Pubertal blockers for transgender and gender diverse youth
Transgender and gender diverse children might choose to temporarily suppress puberty through the use of prescription medications called pubertal blockers. But deciding to get this treatment is a big step.
跨性別和性別不同的兒童可能會選擇通過使用被稱為青春期阻滯劑的處方藥來暫時抑制青春期。但是決定是否接受這種治療是很大的一步。
Here's what you need to know about the pubertal blocker medication known as gonadotropin-releasing hormone (GnRH) analogues, including the benefits, side effects and long-term effects.
以下是關于青春期阻滯劑類似物促性腺激素釋放激素類似物的藥物治療，包括益處、副作用和長期影響。
What do pubertal blockers do?
青春期阻滯劑起什么作用？
Puberty's physical changes can cause intense distress for many gender-nonconforming adolescents. When taken regularly, <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues suppress the body's release of sex hormones, including testosterone and estrogen, during puberty. These hormones affect:
青春期的身體變化可能會給許多性別不符的青少年帶來極大的痛苦。經常服用 GnRH 類似物會抑制青春期身體釋放性激素，包括睪丸激素和雌激素。這些激素影響:
- Primary sex characteristics. 主要性別特征 These are the sexual organs present at birth, including the penis, scrotum and testicles and the uterus, ovaries and vagina. 這些是出生時存在的性器官，包括陰莖、陰囊和睪丸，以及子宮、卵巢和陰道
- Secondary sex characteristics. 第二性征 These are the physical changes in the body that typically appear during puberty. Examples include breast development and growth of facial hair. 這些身體上的變化通常出現在青春期。例如，乳房發(fā)育和面部毛發(fā)生長
In those identified as male at birth, <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues decrease the growth of facial and body hair, prevent voice deepening, and limit the growth of genitalia.
在那些出生時被確定為男性的人群中，GnRH 類似物會減少面部和體毛的生長，防止聲音加深，并限制生殖器的生長。
In those identified as female at birth, treatment limits or stops breast development and delays or stops menstruation.
在那些出生時被確定為女性的人群中，治療限制或阻止了乳房的發(fā)育，推遲或停止了月經。
What are the benefits of use of pubertal blockers?
使用青春期阻滯劑的好處是什么？
Gender dysphoria is the feeling of discomfort or distress that might accompany a difference between experienced or expressed gender and sex assigned at birth.
性別認同障礙是伴隨著出生時經歷或表達的性別和性別差異而產生的不適或痛苦的感覺。
For children who have gender dysphoria, suppressing puberty might:
對于有性別認同障礙的孩子來說，抑制青春期可能會:
- Improve mental well-being 改善心理健康
- Reduce depression and anxiety 減少抑郁和焦慮
- Improve social interactions and integration with other kids 改善與其他孩子的社交互動和融合
- Eliminate the need for future surgeries 消除未來手術的需要
- Reduce thoughts or actions related to self-harm 減少與自我傷害有關的想法或行動
However, puberty suppression alone might not ease gender dysphoria.
然而，僅僅抑制青春期可能不能緩解性別認同障礙。
What are the criteria for use of pubertal blockers?
使用青春期阻滯劑的標準是什么？
To begin using pubertal blockers, a child must:
要開始使用青春期阻滯劑，孩子必須:
- Show a long-lasting and intense pattern of gender nonconformity or gender dysphoria 表現出持久而強烈的性別不一致或性別認同障礙
- Have gender dysphoria that began or worsened at the start of puberty 青春期開始或惡化的性別認同障礙
- Address any psychological, medical or social problems that could interfere with treatment 解決任何可能影響治療的心理、醫(yī)學或社會問題
- Provide informed consent 提供知情同意
Particularly when a child hasn't reached the age of medical consent, parents or other caretakers or guardians must consent to the treatment and support the adolescent through the treatment process.
特別是當兒童未達到醫(yī)療同意年齡時，父母或其他看護人或監(jiān)護人必須同意治療，并在治療過程中支持青少年。
Are the changes permanent?
這些變化是永久性的嗎？
Use of <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues doesn't cause permanent changes in an adolescent's body. Instead, it pauses puberty, providing time to determine if a child's gender identity is long lasting. It also gives children and their families time to think about or plan for the psychological, medical, developmental, social and legal issues ahead.
促性腺激素釋放激素類似物的使用不會引起青少年身體的永久性變化。相反，它會暫停青春期，為判斷孩子的性別認同是否持久提供時間。它也給孩子和他們的家庭時間去思考或計劃未來的心理、醫(yī)療、發(fā)展、社會和法律問題。
If an adolescent child stops taking <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues, puberty will resume.
如果一個青少年停止服用 GnRH 類似物，青春期就會恢復。
What is the typical treatment time frame?
典型的治療時間框架是什么？
For most children, puberty begins around ages 10 to 11, though some start earlier. The effect of pubertal blockers depends on when a child begins to take the medication. <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogue treatment can begin at the start of puberty to delay secondary sex characteristics. In slightly later stages of puberty, the treatment could be used to stop menstruation or erections or to prevent further development of undesired secondary sex characteristics.
