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Impact of gender-affirming treatment on bone health in transgender and gender diverse youth

Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the ap...

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Autores principales: Ciancia, Silvia, Dubois, Vanessa, Cools, Martine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578106/
https://www.ncbi.nlm.nih.gov/pubmed/36048500
http://dx.doi.org/10.1530/EC-22-0280
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author Ciancia, Silvia
Dubois, Vanessa
Cools, Martine
author_facet Ciancia, Silvia
Dubois, Vanessa
Cools, Martine
author_sort Ciancia, Silvia
collection PubMed
description Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the appropriate age to start using gender-affirming hormones. Exposure to pubertal sex steroids is thus significantly deferred in these individuals. Puberty is a critical period for bone development: increasing concentrations of estrogens and androgens (directly or after aromatization to estrogens) promote progressive bone growth and mineralization and induce sexually dimorphic skeletal changes. As a consequence, safety concerns regarding bone development and increased future fracture risk in transgender youth have been raised. We here review published data on bone development in transgender adolescents, focusing in particular on differences in age and pubertal stage at the start of puberty suppression, chosen strategy to block puberty progression, duration of puberty suppression, and the timing of re-evaluation after estradiol or testosterone administration. Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration. Trans girls are more vulnerable than trans boys for compromised bone health. Behavioral health measures that can promote bone mineralization, such as weight-bearing exercise and calcium and vitamin D supplementation, are strongly recommended in transgender youth, during the phase of puberty suppression and thereafter.
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spelling pubmed-95781062022-10-18 Impact of gender-affirming treatment on bone health in transgender and gender diverse youth Ciancia, Silvia Dubois, Vanessa Cools, Martine Endocr Connect Review Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the appropriate age to start using gender-affirming hormones. Exposure to pubertal sex steroids is thus significantly deferred in these individuals. Puberty is a critical period for bone development: increasing concentrations of estrogens and androgens (directly or after aromatization to estrogens) promote progressive bone growth and mineralization and induce sexually dimorphic skeletal changes. As a consequence, safety concerns regarding bone development and increased future fracture risk in transgender youth have been raised. We here review published data on bone development in transgender adolescents, focusing in particular on differences in age and pubertal stage at the start of puberty suppression, chosen strategy to block puberty progression, duration of puberty suppression, and the timing of re-evaluation after estradiol or testosterone administration. Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration. Trans girls are more vulnerable than trans boys for compromised bone health. Behavioral health measures that can promote bone mineralization, such as weight-bearing exercise and calcium and vitamin D supplementation, are strongly recommended in transgender youth, during the phase of puberty suppression and thereafter. Bioscientifica Ltd 2022-09-28 /pmc/articles/PMC9578106/ /pubmed/36048500 http://dx.doi.org/10.1530/EC-22-0280 Text en © The authors https://creativecommons.org/licenses/by-nc/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle Review
Ciancia, Silvia
Dubois, Vanessa
Cools, Martine
Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
title Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
title_full Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
title_fullStr Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
title_full_unstemmed Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
title_short Impact of gender-affirming treatment on bone health in transgender and gender diverse youth
title_sort impact of gender-affirming treatment on bone health in transgender and gender diverse youth
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578106/
https://www.ncbi.nlm.nih.gov/pubmed/36048500
http://dx.doi.org/10.1530/EC-22-0280
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