review except for use in clinical research trials.

Previously, on 30 June 2020, the NHS changed its website, replacing the statement that puberty blockers were "fully reversible" and that "treatment can usually be stopped at any time"; with "little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.

The Bell v Tavistock decision by the High Court of Justice for England and Wales ruled children under 16 were not competent to give informed consent to puberty blockers, but this was overturned by the Court of Appeal in September 2021.

In 2022, the British Medical Association opposed restrictions on puberty blockers, and the NHS restricted their use for children under 16 years of age to centrally administered clinical research.

The April 2024, Cass Review stated that there was inadequate evidence to justify the widespread use of puberty blockers for gender dysphoria, and that more research was needed to provide evidence as to the effectiveness of this treatment, in terms of reducing distress and improving psychological functioning. This led to a de facto moratorium of the routine provision of puberty blockers for gender dysphoria within NHS England and NHS Scotland outside of clinical trials, and a subsequent ban private prescription of puberty blockers in the United Kingdom.

Children already receiving puberty blockers via NHS England will be able to continue their treatment. In England, a clinical trial into puberty blockers is planned for early 2025.

In July 2024, the Royal College of General Practitioners stated that for patients under 18, no general practitioner should prescribe puberty blockers outside of a clinical trial, and the prescription of gender-affirming hormones should be left to specialists. They affirmed they will fully implement the Cass Review recommendations.

United States

See also: Transgender rights in the United States § Healthcare

Since 1993 the US Food and Drug Administration (FDA) has supported the use of puberty blockers to treat precocious puberty. Currently under FDA regulation the use of puberty blockers is considered on-label for the treatment of central precocious puberty.

For years, the FDA, Endocrine Society, American Academy of Pediatrics (AAP) and many other pediatric associations have supported the use of Gonadotropin-releasing hormone analogs (GnRHas) in central precocious puberty (CPP). Access to treatment depends on the classification of precocious puberty as well as other guidelines implemented by the Endocrine Society. To determine if you are experiencing precocious puberty and should receive treatment it is required your doctor take a medical history, physical exam, blood test, and x-rays.

In 2009, the Lawson Wilkins Pediatric Endocrine Society and European Society for Pediatric Endocrinology published a consensus statement highlighting the effectiveness of Gonadotropin-releasing hormone analogs (GnRHas) in early onset central precocious puberty. They confirmed that the use of Gonadotropin-releasing hormone analogs (GnRHas) has had a positive effect on increasing adult height. However these Endocrine Societies believe additional research should be conducted before routinely suggesting GnRHAs for other conditions. There is still some uncertainty surrounding the effectiveness of GnRHas when utilized for other conditions.

Currently under FDA regulation, the use of puberty blockers in pediatrics with gender dysphoria is considered off-label.

The use of puberty blockers in youth experiencing gender dysphoria has been supported by the following organizations:

Since the 2010s, the Endocrine Society, WPATH and many other professional associations have publicized guidelines supporting the use of puberty blocking in patients with severe gender dysphoria. As a result, access to treatment depends on clinical practice guidelines and assessments set by professional organizations. The Endocrine Society and WPATH released eligibility criteria for youth seeking care for gender dysphoria. They recommend the use of puberty suppression once there is a professional diagnoses of gender dysphoria, gender dysphoria worsens with puberty onset, puberty has begun and tanner stage of at least 2.

There has been an increase in youth requesting treatment for gender affirming medical care. The increased medical coverage and societal awareness of transgender youth may be shifting accessibility to standard of care. In September 2023, a group of healthcare professionals, parents, and organizations submitted a petition to the FDA urging for regulation of off-label puberty blockers in youth with gender dysphoria. Right-wing groups, such as Gender Dysphoria Alliance, Foundation Against Intolerance and Racism (FAIR) in Medicine, and Gender-exploratory Therapy Alliance, urged the FDA to address misinformation and implement long-term studies for the off-label use of puberty blockers.

