People keep saying puberty blockers have been used for years as if that ends the argument. It doesn’t.
There has already been legal action and regulatory concern around these drugs, including in uses outside gender medicine.
Lupron has already been the subject of major class-action litigation.
There was a large US class action over Lupron marketing and sales practices, settled for $150 million. That case was about alleged fraudulent marketing/pricing practices, not specifically child side effects, but it matters because it shows this is not some pristine, unquestioned drug history. Lupron has already had serious legal controversy around how it was marketed and sold.
There have been long-running complaints from women treated with Lupron as children for precocious puberty.
STAT reported that women who were given Lupron to halt early puberty later reported serious health problems, and that large numbers of adverse-event reports had been filed with the FDA. The reports included insomnia, depression, joint pain, blurred vision, bone problems, pain/disorders, and inability to walk. Adverse-event reports do not prove causation in every case, but they are exactly the sort of safety signal that should make people stop saying “we know this is harmless”.
The FDA has added a warning for children taking GnRH agonists.
In 2022, the FDA added a warning about pseudotumor cerebri, also known as idiopathic intracranial hypertension, to GnRH agonists used in children for central precocious puberty. The affected drugs included Lupron Depot-Ped, Fensolvi, Synarel, Supprelin LA and Triptodur. Symptoms included headache, papilledema, blurred or lost vision, double vision, eye pain, tinnitus, dizziness and nausea. In the FDA’s review, five of the six identified cases were children being treated for central precocious puberty, and one was for transgender care.
So no, it is not true that these drugs have a clean safety history in children.
Texas investigated puberty-blocking drug manufacturers.
The Texas Attorney General issued civil investigative demands to AbbVie and Endo, looking at whether puberty-blocking drug manufacturers had deceptively advertised or promoted hormone blockers for unapproved uses without properly disclosing risks to children and parents. That again does not prove the final legal conclusion, but it shows there is serious official scrutiny of how these drugs have been promoted.
Reuters found FDA adverse-event reports involving children on puberty blockers.
Reuters reported 72 adverse-event reports from 2013 to 2021 involving children on puberty blockers who showed suicidal, self-injurious or depressive behaviour. The children were taking the drugs for central precocious puberty or gender dysphoria, or were simply identified as under 18. Again, adverse-event reports are not automatic proof of causation, but they are not nothing.
There is now legal action around gender medicine guidance itself.
The US Federal Trade Commission and several states have sued WPATH, alleging it made misleading statements about the benefits and risks of gender-related treatments for young people. WPATH disputes this, and the case is politically contested, but it is still a live legal action about whether families and clinicians were misled about risks and benefits.
Here in UK, puberty blockers have already been through major litigation.
Bell v Tavistock centred on whether children could properly consent to puberty blockers. The Court of Appeal overturned the original High Court ruling, but the case still exposed the huge legal and ethical problem: these are children being asked to make decisions with adult, lifelong consequences. That issue has not gone away.
The US Supreme Court has now upheld the right of states to restrict these treatments for minors.
In United States v Skrmetti, the US Supreme Court upheld Tennessee’s law restricting puberty blockers and hormones for minors when used for gender transition, while still allowing them for conditions such as precocious puberty. That distinction is important: the same drug can be permitted for a real endocrine disorder and restricted for gender distress because the medical purpose and risk-benefit calculation are completely different.
So the line “they’ve been used for years for precocious puberty” is not the trump card people think it is.
First, central precocious puberty is a real, objective, verifiable medical condition: puberty starting abnormally early. The treatment aim is to return development to more normal timing.
Second, even in that use, there have been warnings, adverse-event reports, complaints and legal controversy.
Third, using the same drugs to stop normal puberty in an 11-year-old with gender distress is a completely different ethical and medical question.
The existence of one legitimate use does not make every use safe. Morphine has legitimate uses. Chemotherapy has legitimate uses. That does not mean you give them to physically healthy children because the child is distressed by their body.
The question is not “has this drug ever been used before?” The question is: what is the condition, what is the aim, what is the evidence of benefit, what are the risks, and can this child possibly understand the lifelong stake's