Many transgender teenagers dread puberty, and not just because of the pimples and squeaky voices.

As bodies start to change, children slowly and uncontrollably leave the relative comfort of their younger years; for transgender kids, this transition is even more fraught, as appearances that may have been somewhat androgynous and enabled them to pass for another sex begin to fade into an undeniably gendered adulthood. Transgender youth grow into bodies that are not just more mature versions of themselves but that can feel like a foreign vessel, experts say.

Though Oregon was preparing to become the first state to allow low-income teens to use Medicaid coverage for expensive puberty-blocking drugs to help them delay those body changes, it looks like trans Oregonian youth will have to wait a little longer—or just cope with puberty as it comes.

State health authorities pushed back the October implementation date of coverage for those diagnosed with gender dysphoria to January after other drugs were deemed to take precedence, said Ariel Smits, medical director of the state’s Health Evidence Review.

It’s been a long wait for Oregon trans teens. The state approved Medicaid coverage of puberty blockers for gender dysphoria use two years ago, but implementation delays are common in the state program, Smits said.

The delay, however, hasn’t dented the spirit of triumph in the Oregon trans community, one advocate said.

“We know adolescents who were suicidal—terrified of going into puberty,” said Jenn Burleton, executive director of the TransActive Gender Center in Portland, which works with about 400 transgender youths and their families and was instrumental in pushing the state to cover puberty suppression drugs.

Giving teens the option of blocking anxiety-invoking body changes helps save lives, Burleton said. Transgender people, which comprise about 1 percent of the population, have an exceptionally high suicide rate, about 40 percent.

“It’s preemptive proactive treatment that prevents unnecessary trauma,” she said.

Puberty suppression meds, which cost $750 to $1,200 a month and are often not covered by private insurers in gender dysphoria cases, have been used for several decades to treat precocious puberty. They work by blocking the brain’s release of proteins that stimulate hormones producing secondary sex characteristics, such as breasts and menstruation or facial hair and Adam’s apple.

The effects are completely reversible, said Veronica Gómez-Lobo, a pediatric obstetrician/gynecologist with the Children’s National Medical Center in Washington, D.C. As soon as children stop taking the drug, they move into puberty.

Gender dysphoric teens typically start suppressive therapy at the onset of puberty and continue until they’re about 16, when it is generally considered reasonable to start hormone therapy, which may later be supplemented by gender reassignment surgery.

Parental consent and a psychological assessment are needed before starting the course of therapy.

Both the FDA and the Endocrinological Society have approved puberty blockers for gender dysphoria, Gómez-Lobo said. A study published in July in Pediatrics, the journal of the American Academy of Pediatrics, concluded that suppressing puberty offered teens “the opportunity to develop into well functioning young adults.”

Some concerns exist that delaying puberty could affect the bone mass and brain development that occurs during adolescence, but Gómez-Lobo noted that those concerns have not been substantiated.

Others, including conservative groups, say kids’ biology should not be interfered with when they could be merely going through a gender-questioning phase, a notion that many who work with transgender youth take issue with.

Most transgender kids feel that they are in the wrong biological body early in childhood, and the vast majority are certain about it by the time they reach puberty, Gómez-Lobo said. It makes sense to prevent biological changes that are unwanted and distressful and that may be hard to overcome later in life, such as a male’s deep voice, she said, noting that not all gender dysphoric teens choose to block puberty. Some opt for waiting to undergo hormone therapy later.

Improving gender dysphoric kids’ lives was a main reason that the Oregon Health Authority decided to cover puberty blockers in Medicaid.

“It was a clear benefit without doing any real harm,” Smits said. “We heard a lot of evidence about suicide attempts, emergency room visits, mental health, homelessness.” The savings from reducing the costs in those areas will offset the cost of the drugs to the state, he added.

“I don’t think it would be a huge overall expense to the program,” Smits said, noting that in one year only 170 Medicaid claims were filed in the state for transgender services for all ages.

The commission also considered concerns that delaying puberty could affect bone development but concluded that any loss of bone mass can be recuperated, she added.

Oregon’s move comes as the transgender community’s health needs are getting more attention from federal health programs. In May, Medicare lifted its ban on transgender medical treatments such as hormone therapy and gender reassignment surgery.

Several states, including California and Massachusetts, include adult transgender treatments in their public health plans but do not include puberty suppression.

“More health insurers, public or private, are increasing coverage of transition related health care,” said Jody Herman, manager of transgender research at UCLA’s Williams Institute, a think tank on LBGTQ issues. “Oregon is probably on the cutting edge as far as health insurance coverage.”