Assessing readiness for medical puberty suppressants

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Assessing readiness for medical puberty suppressants

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One of the most exciting things that's come up that's new in the last decade for care of transgender people who desire to undergo sexual reassignment is the emergence of hormones that suppress the natural progress of puberty. So we're talking about that a young person as they go through puberty will go through the puberty that's dictated by their genitals, by their gonads, either male or female. But the exciting thing is in both male and female bodied people, we can give them medications that stop that process from happening. And what they basically do is they stop down the messaging from the brain, the messages from the brain that tell the gonads to produce testosterone or in female bodied people estrogen. Estrogen is responsible for the development of female secondary sex characteristics: breast development, fat redistribution, the menstrual cycle. And in male-bodied kids, testosterone causes the voice to go down, it causes the starting of facial hair, male-patterned body hair, and some linear growth or height. Those are the things that are really scary to trans kids. They don't want to go through the puberty that corresponds to their genitals. So the ability for us as providers to stop that is really exciting for them and can be very alleviating of a lot of that anxiety that goes with that. These medications have been used for many, many years - decades. They're used for children who start puberty at 4-5 years old. And we know that's not healthy for kids. So we give them these same medications and they stay on them for years and years and years. These medications are completely reversible. So just like with kids who start puberty at 4-5 years old, at 12 years old, these medications are stopped, and these kids go through the puberty they would have gone through regardless. So what a lot of people want to understand is "if I give my child this blocker, can I take it away if at the end of a certain amount of time they no longer have a transgender identity, or they don't want to go on to pursue a transition with cross-gender hormones?" And the answer to that is yes, they are reversible, and you can take them off without any problems, or any major medical problems. But it's very rare that that happens. In my practice, I've never had anyone that was put on blockers that didn't want to pursue cross-sex transition at a later point. I know there are some people who have had that experience in the past, but we have not at our clinic.

Watch Johanna Olson, MD's video on Assessing readiness for medical puberty suppressants...

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Johanna Olson, MD

Medical Director, Center for Transyouth Health and Development, Children’s Hospital Los Angeles

Johanna Olson, MD is a pediatrician in the Division of Adolescent Medicine at Children’s Hospital Los Angeles and Medical Director of the hospital’s Center for Transyouth Health and Development.  She specializes in the care of transgender youth, gender variant children, youth with HIV, and chronic pain. Board certified in Pediatrics and Adolescent Medicine, Dr. Olson is also an Assistant Professor of Pediatrics in the Keck School of Medicine of the University of Southern California. She has appeared on ABC's 20/20, The Dr. Phil Show, CNN, Dateline NBC and The Doctors to educate audiences about the needs of transgender youth.

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