"No One Stays Just on Blockers Forever": Clinicians' Divergent Views and Practices Regarding Puberty Suppression for Nonbinary Young People

Purpose: Approximately half of transgender or gender diverse youth identify as gender nonbinary (not entirely or exclusively male or female). This study aimed to explore the views and practices of Australian clinicians working with transgender or gender diverse young people regarding puberty suppression for nonbinary youth, including requests for ongoing puberty suppression into adulthood.

Methods: Individual semistructured key informant interviews were conducted with 14 clinicians (medical and mental health) in Australia to explore their practices, views, and decision-making regarding puberty suppression for nonbinary youth. Transcripts were analyzed using inductive content analysis.

Results: Requests for puberty suppression from nonbinary young people are occurring, with 12 of 14 clinicians reporting they have received such requests. Although all clinicians were prepared to support short-term puberty suppression for nonbinary youth, clinicians diverged in their preparedness to support long-term puberty suppression. Clinicians expressed concerns in relation to risks, resource allocation, and medicalization. Some clinicians required nonbinary young people to choose a masculinizing or feminizing puberty. Some clinicians also put forward arguments in favor of long-term puberty suppression, including potential psychosocial harm of discontinuing puberty suppression, respect for autonomy, equity, and harm minimization. Clinicians also highlighted practical challenges of obtaining long-term puberty suppression in the adult setting.

Conclusions: The decision of whether to provide puberty suppression, particularly long-term, to a nonbinary young person is both ethically and clinically complex. There is currently a diversity of practice in this area, and evidence-based ethical guidelines and outcome data could promote more informed decision-making and support clinicians working in this complex area.