Background: Puberty suppression using gonadotropin releasing hormone analogues (GnRHa) is recommended by current guidelines. Although GnRHa have long been used to treat children with precocious puberty there are few data on the outcome of this treatment in gender dysphoric adolescents.
Objective and hypotheses: We aimed to evaluate the efficacy and safety of triptorelin to suppress puberty in a cohort of gender dysphoric adolescents.
Method: Fourty-nine MtFs (male-to-females) and 68 FtMs (female-to-males) treated with triptorelin were included. During treatment physical examination including assessment of Tanner stage took place every 3 months and regular blood samples were taken to determine gonadotropins, sex steroids, renal and liver function. Body composition was assessed using dual energy X-ray absorptiometry.
Results: Median Tanner B/G stage at the start of treatment was 4. Testicular volume decreased in 43 of 49 MtFs. Menses ceased in postmenarcheal FtMs. Breast development completely regressed in 1 of 4 FtMs with Tanner stage B2 at baseline. After three months gonadotropins and sex steroid levels were suppressed. No sustained abnormalities of liver enzymes or creatinine were observed. Alkaline phosphatase decreased which may be related to decreased growth velocity, as height SDS decreased in both sexes. Lean body mass percentage significantly decreased in both sexes, whereas fat percentage significantly increased.
Conclusion: Puberty is adequately suppressed with GnRHa in gender dysphoric adolescents. Routine monitoring of gonadotropins, sex steroids, creatinine and liver function as suggested by current guidelines does not seem necessary during treatment with triptorelin. Further studies are needed to determine if the changes in height SDS and body composition that were observed during GnRHa treatment can be reversed with cross sex hormone treatment.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology