Puberty blockers, also called puberty inhibitors, are drugs used to postpone puberty in children. These drugs are called gonadotropin-releasing hormone (GnRH) agonists, and they inhibit the action of testosterone. Conditions treated by delaying puberty include treating children whose puberty started abnormally early (precocious puberty), children with idiopathic short stature to promote development of long bones and increase adult height, and transgender children, to stop the development of features that the child considered their wrong sex, with the intent to provide transgender youth more time to explore their identity.
Puberty blockers prevent the development of biological secondary sex characteristics. 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 for children and adolescents and the halting of female features of breast development and menstruation.
Research on the long term effects on brain development is limited, but a 2015 study published in Psychoneuroendocrinology observed the executive functioning in 20 transgender youth treated with puberty blockers compared to untreated youth with gender dysphoria and found that there was no difference in performance.
The medication that is used in order to stop puberty comes in two forms: injections or an implant.
The injections are leuprorelin made intramuscularly by a health professional. The patient may need it monthly (Lupron Depot, Lupron Depot-PED) or each 3, 4 or 6 months (Lupron Depot-3 month, Lupron Depot-PED-3 month, Lupron Depot-4 month, Lupron Depot-6 Month). Lupron Depot can cost from $700 to $1,500 a month depending on the country where it is practiced.
The implant is a small tube containing histrelin. The implant needs to be replaced every year, and is implanted subcutaneously in the upper arm. The doctor makes a small cut in the anesthetized skin of the patient and then inserts the implant. The patient must be careful after the operation to keep the cut clean, dry, and to not move the bandage and the surgical strips or stitches used to close the incision on the skin. The drug is then gradually released in the body during 12 months and it has to be replaced by another one later to continue the treatment. The total cost of histrelin treatment with the surgery is $15,000.
The combination of bicalutamide, an antiandrogen, and anastrozole, an aromatase inhibitor, can be used to suppress male puberty as an alternative to GnRH analogues, or in the case of gonadotropin-independent precocious puberty, such as in familial male-limited precocious puberty (also known as testotoxicosis) in boys, where GnRH analogues are ineffective.
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