Overview

Puberty blockers are drugs that pause the physical changes of puberty. In gender medicine they are usually gonadotropin-releasing hormone agonists (GnRHa) — most commonly leuprorelin (Lupron), triptorelin or histrelin. They work by telling the pituitary gland to stop signalling the ovaries or testes, so sex-hormone production (estrogen or testosterone) drops and pubertal development stalls.

They were first used to treat precocious puberty — puberty that begins unusually early, before age 8 in girls or 9 in boys. Since the late 1990s, following the "Dutch protocol" (the treatment model developed by Dutch gender clinicians), they have also been given to adolescents with gender dysphoria, typically from around Tanner stage 2 (early puberty) onwards, to buy time before a decision about cross-sex hormones.

The central claim made about puberty blockers in gender care is that they are a "pause button" — reversible, low-risk, and a neutral way to give a young person time to think. This page examines what the medical evidence actually shows, and how trans-identified people and detransitioners describe the treatment.

What the drugs actually do

It helps to be precise about the biology, because the phrase "pause button" hides a lot.

• Sex-hormone production drops. Estrogen or testosterone falls to prepubertal levels. In practice this stops periods, breast growth, voice deepening, facial hair, and other secondary sex characteristics.
• Growth continues, but differently. Without the sex hormones that normally close the growth plates in bones, adolescents on blockers often keep growing taller than they otherwise would, and their limbs may grow disproportionately.
• Bone mineral accrual slows. Puberty is the main window in which the skeleton builds density. Blocking sex hormones during that window reduces the amount of bone laid down (see Bone density below).
• Sexual development stalls. In males, the penis and testes do not grow as they would in puberty; in females, breast development is halted. Fertility cannot develop normally during the suppression period.
• The brain is affected too. Puberty is a period of intense brain maturation — neuronal pruning, myelination, and the development of executive function and social cognition — and it is driven partly by sex hormones. What suppressing those hormones does to the adolescent brain is not well understood (see Brain and cognition).

A useful way to think about it: puberty is not a single switch controlling appearance. It is a developmental window in which the skeleton, brain, sexual organs, and cardiovascular system all mature together. Blocking it does not simply hold appearance still while everything else proceeds normally.

The evidence: how strong is it?

What the systematic reviews found

Several independent groups have reviewed the same small literature and reached similar conclusions.

The most rigorous is a 2025 systematic review and meta-analysis by Miroshnychenko et al. 2025, published in Archives of Disease in Childhood. It included 10 studies — three comparative observational studies and seven before-and-after studies, with no randomised controlled trials. Across every outcome measured — global function, depression, gender dysphoria, and bone mineral density — the certainty of evidence was very low. The authors concluded that "we cannot exclude the possibility of benefit or harm" and called for "methodologically rigorous prospective studies."

The Cass Review 2024, an independent review of NHS gender services in England, likewise found the evidence base for puberty blockers and hormones to be weak, and recommended a full research programme and strict clinical oversight. Notably, the Cass Review raised the possibility that "brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions."

A 2024 systematic review by Feigerlova 2025 examined discontinuation and detransition among those on GnRHa and/or hormones. It found puberty-blocker discontinuation rates of roughly 1–7.6% across studies, but stressed that the 15 included studies were highly heterogeneous, mostly retrospective, used inconsistent definitions, and had insufficient follow-up. The overall certainty of evidence was very low.

A 2023 BMJ investigation by Block 2023 documented a striking international split: while US medical organisations describe these treatments as evidence-based, health authorities in Sweden, Finland, France and the UK have restricted them for minors after their own systematic reviews found the evidence inconclusive or very low quality.

Why the evidence is weak

The problems are structural, not a matter of one bad study:

• No randomised controlled trials. There has never been an RCT of puberty blockers for gender dysphoria. Whether one would be ethical is debated, but the absence matters.
• No comparison groups. Most studies compare patients to themselves before and after treatment. Without an untreated group, it is impossible to separate the drug's effect from normal adolescent development, regression to the mean, or the effect of psychological support.
• High loss to follow-up. Young people who stop treatment often disengage from clinics entirely. In one Dutch follow-up study of cognitive outcomes, only 60% of eligible patients took part. When a third or more of a sample disappears, the outcomes of those who left are unknown — and they are precisely the people most likely to have had a poor experience. This systematically makes results look better than they may be.
• Short follow-up. Regret and detransition often emerge years later. Studies that follow patients for one or two years cannot capture this.
• Changing patient population. The original Dutch studies involved a small, carefully screened group with childhood-onset dysphoria and extensive psychological support. Today's clinics see a much larger, mostly female, mostly adolescent-onset population with high rates of co-occurring mental health conditions. Results from the first group cannot simply be transferred to the second.

