Experiences of trans and gender diverse young people
Puberty and puberty blockers
Content warning: discussions of self-harm and suicide attempts.
Puberty is a difficult time during many young people’s lives, but for trans and gender diverse young people it can often be a big challenge for a number of reasons. The young people we spoke to described diverse experiences of puberty and what the changes meant to them. They also spoke about their experiences of puberty blockers, medication that delays puberty. A few of the young people we spoke to had experience of puberty blockers and others talked about the impact puberty blockers would have had on their lives if they had been able to access them at puberty. This summary explores:
- Discomfort and distress with puberty;
- Making sense of puberty changes;
- Managing physical changes such as periods and menstruation;
- Experiences of puberty blockers and;
- Missed opportunities with accessing puberty blockers
Discomfort and distress with puberty
Many young people talked about the distress they felt as their bodies changed during puberty. Several described feelings of deep discomfort, fear, and helplessness at the beginning of puberty: Finn said, ‘It’s a panic, like a feeling of being trapped… like visceral disgust… it’s distressing’. He said ‘It’s that feeling of it looks wrong, it is wrong… that shouldn’t be there.’ Ari remembered being age 12 or 13 and being told ‘in the girls locker room about puberty and what changes happen’. They felt ‘absolutely horrified’ and wished they could ‘cryogenically freeze myself and I wouldn’t ever have to go through it.’
Charke talks about the significant negative impact of going through puberty.
Charke talks about the significant negative impact of going through puberty.
When I went to high school I think there was quite a big sharp that step up, I mean not like only is it just you’re getting old, but I think it being a larger school and hitting puberty was quite a big kind of cocktail that stormed up into quite a terrible time for me at that age. So it was in Year 8 by the time I was 13 I somewhat sorry, so, so yeah so by the time I was 13 I was in Year 8 I sort of accepted that hey I’m not normal, I’m not regular, I’m not fitting in with all these other people and I had an all-female friend group at the time, I felt like I fitted in with them, I got them and stuff, I was very much kind of, it was strange, I was part of it but not part of it, I felt in that it’s, in a way I felt I was in a way more valued than like some of the other members but in a way that was different as such. I’d always felt uncomfortable about that and with the onset of puberty where you have bodies turning more diverse even just, you know, appearance wise never mind what else is going on I think that set off a lot of dysphoric comfort or at least just discomfort with my body and the change in my body anyway. So I think that very much set off a quite a rough time in my life I became severely depressed self-harmed attempted suicide on two occasions and was hospitalised because of it and so it, I think that made me realise I can’t like ignore this I can’t just act like it’s normal and okay and stuff that there is something sort of deeper going on, some other issue.
Evelyn shares her feelings when she ‘started to hit puberty’. She realised ‘I don’t want to be a boy, I am a girl’.
Evelyn shares her feelings when she ‘started to hit puberty’. She realised ‘I don’t want to be a boy, I am a girl’.
I suppose like when I was like really, really, really young, I think I told my Mum that I, like wanted to be a girl or something like that. I don’t remember it myself, but I’ve been told that I said that to my parents. And then as I started to hit puberty I kind of like really realised that this isn’t, I don’t want to be a boy, I am a girl. And this, puberty that I’m going through isn’t right for me. So that’s when I started to come out to my parents.
I suppose obviously, the first kind of things that was really, like that triggered dysphoria was obviously like growing hair in my genital area, and then armpit’s as well, also like voice breaks, voice cracking and then getting deeper, that was like a big thing to me as well. Getting a lot taller and shoe size is also a thing, cos that’s like constantly there, and you always have to buy you know like new shoes, and new clothes and things like that, so you just, so it’s like always in your brain that that’s like abnormal for a regular female.
Several people said the timing and speed of puberty was important. Some experienced early puberty, which could add to the intensity of these feelings. Jack said that he ‘went through puberty at a very early age, I think I was about six or seven… so very, very young to the point that I probably should have got puberty blockers not even for being trans but [for] being that young.’ Finn said that whilst he was ‘flat-chested’, puberty suddenly hit him ‘like a ton of bricks’ and he immediately began to bind his chest. Several people described becoming very aware of puberty at school, particularly in relation to friends and other pupils, and the challenges of using changing rooms, toilets and doing sport.
