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Experiences of parents and carers of young trans and gender diverse people

Views on hormone/puberty blockers

Hormone blockers, also called puberty blockers, pause the physical changes of puberty that can be distressing for many trans or gender diverse young people. Hormone blockers are gonadotrophin-releasing hormone (GnRH) analogues. These synthetic hormones pause puberty and supress naturally occurring hormones (such as oestrogen and testosterone) in the body. According to the Gender Identity Development Service (GIDS, 2020), hormone blockers are a reversible intervention, and the World Professional Association for Transgender Health [add to resources] (WPATH) cite hormone blockers in their established internationally accepted Standards of Care (SOC) guidance. This guidance states that it is more harmful to withhold this intervention that to provide it. For more information on this including possible side effects please see our Resources page.*
 
 

Richard talked about what he knows about hormone blockers and the reasons his daughter wanted to take them.

Richard talked about what he knows about hormone blockers and the reasons his daughter wanted to take them.

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So, from my perspective how to explain is, if the person is going through puberty, it slows down aspects of the puberty, so if you were born male you would not grow facial hair and they would like, if you were born male for you to be at the early stages of puberty and so your penis isn’t like a child’s penis and starting to become like an adult penis. So, it’s essentially longer, so they can make a vagina from it. If you are a woman, you, if you were born female rather and you wanted to be male, then, it would stop things like, slow-down the process of having periods or stop having periods. They have spoken mainly to us about if you were born male and were reassigning to female. They said that you can stop blockers at any time and it’s likely that you will go through puberty at that stage. Some people don’t grow as tall as they may have if they hadn’t been on the blockers. And they don’t know much more that they can say as a fact rather than in theory or what would be likely to be the case. Certainly, my daughter is very keen to avoid any facial hair; that is her main concern. You’re less likely to have a visible Adam’s apple if you have the blockers and I think that’s quite consistent.

 
In our interviews, parents and carers spoke about their children’s experiences with hormone blockers both within the Gender Identity Development services (GIDS) and through seeking private healthcare. In this section, you can read, hear and watch what parents and carers said about:
  • Considering hormone blockers;
  • Getting hormone blockers;
  • Combining private care with NHS treatment;
  • Managing hormone blockers;
  • Side effects of hormone blockers; and
  • Parent’s feelings about hormone blockers.
 

Considering hormone blockers

The parents and carers we spoke to often thought carefully about hormone blockers. They had conversations with their children about the benefits and side effects of hormone blockers. Many parents had researched the topic and looked for information and advice. A conversation about hormone blockers may be had before puberty, but this medication is not introduced before what is known as puberty Tanner Stage 2, which marks the beginning of physical development and hormonal changes.
 
For parents whose children were taking hormone blockers, the decision was often seen as giving the young person time and space to think, taking some of the puberty related pressures away. Adele’s son wanted to start taking hormone blockers to have ‘space’ to think without having to worry about puberty and physical changes. Lisa felt that when her son started hormone blockers it meant that ‘he didn’t have to worry that he was going to see even more problems created.’ Ali felt hormone blockers would give her daughter ‘breathing space,’ to explore her gender identity, without the pressure of developing an Adam’s apple and growing facial hair. 
 
Some parents viewed hormone blockers as a way to prevent irreversible physical changes and the future need for surgery. Georgina said, ‘I'm really hopeful that he's gonna get the blockers in time… to not make him need top surgery… because to me that's one of the huge, huge benefits of blockers is that it takes away the need for another major surgery. And I know that he's gonna feel really, really down if he's made to experience having breasts, basically.’
 
 

Adele said she supported her son starting hormone blockers to put his worries about unwanted puberty changes ‘on the back burner.’

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Adele said she supported her son starting hormone blockers to put his worries about unwanted puberty changes ‘on the back burner.’

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My child, at that point was really had already got said, ‘I need to have blockers.’ They were looking for at least that first stage of medical intervention and I was there, you know, to support them to do that and advocate for them, because they were becoming increasingly you know, kind of stressed at the thought that they were gonna, you know, I’m, you know, imminently hitting puberty and were gonna start going go through kind of physical changes. And they knew that they just needed to have that, you know, space. They were so focused on worrying about that that they just wanted to have, you know, this sort of blocker medication to put that kind of worry on the back burner and, and I agreed that I thought that was, you know, an important thing to do.

 

Lisa talked about the decision to start her son on hormone blockers privately. She felt this gave him peace of mind and was the best decision for him.

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Lisa talked about the decision to start her son on hormone blockers privately. She felt this gave him peace of mind and was the best decision for him.

