When a teen who truly feels they are the opposite gender- a biological female who feels male inside, or vice versa- going through puberty can be quite traumatic. To feel like a young man who has breasts and is menstruating, or a young woman who has a low voice and chest hair, can be jarring and miserable. And yet a teen who is 12 or 13 is usually not considered mature enough to decide to transition their gender permanently.

Many children who have a history of wanting to be the opposite gender do not end up as transgender people. However, if your child has hit puberty and still has a strong desire to be the opposite gender- especially to the point where puberty is traumatizing for them- it’s time to seek medical and psychological help. Constantly feeling like one is “trapped in the wrong body” is a terrible feeling, and studies have shown that it can lead to depression, substance abuse, and other mental health challenges.

An important intervention to explore is pubertal suppression. It’s like hitting a “pause” button on the whole pubertal process. You stop it, but it’s easy to start it again. This isn’t something that will solve any issues long-term; you want your teen to go through a physical puberty at some point. However, this can buy valuable time in terms of your teen’s mental health and emotional well-being.

The reason to suppress puberty is so medical and mental health providers can assess your teen for hormone therapy. We’ll talk more about hormone therapy later, but basically, it involves giving testosterone to biological females who want to look male, or estrogen to biological males who want to look female. If hormone therapy is used through puberty, patients are much more likely to have the masculine/ feminine features and build that they desire.

But it’s a big step. It takes a lot of evaluation, and your teen may not be ready to make this decision. In this case, pubertal suppression gives you time while they are evaluated, while they mull their options, while they make what will be one of the biggest decisions in their life. It’s easy and reasonably safe, and a very good option for a teen traumatized by the unwanted effects of puberty on their body.

Puberty is medically suppressed by administering a type of drug called a GnRH agonist. This medication suppresses reproductive hormones in both male and female patients, and its effects are completely reversible. If a biological female started taking a GnRH agonist at age 12, and stopped at age 14, she would still reach the same puberty that she would have otherwise- just in a different time frame. (In addition to a GnRH agonist, certain medications can be used to stop menstruation in FTM teens: Depo-Provera shots, continuous hormone use, etc. Talk to your health care provider about your options.)

GnRH agonists are not without side effects. While they are rare, you and your teen should work through a cost-benefit analysis with your teen’s medical provider. While GnRH agonists carry some risks, not suppressing puberty can carry risks too. For a transgender teen, going through puberty can be a nightmare and can cause severe distress. Make sure you, your teen, and your medical provider are on the same page about this.

Keep in mind that not all teens may desire to be “classically” male or female. Don’t assume that your FTM or MTF teen wants to look exactly like the opposite sex- or that your third gender/ genderqueer teen won’t desire any alteration in their natural appearance. Like we discussed before, gender is complicated, and the only way to know what is best for your teen is to talk to them often and in depth.