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Endocrine Abstracts (2019) 63 S8.2 | DOI: 10.1530/endoabs.63.S8.2

ECE2019 Symposia Genderdysphoria - delayed puberty (3 abstracts)

Management of puberty in transgender adolescents

Martine Cools


Belgium.


Context: Childhood gender dysphoria, when not attenuating after the onset of puberty, is very likely to persist. The aim of puberty suppressing therapy in gender dysphoric adolescents is increasingly shifting from ‘buying time to reflect on the diagnosis’ towards ‘avoiding the development of secondary sexual characteristics while awaiting eligibility for cross-sex hormones’. Various treatment regimens are available to suppress or decrease the effects of endogenous gonadal hormones.

Methods: We will review the literature and research data from our group to investigate the effects of various puberty suppressing medications (GnRH analogues, pro- and anti-androgenic progestins) on the developing body. Effects on growth, bone mass development and body composition will be discussed, as well as treatment schedules and effects of cross-sex hormones. Unsolved questions and directions for future research will be indicated.

Results: GnRHa can prevent but not reverse the development of secondary sexual characteristics. Progestins are a cheap alternative and induce discrete body changes towards the desired gender, which may be beneficial especially in adolescents diagnosed at more advanced pubertal stages. Final height is suboptimal for many trans boys and girls. GnRHa should be started as early as possible to prevent the early growth-limiting effects of estrogens in trans boys. Bone health is mainly compromised in trans girls, irrespective of treatment choice, and is at least in part related to other than sex steroid effects.

Conclusion: Puberty suppressing and cross-sex hormone therapies can be safely used in transgender adolescents although very little data exist on the long-term use of GnRHa. The respective place of the various alternative medications for puberty suppression needs to be determined. Modifications to the existing schemes for puberty induction are needed in this specific population to ensure optimal outcomes. Transgender youth represent an excellent model to study the development of sexually dimorphic traits during puberty.

Volume 63

21st European Congress of Endocrinology

Lyon, France
18 May 2019 - 21 May 2019

European Society of Endocrinology 

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