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Endocrine Abstracts (2015) 39 EP71 | DOI: 10.1530/endoabs.39.EP71

BSPED2015 e-Posters Gonadal, DSD and reproduction (8 abstracts)

Standard GnRH analogue doses do not adequately suppress puberty in adolescent patients

Francis Lam 1 , Rachel Besser 1 , Claire Goedhart 1 , Caroline Brain 1 & Gary Butler 2


1National Gender Identity Development Service, UCLH NHS Foundation Trust, London, UK; 2Tavistock and Portman NHS Foundation Trust, London, UK.


Introduction: Adolescents with persistent gender dysphoria (GD) receive GnRH analogues to achieve pubertal arrest. It is unclear whether this is adequate to achieve biochemical suppression of gonadotrophin (LH, FSH) and sex hormone production.

Methods: Gonadotrophins, testosterone and oestradiol were measured in GD patients (15–18 years) before and after monthly Gonapeptyl treatment (3.75 mg i.m.). Patients administered other analogues and/or cross-sex hormones were excluded. For data analysis, undetectable measurements were substituted for the assay’s quantitation limit. Biochemical suppression was defined as undetectable gonadotrophins and oestradiol (natal females) or testosterone (males).

Results: Seventy four patients (25 males, 49 females) were treated with Gonapeptyl for a median of 7 months (IQR 6–8). Gonadotrophins were lower following treatment. However, most patients did not achieve complete biochemical suppression. In females, only 14 and 64% achieved complete LH and oestradiol suppression respectively. No males completely suppressed LH and only 20% had undetectable testosterone. FSH was not adequately suppressed in any patients. There was no correlation between age, treatment duration, or body size with responses to Gonapeptyl.

LH (IU/l)FSH (IU/l)Testosterone (nmol/l)Oestradiol (pmol/l)
PrePostPrePostPrePostPrePost
Natal male5.1 (3.0–6.8)0.6* (0.4–0.9)3.1 (2.1–5.8)1.1* (0.8–1.5)14.9 (10.7–18.6)0.9* (0.4–1.3)79 (69–115)<44* (<44–<44)
Natal female6.8 (4.0–10.3)0.4* (0.2–0.6)5.2 (3.7–6.6)3.0* (2.0–4.1)1.0 (0.8–1.3)0.7* (0.4–1.1)157 (99–316)<44* (<44–49)
Results are median (interquartile range).
*P<0.01 vs pre-treatment.

Discussion/conclusion: The majority of patients did not achieve complete biochemical suppression of gonadotrophin or sex hormone production on Gonapeptyl treatment. The suppression was more marked in females than males. No effect was seen when adjusting for body size. The optimal treatment to arrest puberty in GD patients needs a consensus view. Pragmatically, a significant fall in testosterone or oestradiol accompanied by LH suppression and clinical pubertal arrest could be considered adequate.

Volume 39

43rd Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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