Not just a tragic compromise: The positive case for adolescent access to puberty-blocking treatment

Bioethics. 2021 Nov;35(9):925-931. doi: 10.1111/bioe.12929. Epub 2021 Aug 24.


Within bioethics as well as in broader clinical practice, support for transgender and gender-questioning adolescent access to pubertal suppression has often relied heavily on the desire to prevent risky, self-destructive, and suicidal behavior. We argue that framing justifications for access to puberty suppression in this way can actually be harmful to both individual patients as well as to the broader trans population. This justification for access to care makes such access precarious, limits its scope, and introduces perverse incentives to the patient population that is being served. We go on to offer an alternative, positive defense of access to puberty-blocking treatment for transgender youth grounded in the child's right to an open future. We argue that decisions related to pubertal suppression are both importantly weighty and potentially irreversible, and show why this justification is preferable to so-called "informed consent" approaches.

Keywords: adolescent; puberty suppression; puberty-blocking treatment; right to an open future; transgender.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Gender Identity
  • Humans
  • Puberty
  • Sexual Behavior
  • Transgender Persons*