Ezio describes their experience of puberty and how it felt ‘like a mistake’.
Ezio describes their experience of puberty and how it felt ‘like a mistake’.
But I know sort of when I was younger that I knew very much that I was female but I sort of just wished in my head that once puberty came like evolution or whatever it was it would realise it had like make a mistake or something and I would just go into puberty and somehow become a boy. But like and I kept sort of like every night I would go to bed and just wish that I would just wake up and be like male and I still do it now I started like in my sort of childlike head I started like sleeping on my front because I thought if my chest was compressed that the breasts would never come and I, it’s still how I sleep now. I used to have, sometimes when they did actually come I used to wake up and I’d had like a really good dream and I’d think oh good they’re actually are gone and sort of rush to the mirror and they’re still there and you’re like oh well that sucks. And I know when I was younger I sort of like I used to hit my chest a lot in the hopes that if like the nerves were damaged or something again the breasts wouldn’t come and I thought well if they do come can I just like pray they’re gonna be like quite small and thankfully they are but I still don’t like them, I don’t want them to be there and like if I could just like tear them off that would be nice. But I think, trying to think what else I did when I was younger, yeah I think it was just like just general wishing that something would change and I think as I got older and like puberty came I started to wish that I’d get some sort of like breast cancer that I could just have them removed and it would be socially acceptable.
Some young people spoke about how experiencing puberty changes had a negative impact on their mental health. Charke, Reuben and H spoke about experiencing depression as a result of the changes. Charke, Ezio and H shared how the distress of puberty also led to self-harming behaviour. Charke said puberty changes ‘set off a quite a rough time in my life, I became severely depressed, self-harmed, attempting suicide on two occasions and was hospitalised because of it’. Cas described the difficulty of dealing with self-hate and hate of one’s own body during puberty.
N reflects on the onset of puberty as ‘a spanner in the works’ and how their ‘whole relationship with their body shifted’.
N reflects on the onset of puberty as ‘a spanner in the works’ and how their ‘whole relationship with their body shifted’.
I think the thing that then the kind of single biggest spanner in the works this may be a way to talk about it, was puberty. Because I mean well, school uniforms are like, I went to a primary school where I could wear what I wanted, secondary school we had to wear, I went to an all-girls school, so we had to wear skirts. And then yeah puberty hit. And my body suddenly changed very significantly, and like I’d always, I’d always been very sporty, like in play, in the playground I would always play football with the boys at lunchtime or at break or whatever, and like played cricket, football, rode my bike everywhere, and then puberty hit and I didn’t want to run anymore. And I think I just became much more kind of self-aware and self-conscious. And I think it’s, it’s hard in some ways to disentangle that from like to disentangle kind of teenage discomfort with gender, like gender identity. Because everything is just confusing. And so yeah but that was definitely a thing, and like I, like my boobs were like very big as a teenager, and they like, aside from just that being really uncomfortable and gender, like from a gendered perspective, which it really was, like it also just hurt to run, or like play sport or anything else. And so I think my whole relationship with my body shifted at that point in like different ways because of that.
Making sense of puberty changes
People talked about confusion around puberty and their experiences of changes and many described feeling uncomfortable in their bodies and not knowing why. Patrick said when he started puberty between 12 and 13 and ‘didn’t understand why this feels wrong’ he said, ‘I didn’t have the language to describe it’.
People said that they would try to reassure themselves that their feelings were something everyone goes through, rather than see them as linked to gender identity. Kat said, ‘I kind of knew something was wrong and I didn’t like it, but I’ve been told everyone feels like that which kind of I guess is true but like trans people [feel] worse’. PJ described puberty ‘feeling like crap’ but thinking that there was ‘nothing else’ and he’d ‘just have to get on with it’.
Bay reflects on their understanding of puberty changes as they were taking place and how they tried to rationalise it.
Bay reflects on their understanding of puberty changes as they were taking place and how they tried to rationalise it.
