Puberty blockers are rarely prescribed to transgender teens – study

Access to puberty blockers and gender-affirming hormones are at the centre of transatlantic debates over the future of medical care for transgender youth  – but a new analysis indicates that children are prescribed these medicines only rarely.

In the US, more than 300,000 adolescents ages 13 to 17 years identify as transgender or gender-diverse, meaning they do not identify with their biological sex assigned at birth, according to the study published in the journal JAMA Pediatrics.

To give young people time to consider their gender identity, some adolescents are prescribed puberty blockers, which delay physical changes such as a deeper voice and the growth of breasts, testicles, and body hair.

Later on, they may opt for hormones like oestrogen or testosterone to develop in their chosen gender, or get surgeries when they are older.

Debate over the best way to care for transgender youth has spilled into the political arena in recent years, with advocates describing these treatments as life-saving and opponents moving to restrict their use.

With data for nearly 5.2 million adolescents in the US between 2018 and 2022, the new analysis is one of the largest to date to examine how common they really are.

‘Only a minority gets treatment’

For every 100,000 biologically female teens, 20.81 were identified as transgender or gender-diverse and prescribed puberty blockers, according to the study. That’s compared with a rate of 15.22 among biological males.

Young people were slightly more likely to receive gender-affirming hormones, at rates of 49.9 per 100,000 for biological girls and 25.34 per 100,000 for biological boys. Rates rose after teenagers turned 14, peaking at age 17 but remaining low overall.

Notably, the researchers from Harvard University and LGBTQ healthcare provider FOLX Health said no one younger than 12 received a prescription for hormone treatments.

“It’s a rigorous process to get treatment, and at the same time, it’s only a minority that gets treatment,” Dr Louise Frisén, an associate professor at the Karolinska Institute in Sweden who works with transgender youth but was not involved with the study, told Euronews Health.

The findings follow previous research showing that adolescents with gender dysphoria – when someone experiences distress because their gender identity does not match their biological sex at birth – almost never get gender-affirming surgeries in the US.

Among teenagers 15 to 17, that rate was 2.1 per 100,000, while it was 0.1 for those ages 13 to 14 and there were no procedures done on children ages 12 or younger, the analysis found.

Researchers said that taken together, the findings counter public concern that gender-affirming care is being over-prescribed to minors.

“The public debate surrounding gender-affirming care has become highly politicised,” Dr Gianluca Tornese, an assistant professor in paediatrics at the University of Trieste in Italy, told Euronews Health.

But puberty blockers are “just one option among many and [are] typically part of a comprehensive and individualised care plan,” said Tornese, who was not involved with the study.

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Europe is not immune from political and cultural debates over gender-affirming care for children, and access varies greatly among and even within countries.

More recently, a debate over puberty blockers has gripped countries like the United Kingdom, Sweden, Denmark, and France, which have moved to limit their use while more research is done on their long-term effects.

But the US restrictions tend to be more extreme. In 24 states, doctors who offer gender-affirming care to minors can face professional or legal penalties, and 17 states are facing lawsuits that challenge these rules.

“It is difficult to get treatment as a young person with gender dysphoria today, but it is easier in most countries than it is in the US,” Frisén said.

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