Reaching Maturity

The only justification offered for Puberty Denial is to maximize a transgender youth's chance to change their mind about transitioning.   10-year olds are too young and immature to make such an important decision, the "experts" say.   It's better for the decision to wait until they're older and more mature.

The section on brain development (above) emphasizes the key role puberty plays in brain growth & development.  ...And those biologic changes lead to better judgement and reasoning power.  And more mature decisions.

Except, Puberty Denial halts brain development and maturation.  After 8 years of hormone blockers, the body may be 18 years old, but that body's size, development, maturity and judgement are still those of a 10-year old.  The individual's ability to make important decisions hasn't improved.

For that matter, a pre-pubertal transsexual could undergo formal testing to demonstrate their judgement and ability to make valid decisions.  If they pass the test, they could be allowed to transition without the high-risk process of Puberty Denial. 

So why do the "experts" insist on Puberty Denial?  The answer is suggested by the fact that Denial continues until the age of legal majority, whatever that is:  16 - 21 years old.  It doesn't last until the youth can pass some kind of cognitive test.  There's no explanation why WPATH authorizes transitioning at age 18 years in most states, age 19 years in Alabama & Nebraska, but 21 years in Mississippi & Puerto Rico?  Why does a medical decision depend on local law instead of the best interests of the patient?

The real reason for imposing the horrors of Puberty Denial is so that medical professionals won't be legally liable for the transitioning decision.

          ...Instead, they're legally liable for Puberty Denial and the injuries it causes.

Just stay that way for 10 years  and I'll let you transition.

I promise.

The Gender Police want to stop all transitioning.  The gatekeepers explain that they're unable to tell the difference between a Real Transsexual and a misguided normal child.  Their solution is to put a halt on all medical treatment until adulthood.   That way, youth will have every opportunity to give up all that gender-change "foolishness".  To provide an even greater incentive, gender-change wannabe's aren't allowed to go through puberty unless they surrender first. 

The torture of puberty denial is horrendous, but transsexuals endure it.  But the damage done is catastrophic and life-long.  

In reality, there's no justification for WPATH's transitioning embargo.  Transsexuality during childhood can be recognized easily.  It's in the child's best interest to transition immediately, to allow for development & socialization to take place in the correct gender.  Surgery and an effective hormonal regimen must be in place before puberty, so the youth can go through adolescence as their real self.

WARNING!  Transsexual Youth Should Never Go Through the Wrong Puberty!

The Bottom Line: 

Puberty denial is a high risk adventure into the unknown.  It's certainly not justified in order to please transphobic psychiatrists.  It's definitely not in the best interests of the transsexual. 

The best interests of the youth are served by medical transitioning prior to puberty.  They can then go through a normal adolescence in their proper gender.  There's no worry afterward about catching up or repairing the damage.  (For effective treatment designed to help transsexuals, see HERE.)

WARNING!  Transsexual Youth Should Never Be Allowed to Go Through the Wrong Puberty!

Puberty Denial

You're going to do WHAT?

The "experts" at WPATH recommend giving hormone blockers to all transsexual children at the first sign of puberty.  The blockers are GnRH (Gonadotropin Releasing Hormone) inhibitors whose primary purpose is to stop the body's production of sex hormones ( testosterone or estrogen.)  As an extra bonus, they also stop production of Growth Hormones and Adrenal Hormones.  

TOO IMMATURE:  Psychiatrists explain that 8 - 10 year olds don't have the maturity to make life-altering decisions like "choosing" to transition.  The solution is to place the youth into stasis by removing all hormonal exposure for 6 - 12 years.  By that time, the youth will be old enough to make a valid decision.   The hope is that the youth will be convinced to finally give up their non-conformity & rebellion.  If they do, the GnRH is immediately stopped and puberty takes place.

Apparently 8 - 10 year olds are mature enough to decide NOT to transition.