References

  1. ^ Hemat RA (2 March 2003). Andropathy. Urotext. pp. 120–. ISBN 978-1-903737-08-8.
  2. ^ Becker KL (2001). Principles and Practice of Endocrinology and Metabolism. Lippincott Williams & Wilkins. pp. 973–. ISBN 978-0-7817-1750-2.
  3. ^ "Pubertal blockers for transgender and gender diverse youth". Mayo Clinic. 16 August 2019. Archived from the original on 31 December 2022. Retrieved 15 December 2020.
  4. ^ Stevens J, Gomez-Lobo V, Pine-Twaddell E (December 2015). "Insurance Coverage of Puberty Blocker Therapies for Transgender Youth". Pediatrics. 136 (6): 1029–1031. doi:10.1542/peds.2015-2849. PMID 26527547.
  5. ^ Alegría CA (October 2016). "Gender nonconforming and transgender children/youth: Family, community, and implications for practice". Journal of the American Association of Nurse Practitioners. 28 (10): 521–527. doi:10.1002/2327-6924.12363. PMID 27031444. S2CID 22374099.
  6. ^ Helyar S, Jackson L, Patrick L, Hill A, Ion R (May 2022). "Gender Dysphoria in children and young people: The implications for clinical staff of the Bell V's Tavistock Judicial Review and Appeal Ruling". Journal of Clinical Nursing. 31 (9–10): e11–e13. doi:10.1111/jocn.16164. PMID 34888970. S2CID 245029743.
  7. ^ Watson SE, Greene A, Lewis K, Eugster EA (June 2015). "BIRD'S-EYE VIEW OF GnRH ANALOG USE IN A PEDIATRIC ENDOCRINOLOGY REFERRAL CENTER". Endocrine Practice. 21 (6): 586–589. doi:10.4158/EP14412.OR. PMC 5344188. PMID 25667370.
  8. ^ Panday K, Gona A, Humphrey MB (October 2014). "Medication-induced osteoporosis: screening and treatment strategies". Therapeutic Advances in Musculoskeletal Disease. 6 (5): 185–202. doi:10.1177/1759720X14546350. PMC 4206646. PMID 25342997.
  9. ^ "State Advocacy Update". American Medical Association. 26 March 2021. Archived from the original on 2 December 2022. Retrieved 18 May 2022.
  10. ^ "Criminalizing Gender Affirmative Care with Minors". APA. Archived from the original on 7 April 2022. Retrieved 20 June 2024.
  11. ^ Wyckoff AS. "AAP continues to support care of transgender youths as more states push restrictions". AAP. Archived from the original on 18 December 2022. Retrieved 20 June 2024.
  12. ^ "Legal". Parents of Gender Diverse Children. Australia. 15 November 2023. Archived from the original on 24 October 2022. Retrieved 21 August 2022.
  13. ^ "Endocrine Society opposes legislative efforts to prevent access to medical care for transgender youth". Endocrine Society. 15 April 2021. Archived from the original on 23 October 2022. Retrieved 18 May 2022.
  14. ^ "USPATH Position Statement on Legislative and Executive Actions Regarding the Medical Care of Transgender Youth" (PDF). US Professional Association for Transgender Health (USPATH). 22 April 2022. Archived (PDF) from the original on 10 November 2022. Retrieved 18 May 2022.
  15. ^ Barnes H (30 May 2024). "The government's 11th-hour ban on puberty blockers". New Statesman. Archived from the original on 2 August 2024. Retrieved 20 August 2024.
  16. ^ Parry J (12 March 2024). "NHS England to stop prescribing puberty blockers". BBC News. Archived from the original on 21 April 2024. Retrieved 20 April 2024.
  17. ^ Choi A, Mullery W (6 June 2023). "19 states have laws restricting gender-affirming care, some with the possibility of a felony charge". CNN. Archived from the original on 4 August 2023. Retrieved 17 September 2023.
  18. ^ Alfonseca K (22 May 2023). "Map: Where gender-affirming care is being targeted in the US". ABC News. Archived from the original on 24 May 2023. Retrieved 14 August 2023.
  19. ^ Boyar RM (November 2003). "Control of the onset of puberty". Annual Review of Medicine. 29: 509–520. doi:10.1146/annurev.me.29.020178.002453. PMID 206190.
  20. ^ Mul D, Hughes IA (December 2008). "The use of GnRH agonists in precocious puberty". European Journal of Endocrinology. 159 (suppl_1): S3–S8. doi:10.1530/EJE-08-0814. PMID 19064674.
  21. ^ Aguirre RS, Eugster EA (August 2018). "Central precocious puberty: From genetics to treatment". Best Practice & Research. Clinical Endocrinology & Metabolism. Issue Update in paediatric endocrinology. 32 (4): 343–354. doi:10.1016/j.beem.2018.05.008. hdl:1805/16522. PMID 30086862.
  22. ^ Latronico AC, Brito VN, Carel JC (March 2016). "Causes, diagnosis, and treatment of central precocious puberty". The Lancet. Diabetes & Endocrinology. 4 (3): 265–274. doi:10.1016/S2213-8587(15)00380-0. PMID 26852255.
  23. ^ Fuqua JS (June 2013). "Treatment and outcomes of precocious puberty: an update". The Journal of Clinical Endocrinology and Metabolism. 98 (6): 2198–2207. doi:10.1210/jc.2013-1024. PMID 23515450.
  24. ^ Magiakou MA, Manousaki D, Papadaki M, Hadjidakis D, Levidou G, Vakaki M, et al. (January 2010). "The efficacy and safety of gonadotropin-releasing hormone analog treatment in childhood and adolescence: a single center, long-term follow-up study". The Journal of Clinical Endocrinology and Metabolism. 95 (1): 109–117. doi:10.1210/jc.2009-0793. PMID 19897682.
  25. ^ López-Miralles M, Lacomba-Trejo L, Valero-Moreno S, Benavides G, Pérez-Marín M (May 2022). "Psychological aspects of pre-adolescents or adolescents with precocious puberty: A systematic review". Journal of Pediatric Nursing. 64: e61–e68. doi:10.1016/j.pedn.2022.01.002. PMID 35033399.
  26. ^ Menk TA, Inácio M, Macedo DB, Bessa DS, Latronico AC, Mendonca BB, et al. (May 2017). "Assessment of stress levels in girls with central precocious puberty before and during long-acting gonadotropin-releasing hormone agonist treatment: a pilot study". Journal of Pediatric Endocrinology & Metabolism. 30 (6): 657–662. doi:10.1515/jpem-2016-0425. PMID 28599388.
  27. ^ Eroukhmanoff J, Tejedor I, Potorac I, Cuny T, Bonneville JF, Dufour H, et al. (2017). "MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment". European Journal of Endocrinology. 176 (3): 323–328. doi:10.1530/eje-16-0897. PMID 28073906. Archived from the original on 3 June 2024. Retrieved 31 July 2024.
  28. ^ Carel JC, Léger J (May 2008). "Clinical practice. Precocious puberty". The New England Journal of Medicine. 358 (22): 2366–2377. doi:10.1056/NEJMcp0800459. PMID 18509122.
  29. ^ Lewis KA, Eugster EA (September 2009). "Experience with the once-yearly histrelin (GnRHa) subcutaneous implant in the treatment of central precocious puberty". Drug Design, Development and Therapy. 3: 1–5. doi:10.2147/DDDT.S3298. PMC 2769233. PMID 19920916.
