Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism

Tack, Lloyd; Craen, Margarita; Lapauw, Bruno; Goemaere, Stefan; Toye, Kaatje; Kaufman, Jean‐Marc; Vandewalle, Sara; T’Sjoen, Guy; Zmierczak, Hans‐Georg; Cools, Martine

doi:10.1210/jc.2017-02316

Cited by 39 publications

(64 citation statements)

References 40 publications

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“…Including Gooren and Bunck [62], 12 longitudinal studies [53,[63][64][65][66][67][68][69][70][71][72][73] have examined the effects of testosterone suppression on lean body mass or muscle size in transgender women. The collective evidence from these studies suggests that 12 months, which is the most commonly examined intervention period, of testosterone suppression to femaletypical reference levels results in a modest (approximately − 5%) loss of lean body mass or muscle size (Table 4).…”

Section: Muscle and Strength Metricsmentioning

confidence: 99%

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

2020

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Males enjoy physical performance advantages over females within competitive sport. The sex-based segregation into male and female sporting categories does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been scrutinized. Here, we review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage and thus delivers fair and safe competition. We report that the performance gap between males and females becomes significant at puberty and often amounts to 10–50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations should consider this evidence when reassessing current policies regarding participation of transgender women in the female category of sport.

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Section: Muscle and Strength Metricsmentioning

confidence: 99%

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

2020

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“…During GnRHa treatment we observed a decline of aBMD and BMAD z-scores in line with previous studies ( 8-10 ). In transgirls a decrease of aBMD z-scores was also reported with the use of the anti-androgenic progestin cyproterone acetate ( 18 ). In contrast, 1 study showed that in transboys treated with the progestin lynestrenol for an average of 11.6 months aBMD z-scores were stable or increased ( 18 ).…”

Section: Discussionmentioning

confidence: 80%

“…In transgirls a decrease of aBMD z-scores was also reported with the use of the anti-androgenic progestin cyproterone acetate ( 18 ). In contrast, 1 study showed that in transboys treated with the progestin lynestrenol for an average of 11.6 months aBMD z-scores were stable or increased ( 18 ). If these results are confirmed, also with more prolonged treatment duration, the better safety profile with regard to bone health is an important point to discuss with adolescents.…”

Section: Discussionmentioning

confidence: 80%

Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones

Schagen

Wouters

Cohen‐Kettenis

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Hormonal interventions in adolescents with gender dysphoria may have adverse effects such as reduced bone mineral accrual. Objective To describe bone mass development in adolescents with gender dysphoria treated with gonadotropin-releasing hormone analogues (GnRHa), subsequently combined with gender affirming hormones. Design Observational prospective study.. Subjects 51 transgirls and 70 transboys receiving GnRHa and 36 transgirls and 42 transboys receiving GnRHa and gender affirming hormones, subdivided in early and late pubertal groups. Main outcome measures bone mineral apparent density (BMAD), age and sex specific BMAD Z-scores, and serum bone markers. Results At start of GnRHa treatment, mean areal bone mineral density (aBMD) and BMAD values were within the normal range in all groups. In transgirls the mean Z-scores were well below the population mean. During two years of GnRHa treatment BMAD stabilized or showed a small decrease, whereas Z-scores decreased in all groups. During three years of combined administration of GnRHa and gender affirming hormones, a significant increase of BMAD was found. Z-scores normalised in transboys but remained below zero in transgirls. In transgirls and early pubertal transboys all bone markers decreased during GnRHa treatment. Conclusions BMAD Z-scores decreased during GnRHa treatment and increased during gender affirming hormone treatment. Transboys had normal Z-scores at baseline and at the end of the study. However, transgirls had relatively low Z-scores, both at baseline and after three years of estrogen treatment. If this results in adverse outcomes such as increased fracture risk in transgirls as they grow older is currently unclear.

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“…87 Another recent study looked at the use of CPA in 21 late pubertal trans girls (Tanner 4 with mean bone age at study start of 17.1 ± 1.28 years) as a potential way to avoid the negative bone effects of GnRHas. 88 However, after 1 year of therapy there was a loss of lean mass and gain of fat mass as well as a decrease in Z -scores most profoundly at the LS, but also at the femoral neck and total hip. These findings all raise concerns, particularly since youth today are starting GnRHas earlier than in these studies (i.e.…”

Section: Part 2: Benefits Associated With Gahtmentioning

confidence: 91%

Health considerations for transgender women and remaining unknowns: a narrative review

Iwamoto

Defreyne

Rothman

et al. 2019

Therapeutic Advances in Endocrinology

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Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW’s health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.

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Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism

Abstract: Proandrogenic and antiandrogenic progestins induce body composition changes in line with the desired appearance within 1 year of treatment. Bone health, especially at the lumbar spine, is of concern in trans girls, as bone mass accrual is severely affected by androgen suppressive therapy.

Cited by 39 publications

References 40 publications

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones

Health considerations for transgender women and remaining unknowns: a narrative review

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