Puberty Blockers and Mental Health: What the Evidence Shows

TransHealthHub

Sep 25

4 min read

Key Takeaways

The puberty blockers mental health evidence points toward improvement, but study designs cannot prove causation. The largest review to date found better mental health outcomes and called long-term safety uncertain.
A 2025 systematic review identified 51 studies of puberty-pausing medication in young people and rated 22 of them moderate to high quality.
The same review reported reduced depression, anxiety, and suicidality, alongside a decline in bone density during treatment.
In U.S. hospital records covering 3,414 young people, those prescribed puberty-pausing medication showed no statistically significant change in suicidality diagnoses. Few in the sample received it, so the result is underpowered rather than negative.
Very few young people take this medication. In The Trevor Project's 2025 national survey, 3% of transgender and nonbinary respondents reported taking it.
Elevated mental health risk among transgender young people is attributed to stigma, rejection, and mistreatment, not to being transgender.
This medication also appears as puberty suppression or puberty-pausing medication. The labels differ; the treatment does not.

The short answer

If a young person in your life is struggling, support is available now. The 988 Suicide and Crisis Lifeline (call or text 988) and The Trevor Project (1-866-488-7386) are confidential and staffed around the clock, and our crisis support page lists more.

The evidence on puberty blockers and mental health leans positive and remains limited. Reviews of the published studies report improvements in depression, anxiety, and wellbeing. Almost none of those studies randomly assigned treatment, so they show that two things occur together rather than which caused which, and the follow-up periods are short.

At TransHealthHub, we think parents are better served knowing the shape of the evidence than being handed a verdict.

What the largest review found

Gianluca Tornese and colleagues searched the literature from 2011 to 2024 and identified 51 studies of puberty-pausing medication in transgender and gender-diverse young people, publishing in Frontiers in Endocrinology in 2025. They rated 22 of those studies moderate to high quality.

On mental health, the review reported reduced depression, anxiety, and suicidality. It also reported that bone density declined during treatment, and concluded that long-term safety remains uncertain, with bone monitoring, fertility counseling, and psychological support needed alongside the medication. The review pooled studies from several countries, so it describes the international literature rather than U.S. practice specifically. Our guide to the long-term effects covers the physical side.

What was measured	What the review reported
Depression, anxiety, suicidality	Reduced
Bone density	Declined during treatment
Long-term safety	Uncertain

Where the evidence is weakest

Suicidality is the outcome families most want answered, and it is among the least settled. In a 2025 paper in LGBT Health, Marissa Nunes-Moreno and colleagues drew on pediatric health records covering 3,414 transgender and gender-diverse young people aged 8 to 18. Those prescribed puberty-pausing medication showed no statistically significant change in suicidality diagnoses in emergency or inpatient settings.

That is not a finding that the medication fails. Very few young people in the sample received it, so the study lacked the numbers to detect a difference either way. An underpowered result and a negative result look similar and mean different things.

The outcome also counts only young people whose crisis reached an emergency room or a hospital admission, which is a narrow window on distress. Nothing in that design captures a teenager who felt steadier at home.

How common is this treatment

This treatment is quite rare. In The Trevor Project's 2025 national survey of more than 16,000 LGBTQ+ young people aged 13 to 24 across the United States, 3% of transgender and nonbinary respondents reported taking puberty-pausing medication, against 10% of those aged 13 to 17 taking hormones. These are self-reported figures from a non-probability sample.

That rarity shapes the research. Small treated groups are why so many of these studies end up underpowered, and why single clinics rather than national samples produce most of the data.

How to read the cautious reviews

A 2025 U.S. Department of Health and Human Services report found the quality of evidence on the effects of any intervention to be low. Writing in May 2025, KFF noted that the report was criticized by researchers and medical associations over its methods and its undisclosed authorship.

A low certainty rating means important questions remain open. It is not a finding that the care causes harm. The American Psychological Association, in a policy approved in February 2024, supports unobstructed access to evidence-based clinical care for transgender children, adolescents, and adults.

Frequently asked questions

Do puberty blockers improve mental health? Reviews report improvement in depression and anxiety. The studies are observational, so researchers describe association rather than cause, and the young people who receive this medication differ from those who do not in ways the research cannot fully separate.

Does the evidence show they prevent suicide? No study design so far can show that. The suicidality findings are mixed, and the samples are small.

Is the treatment reversible? Its pubertal effects are described as reversible. Our page on reversibility covers what that does and does not mean.