Puberty blocker

Page semi-protected
From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by Mrmariomaster (talk | contribs) at 10:28, 31 August 2022 (Removed US-centric sentence). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

"Hormone blocker" redirects here. For testosterone blockers, see Antiandrogen. For estrogen blockers, see Aromatase inhibitor.

Puberty blockers, also called puberty inhibitors or hormone blockers, are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the production of sex hormones, including testosterone and estrogen.[1][2][3] In addition to their various other medical uses, puberty blockers are used for transgender children to delay the development of unwanted sex characteristics,[4] so as to allow transgender youth more time to explore their identity.[5]

Medical uses

Delaying or temporarily suspending puberty is a medical treatment for children whose puberty started abnormally early (precocious puberty). Puberty blockers are also commonly used for children with idiopathic short stature, for whom these medications can be used to promote development of long bones and increase adult height.[6] In adults, the same drugs are used to treat endometriosis[7] and prostate cancer.[8] Puberty blockers have been used on-label since the 1980s to treat precocious puberty in children.[9] Puberty blockers prevent the development of biological secondary sex characteristics.[10] They slow the growth of sexual organs and production of hormones. Other effects include the suppression of male features of facial hair, deep voices, and Adam's apples, and the halting of female features of breast development and menstruation.

Puberty blockers are sometimes prescribed to young transgender people, to temporarily halt the development of secondary sex characteristics.[4] Puberty blockers allow patients more time to solidify their gender identity, without developing secondary sex characteristics.[5] If a child later decides not to transition to another gender the medication can be stopped, allowing puberty to proceed. Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although puberty blockers are known to be safe and physically reversible treatment if stopped in the short term, it is also not known whether hormone blockers affect the development of the factors like bone mineral density, brain development and fertility in transgender patients.[11][12][13][14] Puberty blockers give transgender youth a smoother transition into their desired gender identity as an adult.[5]

While few studies have examined the effects of puberty blockers for gender non-conforming or transgender adolescents, the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals,[15][16][17] and an association has been found between puberty blockers and decreased lifetime suicidality.[11] A 2020 UK Department of Health and Social Care commissioned review found that the quality of evidence was of very low certainty for puberty blocker outcomes regarding mental health, quality of life and impact on gender dysphoria.[18] A 2022 study published in the Journal of the American Medical Association found a 73% reduction in suicidality among transgender youth aged 13-20 who took puberty blockers and gender-affirming hormones over a 12-month follow-up.[19]

A review published in Child and Adolescent Mental Health found that puberty blockers are reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.[20]

The longest follow-up study followed a transgender man who began taking puberty blockers at age 13 in 1988, before later taking hormone treatments, and later gender confirmation surgery. His health was monitored for 22 years and at age 35 in 2010 was well-functioning, in good physical health with normal metabolic, endocrine, and bone mineral density levels. There were no clinical signs of a negative impact on brain development from taking puberty blockers [21]

Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches and changes in breast tissue, mood, and weight.[22]

Adverse effects on bone mineralization and compromised fertility are potential risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists.[16][23] To protect against lower bone density, doctors recommend exercise, calcium, and Vitamin D.[24] Additionally, genital tissue in transgender women may not be optimal for potential vaginoplasty later in life due to underdevelopment of the penis.[25]

Research on the long-term effects on brain development is limited.[26][27]

According to the FDA, there have been six cases of idiopathic intracranial hypertension in 5 to 12-year-old girls taking puberty blockers.[28]

Available forms

A number of different puberty blockers are used.[29][30] These include the GnRH agonists buserelin, histrelin, leuprorelin, nafarelin, and triptorelin.[29][30] GnRH agonists are available and used as daily subcutaneous injections, depot subcutaneous or intramuscular injections lasting 1 to 6 months, implants lasting 12 months, and nasal sprays used multiple times per day.[29][30] GnRH antagonists are also expected to be effective as puberty blockers but have not yet been widely studied or used for this purpose.[29][31] Progestogens used at high doses such as medroxyprogesterone acetate and cyproterone acetate have been used as puberty blockers in the past or when GnRH agonists are not possible.[29] They are not as effective as GnRH agonists and have more side effects.[29] The antiandrogen bicalutamide has been used as an alternative puberty blocker in transgender girls for whom GnRH agonists were denied by insurance.[32][33]

