Bone development in transgender adolescents treated with gnrh analogues and subsequent gender-affirming hormones
Journal of Clinical Endocrinology and Metabolism , Volume 105 - Issue 12
Context: Hormonal interventions in adolescents with gender dysphoria may have adverse effects, such as reduced bone mineral accrual. Objective: To describe bone mass development in adolescents with gender dysphoria treated with gonadotropin-releasing hormone analogues (GnRHa), subsequently combined with gender-affirming hormones. Design: Observational prospective study. Subjects: 51 transgirls and 70 transboys receiving GnRHa and 36 transgirls and 42 transboys receiving GnRHa and gender-affirming hormones, subdivided into early- and late-pubertal groups. Main Outcome Measures: Bone mineral apparent density (BMAD), age- and sex-specific BMAD z-scores, and serum bone markers. Results: At the start of GnRHa treatment, mean areal bone mineral density (aBMD) and BMAD values were within the normal range in all groups. In transgirls, the mean z-scores were well below the population mean. During 2 years of GnRHa treatment, BMAD stabilized or showed a small decrease, whereas z-scores decreased in all groups. During 3 years of combined administration of GnRHa and gender-affirming hormones, a significant increase of BMAD was found. Z-scores normalized in transboys but remained below zero in transgirls. In transgirls and early pubertal transboys, all bone markers decreased during GnRHa treatment. Conclusions: BMAD z-scores decreased during GnRHa treatment and increased during gender-affirming hormone treatment. Transboys had normal z-scores at baseline and at the end of the study. However, transgirls had relatively low z-scores, both at baseline and after 3 years of estrogen treatment. It is currently unclear whether this results in adverse outcomes, such as increased fracture risk, in transgirls as they grow older.
|bone mineral density, bone, GnRH analogue, sex steroids, gender dysphoria, transgender, adolescents|
|Journal of Clinical Endocrinology and Metabolism|
|Organisation||Department of Pediatrics|
Schagen, S.E.E., Wouters, F.M., Cohen-Kettenis, P.T, Gooren, L.J, & Hannema, S.E. (2020). Bone development in transgender adolescents treated with gnrh analogues and subsequent gender-affirming hormones. Journal of Clinical Endocrinology and Metabolism, 105(12). doi:10.1210/clinem/dgaa604