Lee Janet Y, Finlayson Courtney, Olson-Kennedy Johanna, Garofalo Robert, Chan Yee-Ming, Glidden David V, Rosenthal Stephen M
Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California.
J Endocr Soc. 2020 Jul 2;4(9):bvaa065. doi: 10.1210/jendso/bvaa065. eCollection 2020 Sep 1.
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.
To describe BMD in early-pubertal transgender youth.
Cross-sectional analysis of the prospective, observational, longitudinal Trans Youth Care Study cohort.
Four multidisciplinary academic pediatric gender centers in the United States.
Early-pubertal transgender youth initiating GnRHa.
Areal and volumetric BMD Z-scores.
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 ( = 0.01). There were no significant deficiencies in vitamin D, but dietary calcium intake was suboptimal in all youth.
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.
跨性别青少年可能会使用促性腺激素释放激素激动剂（GnRHa）来抑制青春期，而青春期是骨量积累的关键时期。有报道称，在接受性别肯定治疗之前，青春期晚期的跨性别女孩骨矿物质密度（BMD）较低，但对于青春期早期的跨性别青少年的BMD情况却知之甚少。
描述青春期早期跨性别青少年的BMD情况。
对前瞻性、观察性、纵向的跨性别青少年护理研究队列进行横断面分析。
美国的四个多学科学术儿科性别中心。
开始使用GnRHa的青春期早期跨性别青少年。
面积BMD和体积BMD的Z评分。
与男性参考标准相比，出生时被指定为男性（DMAB）的青少年BMD的Z评分低于平均水平；与女性参考标准相比，出生时被指定为女性（DFAB）的青少年除髋部部位外，BMD的Z评分也低于平均水平。30%的DMAB和13%的DFAB至少有1个BMD的Z评分< -2。BMD较低的青少年在《大龄儿童身体活动问卷》上的得分低于BMD正常的青少年，分别为2.32±0.71和2.76±0.61（P = 0.01）。维生素D没有明显缺乏，但所有青少年的膳食钙摄入量均不理想。
在青春期早期的跨性别青少年中，BMD低于出生时所指定性别的参考标准。这种较低的BMD可能部分是由于钙摄入量不理想和身体活动减少所致，这是潜在的干预目标。我们的结果表明，可能需要对青春期前性别多样化的青少年进行BMD评估，并在性别肯定治疗的整个青春期持续监测BMD。
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