The effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria: findings from a large national cohort
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Tobin Joseph
Abstract
Background
More young people with gender dysphoria (GD) are undergoing hormonal intervention starting with gonadotropin-releasing hormone analogue (GnRHa) treatment. The impact on bone density is not known, with guidelines mentioning that bone mineral density (BMD) should be monitored without suggesting when. This study aimed to examine a cohort of adolescents from a single centre to investigate whether there were any clinically significant changes in BMD and bone mineral apparent density (BMAD) whilst on GnRHa therapy.
Methods
A retrospective review of 70 subjects aged 12–14 years, referred to a national centre for the management of GD (2011–2016) who had yearly dual energy X-ray absorptiometry (DXA) scans. BMAD scores were calculated from available data. Two analyses were performed, a complete longitudinal analysis (n=31) where patients had scans over a 2-year treatment period, and a larger cohort over the first treatment year (n=70) to extend the observation of rapid changes in lumbar spine BMD when puberty is blocked.
Results
At baseline transboys had lower BMD measures than transgirls. Although there was a significant fall in hip and lumbar spine BMD and lumbar spine BMAD Z-scores, there was no significant change in the absolute values of hip or spine BMD or lumbar spine BMAD after 1 year on GnRHa and a lower fall in BMD/BMAD Z-scores in the longitudinal group in the second year.
Conclusions
We suggest that reference ranges may need to be re-defined for this select patient cohort. Long-term BMD recovery studies on sex hormone treatment are needed.
Acknowledgements
We are grateful to the staff from the Department of Nuclear Medicine UCLH for conducting the scans; colleagues from the National Adolescent Gender Identity Development Service, Tavistock and Portman NHS Trust for the assessment and referral of subjects; Elaine Perkins, Professor Russell Viner, Dr Elena Monti and the adolescent endocrine team at UCLH, and Professor Mary Fewtrell UCL for guidance on the analysis.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. The project was conceived by GB. Data collection and analysis was conducted by TJ and JT with input from GB as part of a UCL Medical School academic programme.
Research funding: None. All scans were conducted as part of the NHS routine care programme.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Long-term follow-up of children with classic congenital adrenal hyperplasia: suggestions for age dependent treatment in childhood and puberty
- Changes in body mass index in children on gonadotropin-releasing hormone agonist therapy with precocious puberty, early puberty or short stature
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- The effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria: findings from a large national cohort
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- Case Reports
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Artikel in diesem Heft
- Frontmatter
- Original Articles
- Ghrelin and leptin levels in children with anxiety disorders
- The effectiveness of enzyme replacement therapy on cardiac findings in patients with mucopolysaccharidosis
- Long-term follow-up of children with classic congenital adrenal hyperplasia: suggestions for age dependent treatment in childhood and puberty
- Changes in body mass index in children on gonadotropin-releasing hormone agonist therapy with precocious puberty, early puberty or short stature
- Psychological effects of gonadotropin-releasing hormone agonist treatment in girls with central precocious puberty
- The effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria: findings from a large national cohort
- Zinc deficiency in Japanese children with idiopathic short stature
- Psychometric performance of the Quality of Life in Short Stature Youth (QoLISSY) questionnaire in a randomized open-label comparator trial in idiopathic short stature
- Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants
- Effect of home-based strength training program on IGF-I, IGFBP-1 and IGFBP-3 in obese Latino boys participating in a 16-week randomized controlled trial
- Adiposity and attained height in adolescents: a longitudinal analysis from the LabMed Physical Activity Study
- Providing quality care for children and adolescents with diabetes from lower-income families in Mexico
- Screening of monogenic autoimmune diabetes among children with type 1 diabetes and multiple autoimmune diseases: is it worth doing?
- Validation of a risk screening tool for pediatric type 1 diabetes patients: a predictor of increased acute health care utilization
- Triglyceride/glucose index is a reliable alternative marker for insulin resistance in South American overweight and obese children and adolescents
- Micro-RNA 196a2 expression and miR-196a2 (rs11614913) polymorphism in T1DM: a pilot study
- Case Reports
- Successful treatment of infantile-onset ACAD9-related cardiomyopathy with a combination of sodium pyruvate, beta-blocker, and coenzyme Q10
- Short stature: making a crystal clear diagnosis
- Severe arterial hypertension and hyperandrogenism in a boy: a rare case of catecholamine- and β-HCG-secreting pheochromocytoma