A 2023 paper by Cohn 2023 argues that because of these flaws, the true rates of detransition and regret are unknown, and that presenting very low figures as established fact undermines informed consent. (This paper has its own limitations, including the author's affiliation with an organisation critical of youth gender medicine.)

Known risks

The table below brings together every risk of puberty blockers for which there is published evidence, an official drug-safety warning, or credible expert testimony. "Evidence strength" describes how certain the evidence is, not how big the harm is. Very low certainty means the true risk could be smaller or larger than reported. The sections after this one look at the most important risks in more depth.

Unknowns. Much of the most important information does not exist yet. No study has followed blocked adolescents into middle age to measure fractures, adult brain function, sexual function or fertility. Nobody knows whether the experience of being out of step with peers leaves lasting psychological effects, or how far blockers lock in a trans identity that might otherwise have resolved. England's National Institute for Health and Care Excellence (NICE) evidence review found that every critical outcome (gender dysphoria, mental health, quality of life) and every safety outcome rested on very low certainty evidence (NICE 2020). The University of York's systematic review for the Cass Review looked at 50 studies and found only one of high quality. It concluded there is "a lack of high-quality research" (Taylor et al. 2024). An honest consent process has to say these things are unknown, not imply they are safe.

What detransitioners report

The drug labels and systematic reviews describe risks in the abstract. On /r/detrans, people who were given blockers as children and teenagers describe what those risks felt like when they happened to them. These accounts are self-selected and can't show how common each harm is. They do show that the harms in the table above are not hypothetical. More accounts are collected in Detransition perspectives below.

Bones and chronic pain.

As someone who took Lupron for like 2 1/2 years: the bone pain never goes away. —weaboltonsquid, detrans female

I have osteogenesis and they knew I have it. It was something I brought up being worried about. Even though my bone density was very low I was still put on this drug. They should not have put me on it —lunksboot, detrans female

Genital development and sexual function. This is one of the most painful accounts on the forum. It describes exactly the tissue-insufficiency and orgasm risks listed above.

Because of puberty blockers(started before natural Puberty) my penis and testicles never developed the proper growth… When I was 18 and started the process to get a vaginoplasty, I was told that I simply didn't have the anatomy needed to create a neovagina because my puberty was stopped and I never gave my body the chance to fully grow… I also have never and will NEVER achieve orgasm. —Crafty-Damage2808, detrans male

Growth, strength and development.

I'm a sophomore boy in highschool with most 8th grade girls being taller than me, my muscles and bones are so extremely weak, and I feel a mile behind every boy in my grade when it comes to development. —Appropriate-Most-969, detrans male

Neurological and cognitive symptoms.

I was on the same medications and something called Lupron which is the puberty blocker that is literal poison. All for nearly two years. My symptoms are fatigue, headaches, brain fog/memory loss, dysautonomia, hearing and vision loss too. —Tawayy13, detrans male

When doctors prescribe these drugs they tend not to mention the cognitive aspect at all, and almost brush off the impact they cld have on your bones, so most kids and parents rlly aren't in a position to give informed consent… I was placed on them for almost four years. —Anonbiennio, detrans female

Fertility, migraines and emotional development.

i was on hormone blockers for six years, since i was fourteen. i was not old enough to make the decision to be infertile, stop the way my body naturally grows, give myself weekly migraines. im emotionally stunted because i didnt have a real puberty. —alwaysontheupswing, detrans female

Concerns brushed aside. Several people describe being put on blockers when they had already finished puberty, or having their worries dismissed.

Invasive physical exam at 16 to see if I had finished puberty determined that I had, and then they prescribed lupron for... what? It's such a shitty drug to be on, and they made it sound mandatory/totally brushed off my concerns about side effects. —Illustrious_Peak7985, detrans female

These accounts share a pattern. The harms people describe are the ones that were never meant to happen with a "pause button": bone pain years after stopping, missing genital development, and cognitive and emotional effects. Again and again, people say nobody told them or their parents these things were possible. The site's own iatrogenic harm and informed consent pages go into this in more detail.

Bone density

This is the best-studied physical harm, and the picture is fairly consistent even if the certainty of evidence is low.

Puberty is when the skeleton builds most of its lifetime bone mass. Suppressing sex hormones during that window slows bone mineral accrual. The 2025 meta-analysis by Miroshnychenko et al. 2025 found bone density at the hip, lumbar spine and femoral neck to be lower after treatment than before, though the certainty was very low.

A 2025 systematic review and meta-analysis of bone accrual (published in a US endocrinology journal) found that lumbar-spine z-scores declined during GnRHa treatment, and that after later hormone therapy bone density increased but z-scores remained numerically below baseline at longer follow-up. Recovery was smaller and less consistent at the hip and femoral neck. Shorter blocker duration and longer hormone exposure were associated with better outcomes.

A New Zealand evidence brief (2024) reviewing eight cohort studies found that while bone density usually increased during treatment, it increased less than expected for age, producing falling z-scores. It also noted high rates of vitamin D deficiency at the start of treatment.

The practical picture that emerges:

• Bone density reliably falls relative to peers during treatment.
• Starting cross-sex hormones afterwards partially restores it — more reliably in females taking testosterone than in males taking estrogen.
• Whether full catch-up occurs, and what it means for fracture risk in later life, is not established.

Yeah I have a very low bone density now and have very bad bone and joint pain. It hurts to walk and the pain keeps me up most nights. This was with taking calcium supplements too. I was only on puberty blockers for 1.5 years but the effects haven't improved at all since going off bone and joint wise... I went from having very good vision to very bad vision within just a year. —AttorneyRich8118, detrans female.

Brain and cognition

This is the area of greatest uncertainty, and arguably the greatest concern.

Puberty is a critical period of brain development. Sex hormones drive neuronal pruning, myelination, and the maturation of the prefrontal cortex — the part of the brain responsible for planning, decision-making and impulse control. A 2024 review by Sallie Baxendale in Acta Paediatrica examined 16 studies on the neuropsychological effects of puberty suppression and found:

• In animal studies (mice, sheep, primates), suppressing puberty alters brain structure and cognitive and social function, in ways that are often sex-specific. There is no evidence these effects are reversible after the drugs are stopped.
• In humans, only five studies exist — two on precocious puberty, three on gender dysphoria. Three reported lower IQ in treated patients.
• One study of 25 girls treated for precocious puberty found an average 7-point drop in IQ after three years, with one girl dropping from 138 to 123.
• A single case study of a gender-dysphoric young person found a 9-point drop in global IQ and a 15-point drop in working memory over treatment.
• No human study has systematically measured cognitive function before and after treatment with adequate follow-up.

Baxendale concluded that "there is no evidence that cognitive effects are fully reversible following discontinuation of treatment" and called for urgent research. Her review was initially rejected by three journals.

It is important to be fair to the counter-evidence. A 2022 Dutch study (Arnoldussen et al.) reported that pre-treatment IQ still predicted educational achievement after treatment, which the authors described as reassuring. However, that study did not measure IQ after treatment, used a coarse proxy for cognitive ability, and lost 40% of its sample to follow-up. Baxendale argues it "tells us nothing about the impact of puberty blockers on cognitive development."

The honest summary: we do not know what puberty suppression does to the adolescent brain, and the little evidence there is points in a concerning direction rather than a reassuring one.

Fertility and sexual development

• Fertility during suppression is not possible, because the gonads are not maturing. Whether fertility fully returns after stopping blockers alone is not well studied; the Mayo Clinic study discussed below raises concerns in males.
• Genital development does not occur during suppression. In males, the penis and testes remain at a prepubertal size. This has practical consequences: one widely reported surgical complication occurred when a young male who had been blocked since early puberty later had vaginoplasty, but there was insufficient penile tissue for the standard technique, requiring a riskier bowel-based procedure. The patient died of infection.
• Sexual function may be affected. Marci Bowers, a prominent US gender surgeon and former WPATH president, has stated that adolescents blocked at Tanner stage 2 have essentially never experienced orgasm (see Known risks). The evidence base here is essentially anecdotal.

