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Estrogen induces pubertal induction in adolescents transitioning from male to female
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In adolescents transitioning from male to female, estrogen therapy for at least 1 year was effective and safe for inducing puberty, study data show.
Sabine E. Hannema, MD, PhD, of the department of pediatrics, Leiden University Medical Centre in the Netherlands, and colleagues evaluated 28 adolescents (median age, 16 years) transitioning from male to female treated with oral estrogen for at least 1 year to determine the efficacy and safety of estrogen treatment for pubertal induction. Researchers evaluated Tanner stages, anthropometry, laboratory parameters, bone age and body composition.
Among participants with available data, breast development began in 15 of 18 participants at 3 months and in 27 of 27 participants at 1 year. Median Tanner breast stage was 3 at 1 year, stage 4 at 2 years and stage 5 at 3 years.
There was no significant change in waist circumference, whereas waist circumference standard deviation score (SDS) decreased from 0.67 SDS to 0.22 SDS during 3 years of treatment. During the first 2 years of ET, hip circumference increased from 93.5 cm to 97.5 cm (P = .003), whereas hip circumference SDS did not change. During 3 years of ET, waist-to-hip ratio decreased from 0.79 to 0.75 (P < .001) and waist-to-hip ratio SDS also decreased from 0.48 SDS to –0.04 SDS (P = .002).
During the first year of treatment, testicular volume slightly decreased (P = .02), but no significant changes were found in subsequent years.
“We have shown that pubertal induction with a gradually increasing dosing schedule of estradiol effectively induces breast development and female fat distribution in transgender adolescents,” the researchers wrote. “However, an adult dose of 2 mg does not always result in appropriate serum estradiol levels, and especially in the presence of elevated [luteinizing hormone] and low [bone mineral density], a higher dose should be considered. No adverse effects were observed during estradiol treatment, and we feel that monitoring of renal function, liver enzymes, hematocrit and HbA1c during pubertal induction is not necessary. After the completion of pubertal induction, adult guidelines for monitoring can be followed.” – by Amber Cox
Disclosure: Hannema reports financial ties with Ferring and Pfizer.
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