Use of Puberty Suppressing Drugs

GnRH agonist medications temporarily suppress hormones. 

Hormone-pausing medications, or gonadotropin-releasing hormone (GnRH) agonists, are made to look and act like the hormone GnRH (Lahlou et al. 2000). These medications are commonly called “puberty blockers.” The brain releases GnRH in short pulses to activate the pituitary gland and ovaries or testes to eventually increase estrogen and testosterone (Hu et al 2022). GnRH medications provide a constant dose that is higher than the natural pulses which desensitizes this pathway, decreasing estrogen and testosterone (Lahlou et al. 2000, Swayzer & Gerriets 2023).  

GnRH medications are only effective during active treatment and the hormone suppression is reversible (Krebs et al. 2022, Patel et al. 2025). The body resumes normal hormone secretion within three to six months after stopping the medication. Most GnRH medications are long-acting injections given every one, three, or six months (Popovic et al. 2022). Other options include a yearly surgical implant or a short-acting daily nasal spray (Patel et al. 2025, Swayzer & Gerriets 2023).  

GnRH agonists treat cancer, infertility, gynecological problems, and early puberty. 

The most established use for GnRH medication is treating central precocious puberty (CPP) where puberty begins before 8 in girls and 9 in boys (Sharma & Daley 2025, Lahlou et al. 2000). GnRH medications pause these changes to allow for bone growth to attain final adult height align psychosocial development with physical changes (Sharma & Daley 2025, Mendle et al. 2007, Lahlou et al. 2000). CPP treatment involves a long-acting injection or a yearly implant (Popovic et al. 2022). Physicians also use these medications off-label to temporarily pause puberty in adolescents with gender dysphoria (Hughes et al. 2025). 

As a supplementary treatment for hormone-sensitive cancers, GnRH medications lower testosterone to decrease prostate tumor growth and lower estrogen to slow breast cancer progression in premenopausal women (Ma et al 2024, Swayzer & Gerriets 2023, Food and Drug Administration 2010). For cancer treatment, these medications are given as long-acting injections (Swayzer & Gerriets 2023). 

GnRH medications manage reproductive and gynecological problems (Verified Market Reports 2025, Yang et al. 2021). In endometriosis, uterine tissue grows outside of the uterus causing chronic pain (Moradi et al. 2021). Uterine fibroids are noncancerous growths inside of the uterus leading to pain and heavy bleeding (Ciebiera et al. 2023, Marsh et al. 2018). GnRH medications lower estrogen to shrink these abnormal growths and reduce pain (Swayzer & Gerriets 2023). They are used s assisted reproductive technology (ART) to control ovulation during an in vitro fertilization (IVF) cycle (Maghraby et al. 2022, Yang et al. 2021). GnRH medications are given as an injection every one to three months for gynecological conditions or targeted injections in an IVF cycle (Swayzer & Gerriets 2023, Yang et al. 2021).  

Endometriosis and fibroids affect more people than infertility, cancer, or early puberty.  

The total number of GnRH prescriptions in the U.S. is not publicly available but can be estimated by the number of people affected by the conditions GnRH medications treat (Swayzer & Gerriets 2023, Figure 1). Endometriosis and uterine fibroids represent the largest group of potential users, affecting roughly one in 10 or eight in 10 U.S. women (Moradi et al. 2021, Marsh et al. 2018).  

Fertility and hormone-sensitive cancer treatments are the next most common conditions treated by GnRH medications. Around 13 ART cycles per 10,000 people were perfomed in the US in 2022 (Centers for Disease Control and Prevention 2026). Around 12 in 10,000 U.S. men are diagnosed with prostate cancer and around  10 in 10,000 U.S. women are diagnosed with hormone-sensitive breast cancer each year (Surveillance, Epidemiology, and End Results (SEER) Program 2025a, SEER Program 2025b, Ma et al 2024).  

Pediatric and adolescent use is least common (Sharma & Daley 2025). CPP affects approximately one in 500 girls and fewer than one in 2,000 boys in the U.S. Use for gender-affirming care occurred in around one of every 5,000 U.S. adolescents (Hughes et al. 2025). Of the 122,000 U.S. children diagnosed with gender dysphoria between 2017 and 2021, about 4% used a GnRH medication (Respaut & Terhune 2022). 

Figure 1. Comparison of population eligibility and active use of GnRH medications (per 100,000). Gonadotropin-releasing hormone (GnRH) agonists decrease estrogen and testosterone to treat gynecological conditions, infertility, hormone-sensitive cancers, and central precocious puberty (CPP). For uterine fibroids, endometriosis, and central precocious puberty (CPP), the bars represent the number of people currently living with the conditions (blue). For fertility and cancer treatment, the bars show new annual diagnoses to identify how many people are entering treatment (green). Data for gender-affirming care represents the number of adolescents actively receiving these medications (orange). 

