We want to work with you to determine the best care for you and your family. Below are four of our most common treatments for patients in the program: pubertal suppression therapy, hormone therapy for transgender males and transgender females, and mental health support.
While we believe in providing safe and effective care for our patients, the long-term consequences of some of the treatments are still unknown. Visit PBS.org to read an article in which our doctors discuss the risks and reasoning behind our care.
Pubertal Suppression Therapy
Transgender and gender-questioning adolescents who have not yet reached the later stages of puberty may undergo pubertal suppression therapy before they begin hormone therapy. Pubertal suppression therapy is also referred to as “puberty blocking.” Pubertal suppression therapy is a non-invasive, reversible process achieved by using compounds that mimic the actions of gonadotropin-releasing hormone (GnRH) – a puberty-stimulating hormone released in the brain. One such compound, Leuprorelin (brand names: Lupron or Eligard) acts on the pituitary gland by making it less sensitive to GnRH. By desensitizing the pituitary gland to GnRH, fewer pubery-stimulating hormones are released, such as follicle stimulating hormone (FSH) and luteinizing hormone (LH). A reduction in FSH and LH results in a reversible “pause” of pubertal development while a patient is actively taking Leuprorelin.
Before initiating pubertal suppression therapy, patients undergo a physical examination to assess pubertal development. Our medical providers approach physical exams in a sensitive manner, recognizing that physical exams can be distressing for some gender diverse youth. Baseline hormone levels and bone health are also examined at this time. The duration of pubertal suppression therapy varies by patient. Leuprorelin is most commonly administered through an intramuscular injection, which the patient and caregiver may be taught to inject at home.
Hormone Therapy for Transgender Males
Hormone therapy for transgender males (i.e., “female-to-male” adolescents) consists of testosterone, which is most commonly administered by intramuscular injection. Before a patient starts testosterone therapy, we obtain baseline lipid and cholesterol levels, which may increase as a result of testosterone use. Other possible side effects of testosterone therapy include change in mood, increased aggression, acne, and over the long term, increased risk of heart disease. Testosterone injections are typically administered every two weeks, with the dose ranging from 50-200 mg. Patients and caregivers are often taught by healthcare staff to administer the injection at home. Once injections have been started, we advise hormone levels be checked at three to six month intervals to ensure desired testosterone levels are achieved.
Hormone Therapy for Transgender Females
Hormone therapy for transgender females (i.e., “male-to-female” adolescents) typically consists of estrogen, which is commonly administered by intramuscular injection. As with any hormone therapy, baseline hormone levels are obtained. Depending on the dosing level, estrogen is administered either weekly or every two weeks. The most common dose levels are 10-20 mg. In addition to baseline labs, we gather a thorough family and past medical history of bleeding disorders since increased risk of blood clot formation is a possible side effect. Other side effects of estrogen include change in mood and increased risk of certain forms of cancer, such as breast cancer. Patients and caregivers are taught by medical staff to administer the injection at home, and we advise hormone levels be checked at three to six month intervals to ensure desired hormone levels are achieved.
Mental Health Support
Many families in our care may benefit greatly from talking with a psychologist on our mental health team about issues related to gender identity or expression. Our psychologists have specialized training in psychosocial and mental health issues related to gender development, and they can provide support in a number of ways, including (but not limited to):
- Supporting the family of a child with gender-non conforming behavior
- Helping parents learning more about gender development and providing helpful ways to explain gender-related issues to their family and friends
- Partnering with parents to develop age-appropriate ways to explain support their children
- Supporting a family as they decide to start (or not start) gender-related medical care, such as pubertal suppression therapy or hormone therapy
- Helping children and adolescents cope with worry, stress, and other strong feelings related to their gender identity, their bodies, or body changes associated with puberty
- Empowering adolescents to foster skills at managing interpersonal relationships and maintain healthy self-esteem
- Facilitating peer-support opportunities for families through ongoing support groups and through social family outings
We match the diverse support needs of our families by providing them with an array of ways to meet one-on-one with our psychologists. Some families choose to meet with a psychologist once or twice a year, and some choose to meet more regularly. Other families choose to meet with one of our psychologists just once in order to have this relationship established should a need for support arise at some point in the future.
To find out more information about our clinic’s mental health support, contact our program coordinator, Jen Leininger, at 773.303.6056 or e-mail firstname.lastname@example.org.