Centrally acting puberty blockers such as GnRH agonists are ineffective in peripheral precocious puberty, which is gonadotropin-independent.[34] In this situation, direct inhibitors of sex hormone action and/or synthesis must be employed instead.[34] Treatment options for peripheral precocious puberty in girls, such as in McCune–Albright syndrome, include ketoconazole, the aromatase inhibitors testolactone, fadrozole, anastrozole, and letrozole, and the antiestrogens tamoxifen and fulvestrant.[34] Treatment possibilities for peripheral precocious puberty in boys, such as in familial male-limited precocious puberty, include the antiandrogens bicalutamide, spironolactone, and cyproterone acetate, ketoconazole, and the aromatase inhibitors testolactone, anastrozole, and letrozole.[34]

Legal and political challenges

There is criticism regarding issues of informed consent and limited research support for the use of puberty blockers on transgender children.[35][36][37][38][excessive citations] The Endocrine Society Guidelines call for more rigorous safety and effectiveness evaluations and careful assessment of "the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development)."[17]

Some opponents of the use of puberty blockers argue that minors are not able to give proper consent.[39] Some advocates for the use of puberty blockers consider the psychological and developmental benefits of puberty blockers compelling enough to overlook the issue of informed consent in many cases.[40] Consent is often achieved after extensive analysis and counseling.[41] A 2021 editorial in The Lancet Child & Adolescent Health stated "Disproportionate emphasis is given to young people’s inability to provide medical consent, a moot point given that—like any medical care—parental consent is required. ... what matters ethically is whether an individual has a good enough reason for wanting treatment", and that "Social conservatives in the USA, UK, and Australia frame gender-affirming care as child abuse and medical experimentation. This stance wilfully ignores decades of use of and research about puberty blockers and hormone therapy".[42]

Bioethicist Maura Priest contends that, even in the absence of parental permission, the use of puberty blockers could mitigate any adverse effects on familial relationships within the home of a transgender child. She posits that there are benefits to having access to puberty blockers, while psychological costs are often associated with untreated gender dysphoria in children.[40] Bioethicist Florence Ashley adds that counseling and educating the parents of transgender youth could also be beneficial to familial relationships.[43]

Michael Biggs has said that studies on the effects of puberty blockers on transgender children lack transparency or validity.[39][44] Opponents express concern over validation of a child's gender dysphoria; however, research has shown that treatment with puberty blockers prevents harmful behavior[vague] and does not increase gender dysphoria.[25] Research has suggested that the use of puberty blockers decreases the risk of depression and contributes to the mitigation of behavioral issues.[25] Opponents to the use of puberty blockers have argued that puberty blockers encourage children to go through with hormone replacement therapy and gender reassignment surgery. A study regarding the long term effects of puberty blockers found that, upon later assessment, subjects did not regret transitioning and were less likely to experience depression in early adulthood.[25]

Opponents of the use of puberty blockers in adolescents argue that gender identity is still fluctuating at this age and that blockers might interfere with gender identity formation and development of a free sexuality, as well as pointing to what they consider to be high rates of desistance after puberty.[25]  Almost all (98%) children who took puberty blockers in a significant recent study by the main UK child/adolescent gender clinic continued on to hormone replacement therapy.[45] Similarly, most reviews[17][25] noting psychological benefits refer to the classic Dutch study[27] which had very stringent requirements for medical treatment.[46]

In April 2021, Arkansas passed a ban on treatment of minors under 18 with puberty blockers, but it was temporarily blocked by a federal judge a week before the law was set to take effect.[47][48] In April 2022, Alabama passed a ban from minors under 19 from obtaining puberty blockers and made it a felony for a doctor to prescribe puberty blockers to a minor with a punishment of up to ten years in prison.[49] The Alabama law was partially blocked by a federal judge a few days after the law took effect.[50][51] In August 2022, Florida banned Medicaid from covering gender affirming care, including puberty blockers.[52]

Efforts to ban puberty blockers are opposed by the American Medical Association,[53] the American Academy of Child and Adolescent Psychiatry (AACAP),[54] the American Academy of Pediatrics,[55] the American Psychiatric Association,[56] the Endocrine Society,[57] the American College of Obstetricians and Gynecologists,[58] the American Psychological Association,[59] and the World Professional Association for Transgender Health (WPATH).[60] In Australia, the Royal Australasian College of Physicians, the Royal Australian College of General Practitioners, the Australian Endocrine Society, and AusPATH also all support access.[61] In the UK, the British Medical Association supports access.[62]

Medical organization policy changes

On June 30, 2020, the British National Health Service changed the information it displayed on its website regarding the reversibility of the effects of puberty blockers and their use in the treatment of minors with gender dysphoria, according to a report by BBC's Woman's Hour.[63] Specifically, the NHS removed "the effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time after a discussion between you, your child and your MDT (multi-disciplinary team)," and added "little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although the Gender Identity Development Service (GIDS) advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be. It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones. Side effects may also include hot flushes, fatigue and mood alterations."[63]

In Europe, some medical groups have discouraged or limited the use of puberty blockers.[64] Following the Bell v Tavistock decision by the High Court of Justice for England and Wales, in which the High Court ruled children under 16 were not competent to give informed consent to puberty blockers — overturned by the Court of Appeal in September 2021 — Sweden's Karolinska Institute, administrator of the second-largest hospital system in the country, announced in March 2021 that it would discontinue providing puberty blockers or cross-sex hormones to children under 16. Additionally, the Karolinska Institute changed its policy to cease providing puberty blockers or cross-sex hormones to teenagers 16–18, outside of approved clinical trials.[65] On February 22, 2022, Sweden's National Board of Health and Welfare said that puberty blockers should only be used in "exceptional cases" and said that their use is backed by "uncertain science".[66]

Public opinion

A February 2022 poll by Morning Consult found that 52 percent of American adults support transgender minors having access to puberty blockers.[67]

