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The more you have, the more energy your body uses even when you are sitting still

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As the Cass Review itself notes, puberty blockers have undergone extensive testing for use in precocious puberty (a very different indication from use in gender dysphoria) and have met strict safety requirements to be approved for this condition. The diagnosis of central precocious puberty relies on blood work, an objective test, whereas the diagnosis of gender dysphoriato the extent gender clinicians even try to follow DSM-5 criteria, which they often do notrelies on more subjective and potentially transitory measures like the feelings and desires of adolescents