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Published August 25, 2020 | Version v1
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Supplemental Data: Low bone mineral density in early pubertal transgender/gender diverse youth: Findings from the Trans Youth Care Study

  • 1. University of California, San Francisco
  • 2. Northwestern University Feinberg School of Medicine*
  • 3. Keck School of Medicine of University of Southern California*
  • 4. Boston Children's Hospital

Description

Context. Transgender youth may initiate gonadotropin-releasing hormone agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls prior to gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth.

Objective. To describe BMD in early-pubertal transgender youth.

Design. Cross-sectional analysis of the prospective, observational, longitudinal Trans Youth Care Study cohort.

Setting. Four multi-disciplinary academic pediatric gender centers in the United States.

Participants. Early-pubertal transgender youth initiating GnRHa.

Main Outcome Measures. Areal and volumetric BMD Z-scores.

Results. Designated males at birth (DMAB) had below-average BMD Z-scores when compared with male reference standards, and designated females at birth (DFAB) had below-average BMD Z-scores when compared with female reference standards except at hip sites. At least one BMD Z-score was < -2 in 30% of DMAB and 13% of DFAB. Youth with low BMD scored lower on the Physical Activity Questionnaire for Older Children than youth with normal BMD, 2.32 ± 0.71 vs. 2.76 ± 0.61 (p = 0.01). There were no significant deficiencies in vitamin D, but dietary calcium intake was suboptimal in all youth.

Conclusions. In early-pubertal transgender youth, BMD was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity – potential targets for intervention. Our results suggest a potential need for assessment of BMD in pre-pubertal gender-diverse youth and continued monitoring of BMD throughout the pubertal period of gender-affirming therapy.

Notes

Funding provided by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Crossref Funder Registry ID: http://dx.doi.org/10.13039/100009633
Award Number: R01HD082554

Funding provided by: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Crossref Funder Registry ID: http://dx.doi.org/10.13039/100009633
Award Number: F32HD098763

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TYC_Baseline_Bone_Measures_-_JES_Supplemental_Data.pdf

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Related works

Is cited by
10.1210/jendso/bvaa065 (DOI)