Lucy Nicholson/Reuters

Up until a few weeks ago, Cody, a 16-year-old living in a small community outside of Boise, Idaho, wore almost nothing but black. While the look may be a relatively common one, Cody had a deeper reason driving his wardrobe choice: The black concealed the contours of his changing form, which was becoming a growing source of distress. As a transgender teen, Cody was going through puberty, and he didn’t identify with the gender that matched his body.

“It almost feels like your mind and your body are betraying you,” says Cody, who was born biologically female and came out last year to his family as a boy. “You just want to curl up in a hole and not look up at the light or people.” When he grew breasts, he began wrapping them in Ace Bandages; he became suicidal every time he had his period. Over time, it became more difficult to relate to the girls in his class, and he withdrew from people as he became increasingly alienated from his own body.

Adolescence, with its accompanying bodily changes, can be an awkward time for anyone—but puberty can be even more difficult for transgender teens as voices change, Adam's apples and breasts emerge, and the androgyny of childhood is lost. Often, the experience is accompanied by deep depression and thoughts of suicide.

The country's attitude toward the transgender community is shifting, with the once rarely-discussed topic moving further into mainstream conversation. The nascent acceptance of transgender people has important consequences for their medical care, and earlier this month, Oregon became the first state in the country to offer drugs that delay the onset of puberty for transgender adolescents enrolled in its Medicaid plan.

For 15 years, clinics in the U.S. and Europe that treat transgender children have prescribed these drugs to stop their bodies from maturing. The idea behind the treatment is twofold: First, it buys patients time to make an informed decision on how and if they want to physically transition to the gender with which they identify. And second, if they do decide to go through with the transition, puberty-suppressing drugs make the process smoother. By staving off breast development, for instance, an adolescent undergoing a female-to-male transition wouldn't have to undergo chest reconstruction surgery. But the medication offers mental benefits as well: Teens who are already living as the gender they identify with won't be “outed” by their bodies, and they won't have to go through puberty for the wrong gender, which research has shown can cause depression and suicidal thoughts.

“We feel that this is a medical necessity when the parents and the child agree that this is what they want,” says Jamison Green, the president of the World Professional Association for Transgender Health, which publishes widely-used protocols for the medical care of transgender patients. “Not providing this treatment is actually quite damaging.”

He points to a handful of clinicians that have been using it for years, such as Dr. Norman Spack, an endocrinologist at the Boston Children’s Hospital who specializes in transgender care.

Even so, there remains some reluctance among physicians to treat gender-dysphoric adolescents, partially out of the concern that it's just a phase that they'll outgrow. A 2008 study in the Journal of the American Academy of Child & Adolescent Psychiatry concluded that “most children with gender dysphoria will not remain gender dysphoric after puberty.” In June, the Wall Street Journal published a controversial opinion piece by Dr. Paul McHugh, the former chief psychiatrist at Johns Hopkins Hospital, who argued that most gender-dysphoric children were just going through a phase and stopped short of equating puberty-suppressing treatment to child abuse.

“As far as I know, I have not heard of anyone reversing their decision,” Green says of young people who undergo puberty-suppressing treatment, which he also says is completely reversible.

Despite being relatively new, the treatment is becoming a standard in care for transgender adolescents. In 2009, the Endocrine Society published a best-practices guide for treating transgender teens that included the use of puberty suppressants. Last year, the American Academy of Pediatrics released a technical report on care for LGBTQ youth that gave its blessing to the Endocrine Society's best practices. And in September, the journal Pediatrics published a long-term study that found that gender-dysphoric teens who underwent puberty suppression, followed by hormone treatment and gender-reassignment surgery, could become well-functioning adults.