  30. ^ Rew L, Young CC, Monge M, Bogucka R (February 2021). "Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature". Child and Adolescent Mental Health. 26 (1): 3–14. doi:10.1111/camh.12437. PMID 33320999. S2CID 229282305.
  31. ^ Cass H (2024). "Final Report". The Cass Review. U.K.: National Health Service. Archived from the original on 9 April 2024. Retrieved 20 April 2024.
  32. ^ Biggs M (19 May 2023). "The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence". Journal of Sex & Marital Therapy. 49 (4): 348–368. doi:10.1080/0092623X.2022.2121238. PMID 36120756.
  33. ^ de Vries AL, Cohen-Kettenis PT (March 2012). "Clinical management of gender dysphoria in children and adolescents: the Dutch approach". Journal of Homosexuality. 59 (3): 301–320. doi:10.1080/00918369.2012.653300. PMID 22455322.
  34. ^ Zepf FD, König L, Kaiser A, Ligges C, Ligges M, Roessner V, et al. (2024). "[Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria]". Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. 52 (3): 167–187. doi:10.1024/1422-4917/a000972. PMID 38410090.
  35. ^ Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A (October 2017). "Puberty suppression in transgender children and adolescents". The Lancet. Diabetes & Endocrinology. 5 (10): 816–826. doi:10.1016/s2213-8587(17)30099-2. PMID 28546095. S2CID 10690853. The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits.
  36. ^ Rafferty J (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam's apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.
  37. ^ Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902. Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains", "In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols. Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development);
  38. ^ Latham A (September 2022). "Puberty Blockers for Children: Can They Consent?". The New Bioethics. 28 (3): 268–291. doi:10.1080/20502877.2022.2088048. PMID 35758886.
  39. ^ Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, et al. (2022). "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8". International Journal of Transgender Health. 23 (Suppl 1): S1–S259. doi:10.1080/26895269.2022.2100644. PMC 9553112. PMID 36238954.
  40. ^ Chew D, Anderson J, Williams K, May T, Pang K (April 2018). "Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review". Pediatrics. 141 (4). doi:10.1542/peds.2017-3742. PMID 29514975.
  41. ^ Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902.
  42. ^ Tuvemo T (May 2006). "Treatment of central precocious puberty". Expert Opinion on Investigational Drugs. 15 (5): 495–505. doi:10.1517/13543784.15.5.495. PMID 16634688. S2CID 34018785.
  43. ^ Eugster EA (May 2019). "Treatment of Central Precocious Puberty". Journal of the Endocrine Society. 3 (5): 965–972. doi:10.1210/js.2019-00036. PMC 6486823. PMID 31041427.
  44. ^ Roth C (September 2002). "Therapeutic potential of GnRH antagonists in the treatment of precocious puberty". Expert Opinion on Investigational Drugs. 11 (9): 1253–1259. doi:10.1517/13543784.11.9.1253. PMID 12225246. S2CID 9146658.
  45. ^ Rosenthal SM (October 2021). "Challenges in the care of transgender and gender-diverse youth: an endocrinologist's view". Nature Reviews. Endocrinology. 17 (10): 581–591. doi:10.1038/s41574-021-00535-9. PMID 34376826. S2CID 236972394.
  46. ^ Neyman A, Fuqua JS, Eugster EA (April 2019). "Bicalutamide as an Androgen Blocker With Secondary Effect of Promoting Feminization in Male-to-Female Transgender Adolescents". The Journal of Adolescent Health. 64 (4): 544–546. doi:10.1016/j.jadohealth.2018.10.296. PMC 6431559. PMID 30612811.
  47. ^ Terhune C, Respaut R, Conlin M (6 October 2022). "As children line up at gender clinics, families confront many unknowns". Reuters. Archived from the original on 6 October 2022. Retrieved 10 October 2022.
  48. ^ Volans G, Wiseman H (2011). "Vantas (r)". Drugs Handbook 2012–2013. Bloomsbury Academic. doi:10.5040/9781350363595.art-3616. ISBN 978-0-2303-5601-6.
  49. ^ Okada H (19 April 2016). "Depot Injectable Microcapsules of Leuprorelin Acetate (Lupron Depot)". In Morishita M, Park K (eds.). Biodrug Delivery Systems. CRC Press. pp. 386–399. doi:10.3109/9781420086713-25. ISBN 978-0-429-14228-4.
  50. ^ McNamara D (July 2007). "Supprelin LA, Xyzal Tablets". Pediatric News. 41 (7): 52–53. doi:10.1016/s0031-398x(07)70462-9. ISSN 0031-398X.
  51. ^ Twardowski P, Henry J, Atkinson S (20 February 2023). "Major adverse cardiovascular events after androgen deprivation therapy in patients with prostate cancer with hypercholesterolemia". Journal of Clinical Oncology. 41 (6_suppl): 348. doi:10.1200/jco.2023.41.6_suppl.348. ISSN 0732-183X.
  52. ^ Ginsburg ES, Jellerette-Nolan T, Daftary G, Du Y, Silverberg KM (November 2018). "Patient experience in a randomized trial of a weekly progesterone vaginal ring versus a daily progesterone gel for luteal support after in vitro fertilization". Fertility and Sterility. 110 (6): 1101–1108.e3. doi:10.1016/j.fertnstert.2018.07.014. PMID 30396554.
  53. ^ Drieu K, Devisague J, Dray F, Ezan E (August 1987). "Pharmakinetics study in man of D-Trp-6-LHRH (decapeptyl, Ipsen-Biotech) administered as slow release microspheres". European Journal of Cancer and Clinical Oncology. 23 (8): 1238. doi:10.1016/0277-5379(87)90191-x. ISSN 0277-5379.
  54. ^ Solarić M, Bjartell A, Thyroff-Friesinger U, Meani D (December 2017). "Testosterone suppression with a unique form of leuprorelin acetate as a solid biodegradable implant in patients with advanced prostate cancer: results from four trials and comparison with the traditional leuprorelin acetate microspheres formulation". Therapeutic Advances in Urology. 9 (6): 127–136. doi:10.1177/1756287217701665. PMC 5444576. PMID 28588651.
  55. ^ Okumura H, Ueyama M, Shoji S, English M (June 2020). "Cost-effectiveness analysis of fidaxomicin for the treatment of Clostridioides (Clostridium) difficile infection in Japan". Journal of Infection and Chemotherapy. 26 (6): 611–618. doi:10.1016/j.jiac.2020.01.018. PMID 32165072.
  56. ^ "Leuprolide Acetate". USP Access Point. U.S. Pharmacopeial Convention. doi:10.31003/uspnf_m44592_03_01.
  57. ^ Kaufmann R, Wade R, Patton G (September 2000). "Very Low Dose Luteal Lupron and Microdose Lupron Flare Offer Comparable Outcomes in Poor Responders". Fertility and Sterility. 74 (3): S232. doi:10.1016/s0015-0282(00)01408-4. ISSN 0015-0282.
  58. ^ "Puberty Blockers". www.stlouischildrens.org. Archived from the original on 3 August 2022. Retrieved 18 August 2022.
