Puberty blocker

Puberty blockers, also called puberty inhibitors, puberty suppressors, or hormone suppressors, are a group of medications used to inhibit puberty. They were originally used to treat children with precocious puberty or other such early onset of puberty. Puberty blockers slow the growth of sexual organs and production of hormones. Other effects include the suppression of facial hair, deep voices, and Adam's apples for boys and the halting of breast growth and menstruation in girls.[1]

They have been used by transgender children. Children can be prescribed puberty blockers, with their parent's permission, by an endocrinologist, usually after psychiatric or mental health evaluations. Puberty blockers take the form of a monthly injection. Currently, treatment including puberty blockers are not worldwide.

Medications

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). Depot Lupron 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 has 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 inserts the implant. The patient must be careful after the operation to keep the cut clean, dry, and not to move the bandage and the surgical strips or stitches used to close the incision on the skin. The drug is then gradually being 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.

Initiating the treatment early for a child who experiences gender dysphoria has greatest effect; the body of the patient is less developed and later, the need for surgery such as mastectomy or “reduction thyroid chondroplasty and voice modification therapy” is avoided. There is as well fewer chances of regrets if the operation does not produce good results. Also, the patient will psychologically feel better about their transformation if they have not already seen the secondary sexual characteristics on their body representing what they consider the wrong gender.[2][3][4]

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.[5][6]

References

  1. ↑ "Puberty blocker for children considering sex change- Telegraph Online"
  2. ↑ "Histrelin Implant". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 October 2014.
  3. ↑ "Leuproline Injection". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 October 2014.
  4. ↑ Allen, Heidi; Blenning, Carol; Rindel, Sheryl; Selva, Karin; Burleton, Jenn. "Puberty Blocking and Hormone Therapy Needs of Transgender Adolescents" (PDF). www.TransActiveOnline.org. Retrieved 23 October 2014.
  5. ↑ Kreher NC, Pescovitz OH, Delameter P, Tiulpakov A, Hochberg Z (Sep 2006). "Treatment of familial male-limited precocious puberty with bicalutamide and anastrozole". The Journal of Pediatrics. 149 (3): 416–20. doi:10.1016/j.jpeds.2006.04.027. PMID 16939760.
  6. ↑ Reiter EO, Mauras N, McCormick K, Kulshreshtha B, Amrhein J, De Luca F, O'Brien S, Armstrong J, Melezinkova H (Oct 2010). "Bicalutamide plus anastrozole for the treatment of gonadotropin-independent precocious puberty in boys with testotoxicosis: a phase II, open-label pilot study (BATT)". Journal of Pediatric Endocrinology & Metabolism. 23 (10): 999–1009. doi:10.1515/jpem.2010.161. PMID 21158211.

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