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1. What are puberty blockers?

Puberty blockers are medicines that pause puberty. They lower the hormones (estrogen or testosterone) that cause many of the changes of puberty.​​

People sometimes call this the “pause button” on puberty. While the medicine is working, your body does not keep moving forward through those hormone-driven changes. When blockers are stopped, puberty starts again, based on your body’s own hormones or on gender-affirming hormones if you and your care team choose that.​​

2. Why might someone choose puberty blockers?

Puberty can be very upsetting for some transgender and gender-diverse youth, especially when their body starts to change in ways that do not match their gender. Puberty blockers can:

• Give more time and space to think about gender, without your body changing quickly.​​

• Reduce distress from things like chest growth, periods, voice changes, and facial hair.​​

• Sometimes lower the need for future surgeries to change or undo certain puberty changes.​​

Many studies show that youth who receive gender-affirming care, including puberty blockers when appropriate, often have lower depression and suicidal thoughts.

3. What changes do puberty blockers affect?

Puberty blockers mainly affect changes caused by estrogen and testosterone.​​

For people with ovaries and estrogen, blockers can pause or slow:​

• Chest/breast growth

• Changes in body shape (like fuller hips)

• Menstrual periods

For people with testicles and testosterone, blockers can pause or slow:​

• Testicle and penis growth

• Voice deepening

• Facial hair growth

Blockers do not fully stop pubic or underarm hair from growing and do not completely stop acne. You may still notice some of those changes over time.​

4. Are puberty blockers permanent?

No. Puberty blockers are not permanent.​​

• If you stop puberty blockers and do not start gender-affirming hormones, your body will go through puberty based on your own hormones.​

• If you later start gender-affirming hormones (like estrogen or testosterone), blockers may be continued for a while to support that transition.​​

Because of concerns about bone health, most experts do not recommend staying on blockers alone for more than a few years.​​

5. When can someone start puberty blockers?

Puberty blockers are only used after puberty has begun.​​

• For people with testicles, this is usually when testicles and penis start to grow.​

• For people with ovaries, this is usually when chest/breast “buds” appear.​

Before starting blockers, your provider will check for signs of puberty and may order morning blood tests and a physical exam. Blockers are most helpful early in puberty and may have fewer benefits if puberty is already complete.​

6. How do puberty blockers work and how long do they take?

Puberty blockers used for gender care are called GnRH analogues. They tell the brain to stop sending puberty signals (LH and FSH), which lowers estrogen or testosterone.​​

It usually takes 1–2 months for puberty blockers to have clear effects. In the beginning, some people notice a brief increase in puberty changes before things slow down.​

7. What types of puberty blockers are there?

Two common options are:​​

• Leuprolide (Depot Lupron or Eligard) injections

  • Given as a shot every 3 months in the arm, leg, or hip.​

  • The area can be sore for about a day afterward.​

• Histrelin (Supprelin) implant

  • A small plastic rod placed under the skin of the upper arm.​​

  • Works for at least a year, often up to about 18–24 months.​

  • Inserted and later removed in a brief procedure, with numbing medicine or anesthesia.​

Your team will talk with you about which option fits your body, your health, and your insurance situation.​​

8. What are the risks and side effects?

Every medicine has possible risks. With puberty blockers, the main long-term concern we watch is bone health.​​

• Blocking puberty can slow down how quickly bones get stronger.​

• Bone strength usually improves again after blockers are stopped or when gender-affirming hormones are started.​​

• Your provider may suggest calcium and vitamin D and recommend activities like walking, jumping, or light weightlifting to support bone health.​

• Sometimes a bone density scan (DEXA) is done every couple of years to check bone strength.​

Other things to know:​​

• The injection or implant site can be sore or bruised for a few days.

• Serious complications from the procedure are rare, but you should call the clinic if pain gets worse, or if there is redness, swelling, or fever.

Your team will talk with you about your own health history and any special risks before starting treatment.​​

9. What about fertility?

Puberty blockers by themselves are not expected to prevent someone from having biological children in the future.​​

However, fertility can be affected later if a person goes from puberty blockers into long-term gender-affirming hormones (like estrogen or testosterone). For that reason:​​

• Your provider will talk with you about possible effects on fertility before starting blockers and again before starting hormones.​​

• In some cases, families may want to talk about options for fertility preservation, depending on age, stage of puberty, and family values.

10. How long can someone stay on puberty blockers?

Puberty blockers are usually used until one of two things happens:​​

• You decide to let your body continue its own puberty.

• You are ready to start gender-affirming hormones.

Because of bone health concerns, many clinics do not recommend using puberty blockers alone (without hormones) for more than about 2–4 years. Your provider will check in regularly about how you are doing and what your goals are.​​

11. Are puberty blockers “approved” and supported by experts?

In the United States, the FDA has approved these medicines for children with very early (“precocious”) puberty, but not specifically for transgender or gender-diverse youth.​​

However, major medical organizations, including the Endocrine Society and the World Professional Association for Transgender Health (WPATH), support the careful use of puberty blockers as part of gender-affirming care for youth. These guidelines recommend thorough evaluation and ongoing monitoring.​​

12. How much do puberty blockers cost?

Puberty blockers can be expensive, and costs change over time.​​

• Some insurance plans cover injections but not implants, or vice versa.​

• Costs may be higher if the implant is placed with anesthesia in an operating room.​

Your clinic’s staff can help you:

• Check what your plan covers.

• Understand your deductible, copay, and coinsurance.

• Explore financial assistance options if available.​

13. How do therapy and family support fit in?

Most experts recommend that youth and families also work with a mental health therapist who has experience with gender-diverse youth.​​

• A therapist can help the teen and family talk through emotions, decisions, and changes.

• They can help parents learn how to support their child.

• Sometimes letters from therapists are required by doctors or insurance to start or continue gender-related care.​​

Family support, including using a young person’s name and pronouns, is strongly linked to better mental health and fewer suicide attempts in transgender and gender-diverse youth.

14. Questions to ask your provider

You and your teen might bring questions like:

• Why are puberty blockers being recommended in our situation?

• What changes should we expect in the first 3–6 months?

• How will you monitor bone health and overall safety?

• How long do you expect my teen to stay on blockers?

• What are our options for fertility in the future?

• Who do we contact if we notice side effects or have new concerns?

Bringing these questions to your appointments can help everyone feel more prepared and informed.​​

Puberty Blockers: Selected References and Further Reading

• OPA. Gender-Affirming Care and Young People. U.S. Office of Population Affairs, 2023.​

• Mayo Clinic. Puberty blockers for transgender and gender-diverse youth, 2026.​

• Turban JL et al. Pubertal suppression for transgender youth and mental health outcomes.

• Seattle Children’s. Puberty Blockers – Patient and Family Education, 2023.​