Hormone therapy to halt puberty safe, effective in transgender adolescents

SAN FRANCISCO — New data indicate that gonadotropin-releasing hormone analogs effectively suppressed puberty and did not adversely affect bone health in transgender adolescents, a presenter said here at ENDO 2013.

“During puberty, girls will develop breasts, menarche and menses, and boys experience growth of the testes, penis and a lowering of the voice. But when you’re transsexual and have gender dysphoria, you feel you’re in the wrong body and then are confronted with your own sex characteristics, which can lead to anxiety and depression,” study researcher Henriette Delemarre-van de Waal, MD, PhD, professor of pediatric endocrinology at Leiden University Medical Center in the Netherlands, said at a press conference. “This is an important reason to develop protocol to help these adolescents during puberty.”

Henriette Delemarre-van de Waal

Pubertal suppression with gonadotropin-releasing hormone (GnRH) analogs offers an attractive option, according to Delemarre-van de Waal, largely because the treatment is reversible and therefore allows an adolescent to have more time to consider the decision to transition to the opposite sex. Nevertheless, questions persist about the safety of this therapy.

“During puberty, there are a lot of processes,” Delemarre-van de Waal said. “In addition to development of sex characteristics, insulin sensitivity decreases; lipids slightly decrease; growth spurts occur; and bone mass begins to increase until age 25 to 35 years.”

To evaluate the effects of GnRH analogs for blocking puberty, Delemarre-van de Waal and colleagues followed 127 patients who later opted to receive cross-sex hormones beginning at age 16 years for development of characteristics of the opposite sex. Fifty-three boys received estrogen to transition to the female sex and 73 girls transitioned to the male sex using testosterone.

During the 2 years of treatment, BMI increased by approximately 6%, according to the study abstract. Body fat mass also increased, with greater increases found in biologic males vs. females.

“In the older stages of puberty, insulin sensitivity had decreased, but it did not change during our treatment, and that’s an important phenomenon for us,” Delemarre-van de Waal said. “We also observed no changes in cholesterol, HDL or LDL during the 2 years of treatment and when cross-sex hormones were added. At 1 year, there was no change, so it seems that the treatment has no adverse effects on metabolic parameters.”

The researchers noted a decrease in height velocity as well as a delay in bone age during treatment. The height difference between boys and girls is about 12 cm, according to Delemarre-van de Waal, but growth can be manipulated to achieve a more appropriate height for either sex with administration of other therapies, such as oxandrolone or estrogen.

In terms of bone health, patients who were in late puberty had higher bone density and experienced a stabilization of bone mass during treatment. Patients in early puberty, however, still experienced increases in bone mass but less than they would have if they had experienced their own puberty. Similar results were noted for whole-body bone density. Best results for bone mass at the conclusion of treatment occurred in patients who initiated therapy at a younger age, according to the study abstract.

“Long-term suppression of puberty has no deleterious effects on metabolism; height can be manipulated into a more appropriate range for each sex, [and] bone development after stabilization on GnRH agonists catches up during the administration of cross-sex hormones,” Delemarre-van de Waal said. “Therefore, medical intervention in young transgender patients appears to be safe and effective.” – by Melissa Foster

For more information:

Delemarre-van de Waal H. #FP37-3. Presented at: The Endocrine Society Annual Meeting and Expo; June 15-18, 2013; San Francisco.