A 2024 Mayo Clinic analysis (Murugesh et al. 2024) examined testicular tissue from children with gender dysphoria on long-term puberty blockers, as part of the largest such juvenile testicular biorepository reported to date. It found mild-to-severe "sex gland atrophy", and tissue from a patient blocked for 52 months still appeared prepubertal at the cellular level. The authors raised "a potential concern regarding the complete 'reversibility'" of the treatment. This is a bioRxiv preprint that has not been peer-reviewed, and the sample is small, so it cannot establish what happens to fertility in adulthood — but it is direct tissue evidence that the drugs are not simply "pausing" a process that later resumes untouched.

The "pause button" question

The phrase "reversible pause button" is the most contested claim in this debate. It is worth separating three different questions:

1. Does puberty resume after stopping? Usually yes, in some form. Adolescents who stop blockers generally do go through puberty. But it may not be the same puberty: timing, tempo, and final outcome can differ, and the developmental window for some processes may have passed.
2. Are all effects reversible? No. Bone accrual not gained during the suppressed years is not simply made up later. Genital development that did not occur during a suppressed puberty may not fully catch up. Time spent out of step with peers is not reversible. And on the cognitive question, there is no evidence of reversibility.
3. Is it a neutral "time to think"? This is the most important question, and the data suggest it is not neutral. In the Norwegian cohort study by Nyquist et al. 2025, retracted 2026, 97% of those who received puberty blockers went on to cross-sex hormones. A US systematic review cited in a 2025 US Department of Health and Human Services report found a figure of 92%. Whatever the mechanism — whether blockers confirm a young person's conviction, or make the medical pathway feel like the path of least resistance, or simply reflect that clinics prescribe blockers to those already strongly identified — the practical reality is that blockers are very rarely a stopping point. They are a bridge.

There is a nearly 100% that a person who starts on Puberty Blockers will proceed to cross-sex hormones and surgery. … Giving puberty blockers to 11-12 year olds is effectively committing them to a life of patient hood, reliance on drugs and surgeries, and likely sterility. … They are not a harmless pause button. —ConnectPen, /r/detrans commenter.

Trans perspectives

Trans-identified people generally describe puberty blockers as one of the most important and least harmful interventions available — and many describe not having access to them as a source of lasting grief.

The dominant framing is that a natal puberty is a permanent, irreversible damage to a trans person's body, and that blockers are the only way to prevent it. As one trans woman put it, blockers "prevent the irreplaceable effects of the wrong puberty, allowing someone to achieve far better results from HRT a few years later," while being "very low-risk" because "should the person come off them later... they'll go through their normal puberty."

I wholeheartedly agree with you this time, we should give trans teens way easier access to puberty blockers, because that saves us so many lives, so many traumas, and gives us the possibility to explore the best of ourselves! I myself wish so many things that have been taken from me that cannot be obtained by current medicine, but could've been preserved with more widely available puberty blockers. —Mtfdurian, trans woman (MTF).

I know for myself, if I had been able to get puberty blockers before natal puberty left its scars, I wouldn't have needed top surgery later on.. and maybe I could have lived some of the childhood I missed out on. —_delgrey, trans man (FTM).

Many trans people also describe the urgency of access — the sense that every week of untreated puberty causes further irreversible change — and some express anger at parents or clinicians who delay. Others describe being denied blockers as having "ruined my teen years."

Trans perspectives are not uniform on the risks, however. Some trans people who took blockers are candid about the trade-offs:

The main concern health providers will mention with blockers is the bone density loss. That's something that will happen, however if your child decides to start HRT the bone density will return to normal. Puberty blockers are just not a great long term option in regard to bone health at the moment. Only other side-effects I noticed were hot flashes. —arrowskingdom, trans man (FTM).

A smaller number of trans voices push back on the most extreme claims. One trans man objected to the idea that going through natal puberty is "mutilation," arguing that "the logical consequence of this position is that those of us who did not have access to blockers... were irreparably damaged by puberty and that's not a position I'm willing to sign up for."

It is also worth noting that some trans people describe blockers as insufficient on their own — a stopgap while waiting for hormones, not a solution. As one trans woman put it, "a blocker isn't enough... all in the name of harm reduction but it was abysmally traumatic." For some, the framing of blockers as a cautious middle path is itself a problem, because what they want is the hormones.

