Puberty and puberty blockers
- Discomfort and distress with puberty
- Making sense of puberty changes
- Managing physical changes such as periods and menstruation
- Experiences of puberty blockers
- 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.
Read transcript
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”.
Read transcript
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 armpits 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.
Ezio describes his experience of puberty and how it felt “like a mistake”.
Read transcript
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, made 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.
‘N’ reflects on the onset of puberty as “a spanner in the works” and how their “whole relationship with their body shifted”.
Read transcript
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.
Read transcript
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.
Rahul speaks about Ruby Rose and their role in Orange Is The New Black as an important role model.
Read transcript
I think I first properly came to terms with it when I was 20 because my friends were quite confused about Ruby Rose’s character in Orange is the New Black or not her character actually but the actual actress. They, I think identify as gender fluid. My friend didn’t really understand it. The conversation felt like to me that she was kind of discredited like the friend was discrediting Ruby Rose’s gender identity and that is when we really got started talking about gender and she kind of confronted me on the fact it sounded like I was very uncomfortable being a woman. I was like, this is accurate. Obviously, I’d had thoughts about being unhappy being a female before, but not really ever considered myself anything other than because the research you do as a young person is very horrifying, especially if you are like 13, 14 which is when I think I first started having these thoughts and actually realising that you could be transgender and there were like surgeries and treatments and you could socially be accepted as a different gender than the one you were born as. it’s a very scary place because the only like kind of resources in terms of like fiction and facts is these kind of like horrible images of like surgeries and being social outcasts and you know, this kind of thing. I’d already, like I’d always kind of pushed the idea away again. Yeah, when I was 20 I kind of realised that that was the case for me and I was more unhappy pretending to be female than whatever consequences I would have living as a male.
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 armpits 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.
Read transcript
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.
Tom describes his experience of taking puberty blockers as “really good”, reversing changes in breast development.
Read transcript
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.
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.
Read transcript
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 9 to 12 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 9 months when the waiting list was like up to 12 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.
‘H’ reflects on transitioning as an adult and the missed opportunity of starting younger.
Read transcript
For me it’s a hard one because obviously I started my transition you know in my twenties. But you know I always said to myself, if I could change one thing I would have done this earlier, like cos obviously it was always there, but it took, it did take me a while to accept it. Now obviously some, some people know themselves, like some, it’s possible to be, you know for people to know themselves at different points in their lives, so you know it is, it’s one of those things no matter sort of you know, a child, you know teenager or adult, you should be taken seriously about this if you’re distressed, you’re distressed. Like just because you’re you know young you shouldn’t be dismissed about how you feel. So I feel like if they were to take away the opportunity for people to transition before they’re eighteen, cos I don’t actually know you know what exactly happens before, before you’re eighteen, if it’s possible, I just hear you know rumours here and there, but if you take that away I feel like it would cause a lot of, it would cause more harm than good because everyone, and as I said everyone’s different, like some, some teenagers may, you know they may really express this and you know some people mature quicker than others. So, you can’t say oh well you’ve got to wait until you know they’re eighteen to transition, because by then sometimes the damage is done. Because you know with the whole blockers to sort of halt your puberty, to you know so it gives you that extra bit of time you know to sort of figure things out and it, you know the puberty it gives, it gives off you know irreversible changes. So you know obviously I went through puberty, now I’ve got to have surgery and it’s really long whereas you know say if, say if you know for a young trans man if they was to have you know the blockers, it would it’s meant to stop them from growing breasts and things like that. So that for me, if I was in the situation where I had, you know accepted this when I was younger then I would obviously have wanted, that’s what I would have wanted.
Bay talks about how incorrect information in media articles impacts people’s discussions around trans healthcare.
Read transcript
A lot of sensationalism. A lot of just incorrect stuff. It, you know the, the, the discussions around the discussions around treatment of trans youth and trans children I find very frustrating because although I appreciate that it is a incredibly complex topic, and incredibly complex issue and, and you know it, there are a lot of different factors to consider in that, those discussions in the media are often filled with stuff that isn’t true. So those discussions cannot be had in a, you know in a productive way because people are reading things and, that aren’t true, and then the discussions haven’t, you know you, you read through a conversation that’s gone on on Twitter, in response to an article in a paper or something, and the whole conversation has developed around one sentence that is, you know that you know isn’t true, so you know that, those conversations are incredibly frustrating to read. You know around what age people can access hormones, and you know the confusion between hormone treatment and puberty blockers, and the stuff like that. Yeah it, so I guess my, yeah. A lot of it’s sensationalist, a lot of it’s just incorrect. And therefore all the discussions that happen off the back of it are based around incorrect things.
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”.
Read transcript
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.