Notice the "or"--in the US, some gender doctors have been skipping blockers entirely "at the first sign of puberty"--for years. https://gendertrender.wordpress.com/2014/11/11/skipping-the-puberty-blockers-american-transgender-children-doctors-are-going-rogue/ …
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I can't get into details BC of how I personally know, but there are 13-14 year olds on cross sex hormones in Canada too. I can try to find a Canada specific study or reports if you want, assuming it's being examined that is
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Please do.
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