References 

Ciebiera M, Madueke-Laveaux OS, Feduniw S, Ulin M, Spaczyński R, et al (2023) GnRH Agonists and Antagonists in Therapy of Symptomatic Uterine Fibroids – Current Roles and Future Perspectives. Expert Opinion on Pharmacotherapy 24(16): 1799- 1809. https://doi.org/10.1080/14656566.2023.2248890  

Centers for Disease Control and Prevention (2026) ART Data Reporting for 2022. U.S. Department of Health and Human Services. https://art.cdc.gov/  

Food and Drug Administration (2010) FDA Drug Safety Communication: Ongoing Safety Review of GnRH Agonists and Possible Increase of Diabetes and Certain Cardiovascular Diseases. U.S. Department of Health and Human Services. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-ongoing-safety-review-gnrh-agonists-and-possible-increased-risk  

Hu K, Chen Z, Li X, Cai E, Yang H, et al. (2022) Advances in Clinical Applications of Kisspeptin-GnRH Pathway in Female Reproduction. Reproductive Biology and Endocrinology, 20(81). https://doi.org/10.1186/s12958-022-00953-y  

Hughes LD, Charlton BM, Berzansky, Corman JD (2025) Gender-Affirming Medications Among Transgender Adolescents in the U.S., 2018 – 2022. JAMA Pediatrics 179(3): 342 – 344. https://doi.org/10.1001/jamapediatrics.2024.6081  

Krebs D, Harris RM, Steinbaum A, Pilcher S, Guss C, et al. (2022) Care for Transgender Young People. Hormone Research in Paediatrics, 95(5): 405-414. https://doi.org/10.1159/000524030  

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Ma L, Yang B, Wi J (2024) Revisiting Ovarian Function Suppression with GnRH Agonists for Premenopausal Women with Breast Cancer: Who Should Use and the Impact on Survival Outcomes. Cancer Treatment Reviews 129: 102770. https://doi.org/10.1016/j.ctrv.2024.102770  

Maghraby H, Abdelbadie AS, Aboali A, Elnashar A (2022) GnRH Agonist as Luteal Support in IVF Cycle: Mini-Review – Is There A Role? Middle East Fertility Society Journal 27:18. https://doi.org/10.1186/s43043-022-00109-3  

Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, et al (2018) Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. Journal of Women’s Health 27(11): 1359 – 1367. https://doi.org/10.1089/jwh.2018.7076  

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Moradi Y, Shams-Beyranvand M, Khateri S, Gharahjeh S, Tehrani S, et al. (2021) A Systematic Review on the Prevalence of Endometriosis in Women. Indian Journal of Medical Research 154: 446 – 454. https://doi.org/10.4103/ijmr.ijmr_817_18  

Patel S, Saxena B, Mehta P, Niazi SK (2025) GnRH Peptide Antagonist: Comparative Analysis of Chemistry and Formulation with Implications for Clinical Safety and Efficacy. Pharmaceuticals, 18(1): 36. https://doi.org/10.3390/ph18010036  

Popovic J, Geffner ME, Rogol AD, Silverman LA, Kaplowitz PB, et al (2022) Gonadotrophin-Releasing Hormone Analog Therapies for Children with Central Precocious Puberty in the United States. Frontiers in Pediatrics, 10: 968485. https://doi.org/10.3389/fped.2022.968485  

Respaut R, Terhune C (2022) Putting Numbers on the Rise in Children Seeking Gender Care. Reuters Investigates. https://www.reuters.com/investigates/special-report/usa-transyouth-data/  

Sharma L, Daley SF (2025) Precocious Puberty. StatPearls. National Library of Medicine, National Institutes of Health. https://pubmed.ncbi.nlm.nih.gov/31335033/  

Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute (NCI) (2025a) Cancer Stat Facts: Prostate Cancer. National Institutes of Health. https://seer.cancer.gov/statfacts/html/prost.html  

Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute (NCI)(2025b) Cancer Stat Facts: Female Breast Cancer Subtypes. National Institutes of Health. https://seer.cancer.gov/statfacts/html/breast-subtypes.html  

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Verified Market Reports (2025) Global GnRH Agonist Market Size, Growth Trends, Industry Share, and Forecast. https://www.verifiedmarketreports.com/product/gnrh-agonist-market/  

Yang R, Guan Y, Perrot V, Ma J, Li R (2021) Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women undergoing In Vitro Fertilization: A Systematic Review and Meta-Analysis. Advanced Therapy 38: 2007 – 2037. https://doi.org/10.1007/s12325-020-01612-7