  59. ^ Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902. Archived from the original on 28 August 2024. Retrieved 31 July 2024.
  60. ^ Klink D, Caris M, Heijboer A, Van Trotsenburg M, Rotteveel J (2015). "Bone Mass in Young Adulthood Following Gonadotropin-Releasing Hormone Analog Treatment and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria". The Journal of Clinical Endocrinology & Metabolism. 100 (2): E270–E275. doi:10.1210/jc.2014-2439. PMID 25427144. Archived from the original on 24 September 2024. Retrieved 31 July 2024.
  61. ^ Bangalore Krishna K, Fuqua JS, Rogol AD, Klein KO, Popovic J, Houk CP, et al. (2019). "Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium". Hormone Research in Paediatrics. 91 (6): 357–372. doi:10.1159/000501336. PMID 31319416. GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents.
  62. ^ Benisek A (16 May 2022). Nazario B (ed.). "What Are Puberty Blockers?". WebMD LLC. Archived from the original on 21 December 2022. Retrieved 27 August 2022.
  63. ^ Reid BM, Miller BS, Dorn LD, Desjardins C, Donzella B, Gunnar M (August 2017). "Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development". Pediatric Research. 82 (2): 278–284. doi:10.1038/pr.2017.35. PMC 5552432. PMID 28170387.
  64. ^ Rafferty J (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4). doi:10.1542/peds.2018-2162. PMID 30224363.
  65. ^ de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT (August 2011). "Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study". The Journal of Sexual Medicine. 8 (8): 2276–2283. doi:10.1111/j.1743-6109.2010.01943.x. PMID 20646177.
  66. ^ U.S. Food and Drug Administration (1 July 2022). "Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists". American Academy of Pediatrics. eISSN 1556-3332. Archived from the original on 27 December 2022. Retrieved 18 August 2022.
  67. ^ "Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists" (PDF). U.S. Food and Drug Administration. 1 July 2022. Archived from the original on 22 October 2022. Retrieved 12 September 2022.
  68. ^ Tordoff DM, Sequeira GM, Shook AG, Williams F, Hayden L, Kasenic A, et al. (2023). "Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth". Transgender Health. 8 (5): 420–428. doi:10.1089/trgh.2021.0116. PMC 10551760. PMID 37810940.
  69. ^ Davis E (27 July 2022). "FDA issues warning on puberty blockers; some Ala. lawmakers support findings". WSFA News. Montgomery, AL. Archived from the original on 23 October 2022. Retrieved 12 September 2022.
  70. ^ Murchison G, Adkins D, Conard LA, Elliott T, Hawkins LA, Newby H, et al. (September 2016). Supporting and Caring for Transgender Children (PDF) (Report). American Academy of Pediatrics. p. 11. Archived (PDF) from the original on 18 December 2022. Retrieved 17 September 2018. To prevent the consequences of going through a puberty that doesn't match a transgender child's identity, healthcare providers may use fully reversible medications that put puberty on hold.
  71. ^ "Gender dysphoria - Treatment". National Health Service. U.K. 3 October 2018. Archived from the original on 2 November 2013. Retrieved 31 March 2022.
  72. ^ Wilson L (11 May 2021). "What Are Puberty Blockers?". The New York Times. ISSN 0362-4331. Archived from the original on 26 December 2022. Retrieved 31 March 2022.
  73. ^ Taylor J, Mitchell A, Hall R, Heathcote C, Langton T, Fraser L, et al. (April 2024). "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review" (PDF). Archives of Disease in Childhood. doi:10.1136/archdischild-2023-326669. PMID 38594047. Archived (PDF) from the original on 14 August 2024. Retrieved 29 September 2024.
  74. ^ Cohen-Kettenis PT, Schagen SE, Steensma TD, de Vries AL, Delemarre-van de Waal HA (August 2011). "Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up". Archives of Sexual Behavior. 40 (4): 843–847. doi:10.1007/s10508-011-9758-9. PMC 3114100. PMID 21503817.
  75. ^ Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A (October 2017). "Puberty suppression in transgender children and adolescents". The Lancet. Diabetes & Endocrinology. 5 (10): 816–826. doi:10.1016/s2213-8587(17)30099-2. PMID 28546095.
  76. ^ Rosenthal SM (December 2016). "Transgender youth: current concepts". Annals of Pediatric Endocrinology & Metabolism. 21 (4): 185–192. doi:10.6065/apem.2016.21.4.185. PMC 5290172. PMID 28164070. The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.
  77. ^ de Vries AL, Cohen-Kettenis PT (2012). "Clinical management of gender dysphoria in children and adolescents: the Dutch approach". Journal of Homosexuality. 59 (3): 301–320. doi:10.1080/00918369.2012.653300. PMID 22455322. S2CID 11731779.
  78. ^ Baxendale S (June 2024). "The impact of suppressing puberty on neuropsychological function: A review". Acta Paediatrica. 113 (6): 1156–1167. doi:10.1111/apa.17150. PMID 38334046. While there is some evidence that indicates pubertal suppression may impact cognitive function, there is no evidence to date to support the oft cited assertion that the effects of puberty blockers are fully reversible.
  79. ^ Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP (July 2017). "Low Fertility Preservation Utilization Among Transgender Youth". The Journal of Adolescent Health. 61 (1): 40–44. doi:10.1016/j.jadohealth.2016.12.012. PMID 28161526.
  80. ^ Giovanardi G (September 2017). "Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents". Porto Biomedical Journal. 2 (5): 153–156. doi:10.1016/j.pbj.2017.06.001. PMC 6806792. PMID 32258611.
  81. ^ Bizic M, Kojovic V, Duisin D, Stanojevic D, Vujovic S, Milosevic A, et al. (2014). "An overview of neovaginal reconstruction options in male to female transsexuals". TheScientificWorldJournal. 2014: 638919. doi:10.1155/2014/638919. PMC 4058296. PMID 24971387.{{cite journal}}: CS1 maint: overridden setting (link)
  82. ^ van der Sluis WB, de Nie I, Steensma TD, van Mello NM, Lissenberg-Witte BI, Bouman MB (17 December 2021). "Surgical and demographic trends in genital gender-affirming surgery in transgender women: 40 years of experience in Amsterdam". British Journal of Surgery. 109 (1): 8–11. doi:10.1093/bjs/znab213. ISSN 0007-1323. PMC 10364763. PMID 34291277. Archived from the original on 7 October 2023. Retrieved 9 September 2024.
  83. ^ Brandt AK (3 March 2023). "Robotic peritoneal vaginoplasty". MDedge. Retrieved 5 February 2024.
