Bone Accrual During Puberty Suppression and Gender-Affirming Therapy in Transgender Adolescents

What are the effects of pubertal suppression with gonadotropin-releasing hormone agonists (GnRHa) and subsequent gender-affirming hormone therapy (GAHT) on bone accrual in transgender and gender-diverse adolescents? In this systematic review and meta-analysis of 10 cohorts including 751 adolescents, lumbar spine z scores declined during GnRHa and partially recovered after GAHT, remaining numerically below baseline but not consistently statistically different across skeletal sites. Pubertal suppression followed by GAHT was associated with a modest and uncertain shortfall in bone catch-up; monitoring treatment duration, timely GAHT initiation, and optimization of nutrition, vitamin D status, and physical activity are important to support skeletal development.

Corresponding Author: Daniele Tienforti, MD, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio snc, Coppito, 67100 L’Aquila, Italy (danieletienforti@gmail.com).

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