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We had begun to pay privately for hormone blockers for my son. The reason that we did that was because we felt that he deserved an opportunity to be able to explore his identity free from the pressure of time that pubertal development was bringing. And we felt that we did a lot of research. We’re both educated people. We consulted closely with [name of participant’s child]. We knew what the risks were. And we knew what the benefits were likely to be. And we felt that it was worth trying. The, my son didn’t have any side-effects from the blockers, none whatsoever. If anything it gave him, it gave him peace of mind that he didn’t have to worry that he was going to see even more problems created like breast development, like hip development, like the change in the shape of his hands or his face. He didn’t have to worry about a period starting. He didn’t have to worry about how he was perceived by other people. He could just get on and look the way he wanted to look and be the way he wanted to be and be the person he wanted to be, free of any pressure. I think that’s the best decision that we have made for [name of participant’s child], so far.

 
Oonagh talked about introducing the idea of hormone blockers to her pre-pubertal daughter. She said her daughter understood that they would give ‘her some time to think about what she wants for the future.’ Similarly, Leigh said that whilst she trusted her foster son 100% to know who he was, she felt hormone blockers gave him extra time and allowed him to take things slow.
 
 

Oonagh talks about her daughter’s understanding of hormone blockers and her daughter not wanting to develop “the male things”.

Oonagh talks about her daughter’s understanding of hormone blockers and her daughter not wanting to develop “the male things”.

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I'm introducing ideas as well about what's gonna happen when we go to the appointments and that will be discussed about, I say, how do you feel about puberty. Cause she's seen her older sister go through puberty. She's aware that it's happening and she sometimes she doesn't really ask a lot of questions. If I try and initiate discussion or she's quite open about talking about it with me. And she just, with the puberty blockers I think she understands what it means. She knows that it gives her some time to think about what she wants for the future. And I think that's appealing, as far as I can tell that that's appealing to her at the moment, yeah. So definitely, she doesn't, she definitely doesn’t want to develop the male things that she sees you know, like her dad, you know, hairy and you know, beard and all that stuff, she definitely doesn't want any of that.

 

Georgina’s son found out about hormone blockers from a friend. She explained to him how they work and said that part of the reason they were going to GIDS was to be able to access them, if needed.

Georgina’s son found out about hormone blockers from a friend. She explained to him how they work and said that part of the reason they were going to GIDS was to be able to access them, if needed.

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He asked me what they were because I don't think his friend knew exactly because he's also quite young. He, they just knew that they could get them young and it was something that, that they needed in order to not develop. He just didn't know exactly. Does that make sense? So, he asked me what they were and he looked, he was quite upset at the time about it and asked if he could go on them and I said, well, right now, there isn't any point, because there's nothing to block, cause there wasn't. And essentially, at the moment there still isn't. So I, but I did say that that was kind of part of the reason we went to [Gender identity Development Services] so early was so that that could happen if he needed it.

 

Getting hormone blockers

In our interviews, parents and carers had a range of experiences trying to access hormone blockers for their children. Accessing hormone blockers on the NHS requires assessment by the specialist Gender Identity Development Services (GIDS). This service refers the young person to a doctor specialising in hormones called an endocrinologist, who assesses the stage of puberty the young person is at and prescribes the blockers, if appropriate.
 
 

Adele talked about the assessment process at the GIDS and the process of getting her son approved for hormone blockers.

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Adele talked about the assessment process at the GIDS and the process of getting her son approved for hormone blockers.

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So we went to the appointment and as I’ve already mentioned, you know, there was a whole load of just talking, going back and telling our story and talking about things. And I was sort of saying, okay, well we are also hearing, you know, we, you know, he’s coming up, he’s hitting puberty and we need to look at blockers. So we kind of talked about how long that would take and how many appointments he would need. So, I think we they sort of said, he’ll take four appointments and they need to be kind of like a month apart. So those first four appointments were fine and we went along kind of every month. You know, we were just kind of I suppose just discuss where we were at that particular moment in time. The sorts of things that we’d been talking about. How my son was feeling. You know, we separated off into two separate rooms, you know, I talked to one of the therapists, my son would, you know, talk to the other. There wasn’t, to me it was very much a kind of assessment period that they, you know, it seems that there was a lot of us talking and a lot of them making notes. So it wasn’t, there wasn’t really a kind of any therapeutic kind of involvement in that. And then we kind of got referred down to almost, referred down to [hospital] to get blockers. And so that was probably about another don’t know, six, eight weeks or something like that for the first appointment for that. So, there was very much a kind of focus on, okay, so he’s gonna go down there. I had, went down and had the assessment in [city]. So, the first meeting was there some initial kind of blood tests and scans and then we had sort of go back down to them about a few months few weeks later in order to sign the forms both my son and myself had to sign sort of individually the consent, so really there was like this multiple page kind of consent form. I think they’d been sent it previously as well to look at. And to have, you know, the additional scans before they went, ‘Okay, that’s it. We are gonna approve your son to have blockers.’ The GP hopefully would at least be on board to do that. But so we were very much kind of looking at, you know, that journey and that pathway of making that happen. It then carries on, we’d have I can’t remember if he had appointments like every month, initially or if it went to every three months.

