Puberty blockers for an eight-year-old with early puberty and short stature?

[Cattenberg]

This isn’t about gender, but as you collectively seem to know a lot about puberty blockers, I thought you might give me some things to think about before I take DD to a GP appointment next week.

DD is eight and is already showing some early signs of puberty. She is also very short for her age (a family trait) and sometimes complains about being the shortest in her class and the second shortest in her year group.

I understand that starting puberty at eight isn’t classed as precocious puberty, but that it would be if she were seven. And I know that everyone develops at their own rate, but my concern is that by starting puberty early, DD won’t reach her full potential height (which would be short, anyway).

I don’t know if taking puberty blockers for a year or two would be an option in DD’s case, but I’d like to know more about the benefits and drawbacks.

What does your/ your child’s endocrinologist suggest?
Height and menarch has long been debunked as an old wives tale.
Some signs of puberty are normal and occur as much as two years prior.
Your wording makes the whole thing sound hypothetical.

What do you mean that the height and menarch myth has been debunked? I thought that it was understood that girls generally stopped growing 2 (to 3) years after their period starts. Is that untrue, or so you mean something else?

OP, having been through this with DD - we never got to the point where puberty blockers were recommended so I can't specifically advise on that. But what I can tell you is that the endocronologist really looked carefully and has been monitoring her growth and development ever since. He did not want to put her on puberty blockers if he could avoid it. In part, I think, because he saw that as potentially harmful to her mental/emotional health.

So I would not assume that this is something they will absolutely recommend asap.

DD is now almost 12 and he expects her to start her period within the next few months (she's been having annual ultrasounds so we do have a sense of where she's at vs other children). But when he first saw her - when she was 7 or 8 - he started with a battery of tests and ultrasounds and then monitoried her on a 6 monthly basis with a clear instruction tom e that if at any point, i saw anything accelerate, I should leap into action to get an earlier appointment with him. When she was 9 or so we moved to annual monitoring (same instruction for if anything changed), alongside the annual ultrasound to review the womb and ovaries.

One other thing which was relevant for her but is not, I think, standard but I will mention - we discovered she has a diary intolerance and when we cut diary, a lot of the early puberty signs stopped or slowed down. He told me there's no research on causation but they do see early puberty and dairy intolerances in the same patients often.

I think you should talk to your GP and ask for a referral to an endocrinologist. It is highly unlikely that anyone on this forum has any experience of the on-label use of puberty blockers. In fact, you'd likely get a bigger response if you posted on MN but not on this forum.

I think you are best off starting the discussion with your gp, who can refer to a paediatric endocrinologist for testing and assessment of your child's stage of puberty and development, and allow you to find out what is medically appropriate and advisable in your child's case, and then weigh up any pros and cons.
These are powerful drugs with significant clinical effects and should be discussed, prescribed and monitored on well defined grounds in a specialist setting, for verifiable precocious puberty, not vague ideas of pauses, height or identity.

This is old but a sobering read. I would not mess with my child's bone density if I could help it especially if it wasnt truly precocious puberty

https://www.pbs.org/newshour/amp/health/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems

You need to talk to your GP - an actual doctor rather than random people on Mumsnet.

GP appointment then hopefully referral. You need the advice of the expert, not mumsnet.
MN is great for lots of things, but specialist medical advice isn't one of them.

The only person who can accurately assess your DD and provide the correct information correlating to her exact circumstances would be an Endocrinologist.
First stop would be you GP who can make a referral if necessary.
Age 8 is not uncommon for girls to start with early signs of puberty. What stage of puberty is your DD experiencing?
Have you still got her Red book? It has a height/growth graph. Use it to plot her height and use the height prediction (using both parents height) to see her predicted height at 18 years. If she is following a good growth pattern/curve (even though she's small), then then she might just need monitoring.
Her growth will stop once the growth plates in her bones finally fuse. If her bone age is younger than her actual age then she will continue to grow after the average girl stops. She would need a DEXA scan to show her bone age.
My DS is currently under paediatric Endocrinology. Have you looked at the Child Growth Foundation charity website, or spoken to anyone there? They might be able to help.

Also, to add to my earlier post, don't jump to early signs of puberty meaning puberty blockers. Have you looked into the difference between the different types of early puberty. I'm always forgetting the names of them (which is poor as DD has the less worrying one) but it's not all the same.

It rather sounds like you WANT to give them to her which I don't really understand. I'm all inf avour of needed medication but overall, any medication for my young child is somethign I'd like to avoid as much as possible unless absolutely necessary and x100 when the medication involved has huge impacts on the child's entire body.

My DD is short. She was referred to a paediatric endocrinologist just to make sure that her growth was normal and that we weren’t missing any possible health conditions. DD around 10yo I think. She had an x-ray of her wrist to check the growth plates. Blood tests for various things. We’re not in the UK so it’s a different health system. We used the private health system in our country.

