GnRH analogues
GnRH analogues are medicines that stop the production of sex hormones. They are widely used by transfeminine people as an antiandrogen (testosterone blocker), by transmasculine people to stop periods, and by teens as a puberty blocker. The most common GnRH analogues are triptorelin (Decapeptyl) and leuprorelin (Lupron), but many others exist.
GnRH analogues are rarely used by people who self-medicate because of their high price and low availability, but they are widely used in formal healthcare settings. GnRH analogues are generally safer and more effective than other testosterone blockers (Hembree at al., 2017).
Key points
- The safest and most effective hormone blockers;
- Used as an antiandrogen (testosterone blocker), as a puberty blocker, and to stop periods
- Rarely used by people who self-medicate
Dosing
Trans people most commonly take GnRH analogues as an injection administered every 1-6 months. Implants and nasal sprays are also available, although their availability varies by country.
Pills that can be swallowed have recently become available under the names elagolix, relugolix, and linzagolix, but these are rarely seen in trans healthcare because they are new, expensive, and have not yet been incorporated into most prescriber guidance (de Lange et al., 2024).
Risks & management
Most people do not need to take multiple antiandrogens at once.
GnRH analogues might have a small negative effect on bone density when used in teenagers as a puberty blocker. In that case, it could be advisable to monitor bone density using a type of X-ray known as a DEXA scan, and to supplement calcium. This is not relevant to most adult transgender people, as they usually take GnRH analogues with a replacement hormone such as estrogen or testosterone (Mitzi, 2022; Hembree at al., 2017).
Interactions
GnRH analogues have minimal interactions with other drugs (AbbVie, 2024).
Other information
Examples of GnRH analogues include:
- Buserelin (Suprefact) nasal spray and injection
- Goserelin IZoladex) implant
- Histrelin (Vantas; Supprelin LA) implant
- Leuprorelin (Lupron; Eligard; Procren; Prostap; Staladex) injection
- Nafarelin (Synarel) nasal spray
- Triptorelin (Decapeptyl; Diphereline) injection
See also
References
- AbbVie. (2009). Lupron Depot: Highlights of prescribing information. [PDF]
- de Lange, M. E., Semmler, A., Clark, T. J., Mol, B. W. J., Bet, P. M., Huirne, J. A. F., & Hehenkamp, W. J. K. (2024). Considerations on implementation of the newest treatment for symptomatic uterine fibroids: Oral GnRH antagonists. British journal of clinical pharmacology, 90(2), 392–405. [DOI:10.1111/bcp.15897]
- Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T'Sjoen, G. G. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869–3903. [DOI:10.1210/jc.2017-01658]
- Mitzi. (2022). Puberty Blockers: A Review of GnRH Analogues in Transgender Youth. Transfeminine Science. [URL]