Bone Health in the Transgender and Gender Diverse Youth Population

Overview

Journal Curr Osteoporos Rep

Publisher Current Science

Specialties Endocrinology
Orthopedics

Date 2023 Jul 3

PMID 37395890

Authors

Janet Y Lee

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: The purpose of this review is to summarize the scientific evidence on bone health in transgender and gender diverse (TGD) youth.

Recent Findings: Gender-affirming medical therapies may be introduced during a key window of skeletal development in TGD adolescents. Before treatment, low bone density for age is more prevalent than expected in TGD youth. Bone mineral density Z-scores decrease with gonadotropin-releasing hormone agonists and differentially respond to subsequent estradiol or testosterone. Risk factors for low bone density in this population include low body mass index, low physical activity, male sex designated at birth, and vitamin D deficiency. Peak bone mass attainment and implications for future fracture risk are not yet known. TGD youth have higher than expected rates of low bone density prior to initiation of gender-affirming medical therapy. More studies are needed to understand the skeletal trajectories of TGD youth receiving medical interventions during puberty.

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References

Chen M, Fuqua J, Eugster E . Characteristics of Referrals for Gender Dysphoria Over a 13-Year Period. J Adolesc Health. 2016; 58(3):369-71. PMC: 5344189. DOI: 10.1016/j.jadohealth.2015.11.010. View

Brik T, Vrouenraets L, de Vries M, Hannema S . Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. Arch Sex Behav. 2020; 49(7):2611-2618. PMC: 7497424. DOI: 10.1007/s10508-020-01660-8. View

Bishop A, Overcash F, McGuire J, Reicks M . Diet and Physical Activity Behaviors Among Adolescent Transgender Students: School Survey Results. J Adolesc Health. 2020; 66(4):484-490. DOI: 10.1016/j.jadohealth.2019.10.026. View

Neyman A, Fuqua J, Eugster E . Bicalutamide as an Androgen Blocker With Secondary Effect of Promoting Feminization in Male-to-Female Transgender Adolescents. J Adolesc Health. 2019; 64(4):544-546. PMC: 6431559. DOI: 10.1016/j.jadohealth.2018.10.296. View

Rosenthal S . Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014; 99(12):4379-89. DOI: 10.1210/jc.2014-1919. View

Rosen H, Hamnvik O, Jaisamrarn U, Malabanan A, Safer J, Tangpricha V . Bone Densitometry in Transgender and Gender Non-Conforming (TGNC) Individuals: 2019 ISCD Official Position. J Clin Densitom. 2019; 22(4):544-553. DOI: 10.1016/j.jocd.2019.07.004. View

Coelho J, Suen J, Clark B, Marshall S, Geller J, Lam P . Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Curr Psychiatry Rep. 2019; 21(11):107. DOI: 10.1007/s11920-019-1097-x. View

Cohen-Kettenis P, Schagen S, Steensma T, de Vries A, Delemarre-van de Waal H . Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up. Arch Sex Behav. 2011; 40(4):843-7. PMC: 3114100. DOI: 10.1007/s10508-011-9758-9. View

Handler T, Hojilla J, Varghese R, Wellenstein W, Satre D, Zaritsky E . Trends in Referrals to a Pediatric Transgender Clinic. Pediatrics. 2019; 144(5). PMC: 6855897. DOI: 10.1542/peds.2019-1368. View

10.

Schagen S, Wouters F, Cohen-Kettenis P, Gooren L, Hannema S . Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones. J Clin Endocrinol Metab. 2020; 105(12). PMC: 7524308. DOI: 10.1210/clinem/dgaa604. View

11.

Tack L, Craen M, Lapauw B, Goemaere S, Toye K, Kaufman J . Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism. J Clin Endocrinol Metab. 2018; 103(6):2147-2156. DOI: 10.1210/jc.2017-02316. View

12.

van der Loos M, Hellinga I, Vlot M, Klink D, den Heijer M, Wiepjes C . 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. J Bone Miner Res. 2021; 36(5):931-941. PMC: 8247856. DOI: 10.1002/jbmr.4262. View

13.

Cohen-Kettenis P, Van Goozen S . Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. Eur Child Adolesc Psychiatry. 1999; 7(4):246-8. DOI: 10.1007/s007870050073. View

14.

Stoffers I, de Vries M, Hannema S . Physical changes, laboratory parameters, and bone mineral density during testosterone treatment in adolescents with gender dysphoria. J Sex Med. 2019; 16(9):1459-1468. DOI: 10.1016/j.jsxm.2019.06.014. View

15.

Navabi B, Tang K, Khatchadourian K, Lawson M . Pubertal Suppression, Bone Mass, and Body Composition in Youth With Gender Dysphoria. Pediatrics. 2021; 148(4). DOI: 10.1542/peds.2020-039339. View

16.

McQuillan M, Kuhns L, Miller A, McDade T, Garofalo R . Gender Minority Stress, Support, and Inflammation in Transgender and Gender-Nonconforming Youth. Transgend Health. 2021; 6(2):91-100. PMC: 8080934. DOI: 10.1089/trgh.2020.0019. View

17.

Nasomyont N, Meisman A, Ecklund K, Vajapeyam S, Cecil K, Tkach J . Changes in Bone Marrow Adipose Tissue in Transgender and Gender Non-Conforming Youth Undergoing Pubertal Suppression: A Pilot Study. J Clin Densitom. 2022; 25(4):485-489. PMC: 9669162. DOI: 10.1016/j.jocd.2022.06.006. View

18.

Spack N, Edwards-Leeper L, Feldman H, Leibowitz S, Mandel F, Diamond D . Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics. 2012; 129(3):418-25. DOI: 10.1542/peds.2011-0907. View

19.

Vlot M, Klink D, den Heijer M, Blankenstein M, Rotteveel J, Heijboer A . Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone. 2016; 95:11-19. DOI: 10.1016/j.bone.2016.11.008. View

20.

Shuhart C, Yeap S, Anderson P, Jankowski L, Lewiecki E, Morse L . Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom. 2019; 22(4):453-471. DOI: 10.1016/j.jocd.2019.07.001. View