Clinical Scorecard: Influence of GnRH Analogues and Hormonal Treatments on Bone Structure in Transgender Populations
At a Glance
Category
Detail
Condition
Gender incongruence and gender dysphoria in transgender individuals
Key Mechanisms
Impact of puberty suppression (PS) with GnRH analogues and gender-affirming hormone therapy (GAHT) on skeletal dimensions, particularly pelvis and shoulder width
Target Population
Transgender adolescents and young adults aged 18-28 years, assigned male at birth (AMAB) and assigned female at birth (AFAB)
Care Setting
Gender identity clinics with access to DXA scanning and hormone treatment protocols
Key Highlights
Early puberty suppression (PS) with GnRH analogues followed by GAHT alters skeletal dimensions aligning more with affirmed gender, especially in AMAB individuals.
In AMAB individuals, early PS results in smaller shoulder width and pelvic dimensions comparable to untreated AFAB individuals.
Late PS or GAHT-only treatments do not significantly alter skeletal dimensions established by endogenous puberty.
Guideline-Based Recommendations
Diagnosis
Assess gender dysphoria and incongruence clinically before initiating PS or GAHT.
Use DXA scanning between ages 18-28 to evaluate skeletal dimensions in transgender individuals.
Management
Consider early initiation of puberty suppression with GnRH analogues in adolescents with persistent gender dysphoria to influence skeletal development.
Follow PS with gender-affirming hormone therapy (GAHT) from approximately age 16 years.
Tailor hormone treatment regimens based on individual pubertal stage and treatment goals.
Monitoring & Follow-up
Monitor skeletal development and bone health via DXA scans during and after treatment.
Evaluate changes in pelvic and shoulder dimensions to inform clinical decisions and surgical planning.
Risks
Potential impact on bone remodeling and skeletal dimensions if PS is initiated after completion of endogenous puberty.
Consider implications for obstetrical and surgical outcomes related to altered pelvic anatomy.
Patient & Prescribing Data
Transgender adolescents and young adults undergoing puberty suppression and/or GAHT
Early puberty suppression combined with GAHT can modify skeletal dimensions to align more closely with affirmed gender; late initiation shows limited skeletal changes.
Clinical Best Practices
Initiate puberty suppression early in adolescents with persistent gender dysphoria to maximize skeletal alignment with affirmed gender.
Use DXA imaging to assess and monitor skeletal changes during treatment.
Consider skeletal dimension changes when planning gender-affirming surgeries or evaluating obstetrical risks.
Educate patients about the potential effects of hormone treatments on bone structure and related clinical implications.
by Lidewij Sophia Boogers, Boukje Teatske Sikma, Mark-Bram Bouman, Adrianus Sarinus Paulus van Trotsenburg, Martin den Heijer, Chantal Maria Wiepjes, Sabine Elisabeth Hannema