  84. ^ Li JS, Crane CN, Santucci RA (3 February 2021). "Vaginoplasty tips and tricks". International Brazilian Journal of Urology. 47 (2): 263–273. doi:10.1590/s1677-5538.ibju.2020.0338. ISSN 1677-6119. PMC 7857744. PMID 32840336.
  85. ^ Soliman AT, Alaaraj N, De Sanctis V, Hamed N, Alyafei F, Ahmed S (5 December 2023). "Long-term health consequences of central precocious/early puberty (CPP) and treatment with Gn-RH analogue: a short update: Long term consequences of precocious puberty". Acta Biomedica Atenei Parmensis. 94 (6): e2023222. doi:10.23750/abm.v94i6.15316. PMC 10734238. PMID 38054666.
  86. ^ Lee W, Hobbs J, Hobaica S, DeChants J, Price M, Nath R (26 September 2024). "State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA". Nature Human Behaviour: 1–11. doi:10.1038/s41562-024-01979-5. PMID 39327480. Archived from the original on 28 September 2024. Retrieved 29 September 2024.{{cite journal}}: CS1 maint: date and year (link) CS1 maint: overridden setting (link)
  87. ^ "More trans teens attempted suicide after states passed anti-trans laws, a study shows". NPR. 26 September 2024. Archived from the original on 27 September 2024. Retrieved 29 September 2024.
  88. ^ "Puberty blockers are 'safe, effective and reversible', independent study finds". PinkNews. Retrieved 10 September 2024.
  89. ^ Ghorayshi A (23 October 2024). "U.S. Study on Puberty Blockers Goes Unpublished Because of Politics, Doctor Says". New York Times. Retrieved 23 October 2024.
  90. ^ "The Impact of Early Medical Treatment in Transgender Youth". NIH. Retrieved 23 October 2024.
  91. ^ "Team of Experts Provides Critical Review of Florida Medical Report on Transgender Care". Yale Law School. 13 July 2022. Retrieved 20 March 2024.
  92. ^ O'Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC (January 2022). "Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents". The Journal of Clinical Endocrinology and Metabolism. 107 (1): 241–257. doi:10.1210/clinem/dgab634. PMC 8684462. PMID 34476487.
  93. ^ Rosenthal SM (December 2014). "Approach to the patient: transgender youth: endocrine considerations". The Journal of Clinical Endocrinology and Metabolism. 99 (12): 4379–4389. doi:10.1210/jc.2014-1919. PMID 25140398.
  94. ^ "Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria". National Institute for Health and Care Excellence (NICE). 2020. Archived from the original on 22 April 2021. Retrieved 1 April 2021. It is plausible, however, that a lack of difference in scores from baseline to follow-up is the effect of GnRH analogues in children and adolescents with gender dysphoria, in whom the development of secondary sexual characteristics might be expected to be associated with an increased impact on gender dysphoria, depression, anxiety, anger and distress over time without treatment.
  95. ^ von der Gönna U (27 February 2024). "Trans identity in minors: Review evaluates current evidence on use of puberty blockers and cross-sex-hormones". Medical Xpress.
  96. ^ Taylor J, Mitchell A, Hall R, Heathcote C, Langton T, Fraser L, et al. (April 2024). "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood. doi:10.1136/archdischild-2023-326669. PMID 38594047.
  97. ^ Horton C (14 March 2024). "The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children". International Journal of Transgender Health: 1–25. doi:10.1080/26895269.2024.2328249. ISSN 2689-5269.
  98. ^ "Joint statement EPATH and WPATH" (PDF). World Professional Association for Transgender Health, European Professional Association for Transgender Health. 30 October 2023. Archived from the original on 11 April 2024. Retrieved 16 March 2024.
  99. ^ "Finnish guidelines for treatment of child and adolescent gender dysphoria" (PDF). Council for Choices in Health Care (COHERE). March 2021. Archived (PDF) from the original on 3 December 2020. Retrieved 22 April 2021. p. 6: Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole. [According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors.]
  100. ^ Abels G. "Trans surgery for minors limited in Europe, not banned". @politifact. Archived from the original on 20 March 2024. Retrieved 20 March 2024.
  101. ^ Frattarelli DA, Galinkin JL, Green TP, Johnson TD, Neville KA, Paul IM, et al. (March 2014). "Off-label use of drugs in children". Pediatrics. 133 (3): 563–567. doi:10.1542/peds.2013-4060. PMID 24567009. S2CID 227262172.
  102. ^ Cohen D, Barnes H (September 2019). "Gender dysphoria in children: puberty blockers study draws further criticism". BMJ. 366: l5647. doi:10.1136/bmj.l5647. PMID 31540909. S2CID 202711942.
  103. ^ Giovanardi G (September 2017). "Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents". Porto Biomedical Journal. 2 (5): 153–156. doi:10.1016/j.pbj.2017.06.001. PMC 6806792. PMID 32258611.
  104. ^ Jorgensen SC, Hunter PK, Regenstreif L, Sinai J, Malone WJ (September 2022). "Puberty blockers for gender dysphoric youth: A lack of sound science". Journal of the American College of Clinical Pharmacy. 5 (9): 1005–1007. doi:10.1002/jac5.1691. ISSN 2574-9870.
  105. ^ Priest M (February 2019). "Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm". The American Journal of Bioethics. 19 (2): 45–59. doi:10.1080/15265161.2018.1557276. PMID 30784385. S2CID 73456261.
  106. ^ Lepore C, Alstott A, McNamara M (October 2022). "Scientific Misinformation Is Criminalizing the Standard of Care for Transgender Youth". JAMA Pediatrics. 176 (10): 965–966. doi:10.1001/jamapediatrics.2022.2959. PMID 35994256. S2CID 251721068.
  107. ^ Fitzsimons T (27 September 2019). "A viral fake news story linked trans health care to 'thousands' of deaths". NBC News. Archived from the original on 28 September 2023. Retrieved 19 September 2023.
  108. ^ McNamara M, Abdul-Latif H, Boulware SD, Kamody R, Kuper LE, Olezeski CL, et al. (September 2023). "Combating Scientific Disinformation on Gender-Affirming Care". Pediatrics. 152 (3). doi:10.1542/peds.2022-060943. PMID 37605864. S2CID 261062959.
  109. ^ Gavulic K, Bhat S, Shanab B (29 June 2022). "Calling Out Scientific Misinformation and Protecting Transgender Youth". American Medical Student Association (AMSA).
  110. ^ Butler G, Wren B, Carmichael P (June 2019). "Puberty blocking in gender dysphoria: suitable for all?". Archives of Disease in Childhood. 104 (6): 509–510. doi:10.1136/archdischild-2018-315984. PMID 30655266. S2CID 58539498.
  111. ^ The Lancet Child & Adolescent Health (June 2021). "A flawed agenda for trans youth". The Lancet. Child & Adolescent Health. 5 (6): 385. doi:10.1016/S2352-4642(21)00139-5. PMID 34000232. S2CID 234769856.