The endocrinologist did a thorough physical examination of DD and measured various limb lengths, arm span, height, etc. She had to see DD’s breasts to assess her puberty stage and DD’s underwear was lowered enough to allow her to see pubic hair growth for the puberty stage assessment.

All of that combined with my and DH’s height allowed her to calculate an expected adult height for DD. The result was short. No health or hormonal conditions that might affect growth were detected. In summary perfectly healthy but short. Delaying puberty might have given her an extra few centimetres of height but the effect on her health and bone density wouldn’t have been worth it and she would still have been short. The endocrinologist recommended no puberty blockers and basically for DD to go live her life, and just that she’ll be shorter than pretty much all adults. Someone has to be at the short end of the height range.

DD is now 16yo. She’s barely grown in the past few years. Period started at 11yo. She’s definitely short. I suspect she’s pretty much her full adult height. She’s less than 5 feet tall. She’s healthy. She needs to use a step stool to reach some things or things have to be lowered so she can easily reach them or ask for help from someone taller. It’s fine.

I should add that my DD had body odour from about 6yo and was using antiperspirant from 7yo. Pubic hair started at maybe 8 or 9yo. Period at 11yo. She was on the younger side but not early. I started my period at 11yo.

I really wouldn’t at 8, most girls start their period around 2 years after starting to show signs of puberty so 8 isn’t all that young for girls.
Puberty blockers have some pretty serious side effects so it’s a balance of what’s more harmful, the drugs or precocious puberty. At 8 I’d say the drugs will be more harmful.

Also if you’re a short family your DD was likely to be tall, that’s ok not everyone is!

Thanks all. I don’t want DD to take puberty blockers, especially after reading that linked article about Lupron 😢 but I wanted to know more about them. DD has Joint Hypermobility Syndrome, so really doesn’t need any more joint problems.

She’s early in the process, just showing the first signs of breasts and dark pubic hair. I developed later than she did (didn’t start my periods until I was 14), yet I stopped growing at 16 when I was just shy of 5ft.

I grew over an inch in my first term in university, more than 5 years after menarche. Most of my growing was done more than two years after.

I feel very sorry for any girl starting to menstruate so young, but doing so is a natural process for her. As everyone says, listen to her physician.

edited for more clarity re: my age. I grew an inch when 19 yoa.

I would as precocious puberty is associated with early menopause. I wouldn't want to gamble with my daughter's option to conceive easily.

Puberty blocker drugs have been in use since the 1980s and are overwhelmingly safe if used appropriately. Side effects such as bone health risks typically only occur with prolonged use past the age of puberty. Unfortunately, because of the opposition to their use in transgender children by gender critical people, their side effects have been exaggerated.

Precocious puberty is very rare and can be damaging if untreated, increasing risks of mental health conditions such as anxiety, anorexia and unfortunately increasing the risk of sexual assault.

I would recommend an urgent appointment with an endocrinologist.

There is no evidence that artificially delaying puberty through the use of powerful drugs has any impact on early menopause.

Starting puberty at eight is not precocious puberty.

Puberty blockers are never ‘overwhelmingly safe’ - they are powerful drugs with serious adverse effects including causing detriment to mental health. In adult women with endometriosis they are recommended for no longer than six months and only once in your life.

If that’s true I would inform my DD that she was at risk of early menopause and encourage her to consider having children at a younger age like 25-30yo instead of waiting until she was 30-35yo. I’d also encourage her to think about freezing her eggs just in case she went through a very early menopause.

Even at seven doctors are likely just to schedule regular check-ups rather than to prescribe puberty blockers. In some cases the benefits might outweigh the risks, but they're certainly not sweeties.

I also find Mouldemort‘s suggestion that we should drug girls to reduce risk of sexual assault rather than safeguard them from men totally abhorrent. What next? Iron their breasts?

If I encouraged her to freeze eggs for later use, I would encourage her to do that as early as possible; I'd also tell her not to believe the claims for success by the individual clinics of 85% success or better; the overall success rate for that procedure is more like an average 82% success in twenty tries, which isn't all that great really and can be heart-breaking if you've been relying on it as a safety backup. It's not the panacea people are led to think.

https://www.bbc.co.uk/news/health-51463488 is worth a read, probably. Winston mostly seems to know his stuff.

@Cattenberg you are unlikely to have anything to worry about, it’s certainly not precocious puberty - breast buds and pubic hair growth at age 8 are within the normal age range in girls - it’s always going to be influenced by a few factors, the only thing I would be concerned about is whether she is classed as obese for her age which is known to impact on early puberty. Just because a girl has these signs at 8 doesn’t mean she is likely to start her periods anytime soon … my d. had pubic hair at this age but didn’t start her periods til age 14 .

ditto @Mouldemort i suggest you both need to educate yourself on normal child development!