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Why are puberty blockers making headlines?
Alberta Premier Danielle Smith made headlines last month when she announced proposed policy changes that would impact the province's transgender community.
In a Jan. 31 video posted to X, formerly Twitter, Smith announced that "on the issue of gender reassignment treatments," Albertans 17 and under will not be permitted to receive top or bottom surgeries. In addition, for minors age 15 and under, "puberty blockers and hormone therapies for the purpose of gender reassignment or affirmation will also not be permitted." Smith did note, an exception would be made for those who have already begun treatment.
The proposed guidelines would permit 16 and 17-year-old minors to have access to puberty blockers and hormone therapies "so long as they are deemed mature enough to make these decisions and have parental, physician and psychologist approval."
In a Feb. 1 news conference, Smith addressed transgender youths, and said that the proposed changes were "to protect the choices you have regarding altering your physical body until after you've grown mature enough t make such choices safely and with a full understanding of what that means for the rest of your life."
What are puberty blockers?
Puberty blockers are medications that postpone the onset of puberty-related changes by suppressing gonadotropin-releasing hormones (GnRH), which help gonads mature and function.
In people born male, GnRH helps stimulate the production of Luteinizing hormone, which affects how much testosterone and androgen the body produces, and the follicle-stimulating hormone, which affects sperm production. When put on puberty blockers, physical changes in appearance, such as developing facial hair, voice deepening and growth of the reproductive organs, are slowed.
These delays are temporary and are only limited so long as the person continues taking puberty blockers.
There are criteria that must be met for teens to have access to puberty blockers, including guardian consent. In terms of puberty blockers for gender dysphoric teens, the earlier someone can begin taking medications, the more effective they are in preventing bodily changes. From a mental health standpoint, this helps limit the extreme anguish a person can feel when their body does not match their identity.
Puberty blockers are not just used for non-binary, trans or gender non-conforming people. Sometimes puberty blockers are given to young children who experience "precocious puberty," meaning they develop or begin maturing at a very young age. For girls, that means they begin developing breasts or menstruating at 8 years old; for boys they begin developing facial hair, penis and testicle growth at 9 years old.
Some parents may choose to "delay" puberty as a way to ease the anxiety, depression and mental stress associated with early development.
Are there side effects to puberty blockers?
According to the Mayo Clinic, possible side effects to receiving GnRH analogue treatment may include weight gain, mood changes and headaches. The medication may have long-term effects on growth spurts, fertility (depending on when the medication is started) and bone growth.
Bone density is a concern for people who take puberty blockers for long periods of time. Physicians may routinely check bone density and require people to take calcium supplements while taking the medication.
What's the difference between puberty blockers and hormone replacement therapy?
Puberty blockers suppress the hormones of the sex you were assigned at birth. For example, if you were born male, puberty blockers will suppress the changes that impact males during puberty. Hormone replacement therapy provides the body with the hormones and secondary sex characteristics of the gender you identify with. The same person who was born male but identifies as female (transfeminine) would receive hormone replacement therapy for estrogen and an androgen blocker.
Do other provinces prohibit access to puberty blockers?
No. If the proposed policies are passed, Alberta would be the first province to prohibit access to puberty blockers to people age 15 and under.
Support for Smith's proposed changes
“We should protect children and their ability to make adult decisions when they’re adults,” Pierre Poilievre, leader of the Conservative Party of Canada, told reporters.
When asked if he is opposed to the use of puberty blockers on children, Poilievre said, "Yes."
"Trans kids are five times more likely in this country to attempt suicide. What Mr. Poilievre and Ms. Smith are proposing is to take away the rights of parents and their kids to make the right choices for them with their doctors," — Prime Minister Justin Trudeau to reporters.
"I know there are many Albertans watching Danielle Smith’s new policy and feeling scared for their future. There is no doubt that these policies will hurt kids and their families. It is the lowest kind of politics to harm vulnerable people.Leaders should bring people together, not divide. Protect and defend everyone’s rights - not cause harm for political gain. Provide education and understanding - not spread lies," — NDP leader Jagmeet Singh to X (formerly Twitter).
"I don't see 'MD' after Pierre Poilievre's name, or Danielle Smith's. So not their business," he said. "It's irresponsible. It's dangerous. Trans rights are human rights, and everybody who values their human rights should be questioning Pierre Poilievre, and why he's siding with Danielle Smith," — Randy Boissonnault, Employment Minister, told reporters.
From the LGBTQIA2S+ Community
“Any proposal regarding the health and welfare of transgender children needs to include medical advice, and involve consultation with all concerned parties; teachers, social workers, families, legal professionals, and most importantly the transgender community. Instead, the UCP’s proposal interferes with Candians’ protected charter rights and runs contrary to the evidence-based medical practices and research over the past 80 years," — joint statement from 47 LGBTQIA2S+ advocacy groups in Alberta posted to X (formerly Twitter)
“If the premier had genuine concerns about the existing healthcare protocols and practices, a responsible government would have said, ‘We’re going to do a systemic review. We’re going to go and chat with a bunch of doctors. This is about government intervention, and putting their government between your family and the healthcare your kid needs," — Fae Johnstone, executive director of Wisdon2Action and Momentum, in an interview with Xtra Magazine.
From a medical standpoint
"If you deprive someone of blockers until they're 18, you have made an irreversible decision yourself by forcing a child to go through puberty and forcing them to have body changes that are anathema to them," — Dr. Daniel Metzger, a pediatric endocrinologist at BC Children's Hospital, in an interview with CTV News.
"The misinformation out there is really astounding. It gets worrying when our politicians take up some ideas without actually vetting the accuracy of what they're saying," — Elizabeth Saewyc, a professor at the University of British Columbia's school of nursing, in an interview with CTV.
What international medical professionals have said about puberty blockers
When Arkansas became the first U.S. state to ban gender-affirming care for minors, experts spoke out about the use and benefit of puberty blockers. The decision to deny gender-affirming care was overturned in 2023.
"Puberty blockers allow transgender kids to really be able to navigate situations without worrying about what their body looks like as soon as puberty becomes part of the picture,”—Dr. Samantha Busa, a psychologist and clinical director of the gender and sexuality service at the Child Study Center at Hassenfeld Children’s Hospital at NYU Langone, in an interview with TODAY in 2021.
“There’s going to be a price. And the price is probably going to be some deficit in skeletal mass," — Dr. Sundeep Khosla, who runs the Osteoporosis and Bone Biology Lab at the Mayo Clinic, in a 2022 interview with the New York Times about the possible long term effects of puberty blockers
"It's not just me as a medical provider deciding 'You know what, you're good to go. We follow guidelines. The young person likely has seen a mental health provider who has expertise in gender identity ... There's oftentimes a social worker ... I certainly work with the parents, the parents need to be on board. It very much is a collaborative, multidisciplinary approach to care, rooted in science and data," —Dr. Caroline Salas-Humara, a pediatrician at NYU Langone in an interview with TODAY in 2021.
“Medications are rarely without side effects. That is usually not enough of a reason to allow a child, who is telling you that they’re extremely distressed by the pubertal changes that they’re seeing, to continue going through puberty....Knowing what we do know, these medications have enormous benefits for the population that we care for,” — Dr. Jessica Kremen, a pediatric endocrinologist for Boston Children’s Hospital’s Gender Multispecialty Service, in a 2021 interview with The New York Times.
“If the brain is expecting to receive those hormones at a certain time and doesn’t, what happens? We don’t know," — Dr. Sheri Berenbaum, head of a gender research lab at Penn State, in a 2021 interview with the New York Times on the long term impact of taking puberty blockers.