“Our transgender son is 7 years old, and is very happy right now. However, I anticipate his gender will be much more of an issue when he hits puberty. We’ve been presented with the option of giving him hormone suppressants. Should we start now or wait until he’s older?”
Question submitted Anonymously
Answered by Candace Waldron, MDiv
You are right to anticipate that gender will likely become more of an issue for your son when puberty occurs and I commend you for doing your research early so you will have the information you need and the treatment team in place when the time comes. Working with your son’s primary care physician and an endocrinologist experienced in treating transgender youth can help you time this very individualized treatment. You probably have a couple more years before starting hormone suppressants for the following reasons.
Hormone suppressants (GnRH analogues) are taken to block biological puberty from occurring. By stopping “the wrong puberty” fewer surgeries are required to undo unwanted secondary sex characteristics for transgender youth—such as breasts and widened hips in females, and a lowered voice, Adam’s apple, and chest and facial hair in males. For gender nonconforming youth who are not yet sure if they are transgender, hormone suppressants (or blockers) can allow a child more time to explore their gender identity before their body undergoes irreversible changes they may wish to alter later. Puberty blockers are reversible so if a youth eventually decides not to transition, biological puberty resumes once treatment is stopped.
Puberty occurs in five stages and most physicians recommend puberty blockers to begin around Tanner stage 2. This is when breast buds appear in anatomical females, and the skin on the scrotum thins and reddens but before the penis elongates in anatomical boys. These physical changes generally occur between ages 9 and 12 but can vary widely so hormone blockers are best prescribed under the care of a pediatric endocrinologist who specializes in treating gender nonconforming and transgender children.
Since slight developmental delays can occur with the treatment, most physicians recommend a limited number of years on hormone suppressants. Optimal timing of this treatment is just in time to prevent the development of unwanted secondary sex characteristics, but late enough to avoid long-term use before cross-gender hormones (testosterone in your child’s case) are prescribed.
Candace Waldron, MDiv, is an educator, administrator, and public policy advocate in violence prevention and women’s health, working in settings that include state government, healthcare, religion, and community non-profits. She is the mother of a transgender son who disclosed at fifteen and transitioned at nineteen. In her book, My Daughter He: Transitioning With Our Transgender Children, Candace explores the stages of her process toward acceptance and invites readers to attend to their own emotional responses while supporting their child’s authentic self-expression. Candace is cofacilitator of PFLAG support groups in the Boston metro area for parents of nonconforming and transgender children. Visit www.candacewaldron.com for more information.
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