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- Title
Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones.
- Authors
Schagen, Sebastian E. E.; Wouters, Femke M.; Cohen-Kettenis, Peggy T.; Gooren, Louis J.; Hannema, Sabine E.
- Abstract
<bold>Context: </bold>Hormonal interventions in adolescents with gender dysphoria may have adverse effects, such as reduced bone mineral accrual.<bold>Objective: </bold>To describe bone mass development in adolescents with gender dysphoria treated with gonadotropin-releasing hormone analogues (GnRHa), subsequently combined with gender-affirming hormones.<bold>Design: </bold>Observational prospective study.<bold>Subjects: </bold>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.<bold>Main Outcome Measures: </bold>Bone mineral apparent density (BMAD), age- and sex-specific BMAD z-scores, and serum bone markers.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
NETHERLANDS; PRECOCIOUS puberty; BONE density; BONE growth; ADOLESCENT development; CALCIUM supplements; ADOLESCENCE; THERAPEUTIC use of testosterone; THERAPEUTICS; RESEARCH; HORMONES; TESTOSTERONE; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; LONGITUDINAL method
- Publication
Journal of Clinical Endocrinology & Metabolism, 2020, Vol 105, Issue 12, p1
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa604