trelstar and Gender-Dysphoria

Young people with gender dysphoria are increasingly seen by pediatric endocrinologists. Mental health child specialists assess the adolescent and give advice about psychological or medical treatment. Provided they fulfill eligibility and readiness criteria, adolescents may receive pubertal suspension, consisting of using gonadotrophin-releasing hormone analogs, later followed by cross-sex hormones (sex steroids of the experienced gender). If they fulfill additional criteria, they may have various types of gender affirming surgery. Current issues involve safety aspects. Although generally considered safe in the short-term, the long-term effects regarding bone health and cardiovascular risks are still unknown. Therefore, vigilance is warranted during and long after completion of the last gender affirming surgeries. The timing of the various treatment steps is also under debate: instead of fixed age limits, the cognitive and emotional maturation, along with the physical development, are now often considered as more relevant.

Topics: Adolescent; Androgens; Estradiol; Estrogens; Female; Gender Dysphoria; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Male; Psychotherapy; Sex Reassignment Procedures; Testosterone; Transgender Persons; Triptorelin Pamoate

Hormonal interventions in adolescents with gender dysphoria may have adverse effects, such as reduced bone mineral accrual.. To describe bone mass development in adolescents with gender dysphoria treated with gonadotropin-releasing hormone analogues (GnRHa), subsequently combined with gender-affirming hormones.. Observational prospective study.. 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.. Bone mineral apparent density (BMAD), age- and sex-specific BMAD z-scores, and serum bone markers.. 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.. 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.

Topics: Adolescent; Adolescent Development; Bone Density; Bone Development; Child; Female; Gender Dysphoria; Gonadotropin-Releasing Hormone; Hormone Replacement Therapy; Humans; Male; Netherlands; Prospective Studies; Sex Reassignment Procedures; Sexual Maturation; Testosterone; Transsexualism; Triptorelin Pamoate