In the US, approximately 0.7% of adolescents identify as transgender or gender fluid.1 Many pediatric centers now provide multidisciplinary care to assist in the transition from a child's or adolescent's assigned sex at birth (or natal sex) to their affirmed (or preferred) gender. During early puberty, therapy is available that results in the suppression of sex steroid production and secretion, followed later in adolescence by the administration of supraphysiologic doses of sex hormones appropriate for their gender identity.1-3 The duration of pubertal suppression with gonadotropin hormone releasing hormone agonists (GnRHa) varies, but can extend up to 4 years for younger patients who are not able to provide consent until age 16 for receipt of gender-affirming therapy. Puberty blockers represent an invaluable intervention for these children and adolescents, to reduce anxiety and "buy time" until final decisions can be made about gender assignment.
Caught in the Middle: The Care of Transgender Youth in Texas.