Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the ap...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2022-10-01
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| Series: | Endocrine Connections |
| Subjects: | |
| Online Access: | https://ec.bioscientifica.com/view/journals/ec/11/11/EC-22-0280.xml |
| _version_ | 1811242810725105664 |
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| author | Silvia Ciancia Vanessa Dubois Martine Cools |
| author_facet | Silvia Ciancia Vanessa Dubois Martine Cools |
| author_sort | Silvia Ciancia |
| collection | DOAJ |
| description | Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the appropriate age to star t using gender-affirming hormones. Exposure to pubertal sex steroids is thus significantl y deferred in these individuals. Puberty is a critical period for bone development: increasing concentrations of estrogens and androgens (directly or after aromatization to estrogens) promote progressive bone growth and mineralization and induce sexually dimorphic skeletal changes. As a consequence, safety concerns regarding bone development and increased future fracture risk in transgender youth have been raised. We here review published data on bone development in transgender adolescents, focusing in par ticular on differences in age and pubertal stage at the start of puberty suppression, chosen strategy to block puberty progression, duration of puberty suppression, and the timing of re-evaluation after estradiol or testosterone administration. Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration. Trans girls are more vulnerable than trans boys for compromised bone health. Behavioral health measures that can promote bone mineralization, such as weight-bearing exercise and calcium and vitamin D supplementation, are strongly recommended in transgender youth, during the phase of puberty suppression and thereafter. |
| first_indexed | 2024-04-12T13:56:35Z |
| format | Article |
| id | doaj.art-1da90ff6ffe7422392d3f9c0b80908fe |
| institution | Directory Open Access Journal |
| issn | 2049-3614 |
| language | English |
| last_indexed | 2024-04-12T13:56:35Z |
| publishDate | 2022-10-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrine Connections |
| spelling | doaj.art-1da90ff6ffe7422392d3f9c0b80908fe2022-12-22T03:30:20ZengBioscientificaEndocrine Connections2049-36142022-10-011111110https://doi.org/10.1530/EC-22-0280Impact of gender-affirming treatment on bone health in transgender and gender diverse youthSilvia Ciancia0Vanessa Dubois1Martine Cools2Department of Internal Medicine and Pediatrics, Ghent University, Ghent, BelgiumBasic and Translational Endocrinology (BaTE), Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, BelgiumDepartment of Internal Medicine and Pediatrics, Ghent University, Pediatric Endocrinology Service, Ghent University Hospital, Ghent, BelgiumBoth in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the appropriate age to star t using gender-affirming hormones. Exposure to pubertal sex steroids is thus significantl y deferred in these individuals. Puberty is a critical period for bone development: increasing concentrations of estrogens and androgens (directly or after aromatization to estrogens) promote progressive bone growth and mineralization and induce sexually dimorphic skeletal changes. As a consequence, safety concerns regarding bone development and increased future fracture risk in transgender youth have been raised. We here review published data on bone development in transgender adolescents, focusing in par ticular on differences in age and pubertal stage at the start of puberty suppression, chosen strategy to block puberty progression, duration of puberty suppression, and the timing of re-evaluation after estradiol or testosterone administration. Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration. Trans girls are more vulnerable than trans boys for compromised bone health. Behavioral health measures that can promote bone mineralization, such as weight-bearing exercise and calcium and vitamin D supplementation, are strongly recommended in transgender youth, during the phase of puberty suppression and thereafter.https://ec.bioscientifica.com/view/journals/ec/11/11/EC-22-0280.xmltransgenderadolescentsgnrha treatmentpuberty suppressiongender-affirming hormonesbonebone mineral density |
| spellingShingle | Silvia Ciancia Vanessa Dubois Martine Cools Impact of gender-affirming treatment on bone health in transgender and gender diverse youth Endocrine Connections transgender adolescents gnrha treatment puberty suppression gender-affirming hormones bone bone mineral density |
| title | Impact of gender-affirming treatment on bone health in transgender and gender diverse youth |
| title_full | Impact of gender-affirming treatment on bone health in transgender and gender diverse youth |
| title_fullStr | Impact of gender-affirming treatment on bone health in transgender and gender diverse youth |
| title_full_unstemmed | Impact of gender-affirming treatment on bone health in transgender and gender diverse youth |
| title_short | Impact of gender-affirming treatment on bone health in transgender and gender diverse youth |
| title_sort | impact of gender affirming treatment on bone health in transgender and gender diverse youth |
| topic | transgender adolescents gnrha treatment puberty suppression gender-affirming hormones bone bone mineral density |
| url | https://ec.bioscientifica.com/view/journals/ec/11/11/EC-22-0280.xml |
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