Most debates about puberty blockers focus on two things: mental health and bone density. But there is a question that worries many families and adolescents and that is hardly ever discussed: what happens to sexuality —the present one and, above all, the future one? Until recently, the evidence available to answer it was scarce and fragmented.
A team from the Center of Expertise on Gender Dysphoria at Amsterdam UMC (Netherlands) has tried to fill that gap. Its researchers reviewed the available evidence and combined the perspectives of endocrinology, urology, psychology, sexology and gynaecology, and also added the conclusions of a round table held at the 2025 conference of the European Professional Association for Transgender Health (EPATH). The result is a clinical consensus published in Nature Reviews Urology.
It is worth recalling what puberty suppression does. Gonadotropin-releasing hormone (GnRH) analogues temporarily pause puberty: they stop the body’s own production of sex hormones and prevent it from developing secondary sexual characteristics that the person does not recognise as their own, buying time to decide calmly. The effect is in principle reversible. But this pause also affects sexual maturation, and for years no rigorous study had examined what consequences it has for intimate life when that person reaches adulthood.
The work provides one reassuring finding that sums up the initial evidence: the first exploratory studies show a similar sexual well-being among young adults who went through puberty suppression and those who received gender-affirming hormone treatment without having needed it. In other words, starting with blockers does not appear to leave an adult with a compromised intimate life, although the authors insist that these are still preliminary data and that longitudinal studies are needed.
The consensus translates into practical recommendations. Among them: offering every adolescent age-appropriate information about puberty, its suppression and sexual development; paying attention to the psychosocial context, such as stigma; making individualised decisions about fertility and future surgical options; and encouraging open, positive communication about sexuality between the young person, their family and professionals.
Important knowledge gaps do remain, however. The authors call for long-term, interdisciplinary research combining qualitative and quantitative methods to understand how puberty suppression influences pleasure and genital sensitivity, and they call for specific assessment tools for transgender people that make it possible to measure sexual development, function and satisfaction while capturing the diversity of their experiences.
Beyond the simplistic yes-or-no debate, this kind of consensus helps make the decision an informed and individualised one that also takes intimate life into account as an aspect of health that deserves care. Accompanying identity without sacrificing a full life is, at bottom, what this is about.
Source: Puberty suppression and sexual well-being in transgender and gender-diverse individuals: evidence- and experience-based counselling and future research directions. van der Meulen IS, van den Boogaard E, Özer M, et al. Nature Reviews Urology 2026. DOI: 10.1038/s41585-026-01182-3.
Publication reference: Nature Reviews Urology.
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