Table 3B.
Summary of findings on bone outcomes of GnRHa treatment in TGD adolescents. Only studies with moderate-high level quality of evidence are included.
| Reference | Design/Population | Intervention (duration) | Bone mineral density | Bone turnover |
|---|---|---|---|---|
| Carmichael 2021 (20) | P/44 (25 AMAB, 19 AFAB) |
GnRHa (29 m AFAB - 37 m AMAB) | No change from baseline in LS BMD at 12 m nor in hip BMD at 24 and 36 m | N/A |
| Schagen 2020 (21) | P/121 (51 AMAB, 70 AFAB) |
GnRHa (1.8 AFAB - 2.0 AMAB) + GAHT (3 y) |
BMAD =/ ↓ during GnRHa ↑ BMAD during GAHT Z-scores normalized in AFAB but remained <0 in AMAB |
P1NP↓/=, P3NP↓, osteocalcin↓, 1CTP↓ After 3 y of GAHT: P1NP↓, P3NP↓/=, osteocalcin↓, 1CTP↓ |
| Van der Loos 2023 (22) | R/75 (25 AMAB, 50 AFAB) |
GnRHa (1.5 y both AFAB and AMAB) + GAHT (5.7 y AFAB - 5.3 y AMAB) |
BMD Z-scores returned to pretreatment levels except LS Z-scores in AMAB | N/A |
| Vlot 2017 (23) | R/70 (28 AMAB, 42 AFAB) |
GnRHa (1.5 y AFAB – 1.3 y AMAB) + GAHT (5.4 y AFAB – 5.8 y AMAB) |
BMD Z-scores ↓ during GnRHa ↑after 24 m of GAHT |
↓P1NP and 1CTP during GnRHa |
1CTP, cross-linked telopeptide of type 1 collagen; AFAB, assigned female at birth; AMAB, assigned male at birth; BMAD, bone mineral apparent density; BMD, bone mineral density; GAHT, gender-affirming hormone therapy; GnRHa, gonadotropin-releasing hormone analogues; LS, lumbar spine; m, months; N/A, not available; P, prospective; P1NP: procollagen type 1 N propeptide; P3NP, procollagen type 3 N propeptide; R, retrospective; TGD, transgender and gender-diverse; y, years.Arrow down: reduced; Arrow up: increased.