My Kid Wants to Start Hormone Replacement Therapy-What Should I Do?
Hormone therapy can be an important step in your kid’s gender journey. However, this can be nerve wracking for parents and that’s understandable. You want to support your kid, but you have concerns about this type of medication. This blog covers some frequently asked questions and what to expect if your child wants to pursue hormone therapy.
What is Gender Affirming Hormone Therapy?
Hormone Therapy is the process of taking either estrogen, testosterone and/or hormone blockers to help achieve masculine or femininizing characteristics. Children and teens also have the option to take medications to delay the start of puberty in the form of puberty blockers. Teenagers may have the option to take estrogen or testosterone to change their outer appearance to align more with their gender identity.
Benefits of Hormone Therapy
Hormone therapy can help your child feel more comfortable in their body and boost self-confidence. Gender affirming hormones can have a positive impact on your child’s feelings and mental health. Research shows that gender identity acceptance from both peers and parents is associated with a lower risk of suicide attempts. (1) Kids who have supportive caregivers have lower risk of mental health concerns including depression and anxiety. (2) Supportive actions include using your child’s correct pronouns and providing access to gender affirming care.
Other benefits include:
Decreases gender dysphoria and discomfort
Improves social interactions with others
Increases positive feelings around their gender
Reduces the need for surgeries that are invasive and expensive in the future
What are puberty blockers?
Hormone blockers delay the physical changes from puberty for your child. These medications have been safely in use since the 1980s and are typically prescribed to address the early onset of puberty. The effects of blockers are fully reversible and only occur while your kid is taking the medication. Some effects can be delaying the onset of a period or preventing your child’s voice from deepening. Puberty blockers can allow your kid time to explore their gender identity before starting estrogen or testosterone therapy. They can also pause certain developments from puberty that may be distressing to your child. Your kid may take blockers for a few years until either stopping hormone therapy altogether or transitioning to a masculine/feminizing protocol.
How old does my kid have to be to start gender affirming hormone therapy?
Puberty blockers are recommended at the start of puberty (Tanner Stage 2), usually around 9-14 years old, though the age can vary. Estrogen and testosterone therapy are recommended when your kid is around the age of 14-16, though the age may vary.
Are the changes of hormone therapy permanent?
The effects of puberty blockers are completely reversible. Once your kid stops taking blockers, puberty will resume. Estrogen and testosterone therapy bring changes that are permanent but some changes are reversible. Some permanent changes include an increase of body hair from testosterone and the onset of breast growth from estrogen therapy.
Is hormone therapy safe?
Medications used for puberty blockers have been safely used to treat teens who develop too early (precocious puberty) for decades. (3) Puberty blockers are backed by The Endocrine Society and American Pediatrics as a safe and effective intervention for transgender youth. (4) While puberty blockers are completely safe, it is recommended that your child be monitored by either a pediatrician or endocrinologist. Certain aspects of your child’s health will need to be considered such as their bone density prior to the start of puberty blockers. While a reduction in bone density is a side effect of puberty blockers, your child’s doctor will be monitoring the effects of the medication. Your child’s doctor may prescribe a calcium supplement to help reduce the impact to bone health. Bone density will return to normal range when your child stops taking blockers, and there are no impacts to bone density in estrogen and testosterone therapy. Estrogen therapy does increase the risk of blood clots but the risk is minimal for people under the age of 50 and who do not have any co-occurring health issues. (5)
Is my child too young to know their gender?
Research shows that your child’s gender identity starts forming around age 2-3 years old and can understand different gender expressions by age 4. Trans kids and teens know there gender just as much as their cisgender peers, and benefit from the same level of acceptance.
What if my child wants to have kids some day?
The reality is that some trans kids must consider their future in a way that cisgender kids may take for granted and this includes fertility. Research shows that puberty blockers do not impact one’s fertility. However, estrogen and testosterone therapy may have a permanent impact on your child’s fertility long term. Your child’s healthcare team will discuss this with your child, and they will be given the option to preserve their fertility if they choose.
What if my child is depressed? Shouldn’t we treat that first?
It is important to screen for any mental health issues at the start of pursuing hormone therapy. However, research shows that kids benefit the most from addressing their gender dysphoria and mental health at the same time. Finding support by connecting your kid to a gender affirming therapist and possibly a psychiatrist can be helpful. Therapy will help your child work on any mental health concerns and give them the outlet to explore their gender identity. While hormone therapy may not resolve all your child’s mental health issues, they will likely start to feel better. Hormone therapy is known to improve mood and reduce anxiety and depression.
How do we get started?
The first step is scheduling an appointment with your child’s pediatrician. Your child’s pediatrician can make a referral to a gender affirming pediatric endocrinologist if needed. Some cities have gender clinics that have doctors, endocrinologists, and mental health therapists on staff. CHOP’s Gender and Sexuality clinic is located in Philadelphia and offers a variety of gender affirming services to kids and teens up to age 21.
A healthcare professional such as a therapist or psychologist can provide an assessment on your child’s readiness to start hormones. The therapist will use an informed consent approach based on criteria from WPATH Standards of Care. Informed consent allows your child to share about their gender journey and their goals for transition. The therapist will also go over the risks and benefits of staring puberty blockers or hormone therapy with you and your child. The informed consent process occurs at every stage through multiple appointments and conversations with everyone on your child’s care team.
The next step is for your child to complete some lab work and health screenings before the start of puberty blockers or hormone therapy. For some teens, it is recommended that they also start gender affirming therapy to give them the space to process their emotions.
Who can I talk to about this?
Your kid’s gender journey may be the first time you’re learning about hormone therapy and transitioning. Even the most supportive parents will feel worried and overwhelmed, which is understandable! You may have questions like “What does this mean for my kid, and will they be okay?” You might be feeling stressed about your kid’s future or anxious about whether your kid’s school will be safe for them. It’s a lot to consider, which is why I always recommend that parents find their own support. This can be through a trusted friend or family member. Some gender clinics offer support groups for parents of transgender kids. Your city may have events for trans kids and their families which can be a great opportunity to make connections. Individual therapy is also a great option.
Want to Learn More?
I specialize in gender affirming care for ages 12 and up and would be happy to set up a phone consultation to answer any questions you might have.
Resources
CHOP’s Gender and Sexuality Program
References
2. How to Best Support Transgender and Non-Binary People -The Trevor Project
