Biggs, M. (2021). Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. Journal of Pediatric Endocrinology & Metabolism: JPEM, 34(7), 937–939. Til artikkelen (åpen tilgang)

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SEGM Summary

Suppressing puberty in children suffering from gender dysphoria by administering Gonadotropin-Releasing Hormone Agonist (GnRHa) entails several known risks. One is that patients could “end with a decreased bone density, which is associated with a high risk of osteoporosis" (Delemarre-van de Waal & Cohen-Kettenis 2006).

This study analyzed data from UK's Tavistock clinic regarding bone density of young gender dysphoric people undergoing puberty blockade. The analysis found that after two years on GnRHa, the Z-scores for a significant minority of the children had declined to clinically-concerning levels. For the hip, one third of Z-scores were below -2. For the spine, over a quarter of Z-scores were below the threshold of -2. Some scores fell below ‑3; such low bone density is found in only 0.13% of the population.

The clinical consequences of the failure to accrue normal bone mass are unknown, as no data on fractures experienced by children undergoing puberty suppression have been tracked. Biggs cites an example of one patient at the Tavistock clinic who started GnRHa at age 12 and then experienced four broken bones by the age of 16, however it is possible that this case is exceptional.

Researchers in the Netherlands have published similar results on bone density, suggesting that future studies should “investigate clinically important outcomes such as fracture risk” (Schagen et al. 2020).