So I guess in the early stages of thinking about being trans, first having that realisation that that might be what was going on, it kind of I guess, that was also the time that I’d heard of the term gender dysphoria, gender incongruence, and for me, my early experiences with it sort of started to explain the uncomfortableness that I’d always felt in my body growing up, and not really knowing why I’d, I guess I’d kind of just assigned it all to what happens in puberty, and, and you know everyone’s uncomfortable with their body through puberty to some extent, and I think I associated a lot of it with not wanting to grow up when actually it was, it was more about not wanting to become a woman, now looking back I think I can it that, I can see that But perhaps didn’t, well definitely didn’t at the time see that it, there was something else gender related going on there. So yeah I guess, I guess my experience of gender dysphoria was that there’s always been an uncomfortableness in my skin, in my body and finding the term trans, finding the term non-binary, and seeing different people’s experiences and stuff, kind of helped me to understand what that uncomfortableness was.
Jacob tried to think of puberty as a ‘natural teenage thing’ and that he was ‘gonna be fine’ and ‘get used to it’. He spoke about trying ‘really, really hard to fit in…pushing myself to be someone I wasn't’. Cassie talks about waiting for puberty to ‘finally click’. This, she thought, would make her ‘happy’ and ‘able to be like the other boys’. Then she would be able to ‘relate to them’ and puberty ‘will stop feeling so foreign and alien’. However she said ‘that never happened’.
Erion says ‘finally having a word to describe a lot of what I was feeling’ felt like a massive weight off my shoulders’.
Erion says ‘finally having a word to describe a lot of what I was feeling’ felt like a massive weight off my shoulders’.
Honestly, like finally having a word to describe a lot of what I was feeling because I hadn't realised, I didn't realise that people didn't feel the same way I did like people weren't just going around feeling super uncomfortable all the time with like the bodies that they had or like really hating their voices and hating like just generally like their body or their posture or like just little things like a kind of, you kind of get brushed off as like ‘oh that is just plain puberty. Everybody, emotions, hormones, that's fine.’ And like nobody ever told me that was not right. So then, finally sitting down with someone who goes, hey that's called dysphoria and that's a very common thing for trans people. And I was like, that fits, that feels right. And it was like just I think for me like a massive weight off my shoulders like knowing like all of these emotions I have had for, my god, like twelve years for me now, at least that were like, you know, valid and real. And that like other people have had those experiences and it was just like such a freeing thing to know that it wasn't sort of just a single, isolated experience of you know, just your standard like weird, oppressed kid, but instead it was like no, like there is actually a bit more to this and yeah there’s a word for that and going through that label and really going yeah, no I am trans and like that is my identity. Yeah was just ah, massive, massive weight.
Managing physical changes such as periods and menstruation
Several people spoke about being very aware of their bodily changes including body hair, breast development, genital changes, skin and voice changes, and starting periods. Evelyn said, ‘I suppose obviously, the first kind of things that was really, like that triggered [gender] dysphoria was obviously like growing hair in my genital area, and then armpit’s as well, also like voice breaks, voice cracking and then getting deeper, that was like a big thing to me as well. Getting a lot taller and shoe size is also a thing.’ Similarly, H spoke about how he found growing breasts ‘quite distressing’. Charke felt that body hair, especially facial hair, ‘was a big part of my dysphoria’.
Declan talks about his experience of puberty changes and his gender identity.
Declan talks about his experience of puberty changes and his gender identity.
I had really bad depression/anxiety which started at puberty and I didn’t really know why but I started feeling it a lot when, because I used to do a lot of sport and I’m starting to do more sport now, it was just that I didn’t really, like I started periods at like eight, so I was just like, ‘Uugh.’ So that felt kind of wrong and I would like hide it. It was, I didn’t really understand what it was. I didn’t feel comfortable going to anyone about it. My chest started growing at quite a young age too and I was like, ‘Ooh everyone’s supposed to be excited about this, excited about these things. Like becoming a woman.’ I didn’t really feel comfortable with it and I’d always had like long hair but I’d never look after it and I got it cut off before I came out and I felt so much better and I was like, ‘oh’ or I’d like hide my hair in a hat when it was long, and I’d be like, ‘Oh this feels really good and people would mistake me for like a boy or something even when I wasn’t out and it would just make me feel really good and I was like, if these things are making me feel bad and if I get rid of them or change and I feel good then surely that’s a good thing. So it’d really like get me down and sometimes it does still but when I was a teenager and things were starting to happen, it was really not good.
