Puberty blocking in gender dysphoria: suitable for all?

We welcome the opportunity to comment on the concerns raised on the use of the hypothalamic blocker, the gonadotropin-releasing hormone (GnRH) analogue, to pause pubertal development in young people who have been assessed as having gender dysphoria and to extend the information presented in our recent review.1 It is important in the first instance to note that transgender identities have been documented across many different societies and historical time. Nowadays, more and more people are challenging the rigid articulation of sex and gender prescribed by many cultures and voicing an incongruity with their biological sex. Internationally, a meta-analytical study reported the prevalence of ‘transsexualism’ was 4.6 in 100 000 individuals: 6.8 for transwomen and 2.6 for transmen; time analysis found an increase in reported prevalence over the last 50 years.2 We may not understand exactly why this happens, but evidence from twin studies and brain differences, although tentative, suggests at least in part a biological component to gender diversity. To account for a strongly felt, unwilled, human capability like gender dysphoria, we probably need multiple-level explanations where the social and the biological intersect. One of the principal impressions in meeting young transpeople is the frequent intense distress caused by the body they experience as …