TY - JOUR
T1 - Low bone mineral density in early pubertal transgender/gender diverse youth
T2 - Findings from the trans youth care study
AU - Lee, Janet Y.
AU - Finlayson, Courtney
AU - Olson-Kennedy, Johanna
AU - Garofalo, Robert
AU - Chan, Yee Ming
AU - Glidden, David V.
AU - Rosenthal, Stephen M.
N1 - Funding Information:
Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (award numbers R01HD082554 and F32HD098763). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© Endocrine Society 2020.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Context: Transgender youth may initiate GnRH agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls before gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth. Objective: To describe BMD in early-pubertal transgender youth. Design: Cross-sectional analysis of the prospective, observational, longitudinal Trans Youth Care Study cohort. Setting: Four multidisciplinary academic pediatric gender centers in the United States. Participants: Early-pubertal transgender youth initiating GnRHa. Main Outcome Measures: Areal and volumetric BMD Z-scores. Results: Designated males at birth (DMAB) had below-average BMD Z-scores when compared with male reference standards, and designated females at birth (DFAB) had below-average BMD Z-scores when compared with female reference standards except at hip sites. At least 1 BMD Z-score was < -2 in 30% of DMAB and 13% of DFAB. Youth with low BMD scored lower on the Physical Activity Questionnaire for Older Children than youth with normal BMD, 2.32 ± 0.71 vs. 2.76 ± 0.61 (P = 0.01). There were no significant deficiencies in vitamin D, but dietary calcium intake was suboptimal in all youth. Conclusions: In early-pubertal transgender youth, BMD was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity-potential targets for intervention. Our results suggest a potential need for assessment of BMD in prepubertal gender-diverse youth and continued monitoring of BMD throughout the pubertal period of gender-affirming therapy.
AB - Context: Transgender youth may initiate GnRH agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls before gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth. Objective: To describe BMD in early-pubertal transgender youth. Design: Cross-sectional analysis of the prospective, observational, longitudinal Trans Youth Care Study cohort. Setting: Four multidisciplinary academic pediatric gender centers in the United States. Participants: Early-pubertal transgender youth initiating GnRHa. Main Outcome Measures: Areal and volumetric BMD Z-scores. Results: Designated males at birth (DMAB) had below-average BMD Z-scores when compared with male reference standards, and designated females at birth (DFAB) had below-average BMD Z-scores when compared with female reference standards except at hip sites. At least 1 BMD Z-score was < -2 in 30% of DMAB and 13% of DFAB. Youth with low BMD scored lower on the Physical Activity Questionnaire for Older Children than youth with normal BMD, 2.32 ± 0.71 vs. 2.76 ± 0.61 (P = 0.01). There were no significant deficiencies in vitamin D, but dietary calcium intake was suboptimal in all youth. Conclusions: In early-pubertal transgender youth, BMD was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity-potential targets for intervention. Our results suggest a potential need for assessment of BMD in prepubertal gender-diverse youth and continued monitoring of BMD throughout the pubertal period of gender-affirming therapy.
KW - Bone QCT
KW - Bone mineral density
KW - DXA
KW - Gender-affirming medical treatment
KW - Gonadotropin-releasing hormone agonists
KW - Transgender youth
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U2 - 10.1210/jendso/bvaa065
DO - 10.1210/jendso/bvaa065
M3 - Article
C2 - 32832823
AN - SCOPUS:85096473565
VL - 4
JO - Journal of the Endocrine Society
JF - Journal of the Endocrine Society
SN - 2472-1972
IS - 9
ER -