For the trans and gender diverse young people assigned female at birth, one of the most distressing changes at puberty was starting periods. Ezio said he tried to ‘block out the experience’. Declan said that he ‘started periods at eight’. He said it ‘felt wrong’ and would hide it. He went on to say that he ‘didn’t really understand what it was’ and ‘didn’t feel comfortable going to anyone about it.’ Cas felt there wasn’t much information available ‘anywhere …about how to deal with a period if you are trans’. Henry started menstruating at eleven and described feeling ‘horrified’ even though his mum was a nurse and had given him information on what to expect. He said he remembered ‘feeling a sense of horror and a complete lack of control.'
Some people also shared how they tried to control and manage their periods – always get the advice of a healthcare professional. Declan talked about managing his periods with the contraceptive pill. Ezio spoke about the different methods for stopping periods. The options he was aware of included the contraceptive pill, the implant, and the coil. Cas said that being able to stop periods was a significant first step and had a positive impact.
Cas talks about managing periods with progesterone injections.
Cas talks about managing periods with progesterone injections.
Well my first experience with healthcare would probably be surrounding periods. So, I actually didn't, there isn't actually any set information anywhere I could find about how to deal with a period if you are trans all the sort of stuff I could find was like it’s not talked about and it is very distressing, which it is very uncomfortable, obviously. The reason I actually found out about it was through doing biology in year eleven and actually talking to a teacher because I had an anxiety attack during that lesson because I couldn't deal with it, because I hated it so much. So I did get an appointment with the doctors and they talked about the different methods of stopping periods. But I think the information that doctors give is very complex. It's quite over complicated the way they deliver it. There was quite a few different options. It's not exactly laid out clearly enough for people to understand. I think depending on where you are again and the education you receive that might be an issue. Because it is quite complex and there are a lot of different names like they are based on progesterone and oestrogen. The names they have can be quite off-putting. And the information surrounding is also quite vague. I do kind of understand what they were saying. But I did get quite contrasting information so it was quite difficult for me to kind of really understand what I was actually being injected with. So I’m on a kind of progesterone injection.
Experiences of puberty blockers
Puberty blockers are Gonadotropin-Releasing Hormone (GnRH) agonists, which delay the progression of puberty. They are described by the Gender Identity Development Service (GIDS) as a ‘physically reversible intervention’ that ‘allows the young person to consider their options and to continue to explore their developing gender identity before making [further] decisions’ (GIDS, 2021)*.
Some young people were able to access puberty blockers and talked about their impact and the process of accessing them. One of the main issues was the long delays and waiting list for NHS gender identity services. Those who had gotten puberty blockers did so with the help of private care. Charke described how they ‘waited and worked with GIDS for a number of years’ but felt ‘they were making no progress and was no closer to accessing the intervention.’ They eventually sought help from a private health care provider. Charke said that for them it felt like the GIDS clinic was ‘withholding care’. Tom, Evelyn and Charke all describe some conflict between the GIDS and private healthcare process. Tom says that it was difficult working with both.
Evelyn talks about accessing puberty blockers and feeling ‘helpless’ to the ‘irreversible changes’ of puberty.
Evelyn talks about accessing puberty blockers and feeling ‘helpless’ to the ‘irreversible changes’ of puberty.
It was hard and then also it felt kind of helpless, like because I couldn’t see the Tavistock cos obviously I was on the waiting list, so I couldn’t see them, and then as soon as I got to the Tavi appointments I still had to wait like, I had to have multiple assessment sessions before I could even get on blockers, and before I was even like on blockers a lot of like the main things that defines a male puberty had already like happened or finished, like voice breaking, getting taller, and things like that.
Like I said we got to, once we got referred, we got a letter back from the Tavistock saying that we were on the waiting list and it was, I think it said nine to twelve months we were waiting for. And it was just kind of like helplessness, especially like after a few months, when I’d started going through puberty a lot more, it was like there’s literally nothing I can do, I just have to wait for an appointment. And then we got, I don’t, we didn’t get lucky, but like we were on it for nine months when the waiting list was like up to twelve months, so I suppose we got the better side of things, but still, we were still waiting for a really long time and lots of changes to my body was happening that are irreversible, and that blockers can’t take back.
