Supporting Kids Who Need Hormone Blockers
Legislation is popping up across the country in an effort to criminalize trans-affirming health care for youth. Although it’s unlikely that kids with precocious puberty will be impacted by anti-trans legislation, insurance issues can and will continue to impact all children. Trans youth are at increased risk for insurance mishaps, as insurance often fails to cover off-label prescriptions.
“The history of pathologizing trans identity forces trans people to interact with the medical community and receive a medical diagnosis in order to access the things that allow them to live the way they want to live,” says Dr. Jackson. “It means that we have to continue participating in the medicalization of the trans experience.”
Dr. Jackson adds, “As a medical doctor, I have a hard time envisioning it a different way. But as a trans person, I really wish it could exist in a different way.” It’s important, Dr. Jackson says, that caregivers work with medical professionals to destigmatize the use of blockers by avoiding pathologizing language. The reality is blockers could simply offer a helpful pause for kids experiencing unwanted puberty changes.
Sacharoff suggests parents can also talk to appropriate providers. “They’ve dealt with this before and can give parents all the information they need to understand what’s happening with their kid and how to better support their kid with whatever’s going on for them.”
*Last names have been withheld for privacy.
Symptoms Of Estrogen And Testosterone Imbalance
Changes to the ratio of estrogen and testosterone in the body can result in health problems for some people. For example, in people with late-onset hypogonadism, lower testosterone levels and an increase of androgens being converted to estradiol is associated with a number of health issues, including:
- Low-energy fractures
Aromatase excess syndrome is a rare genetic condition that results in higher levels of estrogen. It can affect some young men and lead to late childhood developmental symptoms. In addition to breast growth, the associated symptoms include:
- Quicker than normal physical development that stops sooner than others
New Evidence In Debate Over Testosterone Therapy
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Expert Critique
Testosterone therapy for transgender men is no more risky or complex than testosterone therapy for any other man.
Thats the essence of new study data published in the April issue of Endocrine Practice. Study authors arrived at their findings after examining the electronic medical records for 34 transgender men who received testosterone therapy at the Endocrinology Clinic at Boston Medical Center.
Scientists measured estradiol levels in transgender men over years of testosterone therapy. Some clinicians have historically viewed estrogen blockers as a means of mitigating risks related to testosterone therapy in this population, including bone loss and undesired cosmetic changes.
Findings have been mixed on the need for estrogen blockers as a counterweight to testosterone therapy. Authors of the new study, however, indicate that they are not necessary.
There has historically been a misconception that the treatment is more complicated than it is. This simplifies things substantially, said study co-author Joshua Safer, MD, an endocrinologist and executive director of the Center for Transgender Medicine and Surgery at Mount Sinai Health System in New York. Estrogen levels among testosterone-creating transgender men were about the same before they were treated, and sometimes a little bit lower.
Clinical Implications
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How Do They Work
Both puberty blockers are forms of gonadotropin-releasing hormone agonist.
According to one , when a person begins puberty, the hypothalamus in the brain begins producing gonadotropin-releasing hormones.
These hormones activate the pituitary gland, which triggers the release of further hormones, such as gonadotropins.
The gonadotropins cause the maturation of the gonads. This, in turn, produces and releases the sex hormones testosterone and estrogen from the testes and ovaries.
Histrelin acetate and leuprolide acetate prevent the pituitary gland from producing gonadotropins. This means that the body cannot produce the sex hormones that cause the physical effects of puberty.
A person can use puberty blocker medications for several weeks before noticing any effects.
Female To Male Transitioning
Those looking to transition to male will most likely go through masculinizing hormone therapy where the development of male secondary sex characteristics develops. General effects would include increased muscle mass, change in voice, growth of facial hair, a change in sweat and odor, a redistribution of fat, possible male pattern baldness, increased libido, clitoral growth, vaginal dryness, and cessation of menses.
All testosterone used in the U.S. are bioidentical, or chemically equivalent to naturally occurring testosterone. Testosterone is available by injection and topical preparations for those with low androgen levels. Because they are prepared for those with low, but not no testosterone higher doses may be needed for transgender care. The prior use of synthetic testosterone used by body builders have raised concern for negative hepatic effects testosterone my have on transgender men. Hepatic symptoms may include: the yellowing of skin and eyes , abdominal pain and swelling, swelling in the legs and ankles, itchy skin, dark urine color, pale stool color, chronic fatigue, nausea or vomiting, loss of appetite, and the tendency to bruise easily. If any of these symptoms occur, please advise the care team and provider.
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Ranking The Best Estrogen Blockers Of 2021
Estrogen blockers are supplements that counter the action of estrogen, the primary female sex hormone.
Theyre similar to testosterone boosters except they specifically address the blocking of estrogen.
It generally works in opposition to testosterone, meaning high levels of estrogen will cause you to gain fat, lose muscle mass, and, for men, lose their libido and sexual potency.
None of these are good things, especially if you are looking to get stronger and perform better as an athlete. Weve combed through a huge number of supplements to come up with the best estrogen blockers on the market.
Research
PrimeMale attacks the causes of low androgen levels and high estrogen levels on all fronts. First, it takes care of anything that could impair your testosterone levels with a strong dose of vitamin D, magnesium, and zinc.
Next, its got Asian ginseng, a powerful androgen booster, as well as aspartic acid, nettle root, and boron. The bioavailability of all of these ingredients is augmented by BioPerine, a proprietary black pepper extract.
This broad-based strategy to suppress estrogen and boost androgens makes PrimeMale our top pick.
TestoGen is a natural testosterone booster that has been getting some pretty amazing results. And yes, it is a natural T booster, but it works to block estrogen as well.
Hormone Blockers For Transgender People
Hormone blockers or hormone inhibitors are drugs that reduce or stop the effects of hormones in the body. Most work by stopping them from being absorbed, but some drugs slow or stop their production.
These drugs have been safely used for decades to control sexual maturation in youth who are not gender incongruent. They are used for the same purpose in gender incongruent youth. This allows youth to avoid an unwanted puberty and to delay decisions on further medical steps.
Adults take hormone blockers for a number of reasons, including as part of cancer treatment, for contraception, or as part of a gender transition.
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Gnrh Analogues: Advantages And Disadvantages
Gonadotropin-releasing hormone analogues, or GnRH analogues, are long-acting medications which can temporarily and reversibly âpress pauseâ on natural puberty. By acting on the pituitary gland, these puberty blockers prevent the release of chemical signals which stimulate the production of estrogen and testosterone, halting the changes of puberty caused by these sex hormones . In trans youth, puberty blockers are typically given at Tanner developmental stages 2 and 3, usually around ages 11 to 12. This allows more time for kids to consider whether they want to continue transitioning via cross-sex hormones and surgery, without the stress of ongoing unwanted pubertal development. Those who choose not to transition can stop taking blockers, and their original puberty will resume and progress normally.
Even in the UK where blockers are provided through the NHS, trans youth may have to wait 17 weeks for a first appointment, with some facing delays of 9 months:
Green said Mermaids had recently had calls from parents who had been told their child would have to wait nine months for an appointment at Tavistock.
âI spoke to one family who will have to wait until November ,â said Green. âThe mother was absolutely desperate because her daughter is 14, her daughterâs voice has started to break, facial changes and hair are around the corner, her Adamâs apple will become more pronounced. These are changes that will affect her for the rest of her life.â
Treatment For Children And Young People
If your child is under 18 and may have gender dysphoria, they’ll usually be referred to the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust.
GIDS has 2 main clinics in London and Leeds.
Your child or teenager will be seen by a multidisciplinary team at GIDS including a:
- clinical psychologist
- family therapist
The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.
Depending on the results of the assessment, options for children and teenagers include:
- group work for young people and their parents
- regular reviews to monitor gender identity development
- referral to a local Children and Young People’s Mental Health Service for more serious emotional issues
- a referral to a specialist hormone clinic for hormone blockers for children who meet strict criteria
Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.
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Without Help Of A Parent Or Guardian
It is better to get help from your family. That is the choice I hope you will make. These other options are often not as safe.
From a family planning clinic
- Planned Parenthood
- At this time, only some Planned Parenthood health centers have hormones for trans people. Even fewer can help young trans people. The best way to find out is to call your nearest Planned Parenthood health center.
- If you cannot get hormones, you may be able to get blood tests done. This can help if you are taking drugs without medical supervision.
From adult friends and peers
- You might ask a trusted friend or family member who is over 18 to help you. You will need to come out to them. There is a chance they might tell your family, so think hard before talking to someone.
- If you know trusted adults in your area who are making a gender change, you may be able to get one of them to help you.
- Do not ask people you meet online, even other people who say they are like you. Only ask people you have already met in person and trust.
- You can ask them to order what you want from an online pharmacy. Then you can pay them. They need to know this is probably against the law.
What Are Hormone Blockers
Hormone blockers, also called puberty blockers and puberty inhibitors when prescribed to children, treat a variety of health concerns, including cancers, across diverse populations. Puberty blockers often refer to a class of medications called gonadotropin-releasing hormone agonists, which suppress the body’s production of estrogen and testosterone by temporarily interrupting the release of GnRH by the hypothalamus in the brain. When a blocker is not in place, GnRH travels to the pituitary gland and stimulates it to make and release follicle-stimulating hormone and luteinizing hormone, which regulate processes in the reproductive system.
