Table 1

Potential harms and benefits of ongoing puberty suppression*

PhysicalPsychosocialCognitive
Potential harms

  • Localised reaction at injection/implant site (eg, swelling, redness, pain) and/or allergic reaction.

  • Reduced bone density, increasing risk of osteoporosis and fractures.

  • Impaired fertility.

  • Impaired sexual functioning (which may include vaginal atrophy and pain during vaginal intercourse for birth-assigned females).

  • Fusion of bone growth plates will be impaired, resulting in increased final height.

  • Possible increased risk of developing hypertension, cardiovascular disease and metabolic disorders such as obesity, high cholesterol and type 2 diabetes.

  • Distress associated with any physical harms that eventuate.

  • Could result in difficulty finding a romantic partner.

  • Reduced libido.

  • Later regret.

  • Social stigma, which may have a negative impact on psychological functioning.

  • Concerns about puberty suppression may lead to or increase attempted self-harm and/or suicide.

  • Potential negative impact on brain development.

Potential benefits

  • Prevents irreversible development of unwanted secondary sex characteristics.

  • May prevent need for future gender-affirming surgeries.

  • Avoid distress associated with physical changes of puberty.

  • Results in a physical appearance that better matches gender identity.

  • Prevent/alleviate gender dysphoria and related psychosocial issues (eg, anxiety, depression).

  • Improve overall psychosocial functioning and general mental health.

  • Provides more time to consider gender identity and alternative options.

 

  • Table assembled using information and arguments from ref 1 25 28–31 33 38 39 42 43 45.

  • *Some of the potential harms listed above could actually be considered benefits, and vice versa, depending on the patient’s values.