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HT may delay, stunt BMD in adolescents with gender dysphoria

Among individuals with gender dysphoria who initiated gender reassignment during adolescence, gonadotropin-releasing hormone analogue therapy may delay or diminish achievement of peak bone mass potential, according to recent findings.

In a longitudinal, observational study, researchers evaluated 34 young adults aged at least 21 years who were diagnosed with gender identity disorder of adolescence and who initiated sexual reassignment during adolescence. Participants underwent gonadectomy between June 1998 and August 2012 and had bone mineral density available for the following time points: at the start of gonadotropin-releasing hormone analogue (GnRHa) treatment, at the initiation of cross-sex hormone treatment and at age 22 years.

For natal boys with gender dysphoria (transwomen), the median duration of GnRHa monotherapy was 1.3 years, and for natal women (transmen), it was 1.5 years. Transwomen underwent a median 5.8 years of cross-sex HT, and transmen underwent a median of 5.4 years. The median length of combined GnRHa and cross-sex HT was 3.1 years for transwomen and 2.2 years for transmen.

The researchers defined the study’s primary outcome measure as BMD development throughout the duration of sex reassignment, until the age of 22 years. Natal sex was used as a reference for BMD z scores.

The researchers found that between the initiation of GnRHa and age 22 years, transwomen experienced significant decreases in lumber areal BMD z score from –0.8 to –1.4. Transmen demonstrated a trend for decrease from 0.2 to –0.3.

According to the researchers, these findings suggest that the BMD of these individuals was below their pretreatment potential.

“This decrease may reflect either a delay in [peak bone mass] attainment or loss of [peak bone mass] potential and may be attributed to the GnRHa induced hypogonadal state, the relative low hormone dosage during the initial period of [cross-sex hormone] therapy, or the pharmacodynamics characteristics of [cross-sex hormone],” the researchers wrote. “Continuous monitoring of bone mass development in this population is warranted, preferably by a specialist endocrinologist with experience in transgender health care and knowledge of the adolescent treatment protocol.”

Disclosure: The researchers report no relevant financial disclosures.