Hormone blockers are either given as an implant, which typically needs to be replaced every year , or as a shot every one, three, or six months. Children are usually prescribed blockers for short-term use once the early stages of puberty have startedânot as a preventative measure before that process begins. For both trans kids and those with precocious puberty, the goal is to temporarily prevent the unwanted progression of puberty.
Dr. Roberts explains that puberty-blocking medications do not permanently impact puberty. Treatment durations vary, but puberty progression generally resumes within six to 18 months after users stop the medication.
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The Harms Of Denying Care
Data suggest the effects of denying that care are worse than whatever side effects result from delaying sex-assigned-at-birth puberty. And medical society guidelines conclude that the benefits of gender-affirming care outweigh the risks. Without gender-affirming hormone therapy, cisgender hormones take over, forcing body changes that can be permanent and distressing.
A 2020 study of 300 gender-incongruent young people found that mental distressincluding self-harm, suicidal thoughts and depressionincreased as the children were made to proceed with puberty according to their assigned sex. By the time 184 older teens reached the stage in which transgender boys began their periods and grew breasts and transgender girls voice dropped and facial hair began to appear, 46 percent had been diagnosed with depression, 40 percent had self-harmed, 52 percent had considered suicide, and 17 percent had attempted itrates significantly higher than those of gender-incongruent children who were a median of 13.9 years old or of cisgender kids their own age.
But when the researchers analyzed the results based on the kind of gender-affirming care the teens had received, they found that those who had access to puberty blockers or gender-affirming hormones were 60 percent less likely to experience moderate to severe depression. And those with access to the medical treatments were 73 percent less likely to contemplate self-harm or suicide.
What Are The Risks
Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings. But doctors do not yet know how the drugs could affect factors like bone mineral density, brain development and fertility in transgender patients.
The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.
A handfulof studies have underscored low bone mineral density as a potential issue, though a 2020 study posited that low bone mineral density may instead be a pre-existing condition in transgender youth. Treatment with gender-affirming hormones may theoretically reverse this effect, according to Endocrine Society guidelines.
The impact of puberty blockers on brain development is similarly hazy. The Endocrine Society guidelines point to two studies: A small one published in 2015 showed that the drugs did not seem to impact executive functioning , while a 2017 study of rams treated with GnRH agonists suggested chronic use could harm long-term spatial memory.
The effects of puberty blockers are often referred to as fully reversible, including in both the Endocrine Society and WPATH guidelines, because of evidence showing that girls treated for precocious puberty were still able to undergo normal puberty and have children later in life.
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Start Eating Cruciferous Vegetables Often
Professional rugby players have mentioned how they will eat raw broccoli for breakfast for the benefits that they bring to reduce estrogens.
Other cruciferous vegetables such as Brussels sprouts, cauliflower, cabbage, bok choy and turnip greens contain high amounts of glucosinolates.
These are then converted by the body which in turn reduce estrogen levels.
These vegetables also include compounds such as DIM and Indole-3-carbinol which also readdress the balance of estrogen.
Thinking About The Body
On this page, we describe our approach to intervention and provide information about puberty and how to cope with it. We provide a staged approach to physical intervention that takes into account both physical and psychological development.
Many â although not all â adolescents we see consider at some point having physical interventions to change their bodies.
As well as many people who do start physical interventions, there are many people who choose not to do so â or who decide to wait a while.
We are commissioned by NHS England, who set the service specifications for how we work. The specification was updated in 2016 following extensive input from a wide range of stakeholders and the public, plus an independent review of available evidence.
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What Are Hormone Inhibitors And How Do They Work
Hormone inhibitors also target breast cancer cells with hormone receptors, but unlike hormone blockers, they work by reducing the bodys hormone production. When breast cancer cells are cut off from the food supply the tumor begins to starve and die.Generally, the benefits of using hormone therapy and chemotherapy together have a much greater combined effect than using either alone. If your breast cancer is positive for hormone receptors, your doctor may recommend both therapies.
Why Are Estrogen Blockers Being Used
Now, you may wonder why anyone would be interested in inhibiting and/or suppressing the production of such an important hormone, such as estrogen? Everything in our bodies is meant to have a certain balance.
Once that balance has been disturbed, for any reason whatsoever, you are bound to deal with some negative effects.
Higher than normal estrogen levels, in both men and women, is known as estrogen dominance. In women, this condition causes symptoms such as bloating, irregular menstrual periods, anxiety, weight gain, hair loss, low libido, etc.
In men, when there is too much estrogen in their bodies, their testosterone levels are affected. When this hormone balance has been disrupted, men struggle with symptoms such as infertility, erectile dysfunction, and a condition that leads to enlarged breasts called gynecomastia.
Too much estrogen can also increase the risk of stroke and heart disease, potentially causing a life-threatening condition. At times such as these, using a proper estrogen blocker is of vital importance. Not only will it help eliminate the symptoms, but it will also restore the hormone balance once again.
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