Bone Accrual During Puberty Suppression and Gender-Affirming Therapy in Transgender Adolescents: A Systematic Review and Meta-Analysis.
Daniele Tienforti, Lorenzo Marinelli, Giovanni Terrana et al.
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In 30 seconds
This systematic review and meta-analysis evaluated bone mineral density (BMD) and z scores in transgender adolescents undergoing gonadotropin-releasing hormone agonist (GnRHa) therapy followed by gender-affirming hormone therapy (GAHT). Among 751 adolescents, lumbar spine z scores declined during GnRHa treatment but increased after GAHT, with BMD mean differences of 0.09 g/cm² for assigned female at birth (AFAB) and 0.13 g/cm² for assigned male at birth (AMAB).
Key findings
- Lumbar spine z scores declined during GnRHa treatment: AFAB -0.97, AMAB -0.73.
- After GAHT, BMD increased: AFAB mean difference 0.09 g/cm², AMAB mean difference 0.13 g/cm².
- At T2, z scores remained below baseline: AFAB -0.51, AMAB -0.52.
- Higher body mass index and longer GAHT exposure were linked to better skeletal outcomes.
Why it matters
Understanding the impact of GnRHa and GAHT on bone health in transgender adolescents is crucial, as these treatments can influence peak bone mass and long-term fracture risk. Clinicians should consider these findings when managing the care of transgender youth.