  112. ^ Ashley F (February 2019). "Puberty Blockers Are Necessary, but They Don't Prevent Homelessness: Caring for Transgender Youth by Supporting Unsupportive Parents". The American Journal of Bioethics. 19 (2): 87–89. doi:10.1080/15265161.2018.1557277. PMID 30784386. S2CID 73478358.
  113. ^ "Arkansas Lawmakers Override Veto, Enact Transgender Youth Treatment Ban". 6 April 2021. Archived from the original on 31 July 2021. Retrieved 12 March 2022.
  114. ^ "A Federal Judge Blocks Arkansas Ban On Trans Youth Treatments". NPR. Associated Press. 21 July 2021. Archived from the original on 18 December 2022. Retrieved 17 July 2022.
  115. ^ Yurcaba J (14 May 2022). "Judge blocks Alabama's felony ban on transgender medication for minors". NBC News. Archived from the original on 2 December 2022. Retrieved 20 August 2022.
  116. ^ Rojas R (8 April 2022). "Alabama Governor Signs Ban on Transition Care for Transgender Youth". The New York Times. ISSN 0362-4331. Archived from the original on 26 December 2022. Retrieved 17 July 2022.
  117. ^ Sneed T (14 May 2022). "Judge blocks Alabama restrictions on certain gender-affirming treatments for transgender youth". CNN. Archived from the original on 20 December 2022. Retrieved 17 July 2022.
  118. ^ Sarkissian A (11 August 2022). "Florida bans Medicaid from covering gender-affirming treatments". Politico. Archived from the original on 29 December 2022. Retrieved 23 August 2022.
  119. ^ "The Proliferation of State Actions Limiting Youth Access to Gender Affirming Care". KFF. 31 January 2024. Archived from the original on 5 February 2024. Retrieved 5 February 2024.
  120. ^ Panetta G (9 June 2023). "Lawmakers in blue states are linking protections for abortion and gender-affirming care". The 19th. Archived from the original on 5 February 2024. Retrieved 1 January 2024.
  121. ^ "New report critiques UK transgender youth care research study". ABC News. 9 July 2024. Archived from the original on 11 July 2024. Retrieved 17 July 2024.
  122. ^ Breen D (21 June 2023). "Federal judge blocks the country's first ban on gender-affirming care for minors". NPR. Archived from the original on 11 August 2023. Retrieved 11 August 2023.
  123. ^ Block M. "Parents raise concerns as Florida bans gender-affirming care for trans kids". NPR. Archived from the original on 11 June 2023. Retrieved 11 June 2023.
  124. ^ Schott B. "Why GOP lawmakers want to stop doctors from prescribing gender-affirming care for Utah's youth". The Salt Lake Tribune. Archived from the original on 11 June 2023. Retrieved 14 August 2023.
  125. ^ Connell-Bryan A, Kenen J, Holzman J (27 November 2022). "Conservative states are blocking trans medical care. Families are fleeing". Politico. Archived from the original on 30 November 2022. Retrieved 30 November 2022.
  126. ^ Ramirez M. "As state laws target transgender children, families flee and become 'political refugees'". USA Today. Archived from the original on 30 November 2022. Retrieved 30 November 2022.
  127. ^ Yurcaba J (19 April 2021). "'It's not safe': Parents of trans kids plan to flee their states as GOP bills loom". NBC News. Archived from the original on 30 November 2022. Retrieved 30 November 2022.
  128. ^ Barbi L, Tornese G (March 2023). "Ethical dilemmas of gonadotropin-releasing hormone analogs for the treatment of gender dysphoria". Minerva Endocrinology. 48 (1): 1–3. doi:10.23736/S2724-6507.21.03452-7. hdl:11368/2988571. PMID 33880896.
  129. ^ Clark BA, Virani A (March 2021). "This Wasn't a Split-Second Decision": An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy". Journal of Bioethical Inquiry. 18 (1): 151–164. doi:10.1007/s11673-020-10086-9. PMC 8043901. PMID 33502682.
  130. ^ Kreukels BP, Cohen-Kettenis PT (May 2011). "Puberty suppression in gender identity disorder: the Amsterdam experience". Nature Reviews. Endocrinology. 7 (8): 466–472. doi:10.1038/nrendo.2011.78. PMID 21587245.
  131. ^ Pullen Sansfaçon A, Temple-Newhook J, Suerich-Gulick F, Feder S, Lawson ML, Ducharme J, et al. (2 October 2019). "The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics". The International Journal of Transgenderism. 20 (4): 371–387. doi:10.1080/15532739.2019.1652129. PMC 6913674. PMID 32999623.
  132. ^ "USPATH Position Statement on Legislative and Executive Actions Regarding the Medical Care of Transgender Youth" (PDF). USPATH. 22 April 2022. Archived (PDF) from the original on 10 November 2022. Retrieved 28 August 2022.
  133. ^ "Endocrine Society opposes legislative efforts to prevent access to medical care for transgender youth". 15 April 2021. Archived from the original on 23 October 2022. Retrieved 18 May 2022.
  134. ^ "Questioning America's approach to transgender health care". The Economist. 28 July 2022. Archived from the original on 4 August 2022. Retrieved 6 August 2022.
  135. ^ "The real story on Europe's transgender debate". Politico. 8 October 2023. Retrieved 1 October 2024.
  136. ^ ""Norway, Finland, Sweden, Holland, and the UK have now banned gender transition surgery for minors."". PolitiFact. 6 September 2023. Retrieved 1 October 2024.
  137. ^ "Fact check: Did Sweden 'shut down' gender-affirming surgical care for minors?". Houston Chronicle. 25 December 2023. Retrieved 1 October 2024.
  138. ^ "Norway didn't ban gender-affirming care for minors, as headline falsely claims". Associated Press. 8 June 2023. Retrieved 1 October 2024.
  139. ^ "Youth Gender Medications Limited in England, Part of Big Shift in Europe". New York Times. 9 April 2024. Retrieved 1 October 2024.
  140. ^ "Puberty blockers a 'safe, effective and reversible' form of gender-affirming care, finds review triggered by Westmead Hospital investigation". Australian Broadcasting Corporation. 6 September 2024. Archived from the original on 23 September 2024. Retrieved 23 September 2024.
  141. ^ "Evidence for effective interventions for children and young people with gender dysphoria—update" (PDF). Sax Institute. Retrieved 23 September 2024.
  142. ^ Johnson L (15 April 2024). "What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth". CBC. Archived from the original on 16 April 2024. Retrieved 17 April 2024.
  143. ^ "Sociedad Chilena de Pediatría respalda terapia afirmativa y de bloqueo hormonal en niñez y adolescencia trans". ADN Radio Chile (in Spanish). 19 June 2024. Archived from the original on 23 September 2024. Retrieved 23 September 2024.