At that point, your son has got the blockers?

So, he got the blockers so he, he from when he came out so he came out in August and then we had the first appointment at the end of December. And then he got referred down to [hospital] in April. And then he got the blockers.

 

Leigh said they had many conversations with her foster son’s therapist at GIDS and social worker before he was cleared for hormone blockers. She felt the clinical process after that was surprisingly smooth.

Leigh said they had many conversations with her foster son’s therapist at GIDS and social worker before he was cleared for hormone blockers. She felt the clinical process after that was surprisingly smooth.

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In referral in regards to the hormone blockers, with his therapist, we, as a family with his social worker had many, many, many conversations about hormone blockers. The process. What it involves. What it could lead to. Even the fact, you know, having an injection monthly is a major thing for a 11 year old to start. I think maybe three or four months after we started the conversation he was referred to the endocrinology at the [name of hospital] in [name of city]. That was maybe six to eight weeks. From being referred to getting the appointment. We saw one of the lead clinicians at the [name of hospital]. Had blood tests done. Had bone density scans done. It all seemed to go pretty smoothly. Once we'd got to the [name of hospital] it was like not much questions, not many questions. Not much assessing. Not much, not much anything really. It was just a case of, right, you've been referred for blockers, that's what you're here for. Here you go. You know, so that was kinda, I didn't expect that. I expected that to be a bit more, this is our realm, let's delve a little deeper and let's take it a little bit slower.

 
 
Some parents we spoke to felt that the assessment process took too long, which resulted in unwanted physical changes for their children. For Josie’s daughter, a delay in getting hormone blockers, meant she felt it was too late. She said: ‘We really wanted her to start on blockers and it took ages for them to agree. And then, by that time we knew that, what she needed …was oestrogen.’
 
 

Ali felt the process to get her daughter hormone blockers took too long. She said that her daughter has experienced unwanted physical changes.

Ali felt the process to get her daughter hormone blockers took too long. She said that her daughter has experienced unwanted physical changes.

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We were under [Gender Identity Development Service] and my daughter was very keen to go on puberty blockers and how long was it she--Yeah, she was fifteen and when she was going and she was really desperate. The anxiety about everything developing and, and her voice hadn't broken when we went, initially. But obviously it has, it did [sighs]. She was very frustrated, because she wanted that space and time just marched on.

I wish it'd move a bit quicker, but you know, you know yeah. I also did feel that my daughter was desperate to go on puberty blockers, which would have given her more of a breathing space to explain how she felt that she was a bit let down there, because we had to delay so long. And yeah, there’s been a lot of changes (physical) which she's even more unhappy with.

 
Once a young person was allowed to start hormone blockers, it did not always mean that they would be able to start treatment straight away. For young people in the earliest stages of puberty, it was sometimes necessary to wait. 
 
 

Richard’s daughter was waiting for puberty to become more advanced to start on hormone blockers. He felt frustrated and worried in case her puberty ‘accelerates.’

Richard’s daughter was waiting for puberty to become more advanced to start on hormone blockers. He felt frustrated and worried in case her puberty ‘accelerates.’

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They can test what stage of puberty you’re at by either the size of your testicles, by how much pubic hair you produce and a couple of other features and they recommend that she waits until she’s further into puberty before she has the blockers. So, she’s at a stage where it’s relatively frustrating for her, where she’s 13 and almost ready physically to have the blockers, but doesn’t want to miss that opportunity because some people can suddenly move into puberty at an accelerated rate rather than a very steady, gradual process, I think. I think my voice broke one weekend I think, rather than it being a long process as far as I can remember. And I think I probably had facial hair by the time she’s her age. Whereas, she hasn’t got any facial hair and still presents as very feminine.

Combining private care with NHS treatment

For parents whose children had accessed hormone blockers and hormones privately, it was sometimes difficult for this to fit with NHS treatment plans. For Lesley this meant that her son would have to stop taking hormones and go back to being on hormone blockers, before his hormone treatment could be restarted. She felt this was ‘not an option’ for him. 
 
