The results of a survey of takatāpui and rainbow youth highlight the enormous value of puberty blockers to young people in Aotearoa – and indicate a strong need for continued access to them.  

“Puberty blockers [have] given me the opportunity to be with my thoughts, rather than the terrifying (to me) onslaught of puberty. It [has] given me time to think about my future, and what that might look like for me”

– 15-year-old Pākehā boy, North Island

After extensive delays, the coalition government has now announced that it will ban the initiation of medications that delay the changes produced by puberty (puberty blockers) for trans young people. The government press release states there is a “lack of high-quality evidence that demonstrates the benefits or risks” of these medications for “the treatment of gender dysphoria or incongruence”. 

Much ink has been spilled worldwide about the supposed risks of puberty blockers, often by people with no direct connections to trans young people themselves. The New Zealand government’s consultation process also featured a marked lack of consultation with those most affected by this decision in Aotearoa.  

As researchers who work with trans children, youth and their whānau in Aotearoa, our role is to explore what young people themselves say about their experiences, including their use of puberty blockers. In 2021, 4,784 takatāpui and rainbow young people (aged 14-26) from across the motu completed the Identify survey. Of these, just 115 young people had used puberty blockers and they were resoundingly positive about their experiences. 

When asked “what difference has gender-affirming medication made to your life (eg your mental health, how others treat you)?”, 87 young people who had used blockers shared their experiences. Overall, 95% of them were positive about their experience of using gender-affirming medication, 3% were neutral or ambivalent, and 1% reported a negative experience. 

The most common theme was for young people to report an improvement in their mental health: 

“Made my mental health better because people see me the way and the gender that I am.”

“My mental health has improved greatly. Knowing that I am progressing toward getting testosterone makes me very happy and gives me something to look forward to.”

This improvement in mental health was also related to a reported reduction in suicidality.  One in five who responded to this question said that access to these medications had contributed to saving their life:

“Massively improved all aspects of mental health, prevented my suicide, greatly increased my quality of life in every way.”

“Literally everything. Words can’t describe. I’d be dead without it. I am actually a human being with a presence and life now.”

“I am only alive today because of puberty blockers and testosterone.”

Further reported positive outcomes included being more confident, feeling better about themselves, and improved feelings about their bodies, as well as better social, educational and workplace outcomes.  

Among the very small number of neutral or ambivalent responses (three out of 87), one wrote, “I feel more androgynous, but that’s it”, and one simply wrote “idk” (I don’t know).  The sole negative response related to side effects from a different gender-affirming medication, progesterone, not puberty blockers.

Overall, the survey results highlight the enormous value of puberty blockers to young people in Aotearoa and indicate a strong need for continued access to them.  

In light of this data, we have to ask what this new ban on puberty blockers will mean for young people who will not be able to access these medications. In removing hypothetical risks based on the government’s own assessment of the evidence as low-quality, what risks do we introduce in their place? 

The government announcement makes no reference to alternative treatments for trans young people experiencing gender dysphoria, likely because no other effective treatments are available. Karen Chhour, commenting in an Act press release as the party’s children’s spokesperson rather than in an official government statement as minister for children, said she believed “young people should be supported to love themselves, not change themselves with experimental medication’’. At best, this sounds like a vague reference to psychological support. Even when psychological interventions are gender-affirming, on their own they are not sufficient to alleviate gender dysphoria. If psychological support refers to negation of a trans young person’s gender, it is a form of conversion practice, which is illegal in Aotearoa.

Rather than offering any effective alternative treatment, the likely outcome of removing access to puberty blockers is a vacuum of care. In this vacuum, what risks will flourish? We are likely to see the opposite effects of the benefits of puberty blockers that were found in the Identify research. Trans young people may experience worsened mental health, declining sense of self and self-confidence, increased distress about their bodies, poorer social support and relationships, and deteriorating ability to participate in education and work. And they may face increased risk of self-harm and suicide. 

All medications carry some level of risk, which young people weigh up in a process of informed consent, supported by their family and experienced clinicians. Focusing excessively on risks without considering the benefits of interventions, or the risks of not receiving care, is not just poor scientific, medical and public health practice. It puts at risk the very lives of young people who have a right to our care.

Right now, this horrifying decision must be a catalyst for whānau, peers, teachers, health professionals and other adults in supporting roles to do everything they can to support and affirm trans young people. It’s also a rallying cry for all of us to come together to advocate for trans children, young people, their whānau, and trans communities more broadly. In particular, our children and young people must know that we see this injustice, we mourn it, we will resist it, and we will support them as best we can to flourish in spite of it. 

John Fenaughty is associate professor at the University of Auckland and was principal investigator on the Identify Survey of takatāpui and rainbow young people in Aotearoa. Julia de Bres is associate professor at Massey University and principal investigator of Project Village, a research project investigating what good family support looks like for transgender young people in Aotearoa.