#puberty suppression

https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2353224

Effects of puberty suppression on bone, body composition, handgrip strength and glucolipid profile in early-pubertal transgender adolescents

Abstract

Introduction The effects of puberty suppression for more than 2 years before the start of gender-affirming hormones (GAH) on bone mass acquisition and body composition are understudied.

Materials and methods Retrospective study on 46 transgender adolescents (20 trans boys and 26 trans girls) receiving a gonadotropin-releasing hormone analogue (GnRHa) from Tanner stage 2-3, followed by GAH around the age of 16 years. At start of GnRHa and at start of GAH, dual-energy X-ray absorptiometry (DXA) at lumbar spine (LS), femoral neck (FN) and total body (TB), handgrip strength test and fasting blood sampling were performed. Z-scores were calculated using reference values for both cis girls and cis boys.

Results GnRHa were administered for a median of 3.2 years (± 0.69) in trans boys and 2.7 years (± 1.05) in trans girls. Bone mineral apparent density (BMAD)-LS Z-scores decreased significantly in both trans boys and trans girls, while BMAD-FN Z-scores decreased only in trans boys. Fat% and Fat Mass Index Z-scores significantly increased in both groups, while Lean Mass Index Z-scores significantly decreased. Handgrip strength Z-scores for the sex registered at birth (SRAB) remained stable in trans boys while they decreased in trans girls. There was no significant influence of the treatment on either insulin sensitivity or lipid profile.

Discussion GnRHa administration for more than two years during the physiological time of puberty decreases bone mass acquisition, mainly at the lumbar spine and induces a general increase in fat mass. Although lean mass acquisition is undermined in both groups, handgrip strength is affected mainly in trans girls compared with age-matched peers for the SRAB.

==

Lisa T Mullin makes some important observations regarding a letter from British and Irish researchers. 

Note the following:

Transphobic researchers and TERF activists mix data about children with data about youth. These are dissimilar groups.

Secondly: They confuse  data about gender variant kids and youth (which is a broad category that includes both gender nonconforming kids and gender dysphoric kids) with data about those who suffer from gender dysphoria. The fact that many gender nonconforming kids do not chose to transition when they get older, should come as no surprise. This does not mean that the same is true for gender dysphoric kinds. We know that it isn’t!

… sorry if this sounds rude, i sort of think it does? i dunno really.

I tend to find much of the discourse surrounding this issue incredibly alarmist.

I have been treated at a very well-known clinic for sex dysphoric children and adolescents since I was sixteen. This notion that many people seem to have that puberty suppressing drugs are being thrown at any young boy who puts a dress on has no basis in reality, based upon what I have seen. The endocrinologist and the mental health staff at my clinic are smart people who know how to tell the difference between a child who is struggling with gendered social expectations and one who experiences severe dysphoria in relation to their sex characteristics. To this end, there are strict screening measures in place: in order to receive treatment, I had to both be diagnosed with gender identity disorder by my own psychiatrist and complete a lengthy interview with my clinic’s psychologist, with much of that conversation being focused on making sure I was not pursuing hormone therapy for the wrong reasons. 

As far as I know, there have not yet been any instances of regret by individuals who underwent puberty suppression and hormone therapy at my clinic, which is notable given that its earliest patients have now nearly reached adulthood. It is true that we do not know what the long term outcomes will be because this is an experimental treatment, but I maintain that these children and adolescents are likely to be much better off by virtue of having been spared the trauma that puberty would have caused them. I often see people talk about puberty suppression as if it is some kind of fiendish plot to crush the nonconformity of children, when in fact it is a last-ditch attempt to save them from self-destruction. These children are suffering acutely when they are brought in for treatment, and if they are anything like me it is probable that they would become even more dysfunctional during adolescence and adulthood, provided they were able to survive that long.