Decision in England: Puberty blockers – what kind of drugs are they?

The drugs at issue in this discussion belong to the group of so-called GnRH analogues.

Decision in England: Puberty blockers – what kind of drugs are they?

The drugs at issue in this discussion belong to the group of so-called GnRH analogues. This refers to synthetically produced substances that are similar to the hormone GnRH, which stimulates the release of sex hormones from puberty onwards. These agents block the binding sites of the body's own GnRH in the brain and ultimately prevent the male hormone testosterone from being produced in the testicles or estrogen from being produced in the ovaries. Puberty is stopped, voice breaks and beard growth stop, or female breasts stop growing.

Puberty blockers were originally prescribed primarily to children whose puberty began far too early. However, for more than two decades, doctors have been able to use these drugs off-label to treat young people who suffer from feeling like they are the wrong gender. Doctors then also speak of gender dysphoria. Many trans people feel a great deal of inner conflict when they realize that they don't feel consistent with the gender they were assigned at birth because they have a vagina or penis. Some become severely depressed, disgusted with their bodies or, in the worst case, no longer want to live.

The funds are intended to give young people time in which they can decide whether they want to change their physical sexual characteristics. If the young people decide to change their physical gender completely or in part, a second step can be used to grow breasts or facial hair with the targeted administration of estrogen or testosterone. And finally, the genitals can also be changed.

However, by initially stopping the production of sex hormones, the drugs also ensure that, for example, a trans woman is not stigmatized for the rest of her life because she grew broad shoulders during puberty. Because this is something that cannot be undone. Doctors decide individually whether young people will benefit from the funds. In addition to a psychological assessment, a careful examination is necessary.

There is no exact data on this in Germany. It is clear that the numbers are increasing, but at a very low level: in the USA, for example, the number of young people who started puberty blocker therapy increased from 633 to 1,390 between 2017 and 2021. And in England, although more than a few years ago, only around 100 young people are currently taking puberty blockers.

Basically yes. If young people stop the blocker treatment, they go through male or female puberty as usual. However, whether the time delay makes a difference in the long term - for example in growth or in psychosocial health - has not been well studied.

According to the British health service NHS, puberty blockers should initially only be prescribed as part of clinical studies. The reason: There is a lack of evidence regarding safety and clinical effectiveness. An independent review of the health service's gender identity services found a lack of data and evidence about the long-term effects of the drugs. In a review, the National Institute for Health and Care Excellence (NICE) came to the conclusion that significant positive effects of the therapies were rare and that there was no discernible influence on gender dysphoria and quality of life. In other countries, such as Sweden, the thin data situation had also been critically examined and urged to be more careful in the treatment of children and adolescents. The experts' assessment also includes side effects of the medication such as mood swings, slowing of growth and a delay in bone maturation. And since many sex hormone therapies affect the cardiovascular system, close monitoring is recommended.

Not much at first, believes Georg Romer, director of the clinic for child and adolescent psychiatry at the University Hospital of Münster. In a statement for the Deutsche Ärzteblatt he writes: "The current positioning of NHS England, which is also controversial in the British medical community, does not provide any significant insight for our best practice." The treatment principles used there to date would deviate significantly from the internationally established approach. Together with 26 colleagues, Romer has been working on a new guideline for the treatment of trans young people over the past few months. It is intended to give doctors more security when treating young people in the future. However, it has not yet been finally clarified how exactly the recommendation for puberty blockers will be, as the guideline is now entering a comment phase for specialist societies.