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  • Friday, June 17, 2016
  • 0706-000371 BONE MINERAL DENSITY IN ADOLESCENTS WITH GENDER DYSPHORIA DURING PROLONGED GONADOTROPIN RELEASING HORMONE ANALOG TREATMENT.

    June 19, 2016 10:21 AM - June 19, 2016 10:33 AM

    Water Studio

    • Denise Vink, MD ;
    • Joost Rotteveel, MD, PhD ;
    • Daniel Klink, MD, PhD

    Purpose

    Background
    In young adolescents with gender dysphoria (GD) gonadal suppression can be achieved with GnRH analogs (GnRHa). Sex steroids are crucial for bone mass accrual during puberty. The effect of prolonged treatment in early adolescence on bone mineral density (BMD) is unknown and conceivably hazardous.

    Purpose
    To evaluate BMD development during gonadal suppression over a period of up to 4 years among a cohort of adolescents with GD who started GnRHa at an early age.

    Materials and Methods

    Methods
    55 adolescents with GD (14 natal boys and 41 natal girls) were treated with GnRHa for a period of 33 months or longer between June 1998 and April 2014 at the Center of Expertise on GD of the VU Medical Center. Areal BMD of the lumbar spine (LS) and femoral neck (FN) was measured at start of GnRHa treatment and periodically at an interval of 12 months until the start of gender affirming hormones. Volumetric BMD (bone mineral apparent density [BMAD]) and z-scores in reference to natal sex were calculated. Generalized Estimation Equations were used to assess the differences in BMAD and BMAD z-scores during GnHRa treatment.

    Results

    Results
    In natal girls LS BMAD and FN BMAD did not change during a median duration of 42 months (range 38-47) of GnRHa treatment, whereas LS and FN BMAD z-scores decreased from 0.30  to -1.0 (p<0.001) and 0.2 to -0.6 (p<0.001), respectively. Similar, in natal boys LS and FN BMAD did not change during a median period of 36 months (range 34-38) of GnRHa treatment, whereas LS and FN BMAD z-scores decreased from -0.2 to -1.5 (p<0.001) and from -0.2 to -1.6 (p<0.001), respectively.

    Conclusion

    Conclusions
    Absolute bone mass remained stable during prolonged gonadal suppression but a delay in bone mass accrual is reflected by the decline of z-scores. This delay may compromise bone health later in life. Continuing BMD monitoring, well into adulthood, in adolescents with GD who started gender reassignment at an early age is warranted.




    Category: Endocrinology and Hormone Therapy