I’m Not a Doctor — But I Can Provide Psychoeducation About These Medications

I am not a physician, nurse practitioner, or pharmacist, and I do not prescribe, dispense, or manage medications. However, as a licensed mental health professional, I can provide psychoeducation about medications commonly discussed in gender-affirming care—what they are, how they are typically used in medical practice, and what questions to bring to a qualified prescriber who is competent in gender-affirming care.

This information is educational only and is not medical advice. Medication decisions should always be made with a licensed medical provider who can evaluate a person’s health history, labs, risks, benefits, and alternatives.

I want to be explicit: I would never suggest or encourage anyone to pursue “alternative routes” to access prescription medications. I do not provide instructions for obtaining prescription medications outside appropriate medical care, and I encourage people to use legal, medically supervised pathways, with routine lab checks.

At the same time, access to accurate medical information is empowering, and psychoeducation is part of ethical mental healthcare.

Puberty Suppression Medications (GnRH Agonists): What They Are

Puberty suppression is most commonly associated with a class of medications called gonadotropin-releasing hormone (GnRH) agonists (sometimes referred to as “puberty blockers”). These medications have been used in pediatric healthcare for decades, including for central precocious puberty (early-onset puberty) (Endocrine Society patient/clinical overview: https://www.endocrine.org/patient-engagement/endocrine-library/precocious-puberty). They have also been used in other areas of medicine, including treatment approaches for conditions like endometriosis (ACOG guidance: https://www.acog.org/womens-health/faqs/endometriosis), uterine fibroids (ACOG guidance: https://www.acog.org/womens-health/faqs/uterine-fibroids), and prostate cancer (NCI overview: https://www.cancer.gov/about-cancer/treatment/types/hormone-therapy/hormone-therapy-fact-sheet), depending on the clinical context.

When used for puberty suppression, the purpose is to pause pubertal changes. This can give a young person time—physically and emotionally—to continue exploring their identity with support, without being forced through irreversible physical development that may intensify dysphoria (peer-reviewed overview in The Lancet Diabetes & Endocrinology: https://pubmed.ncbi.nlm.nih.gov/28793896/).

Spironolactone: A Medication With Multiple Uses

Spironolactone is not a puberty blocker, and it is not primarily a “trans medication.” It is widely used in general medicine for conditions including high blood pressure (hypertension)—particularly in cases like resistant hypertension where it can be an effective add-on medication (see: Hypertension journal review here: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15199).

It is also used clinically for fluid retention (edema) and related cardiometabolic indications, including longstanding use in heart failure care (classic NEJM trial: https://www.nejm.org/doi/full/10.1056/NEJM199909023411001). Because spironolactone can affect electrolytes, later cardiology literature has also discussed the importance of appropriate clinical oversight and monitoring in real-world use (example discussion: https://www.sciencedirect.com/science/article/abs/pii/S0033062020301535).

Spironolactone is also widely used in dermatology for acne, especially acne influenced by androgen activity. A large randomized controlled trial in the BMJ found spironolactone significantly improved acne outcomes compared to placebo (SAFA trial: https://www.bmj.com/content/381/bmj-2022-074349).

In some gender-affirming treatment plans, spironolactone may be used because it can reduce certain androgen-driven effects in the body. As with any medication, it has risks and requires medical oversight, including appropriate monitoring when potassium levels and kidney function may be relevant. Peer-reviewed endocrine literature specifically examining spironolactone use in transgender populations discusses potassium monitoring practices and the clinical context for how this is handled (Journal of the Endocrine Society: https://academic.oup.com/jes/article/6/11/bvac133/6696042), including adolescent-focused data (open access: https://pmc.ncbi.nlm.nih.gov/articles/PMC6553025/).

Testosterone and Estradiol Are Also Used in Many Other Medical Contexts

It is also important to say this clearly: the hormones involved in gender-affirming care are not exotic or experimental substances—they are widely used in mainstream medicine and are included in established clinical guidance for multiple populations (Endocrine Society clinical practice guideline, 2017): https://academic.oup.com/jcem/article/102/11/3869/4157558

Testosterone is commonly prescribed in medicine for clinically significant low testosterone (hypogonadism) as part of evidence-based endocrine care (Endocrine Society guideline on testosterone therapy in men with hypogonadism, 2018): https://academic.oup.com/jcem/article/103/5/1715/4939465

Estradiol is commonly prescribed as part of care for menopause symptoms, including hot flashes and other hormone-related changes, and is a standard treatment discussed in major medical evidence summaries and clinical recommendations (North American Menopause Society position statement, 2022): https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf

These are established medications used across many populations. The existence of these treatments in mainstream healthcare is part of why it’s misleading when public conversations treat gender-affirming care as inherently illegitimate or uniquely dangerous—and major clinical organizations explicitly recognize gender-affirming hormone therapy as part of evidence-based care when clinically indicated (Endocrine Society gender dysphoria/gender incongruence guidance hub): https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

Why This Matters: Trans Youth Deserve Access to Gender-Affirming Care

Trans youth deserve the same basic medical and ethical respect that any other young person deserves: care that is evidence-informed, developmentally appropriate, individually assessed, and guided by informed consent/assent and family support when possible.

