What to Do if Your Child’s Puberty Blocker Is Running Out

With the UK puberty blocker ban, transgender youth in the UK are likely to be running out of medication. As such, they and their loved ones will likely be looking for the best next steps.

We have heard about parents finding their own solutions to get their child what they need. Some of these solutions include taking their prescription to a pharmacy abroad or getting the prescription created in the name of someone who is over 18. Ask around in trans forums and see what other parents are doing.

But what should parents do if they do not have those options?

Transmasculine Adolescents

Luckily, testosterone is a powerful hormone and on its own can suppress the ovarian cycle and the ovary’s production of oestrogen.

Scenarios

• Not yet started puberty – Children who haven’t started puberty yet should consider their options but don’t need to take any medication yet.
• Under 14 and not yet on testosterone – The average male puberty starts between 8 and 14, and trans boys should be no different. If your trans son is ready to start their male puberty, consider starting testosterone hormones to bring on the developments of puberty and to suppress the ovarian oestrogen production.
• Under 14 and already on testosterone – Is it time to increase the dose? If your child is on a starting dose of testosterone, think about asking for an increase. Do some blood tests checking hormone levels and aim for a testosterone level of between 12 and 20nmol/l.
• Over 14 and not yet on testosterone – Teenagers who haven’t started puberty by the age of 14 are considered to be delayed. Trans and cis children need to experience puberty in their early teenage years, so have that discussion – is it time to start T?
• Over 14 and already on testosterone – Are the levels high enough? You should be getting to a good adult level now. Aim for testosterone levels of between 17 and 25nmol/l.
• Still needing an alternative to blockers – Raloxifene is an oestrogen blocker that hasn’t been widely tested in young people. However, medical experts are considering its use for non-binary people who wish to block the effects of estrogen in breast growth.

Transfeminine Adolescents

Oestrogen isn’t as strong as testosterone. Therefore, it doesn’t always suppress the production of testosterone from the testicles. For that reason, most transfeminine adolescents will require help from a blocker.

Alternatives When Puberty Blocker Is Running Out

Whilst GnRHa provide effective pubertal suppression, use of anti-androgen medications such as cyproterone acetate or spironolactone may also relieve dysphoria in trans female adolescents.

• Spironolactone – This is effective at reducing the effects of testosterone on the body. However, people taking heart medications or blood pressure tablets shouldn’t use it.
• Cyproterone – This is effective at reducing the production of testosterone. In rare cases, there have been reports of liver toxicity.
• Finasteride – This stops the conversion of testosterone. It’s great for people who are at risk of male pattern baldness.

Importance of Finding an Alternative

While it may feel daunting to consider medication for children and young people, it’s important to recognise that not addressing the needs of transgender children can lead to significant, irreversible effects as they progress through puberty. 

Gender-affirming care has been shown to save lives and improve well-being. If your child’s puberty blocker is running out, t’s crucial to carefully weigh your options and understand the potential benefits of such treatments.

Remember, top national medical associations such as the American Medical Association (AMA), American Academy of Child and Adolescent Psychiatry (AACAP), and American Academy of Pediatrics (AAP) support gender-affirming care as safe, effective, and proven to save young people’s lives.

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