Gender affirming hormone treatment in children and adolescents

How many different types of gender-affirming hormones are there for children and adolescents?

There are two types of gender affirming hormones available:

  • Puberty blockers: The GnRH agonist slows down the development of physical characteristics of the gender assigned at birth. This can be beneficial for children who may not be ready to start hormone treatment for gender affirmation. The use of puberty blockers can start in stage 2 on Tanner’s puberty scale, age 8-13 for females and age 9-14 for males.
  • Gender affirming hormones: The use of sex hormones induces the physical characteristics matching the true gender identity. This can start at age 14-16.

What are the benefits of gender affirming hormone treatment?

The benefits of hormone treatment are:

  • Puberty blockers let children live the way they want, reducing the suffering of feeling that the body does not match their internal and true gender. They can also avoid the anxiety and depression due to the undesirable physical characteristics such as a growing penis or broad shoulders in males, and growing breasts or menstruation in females.
  • Gender affirming hormones help adolescents develop physically, in line with their true gender identity; for example, bigger breasts, smoother skin, and wider hips in a male transitioning to female, and a deeper voice, a beard, smaller breasts, and no menstruation in a female transitioning to male.
Are there adverse effects associated with gender-affirming hormones?
While gender affirming hormone treatment has positive effects on the health of those being treated, there are side effects as well. For example, estrogen hormone affects lipids, the fatty compounds in the body, or testosterone hormone affects the hematocrit, the percentage of red cells in the blood.
Therefore, it is necessary to monitor blood levels every three months during the first two years, and every 6-12 months after that.

How long will they have to undergo gender-affirming hormone treatment?
Based on current research and clinical practice guidelines, it is recommended that the gender affirming hormone treatment be lifelong or continue until menopause when the hormones are no longer needed.
If the hormones are not taken regularly, the physical characteristics can be reversed.
In addition to the lack of sex hormones in the body, there may be long-term effects on bone health.

How to start with gender affirming hormone treatment?

There are two steps in receiving gender affirming hormone treatment:

  1. Assessment; preliminary consultation by sexual medicine specialists, pediatrician, and child and adolescent psychiatrists.
  2. Hormone treatment; the therapy is provided by pediatric endocrinologists, adolescent medicine pediatricians, and sexual medicine specialists.
Why are egg and sperm freezing recommended before using gender-affirming hormones?
Hormone treatment affects future gamete formation. Those who would like to have their own children, despite hormone treatment, are advised to consult with doctors regarding sperm or egg freezing before starting the hormone treatment.

Is parental consent necessary?
Children or adolescents under 18 need parental consent. Those over 18 can request the treatment by themselves.

The PRIDE Clinic at Bumrungrad International Hospital, with a team of experienced medical professionals in caring for gender-diverse people, provides a one-stop service including consultation, diagnosis, fertility preservation, and treatment with hormones as well as gender affirmation surgery.

For more information please contact:
             and +66 (0) 2-066 8888 and 1378 between 8 am and 8 pm.

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