I think hormone blockers are good for trans youth, but I think they could be better if the wait and the effort to get them is a lot shorter, because I basically was going through puberty whilst I was waiting to get the puberty blockers, so it was, it seemed really dumb and unnecessary and like I experienced a lot of the things that in the first place I was trying to stop, and I didn’t get to stop them.
The experience of puberty blockers involved dealing with physical and mental changes. The young people described positive impacts as well as the changes and side effects to be aware of when accessing this intervention.
Of the young people we spoke to with no personal experiences, some had heard about others experiences of accessing puberty blockers. Declan spoke about his friend who was ‘actually lucky enough to start them before he started puberty.’ He said his friend has ‘never had a period’, and it ‘stopped his chest from developing further’. He described this being ‘the main two things’ that ‘trans guys want to stop’. Declan also said that his friend ‘was able to start testosterone earlier because of that’.
Tom describes his experience of taking puberty blockers as ‘really good’, reversing changes in breast development.
Tom describes his experience of taking puberty blockers as ‘really good’, reversing changes in breast development.
Well straight away mentally, it was really good. But physically it’s really quite fast that it just stops everything. And obviously with the breast growth it actually goes back a little bit, in the like so some of your breast tissue goes back in well obviously not just goes back in but you know, so yeah, physically it starts quite fast as well, but obviously I only had the breasts were kind of like go off, so I don’t know if there’s other bits of puberty that would go back, but, yeah so on my account with the breasts it goes quite fast, and mentally as well.
Charke described how accessing puberty blockers felt ‘really relieving, it was great’. They said ‘I no longer felt like every day I was deteriorating’ and ‘digging further down to a hole I really didn’t want to be in.’ They said they felt like they could finally ‘breathe again’ and ‘things are no longer getting worse every day… for the first time in a long while’. They felt that finally they had time to ‘just work out, okay what do I want to do here’.
People also described some side effects including mood changes, headaches and hot flushes at the start of taking them. Evelyn and Tom said that some of the less positive changes of taking puberty blockers were ‘mood changes’. Evelyn spoke about having occasional ‘headaches’. She also found herself getting ‘more emotional’. She also said she had one occasion of ‘vomiting and sickness’. She said the information on what to expect was ‘drilled’ into her beforehand by the doctors prescribing puberty blockers which helped her feel prepared. She said while at GIDS ‘we were given a big folder… of stuff to look out for which told us what’ll happen, and side effects as well.’
Charke weighed up the costs and benefits and spoke about the risks of ‘low bone density or osteoporosis with prolonged use’. They described that while taking this into account they are ‘happy just taking blockers and seeing where I want to go in the future.’ Tom described receiving puberty blockers as a ‘thinking period’. In his words it ‘just relieves you of all the stress so you can get your head back where you want it to be’. Charke says that ‘it was absolutely the right move to get blockers when I got them, certainly no later’.
Tom responds to critics of puberty blockers and describes the positive impacts they’ve had on his life.
Tom responds to critics of puberty blockers and describes the positive impacts they’ve had on his life.
Say if there was someone watching or someone out there who was critical about hormone blockers…
Yeah.
…or concerned, didn’t have enough information what would you say to them?
What about just the whole of?
Yeah
I’d probably ask them why and what their kind of concerned and worried about, or don’t know enough about, cos it’s, it’s not a permanent thing, and I think obviously I get that some people like some religious people, and obviously not all of them, but I had a guy in my school, in my old school as well like, “God makes you perfect,” and stuff like that, and I’m totally respectful, I’m an atheist myself, but I’m not like critical of anything and I think everyone should have the right to a religion and stuff like that, but I think it’s, it’s up to them, and it’s up to their decision, and it’s not permanent so they can change it, it’s not a life-changing decision.
And what would you say to people that might actually want to try and stop young kids getting blockers?
Again I’d ask them why, because it’s, it’s, well it helped my mental health, which helped every other thing, which helped my education, get my grades up. It helped my friendships again, it helped me just getting back in the swing of things, and me not having as much anxiety and not falling into, I know a lot of people who have fallen into depression and stuff because they’re just not, they can’t handle it, and they’re just going down and down and down. So, I’d kind of ask them why do you think this is okay then? And this could be resolved by that. And so why wouldn’t you have that, wouldn’t that be the sensible option?
