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  • Friday, June 17, 2016

    June 19, 2016 8:00 AM - June 19, 2016 9:30 AM

    IJ Room

    • Daniel Klink, MD, PhD ;
    • Sabine Hannema, MD, PhD ;
    • Gary Butler, MD, FRCPCH ;
    • Sebastiaan Schagen, MD ;
    • Martine Cools, MD, PhD
    Introduction, Dr. Sabine Hannema, Leiden, The Netherlands   Puberty suspension, most commonly with GnRH analogues, is now widely used as initial treatment for adolescents with gender dysphoria. Although GnRH analogues have been used for decades in the treatment of precocious puberty, there is a lack of data on the outcome of this treatment in adolescent with gender dysphoria. De Vries et al. showed that GnRH analogue treatment improved psychological wellbeing in several domains [de Vries et al, 2011]. However, little data have been reported on the efficacy of treatment in terms of suppressing clinical progression of puberty and sex steroid levels. There are also concerns about adverse effects on bone health, metabolic health, growth and brain development. In this symposium data on efficacy and safety of puberty suppression will be presented. Treatment with GnRH analogues as well as an alternative way to suppress puberty using progestogens or anti-androgens will be discussed.   Speakers: Prof. dr. Gary Butler, London UK   Title: How effective is puberty suspension with GnRH analogues   Although treatment with GnRH analogues to halt pubertal progress has a general effect, detailed assessment suggests that in many individuals, sex hormone suppression is incomplete. This may be due to a body-size effect, but also differing metabolic rates of this competitive hormone blocker. Partial suppression may produce more side effects due to hormone swings, and also a lowering in mood leading to clinical depression. Expectations of improvement in functioning and relief of the dysphoria are not as extensive as anticipated, and psychometric indices do not always improve nor does the prevalence of measures of disturbance such as deliberate self harm improve. Factors affecting persistence-desistence vary considerably by age. New data from the large national UK Gender Identity Development Service will be presented to inform the discussion.    Dr. Sebastian Schagen, Leiden, The Netherlands Title: Efficacy and safety of triptorelin to suppress puberty in gender dysphoric adolescents Although puberty suppression using GnRHa is recommended by the WPATH Standards of Care and the Endocrine Society guideline, limited data are available on the outcome of this treatment. The efficacy and safety of triptorelin to suppress puberty were evaluated in a Dutch cohort of gender dysphoric adolescents. GnRHa treatment resulted in a decrease in testicular volume in natal males and cessation of menses in postmenarcheal natal females. Gonadotropins and sex steroid levels were suppressed within three months. No sustained abnormalities of liver enzymes or creatinine were encountered. Bone mineral density z-scores decreased during treatment with triptorelin in both natal males and females. These data show that triptorelin effectively suppresses puberty but decreased bone mineral accrual is an important side effect.   Prof. dr. Martine Cools, Ghent, Belgium  Title: Alternatives for GnRHa to suppress puberty in transgender adolescents   To bridge the period from diagnosis to the start of gender-affirming hormones in late pubertal adolescents, other methods than GnRHa can be used. Natal girls with gender dysphoria (GD) can be treated with progestagens to suppress menses and natal boys with GD can be treated with anti-androgens.  New data on the long-term use of Lynestrenol and of Cyproterone respectively, first as monotherapy and later in combination with cross-sex hormones, will be presented. The focus will be on clinical effects, side effects, biochemical changes, body composition and bone mass development during mono- and combination therapy. Dr Daniel Klink, Amsterdam, The Netherlands   Title: Shifting the age boundaries of gender affirming treatment from an endocrine point of view Historically the minimum age to start GnRHa treatment and gender affirming hormones was in the Netherlands 12 and 16 years, respectively. The base for these age limits was juridical but nowadays are under debate. Whereas the time to start GnRHa is now more determined by pubertal stage, the age to start sex steroids is still 16 years in the WPATH Standards of Care . The decision to start gender affirming hormones (GAH) is multifactorial such as psychological maturation and situation but also somatic aspects contribute. An earlier exposure to sex steroids approaches the physiological development better. Indeed, present data on potential loss of peak bone mass in the initial cohort may favor an earlier start of GAH. In addition, when considering a final height more appropriate for the desired sex, preliminary data on growth and bone maturation also suggest earlier start of treatment. In this presentation these factors and balancing them will be discussed.

    Category: Pediatrics and Adolescent Health