  144. ^ "Doubts are growing about therapy for gender-dysphoric children". The Economist. Archived from the original on 3 December 2022. Retrieved 19 March 2024.
  145. ^ "Medical treatment methods for dysphoria associated with variations in gender identity in minors – recommendation" (PDF). Council for Choices in Health Care in Finland (Palveluvalikoima). 16 June 2020. Archived (PDF) from the original on 15 March 2023. Retrieved 4 May 2023.
  146. ^ Karjaralainen J (26 June 2020). ""Jos olisin lääkäri, minua pelottaisi ihan hirveästi antaa diagnooseja", sanoo transmies Susi Nousiainen – transsukupuolisten uusista hoitosuosituksista nousi kohu, tästä siinä on kyse" (in Finnish). Archived from the original on 25 February 2024. Retrieved 17 March 2024.
  147. ^ Klapsa K (8 October 2023). "The real story on Europe's transgender debate". POLITICO. Archived from the original on 5 April 2024. Retrieved 9 April 2024.
  148. ^ Davis Jr E (12 July 2023). "European Countries Restrict Trans Health Care for Minors". U.S. News. Archived from the original on 8 August 2023. Retrieved 8 August 2023.
  149. ^ Ristori J, Motta G, Meriggiola MC, Bettocchi C, Crespi C, Falcone M, et al. (February 2024). "A comment from SIGIS, SIE and SIAMS: "Puberty blockers in transgender adolescents-a matter of growing evidence and not of ideology"". Journal of Endocrinological Investigation. 47 (2): 479–481. doi:10.1007/s40618-023-02173-6. hdl:2158/1328245. PMID 37695460.
  150. ^ "性別不合に関する診断と治療のガイドライン (第 5 版)" (PDF). The Japanese Society of Psychiatry and Neurology. August 2024. pp. 16–18. Archived (PDF) from the original on 1 October 2024. Retrieved 29 September 2024.
  151. ^ "性別不合に関する診断と治療のガイドライン｜公益社団法人 日本精神神経学会". www.jspn.or.jp. Archived from the original on 1 October 2024. Retrieved 28 September 2024.
  152. ^ "Protocolo para el Acceso sin Discriminación a los Servicios de Salud para Personas Lesbianas, Gays, Bisexuales, Transexuales, Travestis, Transgénero e Intersex y Lineamientos Específicos de Atención" (PDF). Government of Mexico (in Spanish). June 2020. Archived (PDF) from the original on 10 September 2024. Retrieved 29 September 2024.
  153. ^ "Kwaliteitsstandaard Transgenderzorg -Somatisch" (PDF). Archived from the original (PDF) on 1 April 2024. Retrieved 10 April 2024.
  154. ^ "PATHA's vision for transgender healthcare under the current health reforms". The New Zealand Medical Journal. 28 April 2023. Retrieved 29 September 2024.
  155. ^ "The role of psychiatrists in working with Trans and Gender Diverse people". The New Zealand Medical Journal. December 2023. Retrieved 29 September 2024.
  156. ^ "Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand". Society of Youth Health Professionals Aotearoa New Zealand. October 2018. Retrieved 29 September 2024.
  157. ^ Phan K (8 June 2023). "Norway didn't ban gender-affirming care for minors, as headline falsely claims". AP News. Archived from the original on 17 March 2024. Retrieved 17 March 2024.
  158. ^ "Utredning, behandling og oppfølging". Helsedirektoratet (in Norwegian). Archived from the original on 17 March 2024. Retrieved 17 March 2024.
  159. ^ Block J (March 2023). "Norway's guidance on paediatric gender treatment is unsafe, says review". BMJ. 380: 697. doi:10.1136/bmj.p697. PMID 36958723. S2CID 257666327.
  160. ^ Taylor J, Hall R, Heathcote C, Hewitt CE, Langton T, Fraser L (April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)" (PDF). Archives of Disease in Childhood. doi:10.1136/archdischild-2023-326500. PMID 38594048. Archived (PDF) from the original on 21 September 2024. Retrieved 29 September 2024.
  161. ^ "Doubts are growing about therapy for gender-dysphoric children". The Economist. 13 May 2021. Archived from the original on 10 August 2023. Retrieved 2 November 2021.
  162. ^ "Care of children and adolescents with gender dysphoria: Summary" (PDF). The National Board of Health and Welfare (Socialstyrelsen). 2015. Archived from the original (PDF) on 19 May 2023. Retrieved 4 May 2023.
  163. ^ "Uppdaterade rekommendationer för hormonbehandling vid könsdysfori hos unga". The National Board of Health and Welfare (Socialstyrelsen) (in Swedish). 22 February 2022. Archived from the original on 3 August 2023. Retrieved 4 May 2023.
  164. ^ Linander I, Alm E (20 April 2022). "Waiting for and in gender-confirming healthcare in Sweden: An analysis of young trans people's experiences" (PDF). European Journal of Social Work. 25 (6). Routledge: 995–1006. doi:10.1080/13691457.2022.2063799. S2CID 248314474. Archived (PDF) from the original on 26 September 2022. Retrieved 11 October 2022.
  165. ^ Linander I, Lauri M, Alm E, Goicolea I (June 2021). "Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare". Sexuality Research and Social Policy. 18 (2): 309–320. doi:10.1007/s13178-020-00459-5. S2CID 219733261.
  166. ^ Wikipedia contributors (20 August 2024). "Cass Review". Wikipedia. § Legal ban preventing non-NHS medical providers from prescribing puberty blockers. Archived from the original on 22 August 2024. Retrieved 20 August 2024.
  167. ^ Barnes H (30 May 2024). "The government's 11th-hour ban on puberty blockers". New Statesman. Archived from the original on 2 August 2024. Retrieved 20 August 2024.
  168. ^ "New restrictions on puberty blockers". GOV.UK. Department of Health and Social Care: Government of the United Kingdom. 29 May 2024. Archived from the original on 20 August 2024. Retrieved 20 August 2024.
  169. ^ "Women and Gaming; ICU nurse Dawn Bilbrough; Poulomi Basu; Puberty blockers". Woman's Hour. 30 June 2020. Archived from the original on 10 November 2022. Retrieved 1 November 2021.
  170. ^ Savage R (16 September 2020). "UK doctors back trans self-ID rules and treatment for under-18s". U.S. Archived from the original on 18 May 2023. Retrieved 17 May 2023. The BMA called for trans people to receive healthcare "in settings appropriate to their gender identity" and for under-18s to be able to get treatment "in line with existing principles of consent", which requires they fully understand what is involved.
  171. ^ "Interim service specification for specialist gender dysphoria services for children and young people – public consultation". NHS UK. 20 October 2022. Archived from the original on 31 May 2023. Retrieved 31 December 2022.
  172. ^ "Implementing advice from the Cass Review". NHS UK. 2022. Archived from the original on 4 June 2023. Retrieved 4 May 2023.