對于大多數孩子來說，青春期開始于10到11歲，雖然有些孩子開始得更早。青春期阻滯劑的效果取決于孩子什么時候開始服藥。促性腺激素釋放激素類似物治療可以在青春期開始時開始，以推遲第二性征。在青春期稍晚的階段，這種治療可以用來阻止月經或勃起，或者防止不受歡迎的第二性征的進一步發(fā)展。
While most children take the medication for a few years, every child is different. After suppressing puberty for a few years, your child might decide to stop hormone therapy or pursue other hormone treatments.
雖然大多數孩子服用這種藥物幾年，但每個孩子都不一樣。在抑制了幾年的青春期之后，你的孩子可能會決定停止激素療法或者尋求其他激素療法。
How is the medication given?
如何給予藥物治療？
<abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogue treatments for children are prescribed, administered and monitored by a pediatric endocrinologist. The medication is typically given as injections, either monthly or every three months, or through an implant placed under the skin of the upper arm. The implant typically needs to be replaced every 12 months.
兒童 GnRH 類似物治療是由兒科內分泌專家處方、管理和監(jiān)測的。這種藥物通常以注射的形式給藥，每月或每三個月一次，或者通過植入在上臂皮膚下的植入物。植入物通常需要每12個月更換一次。
While taking pubertal blockers, your child will have regular blood tests to monitor the medication's effectiveness. Your child will also be monitored for any side effects.
在服用青春期阻滯劑的同時，你的孩子會定期進行血液檢測，以監(jiān)測藥物的有效性。你的孩子也會被監(jiān)控任何副作用。
What are the possible side effects and complications?
可能的副作用和并發(fā)癥是什么？
It's important for your child to stay on schedule with all related medical appointments. Contact your child's doctor if any changes cause you or your child concern.
所有相關的醫(yī)療預約都要按時完成，這對你的孩子來說很重要。如果有任何變化引起您或您的孩子的關注，請與您孩子的醫(yī)生聯系。
Possible side effects of <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogue treatment include:
促性腺激素釋放激素類似物治療可能的副作用包括:
- Injection site swelling 注射部位腫脹
- Weight gain 體重增加
- Hot flashes 熱潮紅
- Headaches 頭痛
Use of <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues might also have long-term effects on:
使用促性腺激素釋放激素(GnRH)類似物還可能對以下方面產生長期影響:
- Bone density 骨密度
- Future fertility 未來的生育率
Children will likely have their height checked every three months. Your child's doctor might recommend yearly bone density and bone age tests.
孩子們可能每三個月檢查一次身高。你孩子的醫(yī)生可能會建議每年做一次骨密度和骨齡測試。
If children with male genitalia begin using <abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues early in puberty, they might not develop enough penile and scrotal skin for certain gender confirmation genital surgical procedures, such as penile inversion vaginoplasty. Alternative techniques, however, are available.
如果有男性生殖器的兒童在青春期早期就開始使用 GnRH 類似物，他們可能不會發(fā)育出足夠的陰莖和陰囊皮膚來進行某些確認性別的生殖器外科手術，比如陰莖倒置陰道成形術。然而，替代技術是可行的。
In addition, delaying puberty beyond one's peers can be stressful. Your child might experience lower self-esteem.
此外，把青春期推遲到同齡人之后可能會有壓力，你的孩子可能會感到自尊心降低。
What other treatments are needed?
還需要什么其他的治療方法？
Assessment and counseling by a behavioral health provider can help you and your child as you move through the decision-making process and provide support during therapy. Engaging your child's school teachers and officials also might help ease your child's social adjustment during this process.
行為健康提供者的評估和咨詢可以幫助你和你的孩子完成決策過程，并在治療期間提供支持。在這個過程中，讓孩子的學校老師和官員參與進來也可能有助于緩解孩子的社會適應。
After a period of adjusting to pubertal blockers, adolescents might work with their care team to add cross-hormone treatment. This is done to develop masculine or feminine secondary sex characteristics, helping the mind and body look and act like the gender with which your child identifies. Keep in mind that some of these changes aren't reversible or will require surgery to reverse the effects.
經過一段時間的適應青春期阻滯劑，青少年可能會與他們的護理小組增加交叉激素治療。這樣做是為了發(fā)展男性或女性的第二性別特征，幫助大腦和身體的外觀和行為與你的孩子所識別的性別相似。請記住，這些變化中的一些是不可逆的，或者需要通過手術來逆轉這些影響。
<abbr title="gonadotropin-releasing hormone">GnRH</abbr> analogues aren't the only medications that can delay puberty. If you're interested in alternative treatments, talk to your child's doctor.
促性腺激素釋放激素類似物并不是唯一可以延緩青春期的藥物。如果你對替代療法感興趣，可以和你孩子的醫(yī)生談談。
