You are on a horizontal elective with a pediatric endocrinologist at MUMC when you and your preceptor see your first patient of the day, Chantal. Chantal is a 5-year-2-month-old child presenting with advanced breast development over the past seven months and scant pubic hair growth. This has been associated with rapid growth and intermittent "spotting" over the last two days. Aside from occasional emotional outbursts (crying, arguments with her 9-year-old sister and her mother), there are no other reported concerns. Chantal's mother, a 36-year-old schoolteacher, has a height at the 50th percentile and experienced menarche at age 13. Chantal’s father, a 44-year-old lawyer, also has a height at the 50th percentile and began shaving around age 15 or 16. He has mild hypertension. The family history is negative for early puberty. The parents are not consanguineous. On examination, Chantal's height and weight are both above the 97th percentile. She has grown 9.6 cm in the past year. Physical findings are depicted in the associated media. A bone age radiograph shows a skeletal maturity equivalent to that of a 9-year-old girl. Keanu is a 14-year-old youth who was referred two months ago after repeated attempts to access medical gender-affirming care. Keanu identifies as gender diverse and transfeminine, preferring she/her or they/them pronouns. At Keanu’s last visit, the use of GnRH agonists and gender-affirming hormone therapy (GAHT) was discussed with Keanu and their parents. During today’s appointment, they wish to understand whether the effects of puberty blockers are permanent and to learn about potential health outcomes related to their use.