The fight for time

After puberty blockers were banned for trans minors in Britain and Northern Ireland, Dr Chris Noone, Sibéal Coll and Ryan Goulding of the Professional Association for Trans Health Ireland (PATHI) tell us why the medication matters for gender-diverse youth.

Trans — Healthcare — Medicine

Imagine watching your body change in ways that feel completely wrong, like being trapped in someone else’s skin and knowing that every day takes you further away from who you really are. That’s the reality many transgender young people face as puberty begins. For them, these changes aren’t just uncomfortable; they can feel unbearable. But there’s an option that gives them breathing room: puberty blockers.

You may have heard of them in the news. Often described as “controversial”, puberty blockers are simply medications that temporarily pause the hormonal changes of puberty, giving young people more time to explore their gender identity without the added distress of unwanted physical development. These medicines have been around for three or four decades, even in Ireland, with the first modern puberty blocker licensed 35 years ago in 1989. There is no question that they are both safe and effective in delaying puberty.

Like most medicines for trans people, puberty blockers were originally developed for others, in this case, to help with precocious puberty in cisgender kids. This is when puberty starts earlier than expected. Children are given these medicines to slow down the clock, alleviate discomfort and help them fit in with their peers. But for trans youth, blockers can do something even more vital: they buy time. That extra time matters more than most people realise.

For a trans young person, puberty can feel like a ticking clock, every moment a step closer to irreversible changes that feel alien and distressing. When someone knows deeply that their gender doesn’t match the body they’re growing into, it can cause intense anxiety. Some describe it as living in a body they can’t bear to be in. Others feel desperate or hopeless or even consider harming themselves. Puberty blockers don’t make these feelings vanish, but they can quiet the storm.

In research published by Dr Cal Horton in the UK, one parent described how their transgender child experienced profound relief after starting puberty blockers; the relentless anxiety, sleeplessness, and fear began to ease. Another shared that their child was finally able to return to simply being a child, no longer overwhelmed by distress about what the future might hold.

These aren’t extreme reactions; they’re common, deeply human responses to feeling out of control of your own body. And yet, the process to access blockers can be long and full of hurdles, which means that many young trans people cannot access them in time for them to delay puberty. Because of these hurdles, many trans youth say they feel like they’re being tested or doubted. Instead of being trusted to know themselves, they have to prove they’re suffering enough to deserve care.

Puberty blockers alone don’t cause physical changes, they only delay them. Access to these medications might be what a trans teenager needs to help them focus on all the everyday issues any teenager faces. Early intervention can prevent permanent physical changes, which may reduce the need for subsequent surgeries.

At their heart, blockers are about dignity, about saying to a young person, “We see you, we hear you, and your wellbeing matters.”

While puberty blockers are used by trans teens, similarly to their uncontested use in precocious puberty, they are also routinely used in trans adults to block further unwanted effects of hormones. Incidentally, they are used by cis adults to help with fertility. These medicines are used to assist with in vitro fertilisation (IVF), without anyone contesting. In Ireland, puberty blockers are covered for IVF on government schemes, even when prescribed by private clinics. However, for trans people, to avail of this medication, it takes the involvement of a hospital consultant and a complex coverage process. This is not to even mention the many additional barriers faced by Irish trans people.

Unfortunately, despite their safe and effective use, the subject of puberty blockers has recently become a point of contention in the media, rife with scaremongering. This has led to a ban on puberty blockers—only in the context of trans healthcare for minors—in the UK and Northern Ireland. This ban has been justified by claims by Dr Hilary Cass, who led the Cass Review into gender identity services for young people in the UK, that puberty blockers are not safe because of a perceived lack of evidence showing that they are effective at reducing gender dysphoria. Despite her claim, Dr Cass did not recommend that puberty blockers should be banned—just that they should be used with caution.

In addition, there is no evidence of serious harms for young people who have used puberty blockers, no question that they delay puberty, and several studies have found mental health benefits for the medication. So why did Cass conclude that puberty blockers were unsafe? Rather than speculate about motivations, we can just highlight that the conclusion was based on a review of the evidence regarding puberty blockers carried out by researchers at the University of York. In work that was recently published in the journal BMC Medical Research Methodology, a team of international researchers found severe flaws in the way those researchers at the University of York carried out this review. They showed that almost half of the studies on the topic of puberty blockers were excluded from their review. That means when the Cass Review said there wasn’t enough research, it was only looking at a much smaller picture than what’s actually available.

Now it appears that the only way that young people in England will be able to access puberty blockers is if they agree to participate in a clinical trial. Trans young people in Wales, Scotland and Northern Ireland will have no way of accessing puberty blockers in their own countries. This is unjust, and the proposed trial is arguably unethical since the participants are essentially being coerced to take part due to it being their only way of accessing this form of care.

Nobody would argue that we should stop doing research on puberty blockers. There are, however, types of research, other than clinical trials, which can use data from what we see in real life, over time, to improve our understanding of puberty blockers. This approach is called observational research, and observational studies of puberty blockers have shown improvements in mental health for trans youth. Depression may be alleviated, wellbeing may improve, and importantly, the risk of suicidal ideation is lessened. Observational research informs a significant amount of today’s healthcare. Why should healthcare for trans people be held to a different standard?

This article has focused on the puberty blocker ban in Britain and Northern Ireland, but puberty blockers are practically inaccessible in this state too, due to the lack of functioning gender services for young people in Ireland. The HSE is currently developing a new model of care that is supposed to be in place in 2026, but there has been no engagement yet between those doing this development work and the trans community.

It is vital that allies of the trans community stand up for better services for trans healthcare across Ireland. Speak to your local Sinn Féin representatives about the injustice of the puberty blocker ban in the North. Contact the Minister for Health and your local government representatives about the urgent need for community involvement in the development of gender services in Ireland. This community involvement should, at a minimum, be a two-way dialogue, rather than just a tokenistic listening exercise with the community.

Long ago, disability activists fought for recognition and self-determination in policy-making processes with the phrase “nothing about us without us”, and in recent years, the HSE has committed to responding to this demand across its services. Why should its approach to gender services be any different? In the months ahead, as the model of care for trans people is developed, the voices of young trans people should be heard.