Triptorelin: what it is and how to use it for gender dysphoria, the (disputed) drug that blocks puberty

The UK has banned the drugs that block puberty in use for the «gender dysphoria» (according to the Istituto Superiore di Sanità, a «condition characterized by intense and persistent suffering caused by feeling one's identity as type different from your own sex»).
In Italy the triptorelin is at the center of a political and cultural debate sparked (also) by the recent inspection by the Ministry of Health at the Regional Center for Gender Dysphoria (Crig) of the Careggi hospital in Florence.

* We asked you to answer questions about the drug a Gianluca AimarettiProfessor of Endocrinology at the University of Eastern Piedmont and President of the Italian Society of Endocrinology (SIE).

What is triptorelin and how does it work?

«Triptorelin is a drug available mainly to endocrinologists and urologists. It's a hormone, a peptide of hypothalamic origin. It blocks the secretion of gonadotropins at the level of the pituitary gland, i.e. the two hormones that determine the maturation of the oocytes or gods spermatozoa and sexual hormones (testosterone in males ed estrogens in the female)”.

When is it used?

«It has already been used for decades in children with forms of early puberty or early precisely to delay the continuation of pubertal development, therefore avoiding problems such as excessively accelerated bone maturation and reduced final height and is used in men with prostate cancer or women with breast cancer to reduce the secretion of sex steroids which cause the progression of these two tumors.”

The drug was also approved for the indication “gender dysphoria” in adolescents with determines AIFA (Italian Medicines Agency) in 2019 (after a favorable opinion from the National Bioethics Committee in 2018) following the guidelines produced by the various scientific societies (including SIE).
The rules of use are that gender dysphoria must be ascertained and the prescription made only after careful multi-professional evaluation, with the contribution of a multidisciplinary and specialist team, made up of child and adolescent neuropsychiatrists, developmental psychologists, bioethicists and endocrinologists. Parents are always an active part of the decision-making process regarding therapy. The drug comes as the last step after the psychological and legal evaluations required by the protocols.

How is it used with this last indication?

«In adolescents with recognized e confirmed gender dysphoria For delay the progression of pubertal development and allow subsequent psychological evaluations. When treatment is interrupted, if gender dysphoria were confirmed, it would be easier to intervene for such a change.”

How is it administered and for how long?

«It is administered intramuscularly Once a month for approximately 2 years, or until the problem of gender dysphoria is clearly defined. However, there is no specific time.”

Psychological distress

Does the effect of the drug also impact the patient's psychological distress?
«In that period we take more time to evaluate the situation and this helps psychological distress of patients who don't feel comfortable in a body that isn't theirs.”

From scientific literature data it can be seen that up to 40% of young transgender and gender diverse (TGD) adolescents attempt suicide. Therapy with triptorelin reduces this possibility by 70% (from the press release of 12 Associations, Scientific Societies and the Italian Observatory of Gender Identity).

Are the effects of the drug reversible?

«Of course: it blocks puberty for a certain period. Usually upon resumption of the drug the development process restarts normally: we see it in children with precocious puberty who are administered it.”

Are there any side effects?

“I would say not at all.”

The scientific basis

In Britain the therapy is accused of having little scientific basis for gender dysphoria in practice it would not be decisive to help kids decide on that, is that right?
«It needs to be evaluated. We're still talking about rare cases and infrequent ones which do not yet allow us to have solid, certain data either in one sense or another”.

What do the first studies say about it?

«Some doubt whether slowing down puberty for a year or two can help provide answers. From a physical and hormonal point of view, the past time does not change anything, psychologists must say whether it can change from a psychological point of view, but the studies are few and preliminary.”

Who deals with “gender dysphoria” in Italy?

«There are just a few accredited centers in Rome, Milan, Florence, Turin and Naples. I know the center of Turin and, just to give an order of magnitude, every year around 4-5 patients are treated with triptorelin for gender dysphoria.”

The CRIG of the Careggi hospital in Florence is the largest in Italy: in 2023 (from an internal hospital note, ed) the accesses were 150 and the provisions of triptorelin 26.