Right now, political interference is increasingly getting in the way of trans youth accessing medically appropriate gender-affirming care. That interference is not abstract, and it is not temporary. Puberty is time-sensitive, and delaying or blocking evidence-based care can shape a young person’s body, mental health, and life trajectory in ways that may affect them permanently.

This matters clinically: access to evidence-based care supports long-term psychological adjustment, stability, and wellbeing. For example, supported socially transitioned trans children have been found to show developmentally normative levels of depression and only minimal elevations in anxiety (Olson et al., 2016): https://pubmed.ncbi.nlm.nih.gov/26921285/ and broader pediatric guidance emphasizes the importance of affirming, developmentally appropriate care to support health and positive development (AAP, 2018): https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for

When youth are supported rather than forced into unwanted development, it becomes easier for them to build a grounded sense of self, reduce chronic distress, and engage in healthy social and emotional development. Consistent with that, a large cohort study of trans and nonbinary youth receiving gender-affirming medical interventions found lower odds of depression and suicidality over 12 months (Tordoff et al., 2022): https://pubmed.ncbi.nlm.nih.gov/35212746/

When trans youth are denied access to medically indicated support, the result is not “neutral.” Barriers to care have been associated with worse mental health outcomes, and the opposite pattern appears when care is accessible—for example, access to pubertal suppression has been associated with lower rates of adverse mental health outcomes in adulthood (Turban et al., 2020): https://pubmed.ncbi.nlm.nih.gov/31974216/ and multiple professional standards emphasize that reducing stigma and improving access to care is a pediatric health priority (AAP, 2018): https://pubmed.ncbi.nlm.nih.gov/30224363/

Psychoeducation matters because misinformation thrives in silence. I believe in giving people accurate information, encouraging thoughtful questions, and supporting families and youth in making decisions grounded in health, dignity, and self-determination—and major clinical organizations explicitly recognize the role of education, support, and referral pathways in improving outcomes for transgender and gender-diverse youth (AAP, 2018): https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for

In a landscape where access is increasingly politicized, I approach gender-affirming care with a harm-reduction lens: supporting accurate information, medically supervised pathways whenever possible, and the reality that reducing distress and improving long-term wellbeing is itself a public health priority.

References

American College of Obstetricians and Gynecologists. (n.d.). Endometriosis. https://www.acog.org/womens-health/faqs/endometriosis

American College of Obstetricians and Gynecologists. (n.d.). Uterine fibroids. https://www.acog.org/womens-health/faqs/uterine-fibroids

American Academy of Pediatrics. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4), e20182162. https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for

Bakris, G., Agarwal, R., Chan, J. C., Cooper, M. E., Gansevoort, R. T., Haller, H., … Pitt, B. (2020). Mineralocorticoid receptor antagonists for hypertension. Hypertension, 75(6), 1460–1470. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15199

Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., … Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744. https://academic.oup.com/jcem/article/103/5/1715/4939465

Endocrine Society. (n.d.). Gender dysphoria / gender incongruence. https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

Endocrine Society. (n.d.). Precocious puberty. https://www.endocrine.org/patient-engagement/endocrine-library/precocious-puberty

Hayes, H., Rhee, E., Erickson-Schroth, L., & Iwamoto, S. J. (2022). The utility of monitoring potassium in transgender, gender diverse, and nonbinary individuals on spironolactone. Journal of the Endocrine Society, 6(11), bvac133. https://academic.oup.com/jes/article/6/11/bvac133/6696042

Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., … T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. https://academic.oup.com/jcem/article/102/11/3869/4157558

Mahfouda, S., Moore, J. K., Siafarikas, A., Zepf, F. D., & Lin, A. (2017). Puberty suppression in transgender children and adolescents. The Lancet Diabetes & Endocrinology, 5(10), 816–826. https://pubmed.ncbi.nlm.nih.gov/28546095/

Millington, K., Liu, E., & Chan, Y.-M. (2019). The utility of potassium monitoring in gender-diverse adolescents taking spironolactone. Journal of the Endocrine Society, 3(Suppl 1), SUN-242. https://pmc.ncbi.nlm.nih.gov/articles/PMC6553025/

National Cancer Institute. (n.d.). Hormone therapy for cancer. https://www.cancer.gov/about-cancer/treatment/types/hormone-therapy/hormone-therapy-fact-sheet

North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf

Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223. https://pubmed.ncbi.nlm.nih.gov/26921285/

Pitt, B., Zannad, F., Remme, W. J., Cody, R., Castaigne, A., Perez, A., Palensky, J., & Wittes, J. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure. The New England Journal of Medicine, 341(10), 709–717. https://www.nejm.org/doi/full/10.1056/NEJM199909023411001

Santer, M., Renz, S., Burgess, C., et al. (2023). Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: Pragmatic multicentre phase 3 double blind randomised controlled trial. BMJ, 381, e074349. https://www.bmj.com/content/381/bmj-2022-074349

Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youth receiving gender-affirming care. JAMA Network Open, 5(2), e220978. https://pubmed.ncbi.nlm.nih.gov/35212746/

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725. https://pubmed.ncbi.nlm.nih.gov/31974216/