Trying to integrate private care and NHS treatment, meant that Lisa’s son had to stop taking hormone blockers prescribed privately so that the GIDS could assess his puberty development. Lisa felt that NHS plans ‘prioritised policy’ over her son’s wellbeing, when she was told that her son could not have blockers. Lesley talked about the difficulty of integrating private care with NHS treatment for her son. She shared: ‘We are two sessions into our assessment, because we are on… GIDS child and adolescent pathway… we already know that… we stick to the child and adolescent pathway he’d have to come off hormones. And then… he’d have to be on blockers alone for twelve months before hormones were reinstated… they won’t take into account the twelve months he’s already been on blockers [via private provider]. That would have to start from day dot again.’

Managing hormone blockers

In our interviews, parents and carers spoke about managing hormone blockers. Leigh said hormone blocker injections were being carried out by a nurse at their GP surgery. She said: ‘The nurses are quite happy to do the blockers for injections for him each month. They are keeping the one nurse doing them, so my child does have a relationship with that one nurse.’ She also said the process of getting the prescription at the pharmacy had been straightforward. 
 
 

Andrew’s daughter takes hormone blockers and oestrogen gel. As a retired healthcare professional he is able to give his daughter the hormone blocker injections himself.

Andrew’s daughter takes hormone blockers and oestrogen gel. As a retired healthcare professional he is able to give his daughter the hormone blocker injections himself.

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Well the private GP specialist prescribes the medications. There were two. There’s a testosterone blocker which works on the brain, reduces the production of testosterone. Well, almost completely suppresses the production of testosterone, which stops male puberty. I give her an injection, intramuscular injection every three months. I email the GP specialist, they prescribe it. They send a link to the chemist who sends me a link, three days later it comes in the post. Being an ex-healthcare professional, I have no problem giving my daughter an injection. Most parents wouldn’t have a, wouldn’t, wouldn’t be able to. I understand that completely. And I don’t know what they would do. Perhaps they would find because the GPs are unhappy to do it, because they don’t prescribe it. Why should they give it. If there’s a problem, why should they deal with that problem? So, so I don’t know how other parents would get around, who would do the injection, I really don’t know. For us, it hasn’t been a problem, ‘cos I do it. I used to give injections every day in my career. Every three months we do a blood test to check on the levels of testosterone and oestrogen. She also takes an oestrogen gel now as well to encourage breast development more female shape around the hips. Yeah.

Side effects of hormone blockers

Hormone blockers can cause side effects. Adele thought that the way a young person’s body responds to the blockers ‘varies from child to child, because of their own kind of physiological make-up and their own… mental health.’ Some parents, said their children experienced no side effects with hormone blockers. Other parents talked about a range of side effects their children had (see also our Resources page for further information on possible side effects). Parents whose children have not yet started taking hormone blockers, like Mel, whose stepdaughter has been approved for blockers, were eager to learn more about the side effects of the medicine. 
 

Parent’s feelings about hormone blockers

Parents and carers whose children were not on hormone blockers spoke about concerns they had about starting them. Richard, whose daughter had been approved to start hormone blockers, thought that there were not enough data about long-term effects of blockers. He also felt that the increase in young people coming out as transgender was a positive thing, as for him it meant that it was becoming more socially acceptable. He also thought that would lead to ‘a lot more evidence and research’ on the long-term effects of hormone blockers. Elijah worried that hormone blockers are based on ‘bad science’. He had concerns about his daughter taking them.
 
One parent felt that the existing NHS protocols for hormone blockers were ‘very rigid and inflexible’ and ‘still about the psychologist checking that… a child knows their gender and checking that there aren't external forces forcing a child to pretend to be trans.’ She worried that health professionals didn’t have ‘sufficiently trans positive approach.’ 
 
 

Mel worries about the side effects of hormone blockers and talks about strategies to support her stepdaughter with mindfulness and meditation.

Mel worries about the side effects of hormone blockers and talks about strategies to support her stepdaughter with mindfulness and meditation.

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I mean, everyone’s been so on board. I think I just need to make sure I catch up and what, what does it mean for us. How do we support her. What are the side-effects. This is what I really wanna know, the side-effects of these hormones and, and blockers. Putting an awful lot of chemicals and hormones in your body. How can we keep her well. We’ve been talking about doing a lot more meditation and mindfulness with them and really start practising that, that now, because we feel like we’re gonna need it. They’re going to need it, really, really soon. And, yeah, just all the stuff that comes with being a teenager.

 
* NHS, 2020. Treatment: Gender dysphoria. 
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