Joseph Tobin, Ting Joanna, Butler Gary
Department of Paediatric and Adolescent Endocrinology, University College London Hospital, London, UK.
UCL Great Ormond Street Institute of Child Health, London, UK.
J Pediatr Endocrinol Metab. 2019 Oct 25;32(10):1077-1081. doi: 10.1515/jpem-2019-0046.
Background More young people with gender dysphoria (GD) are undergoing hormonal intervention starting with gonadotropin-releasing hormone analogue (GnRHa) treatment. The impact on bone density is not known, with guidelines mentioning that bone mineral density (BMD) should be monitored without suggesting when. This study aimed to examine a cohort of adolescents from a single centre to investigate whether there were any clinically significant changes in BMD and bone mineral apparent density (BMAD) whilst on GnRHa therapy. Methods A retrospective review of 70 subjects aged 12-14 years, referred to a national centre for the management of GD (2011-2016) who had yearly dual energy X-ray absorptiometry (DXA) scans. BMAD scores were calculated from available data. Two analyses were performed, a complete longitudinal analysis (n=31) where patients had scans over a 2-year treatment period, and a larger cohort over the first treatment year (n=70) to extend the observation of rapid changes in lumbar spine BMD when puberty is blocked. Results At baseline transboys had lower BMD measures than transgirls. Although there was a significant fall in hip and lumbar spine BMD and lumbar spine BMAD Z-scores, there was no significant change in the absolute values of hip or spine BMD or lumbar spine BMAD after 1 year on GnRHa and a lower fall in BMD/BMAD Z-scores in the longitudinal group in the second year. Conclusions We suggest that reference ranges may need to be re-defined for this select patient cohort. Long-term BMD recovery studies on sex hormone treatment are needed.
越来越多患有性别焦虑症（GD）的年轻人开始接受激素干预，起始治疗为促性腺激素释放激素类似物（GnRHa）治疗。其对骨密度的影响尚不清楚，指南虽提及应监测骨矿物质密度（BMD），但未指明监测时机。本研究旨在对来自单一中心的一组青少年进行检查，以调查在接受GnRHa治疗期间，BMD和骨矿物质表观密度（BMAD）是否有任何具有临床意义的变化。方法：对70名年龄在12 - 14岁、转诊至一家全国性GD管理中心（2011 - 2016年）的受试者进行回顾性研究，这些受试者每年接受双能X线吸收测定（DXA）扫描。根据现有数据计算BMAD评分。进行了两项分析，一项是完整的纵向分析（n = 31），这些患者在2年治疗期内进行了扫描；另一项是在第一个治疗年对更大队列（n = 70）进行分析，以扩大对青春期被阻断时腰椎BMD快速变化的观察。结果：在基线时，跨性别男性的BMD测量值低于跨性别女性。尽管髋部和腰椎BMD以及腰椎BMAD的Z评分有显著下降，但在接受GnRHa治疗1年后，髋部或脊柱BMD或腰椎BMAD的绝对值没有显著变化，并且纵向组在第二年BMD/BMAD Z评分的下降幅度较小。结论：我们建议可能需要为这一特定患者群体重新定义参考范围。需要对性激素治疗的长期BMD恢复情况进行研究。