References

  1. ^ Hemat RA (2 March 2003). Andropathy. Urotext. pp. 120–. ISBN 978-1-903737-08-8.
  2. ^ Becker KL (2001). Principles and Practice of Endocrinology and Metabolism. Lippincott Williams & Wilkins. pp. 973–. ISBN 978-0-7817-1750-2.
  3. ^ "Pubertal blockers for transgender and gender diverse youth". Mayo Clinic. 16 August 2019. Retrieved 15 December 2020.
  4. ^ a b Stevens J, Gomez-Lobo V, Pine-Twaddell E (December 2015). "Insurance Coverage of Puberty Blocker Therapies for Transgender Youth". Pediatrics. 136 (6): 1029–31. doi:10.1542/peds.2015-2849. PMID 26527547.
  5. ^ a b c Alegría CA (October 2016). "Gender nonconforming and transgender children/youth: Family, community, and implications for practice". Journal of the American Association of Nurse Practitioners. 28 (10): 521–527. doi:10.1002/2327-6924.12363. PMID 27031444. S2CID 22374099.
  6. ^ Watson SE, Greene A, Lewis K, Eugster EA (June 2015). "Bird's-eye view of GnRH analog use in a pediatric endocrinology referral center". Endocrine Practice. 21 (6): 586–9. doi:10.4158/EP14412.OR. PMC 5344188. PMID 25667370.
  7. ^ "Current treatments for endometriosis". Mayo Clinic.
  8. ^ Panday K, Gona A, Humphrey MB (October 2014). "Medication-induced osteoporosis: screening and treatment strategies". Therapeutic Advances in Musculoskeletal Disease. 6 (5): 185–202. doi:10.1177/1759720X14546350. PMC 4206646. PMID 25342997.
  9. ^ Helyar, Sinead; Jackson, Laura; Patrick, Leanne; Hill, Andy; Ion, Robin (May 2022). "Gender Dysphoria in children and young people: The implications for clinical staff of the Bell V's Tavistock Judicial Review and Appeal Ruling". Journal of Clinical Nursing. 31 (9–10): e11–e13. doi:10.1111/jocn.16164. PMID 34888970. S2CID 245029743.
  10. ^ Boyar RM (November 2003). "Control of the onset of puberty". Annual Review of Medicine. 29: 509–20. doi:10.1146/annurev.me.29.020178.002453. PMID 206190.
  11. ^ a b Rew, Lynn; Young, Cara C.; Monge, Maria; Bogucka, Roxanne (February 2021). "Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature". Child and Adolescent Mental Health. 26 (1): 3–14. doi:10.1111/camh.12437. ISSN 1475-357X. PMID 33320999. S2CID 229282305.
  12. ^ Murchison G, Adkins D, Conard LA, Elliott T, Hawkins LA, Newby H, et al. (September 2016). Supporting and Caring for Transgender Children (PDF) (Report). American Academy of Pediatrics. p. 11. To prevent the consequences of going through a puberty that doesn't match a transgender child's identity, healthcare providers may use fully reversible medications that put puberty on hold.
  13. ^ "Gender dysphoria - Treatment". nhs.uk. 3 October 2018. Retrieved 31 March 2022.
  14. ^ Wilson, Lena (11 May 2021). "What Are Puberty Blockers?". The New York Times. ISSN 0362-4331. Retrieved 31 March 2022.
  15. ^ Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A (October 2017). "Puberty suppression in transgender children and adolescents". The Lancet Diabetes & Endocrinology. 5 (10): 816–826. doi:10.1016/s2213-8587(17)30099-2. PMID 28546095. The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits.
  16. ^ a b Rafferty J (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam's apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.
  17. ^ a b c Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902. Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains", "In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols. Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development);
  18. ^ "Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria". 2020. Retrieved 1 April 2021. The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE.{{cite web}}: CS1 maint: url-status (link)
  19. ^ Tordoff, Diana M.; Wanta, Jonathon W.; Collin, Arin; Stepney, Cesalie; Inwards-Breland, David J.; Ahrens, Kym (25 February 2022). "Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care". JAMA Network Open. 5 (2): e220978. doi:10.1001/jamanetworkopen.2022.0978.
  20. ^ Rew, Lynn; Young, Cara; Monge, Maria; Bogucka, Roxanne (2021). "Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature". Child and Adolescent Mental Health. 26 (1): 3–14. doi:10.1111/camh.12437. PMID 33320999. S2CID 229282305. Archived from the original on 20 May 2022. Retrieved 5 June 2022. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.
  21. ^ https://pubmed.ncbi.nlm.nih.gov/21503817/