Detransition perspectives

Detransitioners and desisters who took puberty blockers as adolescents describe the treatment very differently — most often as something that was presented to them and their parents as harmless and reversible, and was not.

The most common themes in these accounts:

"Reversible" was oversold. Many describe being told blockers were a pause button, and later concluding that this was not accurate.

No. That is a lie. Puberty isn't a switch that we can control... Your organs, bones, nerves, veins, everything, is effected by the process of your body developing. You can't just take the hormones later to make up for it. Once you go past the window, that's it. It's over. —ReaperManX15, desisted.

Physical effects that did not resolve. Detransitioners report low bone density, chronic pain, stunted height, vision loss, hot flashes, irregular or absent periods, breast shrinkage, and genital underdevelopment.

I was on hormone blocker for 2 years, age 14 till 16... After going off the blockers it took a while until my period started again and even then only irregularly... my breast have quite shrunken. Before the blockers I was curvy, with big breasts and an ass and now everything is gone and I look flat and more androgynous... which I feel insecure about because it makes me look like a child and it doesn't help that I'm short. —dramaticskinnybitch, detrans female.

I got Puberty blockers and HRT Since I was a child and now I have medical issues with my ability to get kids, im also way Smaller now and will most likely not grow to my expected hight. I recently talked with a doctor again saying my testosterone is way bellow avarage. —Nanachiowo, detrans male.

Developmental and social losses. Several describe feeling frozen at the age they started blockers, out of step with peers, and robbed of normal adolescent experiences — including sexual development.

It's like they forget children will hopefully become adults one day, even though the point of the whole puberty-blocker argument is to make sure children grow into happy adults, while they simultaneously rob those same children of their ability to explore one of the most important, intimate, and ubiquitous adult experiences.... it's sickening. —GriffinQueenOfHeaven, detrans female.

Blockers as a bridge, not a pause. Detransitioners frequently note that nearly everyone who starts blockers continues to hormones, and argue this is by design rather than by accident.

yeah, i completely agree. how can people think fucking with a child's endocrine system and the hypothalamus of their brain, is no big deal?... almost 100% of kids on puberty blockers go on to hormones, and theyre never going to have their puberty. like. you can't just block someone's puberty for 2 years and start it again, they will not be having a normal development. —portaux, desisted.

Regret about age and assessment. Some who transitioned as teenagers and later detransitioned feel they were too young to consent to what was done to them, and that the assessment process did not explore other explanations for their distress.

I was given leuprorelin for two years at age 16 to 18 even though it was entirely uneccesary. I had already gone through the majority of puberty... Even other medical professionals around my country question this choice by my endocrinologist because he puts every transgender patient on hormone blockers for 2 years, whether thay are 16 or 60, it doesn't matter. It's entirely pointless and presents an avoidable and unnecessary risk. —Wonderful_Walk4093, questioning own transgender status.

Not every detransitioner's experience is one of harm. One detrans female described being on blockers from 14 to 16, experiencing irregular periods and breast shrinkage afterwards, but also said "I'm the happiest I've ever been in a looong time and I finally feel like myself again" after detransitioning. The accounts are varied — but the theme of inadequate informed consent recurs across them.

What this means for decisions

This page does not give medical advice. But the evidence supports several observations that anyone weighing this treatment should be able to consider:

• The evidence is genuinely uncertain. Not "controversial" in the sense of two equal sides, but uncertain in the technical sense: the studies are too weak to establish benefit or harm. Anyone who tells you the science is settled — in either direction — is overstating it.
• "Reversible" is not accurate as a blanket claim. Puberty usually resumes, but bone accrual, genital development, cognitive development, and social experience are not simply restored.
• Blockers are not a neutral pause. The overwhelming majority of young people who start them continue to cross-sex hormones. Whether this reflects genuine persistence of identity or the shaping effect of the treatment pathway is unknown — but it should be disclosed.
• Assessment matters. The detransitioners quoted here, and studies like Littman 2021 and Littman et al. 2024, consistently report that underlying issues — trauma, autism, mental health conditions, internalised homophobia, body image, social contagion — were not adequately explored before medical treatment began. (Both studies have significant limitations, including self-selected online samples.)
• Bone and cognitive monitoring should be standard. Baseline bone density scans, vitamin D levels, and cognitive assessments before treatment are recommended by several experts but are not universally performed.

