1. Development of Hip Bone Geometry During Gender‐Affirming Hormone Therapy in Transgender Adolescents Resembles That of the Experienced Gender When Pubertal Suspension Is Started in Early Puberty
- Author
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Maria A T C van der Loos, Daniel T Klink, Martin den Heijer, Chantal M. Wiepjes, Mariska C. Vlot, Ilse Hellinga, Internal medicine, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, and Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Adult ,Male ,0301 basic medicine ,Peak bone mass ,Pediatrics ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,030209 endocrinology & metabolism ,Transgender Persons ,GENDER‐AFFIRMING HORMONE TREATMENT ,03 medical and health sciences ,0302 clinical medicine ,HIP BONE GEOMETRY ,Gonadotropin-releasing hormone agonist ,Transgender ,medicine ,Humans ,Testosterone ,Orthopedics and Sports Medicine ,Pelvic Bones ,education ,TRANSGENDER ,education.field_of_study ,GONADOTROPIN‐RELEASING HORMONE AGONIST ,business.industry ,Puberty ,Infant, Newborn ,Original Articles ,030104 developmental biology ,medicine.anatomical_structure ,Estrogen ,Hip bone ,Female ,Original Article ,Hormone therapy ,business ,Transsexualism - Abstract
Bone geometry can be described in terms of periosteal and endocortical growth and is partly determined by sex steroids. Periosteal and endocortical apposition are thought to be regulated by testosterone and estrogen, respectively. Gender‐affirming hormone (GAH) treatment with sex steroids in transgender people might affect bone geometry. However, in adult transgender people, no change in bone geometry during GAH was observed. In this study, we investigated changes in bone geometry among transgender adolescents using a gonadotropin‐releasing hormone agonist (GnRHa) and GAH before achieving peak bone mass. Transgender adolescents treated with GnRHa and subsequent GAH before the age of 18 years were eligible for inclusion. Participants were grouped based on their Tanner stage at the start of GnRHa treatment and divided into early, mid, and late puberty groups. Hip structure analysis software calculating subperiosteal width (SPW) and endocortical diameter (ED) was applied to dual‐energy X‐ray absorptiometry scans performed at the start of GnRHa and GAH treatments, and after ≥2 years of GAH treatment. Mixed‐model analyses were performed to study differences over time. Data were visually compared with reference values of the general population. A total of 322 participants were included, of whom 106 were trans women and 216 trans men. In both trans women and trans men, participants resembled the reference curve for SPW and ED of the experienced gender but only when GnRHa was started during early puberty. Those who started during mid and late puberty remained within the reference curve of the gender assigned at birth. A possible explanation might be sought in the phenomenon of programming, which conceptualizes that stimuli during critical windows of development can have major consequences throughout one's life span. Therefore, this study adds insights into sex‐specific bone geometry development during puberty of transgender adolescents treated with GnRHa, as well as the general population. © 2021 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
- Published
- 2021