"SAFE":    Medical professionals assure parents that the process is perfectly safe.  WPATH labels it a "fully reversible intervention" (WPATH Guidelines, p 18).  The Endocrine Society is more explicit:  "Prolonged pubertal suppression using GnRH analogues is reversible and should not prevent resumption of pubertal development upon cessation of treatment."  "Girls can expect no adverse effects when treated with pubertal suppression."  (Endocrine p 12). 

That is, it's "fully reversible" only if the youth surrenders quickly.  People have hormones for a reason.  A claim that anyone can safely survive 10 years without hormones is appalling.  The fact that any medical professional would even consider treating a human that way shows the contempt the "experts" have for transsexuals.

This is how the "greatest minds" in Endocrinology explain their position:

"This recommendation places a high value on avoiding harm with hormonal therapy in prepubertal children who may have GID that will remit after the onset of puberty and places a relatively lower value on forgoing the potential benefits of early physical sex change  induced by hormone therapy in prepubertal children with GID.  This justifies the strong recommendation in the face of very low quality evidence."

             -- Endocrine Guidelines p 12

No-Puberty Consequences

Here's a list of the changes that take place during puberty.   -- Changes that puberty denial youth miss out on.


The physical changes that take place  during puberty are clearly apparent:  there's a growth spurt & skeletal changes; there's muscular development, skin thickening & increased oil production (with acne), changes in hair growth, in addition to the familiar genital changes, beginning of menstruation, and breast development.  For any youth on GnRH hormone blockers, these changes won't occur.

Pubertal growth occurs primarily in the long bones.  Girls experience widening of the hips, while boys develop thicker, stronger bones.  All this bone growth must be carefully coordinated so that changes are proportionate and both sides grow equally.  Deformity occurs if some area of bone growth gets out of hand.  Scoliosis (curvature of the spine) is an example of asymmetrical bone growth and it's 8x more common in girls than in boys.

An important part of bone growth regulation is epiphyseal closure.  Every bone in the body has two or more epiphyseal plates where growth actually takes place.  Once a plate closes, no more growth will take place at that site.  Proper body shape is maintained by carefully managing the timing of epiphyseal closure, and making sure the epiphyses on both sides of the body close at the same time.

Of course, none of this takes place during puberty denial.  

Athletic Risk:  As the years pass, other youth in school will grow and develop, while a puberty denial youth won't.  Peers will become taller, heaver, more competitive, have greater muscle mass, and have stronger bones.  Denial youth shouldn't participate in contact or impact sports with post-pubertal youth (For more details, see HERE). 

A Denial youth's open epiphyses are another risk.  An epiphysis is a weak spot in a bone.  If a fracture occurs, it's likely to involve the growth plate.  If it does, that bone won't be able to grow as it should later on.

Scoliosis Risk:  Adolescent females are known to be relatively high risk already.  How does that translate into transsexual maturation?  Meddling in hormonal control can cause unintended changes in bone growth and in the sequence of epiphyseal closure.


Every person accumulates calcium during puberty as part of the hormonal changes and bone development.  Calcium storage is complete by the mid-twenties.  After that, calcium is gradually lost for the rest of a person's life.  It's not possible to add to the calcium stores later in life.  Any person who doesn't accumulate enough calcium during adolescence is destined to have osteoporosis (weak bones due to calcium depletion) later in life.

Calcium storage doesn't take place during puberty denial.


Just prior to the onset of puberty, the brain begins a massive growth spurt, particularly involving the pre-frontal cortex (used for reasoning and judgement).   Pathways that connect various parts of the brain grow & change.  Scans show that children, adolescents and adults use completely different parts of the brain during tasks like problem-solving, decision-making and impulse control.

The number of neurons (ie, gray matter) increases exponentially during the first few years, then actually decrease during mid-puberty.  Apparently this process of rapid growth and later pruning remodels the brain so that important tasks can be carried out quickly & efficiently, while unused pathways are discarded.

