When a trans child cannot access puberty blockers, research indicates they are required to undergo the puberty of their birth-assigned sex, which evidence shows can cause significant distress. Medical literature documents that this process can create physical changes that may conflict with a young person's gender identity and become increasingly difficult to address later.
For transgender girls, testosterone-driven changes include voice deepening, increased height and hand/foot size, shoulder broadening, and facial and body hair development. Studies suggest these physical changes can contribute to gender dysphoria and may increase vulnerability to social challenges. Similarly, transgender boys experiencing oestrogen-driven puberty may develop breast tissue, wider hips, and other characteristics that don't align with their identity.
Guidelines from major medical organisations recognise that the psychological impact can be substantial. Research documents that many young people in this situation may experience social withdrawal, avoiding mirrors, reluctance to participate in activities, and difficulty leaving home due to distress about their changing appearance.
Healthcare professionals emphasise that each situation is unique, and families facing this challenge benefit from accessing mental health support, connecting with peer support networks, and working with knowledgeable medical teams when possible. The distress experienced during this time is recognised as valid, and various forms of support can help young people and families navigate these difficulties while exploring all available options for care.