Missed opportunities with accessing puberty blockers
Many of the young people and young adults talked about the important timing of puberty blockers and reflected on missed opportunities of accessing timely intervention. Some young people talked about waiting 2-3 years for their first appointment with GIDS and being too young for hormone therapy and too old for puberty blockers.
Eel talks about reaching GIDS at an age where he had ‘already gone through puberty’ and ‘hormone blockers wouldn’t do anything’.
Eel talks about reaching GIDS at an age where he had ‘already gone through puberty’ and ‘hormone blockers wouldn’t do anything’.
Well, when I got my first GIDS appointment I guess we spent like a lot of the sessions talking about like what gender means. And only recently, actually, we started talking about interventions and like other than social kind of transitioning and because I'm in like a weird like twilight or like limbo situation where I'm a year from adult services. And when, which means it'll be a year before I can probably get my hormones. And usually, in the past, they said, if I came into GIDS earlier then I would have to be on like a year of hormone blockers and then I would get testosterone. But because I've already gone through puberty, hormone blockers wouldn't do anything. So, I'm like, I was in a position to choose to go on hormone blockers and basically not do much or not go on hormone blockers and then go to adult services and get testosterone. So I'm kind of just like chilling and waiting for my, getting like an appointment at an adult service.
Noelle talks about the waiting period for puberty blockers; ‘if you think about it, you start, you get that first referral at 12 and you’re only getting treatment at 16 like you’re most of the way through like at least the big changes in puberty. She said, ‘the effect that that has on people, it’s just, it’s cruel. It’s just cruel.’ Some young people talked about the opportunity to have puberty blockers at puberty. Declan spoke about learning about puberty blockers and trying to access GIDS but said ‘when I finally got there most of puberty had finished because I started really early’.
Ari who did not access puberty blockers reflected, ‘If I had known they were a thing, I would have leapt at the opportunity because I was so absolutely horrified by the idea of puberty.’ They said, ‘having the time to press pause on that, the time to think and assess, would have been so helpful.’
However not all the young people we spoke to felt this way. Ezio said, ‘I’m really envious of those people [who accessed puberty blockers] because they’ve had the spirit and courage to do that, but I know for me that that’s not who I am at all, you know, I am, I’m very slow I’m like a snail’.
H reflects on transitioning as an adult and the missed opportunity of starting younger.
H reflects on transitioning as an adult and the missed opportunity of starting younger.
so yeah. In terms of puberty blockers, I do think for you know trans teens and what not, you know if I was in that position that's something that I would want. I always say that if I could change anything, the one thing that I would change is doing this sooner. So obviously for me that's something that I would have, an option if it was available to me at the time would have done. And obviously with puberty blockers it suppresses basically just suppresses your puberty until you, until that person comes of age when they can decide if they want to, you know go on the hormone treatment. So I think you know for me personally I think it's a brilliant idea obviously it’s you know the scientists and everyone they’re still looking into it and whatnot and obviously so far it's been fine. It hasn't proven to have, to make any long-term damage or anything like that. But of course in the media they like to pretend it's something that it's not. But yeah I think they are, I think it's a brilliant idea and obviously if I personally had the chance to do it I would have I would have jumped on that. But yeah I mean I applaud any young trans person, trans teen who you know wants to go down this route. I think they are very brave very strong and you know I just think people should just you know think you know what it's it's their body at the end of the day and they have every right to if they're not comfortable in it, make that change. so yeah that's my take on keeper to blockers and puberty.
See also
Experiences of Gender Identity Development Service (GIDS)
Journeys to identifying as trans and gender diverse
*The World Professional Association for Transgender Health (WPATH) state that ‘treatment of transgender adolescents involving gender affirming medical interventions (puberty suppression and subsequent gender affirming hormones) are a widely accepted and preferred clinical approach in health services for transgender people around the world’ WPATH, 2020. Statement Regarding Medical Affirming Treatment including Puberty Blockers for Transgender Adolescents. Available at: http://epath.eu/wp-content/uploads/2020/12/FINAL-Statement-Regarding-Informed-Consent-Court-Case_Dec-16-2020.docx.pdf