Table 3A.
Summary of findings on physical changes and hormone levels on GnRHa treatment in TGD adolescents.
| Reference | Study design/ Population | Intervention (duration) | Height | Sexual characteristics | Gonadotropins and sexual steroids | Body composition | Lipids /glucose |
|---|---|---|---|---|---|---|---|
| Boogers 2022 (10) | R/161 (161 AMAB, 0 AFAB) |
GnRHa (2.4 ± 0.8 y) GAHT |
↓ (3m) during GnRH ↓ (adult) High dose E and EE ↓ Bone age during GnRH |
N/A | N/A | N/A | N/A |
| Fisher 2024 (4) | P/36 (14 AMAB, 22 AFAB) |
GnRHa (3-12 m) | ↓ HT centile in AMAB | ↓ Tanner stage | ↓ FSH/LH and T in AMAB/E in AFAB | ↑ BMI in AFAB | ↓ HDL in AMAB = |
| Klaver 2018 (11) | R/192 (71 AMAB, 121 AFAB) |
GnRHa AMAB: 2.1 y (1.0-2.8) AFAB: 1.0 years (0.5-2.9) GAHT |
N/A | N/A | N/A | WHR and body composition changed toward the affirmed sex | N/A |
| Klaver 2020 (12) | R/192 (71 AMAB, 121 AFAB) |
GnRHa AMAB: 2.1 y (1.0-2.8); AFAB: 1.0 y (0.5-2.9) GAHT |
N/A | N/A | N/A | > % of obesity vs controls | = Changes in lipids, insulin, HOMA IR, BP and BMI similar to controls |
| Navabi 2021 (13) | R/172 (51 AMAB, 119 AFAB) |
GnRHa (N/A) | N/A | N/A | N/A |
↑ total body fat % increase in gynoid (%fat), and android (%fat) in AFAB and AMAB was detected without changes in BMI z score |
N/A |
| Schagen 2016 (14) | P/116 (49 AMAB, 67 AFAB) |
GnRHa (N/A) | ↓ (3m) during GnRH | ↓ (3m) during GnRH |
↓ (3m) during GnRH |
↓ Lean body mass % and ↑ fat at 1y | N/A |
| Schagen 2018 (15) | P/127 (73 AMAB, 54 AFAB) |
GnRHa (2y) GAHT |
N/A | N/A | ↑ DHEAS / ↑ A | N/A | N/A |
| Schulmeister 2022 (16) | P/55 (26 AMAB, 29 AFAB) |
GnRHa (1y) | No differences vs controls in early PS Lower HV in later Tanner stage PS initiation |
N/A | N/A | N/A | N/A |
| Valentine 2022 (17) | R-C/4172 (1407 AMAB, 2766 AFAB) |
GnRHa (N/A) GAHT | N/A | N/A | N/A | ↑ overweight/obesity | ↑ dyslipidemia, liver dysfunction and hypertension |
| Van de Grift 2020 (18) | R/200 (66 AMAB, 134 AFAB) |
GnRHa (3y) GAHT |
No difference in FH among early, later, or no GnRHa | ↓ during GnRH | N/A | No difference in BMI SDS among early, later, or no GnRHa | N/A |
| Willemsen 2023 (19) | R/146 (0 AMAB, 146 AFAB) |
GnRHa (3.1±0.9 y) + Testosteron | ↓ HV (during GnRHa) ↑ HV (during GAHT) FH exceeded PAH by 3.0 ± 3.6 cm and MPH by 3.9 ± 6.0 cm | N/A | N/A | N/A | N/A |
A, androstenedione; AFAB, assigned female at birth; AMAB, assigned male at birth; AST, aspartate aminotransferase; BMI, body mass index; BMIz, BMI z-score; BP, blood pressure; C, cross-sectional; DBP, diastolic blood pressure; E, estrogen; EE, ethinyl estradiol; FSH, follicular hormone; f/up, follow-up; FH, final height; GAHT, gender-affirming hormone therapy; GD, gender dysphoria; GnRHa, gonadotropin-releasing hormone agonist; HbA1c, hemoglobin A1C; HDL, high-density lipoprotein; HOMA-IR, homeostatic model assessment for insulin resistance; HT, height; HTz, height z-score; im, intramuscularly; LBW, lean body weight; LDL, low-density lipoprotein; LH, luteinizing hormone; N/A, not available; NS, not significant; P, prospective; PAH, predicted adult height; pc, percentile; PS, pubertal suppression; R, retrospective; SBP, systolic blood pressure; sc, subcutaneously; T, testosterone; TBF, total body fat; TGD, transgender and gender-diverse; TV, testicular volume; WT, weight; WTz, weight z-score; WHR, waist-hip ratio; y, year(s).
Only studies with moderate-high level quality of evidence are included.Arrow down: reduced; Arrow up: increased.