A hidden practice that deserves public attention
Across the United States, many residential treatment programs for adolescents promise stabilization, structure, and therapeutic support. Families often turn to these facilities during moments of crisis, believing they offer professional care and evidence-based treatment. Yet inside some programs, especially in states like Mississippi, a disturbing practice has taken place quietly and without the informed consent that medical ethics require.
Some facilities have used pharmaceutical testosterone suppression on adolescent boys during their final weeks or months of treatment. One of the most common drugs used is medroxyprogesterone acetate. This medication is approved for several legitimate uses, but testosterone suppression in adolescents is not among them. When used this way, the drug is functioning completely off label.
Parents are often told the medication will calm their child or make them less reactive as their stay comes to an end. The adolescent is not told the true purpose of the drug. The explanation is usually vague. Staff may describe the pill as something to help with mood or behavior. The real effect is hormonal reduction that alters libido, emotional intensity, and overall physical drive. This is done at a developmental stage when hormones play a major role in growth, identity, and emotional stability.
Why this practice is ethically unacceptable
1. Lack of informed consent
A minor cannot give full medical consent. That consent must come from a parent or guardian, and the information provided must be accurate. When parents are not told the truth, the entire process becomes a violation of medical ethics. When the minor is given medication without understanding its purpose, it becomes a violation of their bodily autonomy.
2. Off-label hormone manipulation in a developing body
Medroxyprogesterone is powerful. Testosterone suppression can affect bone density, growth patterns, mood regulation, sexual development, and long-term endocrine function. Using hormones to control behavior is not a therapeutic intervention. It is chemical restraint.
3. Lack of medical oversight
Residential treatment facilities often rely on contracted or in-house medical staff who may not specialize in adolescent endocrinology. Decisions that should involve specialists are instead made casually, as behavior management tools rather than clinical treatments.
4. The long-term consequences are rarely studied
There is little research examining the long-term effects of giving testosterone suppressants to adolescents without clinical indications. Risks may include hormonal imbalance, depression, sexual dysfunction, reduced energy, and changes in body composition. The absence of data should make the practice even more alarming.
- Increased risk of low bone density and long term skeletal weakness
- Lowered seizure threshold
5. Hormonal pathway disruption during adolescent development
Another overlooked risk involves the hormonal signals that regulate puberty itself. Medroxyprogesterone can reduce the secretion of luteinizing hormone in adolescent males. Luteinizing hormone is produced by the pituitary gland and is essential for normal testosterone production.
During adolescence, this system is still developing. The prefrontal cortex is not fully matured, and the brain is in a sensitive period where endocrine and neurological systems are learning to regulate each other. When a drug artificially suppresses testosterone, the brain may respond by lowering its own natural signals. Luteinizing hormone levels can remain low even after the medication is discontinued.
This creates several potential long term risks:
Delayed or disrupted puberty
- Chronic low testosterone symptoms in adulthood
- Reduced fertility or impaired reproductive function
- Low energy, reduced motivation, and mood instability
- Long term effects on bone density and skeletal strength
- Poor calibration of the hormonal rhythms that normally stabilize in late adolescence
Because the adolescent brain uses these years to set lifelong endocrine patterns, interference during this window may cause long term instability rather than a temporary medication effect. This is not simply a behavior management tool. It is a disruption of a system that is still wiring itself.
Why it happens
Facilities adopt this practice for several reasons:
- A calmer child is easier to manage as their stay concludes
- Staff may mistakenly believe hormonal suppression reduces aggression
- Programs may rely on outdated or inappropriate behavior management strategies
- Families trust clinicians and do not question vague explanations
- Adolescents often do not realize what medications they are receiving or why
The result is a system where powerful drugs can be used as shortcuts instead of providing real therapeutic support.
The human impact
Young people who go through residential treatment often exit feeling confused about changes in their mood, energy levels, or physical state. Some later discover that they were given medication whose real purpose was never disclosed. The experience can shape their relationship with medical care and their sense of bodily autonomy long after they leave the program.
Many hesitate to share that this happened to them. The stigma around residential treatment, combined with the private nature of hormonal changes, makes people reluctant to speak out. Yet the practice deserves attention regardless of any individual story.
What needs to change
Full transparency
Parents and guardians must be informed clearly about every medication, its purpose, its risks, and whether its use is off label.
Proper medical oversight
Hormonal interventions in adolescents should require specialists, second opinions, and strict justification.
Independent state-level monitoring
Mississippi and other states need oversight bodies that audit medication practices inside youth facilities. Chemical restraint should never be hidden inside vague treatment plans.
Legal protections for minors
Youth in residential treatment are among the most vulnerable populations. Stronger laws are needed to prevent misuse of medication and ensure ethical standards.
Public awareness
Even one adolescent given hormone-altering medication without informed consent is unacceptable. Families need to know this can happen so they can ask the right questions when considering residential programs.