When Mary hit puberty, she visited the doctor. At age 12, she was a transgender girl's first visit to an endocrinologist, a doctor who specializes in hormone function and the glands that secrete hormones, to discuss treatments that could help her body align with her gender after puberty.
Mary is not her real name, a name chosen to protect her privacy.
Puberty is when a child's body starts to change into an adult. The body produces more hormones that transform girls into women and boys into men. For the majority of children who are cisgender and match the sex they were assigned at birth, this is fine. These children usually don't need medical care.
but, 1.4% of US teens They are transgender. Their gender is different from the sex they were assigned at birth. An additional 2.5% are non-binary, which means their gender is not just male or female. (They might be somewhere between male and female, neither, or both. Some non-binary people also identify as transgender.)
Having a body that does not match one's gender can cause extreme distress and mental health problems, and as a result, many of these people may require medical procedures to align their body with their gender.
These treatments usually begin with the onset of puberty, which occurs around age 9 to 12 when underarm and pubic hair begins to grow. Treatments to induce puberty have been around for decades and are used by cisgender children who want them. They include medications that pause puberty and hormones that restart it. For some people, treatment also includes surgery to shape their body into an adult shape, usually after age 18.
The pause button of adolescence
The main hormones that guide puberty are estrogen and testosterone. Both have many roles and act as chemical messengers to carry out those tasks. Estrogen plays a role in keeping your bones, brain, heart, and liver healthy. Testosterone also helps keep your bones and muscles healthy. It also affects your mood and energy levels.
During puberty, these hormones take on a new role: They tell the body to start producing what are called secondary sex characteristics, which include facial hair and breasts.
People who are assigned female at birth usually produce more estrogen, and people who are assigned male at birth usually produce more testosterone, but anyone with testes or ovaries produces both hormones, points out Douglas Austin. The amount of each changes throughout life.
Austin is an endocrinologist at the Fertility Center in Eugene, Oregon. Part of his job is managing the hormones that determine how our bodies develop. He works with transgender kids and their families, helping them regulate hormone levels to guide their physical development during puberty.
For many of these young people, puberty-suppressing drugs are the first step, Austin says: If given soon after puberty begins, the drugs act like a pause button. (They can also be given to cisgender kids who start puberty too early, Austin says.)
When puberty begins, a part of the brain called the hypothalamus sends a message to its neighbor, the pituitary gland. The hypothalamus tells the pea-sized gland to send a message to the body's testes or ovaries. It tells them to make more hormones, like testosterone and estrogen. Blockers interfere with this, says Austin. They stop the hormones that drive puberty. They also stop the development of physical changes like breasts and facial hair.
Mary knew she was transgender from the age of 3 or 4. But some transgender people don't realize it until later, usually during puberty. That's one reason blockers can be so helpful: They give teens time to explore their identity before permanent changes occur to their bodies. Mary's doctor prescribed a blocker called Lupron, which stops her body from making extra testosterone.
“Bioidentical” hormone therapy
Most of the young people who block You take hormones that restart puberty. For some, this can take months or even years. Mary's hormone therapy began with estrogen patches twice a week for two years, which she describes as like “putting a sticker on your lower back.” Now she's on pills. As her estrogen levels increased, her body began to resemble a more typical woman's.
Mary says that since taking estrogen, she has felt better about her body and herself.
This is called “bioidentical” hormone therapy, Austin explains. The molecules in the patch or pill are identical to hormones our bodies make. Transgender boys get testosterone. Transgender girls get estradiol, the strongest of the four estrogens produced by the body.
Non-binary kids may want to grow up with a body type that's somewhere between male and female. Austin says achieving this takes some trial and error. He uses hormones to shape his kids' bodies to be “less masculine or less feminine.” The end goal is an adult body type that feels right to the individual.
Gender reassignment surgery
Some transgender and non-binary young people may choose to undergo gender reassignment surgery. Trans men who have developed breasts may choose to remove this tissue and reshape their breasts to appear more typically male. This is called top surgery. Other surgeries can reconstruct the genitals. These are more complicated and have a more difficult healing process, Austin said. This is one reason why people must wait until they are at least 18 to undergo this type of surgery.
Puberty-related surgeries aren't just for transgender or non-binary people. About 4 percent 70% of cisgender boys between the ages of 10 and 19 will develop breast tissue during puberty, and some will later have surgery to remove the unwanted tissue.
Austin begins working with new patients years before the surgery takes place. Still, he starts talking about the procedure from day one. This can be scary for parents, he says, but it's important for kids to know their options and think broadly about their future. Another consideration is whether they want to store sperm or eggs to have biological children in the future. After the surgery, they find out that may not be possible.
Not all transgender or nonbinary people want surgery, adds Tess Kilwain, a psychologist in Nashville, Tennessee, who works with transgender and nonbinary young people across the country through virtual consultations. Some are happy with a social transition that could include changing clothing, hairstyle and pronouns, while others opt for hormone therapy alone.
Mary, now 15, is scheduled to have the surgery. She is excited, but also anxious. She looks forward to the day when she will feel good about her body and be able to wear any outfit she wants.
Life-saving hormones
Gender-affirming care saves lives, Kilwain says. Transgender and nonbinary youth are at much higher risk for depression, eating disorders, and suicidal thoughts than their cisgender peers, she notes. But research is overwhelmingly clear that gender-affirming care improves people's mental health, quality of life, and body image.
In 2023, researchers The study reviewed nearly 50 studies on hormone therapy and mental health in transgender people.Their data came from over 40,000 participants in total. People taking hormone therapy reported fewer symptoms of depression and anxiety. Overall, these people felt more positive about their lives. Blockers have also been shown to have a positive effect on the mental health of transgender youth..
Some may be concerned about the effects of puberty blockers or hormone treatments on the body. Puberty blockers are widely used and considered safe, Austin said. Most of the effects are reversible.
However, both effects can continue into adulthood.
One is height. Puberty is the start of a growth spurt that ends at adult height. If puberty is delayed, a person continues to grow, but there is no growth spurt. If they continue for too long, they can grow abnormally tall. This can be an issue for trans women who don't want to be taller than most women, says Austin. “You need to time your transition appropriately to manage height expectations.”
Bone density is also a consideration. Hormones released during puberty strengthen bones. In
Source: www.snexplores.org
