ESPE Abstracts (2015) 84 P-2-537

Increased Ambulatory Blood Pressure in Adolescents with Gender Dysphoria Treated with Gonadotropin- Releasing Hormone Analogues

Daniel Klink, Arend Bokenkamp, Eline Atsma & Joost Rotteveel


VU University Medical Center, Amsterdam


Background: Adolescents with gender dysphoria (GD) are treated with gonadotropin-releasing hormone analogues (GnRHa) to prevent the development of characteristics of the undesired sex. Subsequently, sex steroids of the desired sex, cross sex hormones (CSH) are added. GnRHa treatment is generally considered to be safe in the treatment of precocious puberty in children. However, we observed that some adolescents with GD developed hypertension during GnRHa monotherapy (Klink D et al. Endocrinol Metab Int J 2015 2(1): 00008).

Objective and hypotheses: To prospectively study blood pressure (BP) development during gonadal suppression with GnRHa in adolescents with GD.

Method: In 34 natal girls (median age 14.5 years) and 16 natal boys (median age 12.8 years) with GD BP was measured using 24 h ambulatory BP monitoring prior to start of GnRHa and throughout gonadal suppression. Mean diurnal, nocturnal and 24 h systolic (SBP) and diastolic BP (DBP) were converted to SDS according to natal sex and height.

Results: Median duration of gonadal suppression in natal girls and natal boys was 11 and 12 months, respectively. Nocturnal SBP (median SDS 0.00 vs. 0.30; P=0.008) and DBP (median SDS −0.55 vs. 0.35; P=0.019) increased in natal girls but not in natal boys.

Conclusion: A sex difference for BP elevation during gonadal suppression in adolescents with GD was observed. This has previously been described in adults (Bonfirraro G et al. Minerva Ginecol 1995 47(10): 467–70) and may be due to loss of the BP lowering properties of estrogens (Hinojosa-Laborde C et al. Hypertension 2000 35 (1 Pt 2):484–9). Furthermore, CSH in natal girls with GD in a later stage includes testosterone which may also increase BP. Natal girls with GD that are treated with GnRHa and CSH may be at risk for hypertension.

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