People achieve the greatest ability to learn during puberty.  After that, it's all downhill.  Judgement isn't so great, however.  That reaches full maturity during a person's early 20's.

How puberty denial impacts brain development has never been studied -- you'd think that would be the first priority in showing that puberty denial is safe.  It is known that testosterone & estrogen play an important part in the brain development process, so one would expect interrupted development.  It's also quite obvious that youth undergoing puberty denial don't have the maturing judgement, interests and intellectual skills that their peers have.


A youth enduring Puberty Denial remains a 10-year old intellectually and developmentally through all of middle school and high school.   Scholastically, they may end 6th grade at the top of their class, but they'll soon be struggling to maintain a D average in remedial  classes.  Their brain stopped developing, while everyone else in the school is enjoying the benefits of teenage brain remodeling.

Meanwhile, the rest of the school is dating, falling in love, exploring sexuality, fighting with their parents, testing limits, becoming independent and doing all those other Raging Hormones activities.  Someone in puberty denial won't be invited to any of the parties. 


Remember that puberty blockers act directly only on the sex hormone system (testosterone & estrogen).  But they obviously have a domino effect on the other hormonal systems -- such as growth hormone, thyroid and the adrenal glands.  (Obviously, because puberty denial youth don't grow and don't undergo changes in skin and hair growth.)  

How extensive the impact on other systems depends on the individual.  While some experience minimal collateral hormone damage, others are left without stress steroids (the cortisol system) and with thyroid problems.

--  A broken stress steroid system is often silent under normal circumstances.  However, the body is unable to react to major trauma, surgery, or serious infections.  Sudden death may result.


-- The thyroid gland regulates a person's metabolism.  Thyroid problems are known to be relatively common during puberty just because the gland is straining to keep up with all the physical changes.  In puberty denial, the thyroid is prevented from undergoing its usual enlargement.  If it's prevented too much, the person will become sick as a result.

Unfortunately, low thyroid function is subtle and may not be recognized.  Anyone undergoing puberty denial must have their thyroid function monitored regularly.

The New Gender Paradigm

Inducing Puberty:  Making up for lost time

Okay.  A transsexual has endured the unendurable.  The time is up.  The lawyers are happy.    What happens next?

You have a 18-year old undeveloped physical body that's weak, fragile & totally calcium depleted.  You have someone with the personality and intellectual ability of a 10-year old.  It's time to play catch up.

What do you do?

It should be no surprise that WPATH and the Endocrinologists don't have much to say about the aftermath of denial.  From their point of view, they've failed in their great quest to halt transitioning.

Beginning on p 16, the Endocrine Society Treatment Guidelines recommend starting gender-appropriate hormones at age 16 years.  Remember that puberty suppression with GnRH will have to continue into adulthood pending removal of the gonads.  (If GnRH is stopped, the transsexual will immediately go into wrong-gender puberty.) 

The Endocrine Society's puberty-induction regimen begins with tiny doses that increase slightly every 6 months.  Physiologic levels won't be achieved for another 2 years.  It's unknown whether an 18-year old denial body responds to hormones the way a 10-year old body would.  Will calcium reserves build up?

It is known that denial bodies turn out about 1 - 2 inches shorter that they otherwise would have. 

Even more concerning is the status of the developing brain.  It's not known what triggers the sudden brain growth that begins prior to puberty.  Nor is it known whether that brain growth continues or stops when GnRH blockers are given.  ...Or whether it can restart with micro-doses of gender-appropriate hormones.

Mid-puberty brain pruning depends on an intense learning environment in order to direct brain remodeling.  It may be helpful to re-create a high school classroom environment for a recovering denial adolescent.

It's unknown why brain maturity maximizes during the mid-20's.  If brain remodeling stops at the usual time, a denial adolescent will get only a quarter to a third of the maturation they otherwise would have.

                        © Cassandra Branch MD