  173. ^ Cass H (2024). "Final Report – Cass Review". cass.independent-review.uk. Archived from the original on 9 April 2024. Retrieved 20 April 2024.
  174. ^ Alfonseca K. "What the trans care recommendations from the NHS England report mean". ABC News. Archived from the original on 23 April 2024. Retrieved 20 April 2024.
  175. ^ McCool M (19 April 2024). "Scotland's under-18s gender clinic pauses puberty blockers". bbc.co.uk. BBC. Archived from the original on 21 April 2024. Retrieved 21 April 2024.
  176. ^ Smyth C, Beal J (20 April 2024). "Private doctors who give children puberty blockers may be struck off". The Times. ISSN 0140-0460. Archived from the original on 20 April 2024. Retrieved 20 April 2024.
  177. ^ Searle M (7 April 2024). "NHS loophole allows puberty blockers for children". The Telegraph. Archived from the original on 8 April 2024. Retrieved 8 April 2024.
  178. ^ "Children Will No Longer Be Able to Access Puberty Blockers at England Clinics". Time. Archived from the original on 16 March 2024. Retrieved 16 March 2024.
  179. ^ John T (12 March 2024). "England's health service to stop prescribing puberty blockers to transgender kids". CNN. Archived from the original on 16 March 2024. Retrieved 16 March 2024.
  180. ^ Campbell D (7 August 2024). "Delayed puberty blocker clinical trial to start next year in England". The Guardian. Archived from the original on 1 October 2024. Retrieved 8 August 2024.
  181. ^ RCGP. "Transgender care". www.rcgp.org.uk. Archived from the original on 29 July 2024. Retrieved 16 August 2024.
  182. ^ Benisek A. "What Are Puberty Blockers?". WebMD. Archived from the original on 21 December 2022. Retrieved 1 August 2024.
  183. ^ Lopez CM, Solomon D, Boulware SD, Christison-Lagay E (October 2018). "Trends in the "Off-Label" Use of GnRH Agonists Among Pediatric Patients in the United States". Clinical Pediatrics. 57 (12): 1432–1435. doi:10.1177/0009922818787260. PMID 30003804.
  184. ^ "Proposed Talking Points to Oppose Gender-Affirming Care Criminalization Bills". apa.org. American Psychological Association. Archived from the original on 5 May 2021. Retrieved 11 October 2022.
  185. ^ Kletter GB, Klein KO, Wong YY (May 2015). "A pediatrician's guide to central precocious puberty". Clinical Pediatrics. 54 (5): 414–424. doi:10.1177/0009922814541807. PMID 25022947.
  186. ^ Klein KO (February 1999). "Precocious puberty: who has it? Who should be treated?". The Journal of Clinical Endocrinology and Metabolism. 84 (2): 411–414. doi:10.1210/jcem.84.2.5533. PMID 10022393.
  187. ^ Eugster EA, Palmert MR (September 2006). "Precocious Puberty". The Journal of Clinical Endocrinology & Metabolism. 91 (9): E1. doi:10.1210/jcem.91.9.9997. ISSN 0021-972X. Archived from the original on 1 October 2024. Retrieved 1 October 2024.
  188. ^ Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, Antoniazzi F, et al. (April 2009). "Consensus statement on the use of gonadotropin-releasing hormone analogs in children". Pediatrics. 123 (4): e752–e762. doi:10.1542/peds.2008-1783. PMID 19332438. Archived from the original on 1 October 2024. Retrieved 8 August 2024.
  189. ^ Chen M, Eugster EA (August 2015). "Central Precocious Puberty: Update on Diagnosis and Treatment". Paediatric Drugs. 17 (4): 273–281. doi:10.1007/s40272-015-0130-8. PMC 5870137. PMID 25911294.
  190. ^ "AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth". 8 November 2019. Archived from the original on 7 June 2021. Retrieved 18 May 2022.
  191. ^ "March 26, 2021: State Advocacy Update". American Medical Association. 26 March 2021. Archived from the original on 2 December 2022. Retrieved 18 May 2022.
  192. ^ "AMA Letter to Bill McBride" (PDF). American Medical Association. 26 April 2021. Archived (PDF) from the original on 16 May 2024. Retrieved 10 April 2024.
  193. ^ Wyckoff AS (6 January 2022). "AAP continues to support care of transgender youths as more states push restrictions". American Academy of Pediatrics. eISSN 1556-3332. Archived from the original on 18 December 2022. Retrieved 18 May 2022.
  194. ^ "Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth" (PDF). American Psychiatric Association. July 2020. Archived (PDF) from the original on 7 December 2020. Retrieved 28 August 2022.
  195. ^ "Transgender Health". Endocrine Society. 16 December 2020. Retrieved 14 October 2024.
  196. ^ "Discriminatory policies threaten care for transgender, gender diverse individuals". Endocrine Society. 16 December 2020. Archived from the original on 18 December 2022. Retrieved 7 October 2022.
  197. ^ "AACE Position Statement: Transgender and Gender Diverse Patients and the Endocrine Community". American Association of Clinical Endocrinology (AACE). Archived from the original on 29 November 2022. Retrieved 29 November 2022.
  198. ^ "Health Care for Transgender and Gender Diverse Individuals". American College of Obstetricians and Gynecologists (ACOG). 18 February 2021. Archived from the original on 16 April 2024. Retrieved 9 April 2024.
  199. ^ "ACP Advocates Against Restrictions on Gender-Affirming Care". American College of Physicians (ACP). 19 May 2023. Archived from the original on 18 April 2024. Retrieved 9 April 2024.
  200. ^ Vance SR, Ehrensaft D, Rosenthal SM (December 2014). "Psychological and medical care of gender nonconforming youth". Pediatrics. 134 (6): 1184–1192. doi:10.1542/peds.2014-0772. PMID 25404716.
  201. ^ Salas-Humara C, Sequeira GM, Rossi W, Dhar CP (September 2019). "Gender affirming medical care of transgender youth". Current Problems in Pediatric and Adolescent Health Care. 49 (9): 100683. doi:10.1016/j.cppeds.2019.100683. PMC 8496167. PMID 31735692.
  202. ^ Lee JY (December 2023). "Puberty Assessment and Consideration of Gonadotropin-Releasing Hormone Agonists in Transgender and Gender-Diverse Youth". Pediatric Annals. 52 (12): e462–e466. doi:10.3928/19382359-20231016-03. PMC 11045295. PMID 38049185.
  203. ^ Lee JY, Rosenthal SM (January 2023). "Gender-Affirming Care of Transgender and Gender-Diverse Youth: Current Concepts". Annual Review of Medicine. 74 (1): 107–116. doi:10.1146/annurev-med-043021-032007. PMC 11045042. PMID 36260812.
  204. ^ "Citizen Petition Seeking FDA Action on Off-Label Use of Puberty Blockers". www.regulations.gov. September 2023. Archived from the original on 6 August 2024. Retrieved 6 August 2024.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Puberty_blocker&oldid=1253509377"