If you are a young person considering this, or a parent weighing it: the question is not whether gender dysphoria is real — it is. The question is whether this particular intervention, with this evidence base, at this age, is the right response to it — and whether the alternatives have been genuinely explored first.

Where to get support

If you are questioning your own transition, or supporting someone who is, the support directory lists gender-exploratory therapists and detransition support groups. You may also find it helpful to read the pages on gender dysphoria, detransition, DIY hormones, and desistance and retransition.

References

• Miroshnychenko, A. et al. (2025). Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis. Archives of Disease in Childhood. study page, source.
• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page, source.
• Feigerlova, E. (2025). Prevalence of detransition in persons seeking gender-affirming hormonal treatments: a systematic review. Journal of Sexual Medicine. study page, source.
• Block, J. (2023). Gender dysphoria in young people is rising—and so is professional disagreement. The BMJ. study page, source.
• Cohn, J. (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.
• Nyquist, C. B. et al. (2025). Treatment trajectories among children and adolescents referred to the Norwegian National Center for Gender Incongruence. Acta Paediatrica. study page, source.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior. study page, source.
• Littman, L., O'Malley, S., Kerschner, H. & Bailey, J. M. (2024). Detransition and Desistance Among Previously Trans-Identified Young Adults. Archives of Sexual Behavior. study page, source.
• Murugesh, V. et al. (2024). Puberty Blocker and Aging Impact on Testicular Cell States and Function. bioRxiv (preprint, not peer-reviewed). study page, source.
• Baxendale, S. (2024). The impact of suppressing puberty on neuropsychological function: A review. Acta Paediatrica. source.
• Ministry of Health New Zealand (2024). Impact of Puberty Blockers in Gender-Dysphoric Adolescents: An Evidence Brief. source.
• Joseph, T., Ting, J. & Butler, G. (2019). The effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria: findings from a large national cohort. Journal of Pediatric Endocrinology and Metabolism. source.
• Biggs, M. (2021). Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. Journal of Pediatric Endocrinology and Metabolism, 34(7). source.
• Vlot, M.C. et al. (2017). Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone, 95:11–19. source.
• Schagen, S.E.E. et al. (2020). Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones. Journal of Clinical Endocrinology & Metabolism, 105(12). source.
• van der Loos, M.A.T.C. et al. (2023). Bone Mineral Density in Transgender Adolescents Treated With Puberty Suppression and Subsequent Gender-Affirming Hormones. JAMA Pediatrics. source.
• Taylor, J. et al. (2024). Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review (University of York, commissioned by the Cass Review). Archives of Disease in Childhood, 109(Suppl 2). source.
• National Institute for Health and Care Excellence (2020). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. source.
• US Food and Drug Administration (2022). Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists (summary by the Pediatric Endocrine Society Drugs & Therapeutics Committee). source.
• AbbVie / US FDA. Lupron Depot-Ped (leuprolide acetate) prescribing information: warnings on psychiatric events, convulsions, pseudotumor cerebri and injection-site reactions. DailyMed, FDA label (2025).
• Puberty suppression in adolescents with gender dysphoria: an emerging issue with multiple implications (2024). Frontiers in Endocrinology. source.
• Boogers, L.S. et al. (2024). Time Course of Body Composition Changes in Transgender Adolescents During Puberty Suppression and Sex Hormone Treatment. Journal of Clinical Endocrinology & Metabolism, 109(8). source.
• Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty (2014). Annals of Pediatric Endocrinology & Metabolism, 19(3). source.
• Fertility preservation for youths with gender dysphoria (2025). Frontiers in Endocrinology. source.
• The attitudes of transgender and gender-diverse adolescents and their parents regarding fertility, parenthood, and fertility preservation before the start of puberty suppression or gender-affirming hormone therapy (2025). Journal of Sexual Medicine, 22(5). source.
• Hembree, W.C. et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 102(11). source.
• Negenborn, V.L. et al. (2017). Lethal Necrotizing Cellulitis Caused by ESBL-Producing E. Coli after Laparoscopic Intestinal Vaginoplasty. Journal of Pediatric and Adolescent Gynecology, 30(1). source.
• Fox News. Influential trans care doctor once warned puberty blockers could cause permanent sexual dysfunction (reporting Marci Bowers' remarks). source.
• US Department of Health and Human Services (2025). Treatment for Gender Dysphoria: Report Appendix. source.