  22. ^ "Puberty Blockers". www.stlouischildrens.org. Retrieved 18 August 2022.
  23. ^ Bangalore Krishna, Kanthi; Fuqua, John S.; Rogol, Alan D.; Klein, Karen O.; Popovic, Jadranka; Houk, Christopher P.; Charmandari, Evangelia; Lee, Peter A.; Freire, A. V.; Ropelato, M. G.; Yazid Jalaludin, M. (2019). "Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium". Hormone Research in Paediatrics. 91 (6): 357–372. doi:10.1159/000501336. ISSN 1663-2826. PMID 31319416. GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation, and currently there are no proven methods to preserve fertility in early pubertal transgender adolescents.
  24. ^ "What Are Puberty Blockers?".
  25. ^ a b c d e f Giovanardi G (September 2017). "Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents". Porto Biomedical Journal. 2 (5): 153–156. doi:10.1016/j.pbj.2017.06.001. PMC 6806792. PMID 32258611.
  26. ^ Rosenthal SM (December 2016). "Transgender youth: current concepts". Annals of Pediatric Endocrinology & Metabolism. 21 (4): 185–192. doi:10.6065/apem.2016.21.4.185. PMC 5290172. PMID 28164070. The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.
  27. ^ a b de Vries AL, Cohen-Kettenis PT (2012). "Clinical management of gender dysphoria in children and adolescents: the Dutch approach". Journal of Homosexuality. 59 (3): 301–20. doi:10.1080/00918369.2012.653300. PMID 22455322. S2CID 11731779.
  28. ^ "Risk of pseudotumor cerebri added to labeling for gonadotropin-releasing hormone agonists". publications.aap.org. 1 July 2022. Retrieved 18 August 2022.
  29. ^ a b c d e f Tuvemo T (May 2006). "Treatment of central precocious puberty". Expert Opin Investig Drugs. 15 (5): 495–505. doi:10.1517/13543784.15.5.495. PMID 16634688. S2CID 34018785.
  30. ^ a b c Eugster EA (May 2019). "Treatment of Central Precocious Puberty". J Endocr Soc. 3 (5): 965–972. doi:10.1210/js.2019-00036. PMC 6486823. PMID 31041427.
  31. ^ Roth C (September 2002). "Therapeutic potential of GnRH antagonists in the treatment of precocious puberty". Expert Opin Investig Drugs. 11 (9): 1253–9. doi:10.1517/13543784.11.9.1253. PMID 12225246. S2CID 9146658.
  32. ^ Rosenthal SM (October 2021). "Challenges in the care of transgender and gender-diverse youth: an endocrinologist's view". Nat Rev Endocrinol. 17 (10): 581–591. doi:10.1038/s41574-021-00535-9. PMID 34376826. S2CID 236972394.
  33. ^ Neyman A, Fuqua JS, Eugster EA (April 2019). "Bicalutamide as an Androgen Blocker With Secondary Effect of Promoting Feminization in Male-to-Female Transgender Adolescents". J Adolesc Health. 64 (4): 544–546. doi:10.1016/j.jadohealth.2018.10.296. PMC 6431559. PMID 30612811.
  34. ^ a b c d Schoelwer M, Eugster EA (2016). "Treatment of Peripheral Precocious Puberty". Endocr Dev. Endocrine Development. 29: 230–9. doi:10.1159/000438895. ISBN 978-3-318-02788-4. PMC 5345994. PMID 26680582.
  35. ^ Richards C, Maxwell J, McCune N (June 2019). "Use of puberty blockers for gender dysphoria: a momentous step in the dark". Archives of Disease in Childhood. 104 (6): 611–612. doi:10.1136/archdischild-2018-315881. PMID 30655265. S2CID 58613069.
  36. ^ Bannerman L (26 July 2019). "Use of puberty blockers on transgender children to be investigated". The Times.
  37. ^ Holt A (7 October 2020). "Children not able to give 'proper' consent to puberty blockers, court told". BBC News Online. Retrieved 14 December 2020.
  38. ^ "Little is known about the effects of puberty blockers". The Economist. 18 February 2021. ISSN 0013-0613. Retrieved 25 March 2021.
  39. ^ a b Cohen D, Barnes H (September 2019). "Gender dysphoria in children: puberty blockers study draws further criticism". BMJ (Clinical Research Ed.). 366: l5647. doi:10.1136/bmj.l5647. PMID 31540909. S2CID 202711942.
  40. ^ a b Priest M (February 2019). "Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm". American Journal of Bioethics. 19 (2): 45–59. doi:10.1080/15265161.2018.1557276. PMID 30784385. S2CID 73456261.
  41. ^ Butler G, Wren B, Carmichael P (June 2019). "Puberty blocking in gender dysphoria: suitable for all?". Archives of Disease in Childhood. 104 (6): 509–510. doi:10.1136/archdischild-2018-315984. PMID 30655266. S2CID 58539498.
  42. ^ The Lancet Child & Adolescent Health (14 May 2021). "A flawed agenda for trans youth". The Lancet Child & Adolescent Health. 5 (6): 385. doi:10.1016/S2352-4642(21)00139-5. ISSN 2352-4642. PMID 34000232.
