Low bone mineral density in early pubertal transgender/gender diverse youth: Findings from the trans youth care study

Janet Y. Lee*, Courtney Finlayson, Johanna Olson-Kennedy, Robert Garofalo, Yee Ming Chan, David V. Glidden, Stephen M. Rosenthal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalJournal of the Endocrine Society
Volume4
Issue number9
DOIs
StatePublished - Sep 1 2020

Keywords

  • Bone QCT
  • Bone mineral density
  • DXA
  • Gender-affirming medical treatment
  • Gonadotropin-releasing hormone agonists
  • Transgender youth

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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