  43. ^ Ashley F (February 2019). "Puberty Blockers Are Necessary, but They Don't Prevent Homelessness: Caring for Transgender Youth by Supporting Unsupportive Parents". American Journal of Bioethics. 19 (2): 87–89. doi:10.1080/15265161.2018.1557277. PMID 30784386. S2CID 73478358.
  44. ^ Biggs M (October 2020). "Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria". Archives of Sexual Behavior. 49 (7): 2227–2229. doi:10.1007/s10508-020-01743-6. PMC 8169497. PMID 32495241. S2CID 219314661.
  45. ^ Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, et al. (February 2021). "Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK". PLOS One. 16 (2): e0243894. Bibcode:2021PLoSO..1643894C. doi:10.1371/journal.pone.0243894. PMC 7853497. PMID 33529227. We found no evidence of change in psychological function with GnRHa treatment as indicated by parent report (CBCL) or self-report (YSR) of overall problems, internalising or externalising problems or self-harm. This is in contrast to the Dutch study which reported improved psychological function across total problems, externalising and internalising scores for both CBCL and YSR and small improvements in CGAS [24].
  46. ^ Zucker KJ (October 2019). "Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues". Archives of Sexual Behavior. 48 (7): 1983–1992. doi:10.1007/s10508-019-01518-8. PMID 31321594. S2CID 197663705. According to Cohen-Kettenis, Delemarre-van de Waal, and Gooren (2008), these included the following: (1) the presence of gender dysphoria from early childhood on; (2) an exacerbation of the gender dysphoria after the first signs of puberty; (3) the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment; (4) adequate psychological and social support during treatment; and (5) a demonstration of knowledge of the sex/gender reassignment process.
  47. ^ "Arkansas Lawmakers Override Veto, Enact Transgender Youth Treatment Ban". 6 April 2021.
  48. ^ "A Federal Judge Blocks Arkansas Ban On Trans Youth Treatments". NPR. Associated Press. 21 July 2021. Retrieved 17 July 2022.
  49. ^ "Judge blocks Alabama's felony ban on transgender medication for minors". NBC News.
  50. ^ Rojas, Rick (8 April 2022). "Alabama Governor Signs Ban on Transition Care for Transgender Youth". The New York Times. ISSN 0362-4331. Retrieved 17 July 2022.
  51. ^ Tierney Sneed (14 May 2022). "Judge blocks Alabama restrictions on certain gender-affirming treatments for transgender youth". CNN. Retrieved 17 July 2022.
  52. ^ "Florida bans Medicaid from covering gender-affirming treatments". Politico.
  53. ^ "March 26, 2021: State Advocacy Update".
  54. ^ "AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse".
  55. ^ Wyckoff, Alyson Sulaski (6 January 2022). "AAP continues to support care of transgender youths as more states push restrictions". American Academy of Pediatrics.
  56. ^ "Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth" (PDF). psychiatry.org. Retrieved 28 August 2022.
  57. ^ "Endocrine Society opposes legislative efforts to prevent access to medical care for transgender youth". 15 April 2021.
  58. ^ "Frontline Physicians Oppose Legislation That Interferes in or Penalizes Patient Care".
  59. ^ https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care [dead link]
  60. ^ "With Date Position Statement Anti Trans Leg USPATH Apr 22 2022" (PDF). WPATH. 22 April 2022. Retrieved 28 August 2022.
  61. ^ "Legal".
  62. ^ "Push for progress on transgender rights in healthcare".
  63. ^ a b "Women and Gaming; ICU nurse Dawn Bilbrough; Poulomi Basu; Puberty blockers". Woman's Hour. 30 June 2020. Retrieved 1 November 2021.
  64. ^ "Questioning America's approach to transgender health care". The Economist. 28 July 2022. Retrieved 6 August 2022.
  65. ^ "Doubts are growing about therapy for gender-dysphoric children". The Economist. 13 May 2021. Retrieved 2 November 2021.
  66. ^ Milton, Josh (23 February 2022). "Swedish health board wants doctors to stop prescribing life-saving puberty blockers". PinkNews. Retrieved 18 August 2022.
  67. ^ "Poll: Majority of U.S. Adults Oppose Anti-LGBTQ Education Policies, Agree that Transgender Youth Should Have Access to Gender-Affirming Care". The Trevor Project. 30 March 2022. Retrieved 30 August 2022.

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Puberty_blocker&oldid=1107691475"