Background: In 2017, the Endocrine Society published guidelines for the endocrine treatment of gender dysphoria/ gender incongruence. Adolescents who meet diagnostic criteria for gender dysphoria undergo pubertal suppression using gonadotropin-releasing hormone analogs (GnRHa) and induction of puberty with gender-affirming hormonal therapy. Blood pressure (BP) monitoring prior to and during treatment with GnRHa in transgender adolescents is recommended. This recommendation is based on a few case reports of arterial hypertension as an adverse effect in girls treated with GnRHa for precocious puberty. There is no published data in transgender adolescents to support the recommendation to monitor BP.
Objective: To examine BP changes in transgender male adolescents treated with GnRHa and after the addition of testosterone treatment.
Methods: Retrospective, single-center, observational study from the Israeli Pediatric Gender Dysphoria Clinic. Included in the analysis were all consecutive transgender male adolescents who were treated solely with GnRHa for at least 2 months. Data extracted from medical records included vital signs, anthropometric measurements, and hormonal levels (LH, FSH, estradiol and testosterone). Outcome measures: systolic and diastolic BP percentiles at baseline, after GnRHa and after testosterone treatment.
Results: 15 transgender males, mean age at baseline was 14.4 ± 1.0 years and Tanner 5 stage of puberty (13 subjects). GnRHa was administered for a mean period of 3 ± 1 months. Testosterone treatment, in 9 transgender males was added at a mean age of 15.5 ± 0.9 years. Diastolic BP (DBP) percentiles increased significantly after GnRHa treatment (from 55.9 ± 26.4 to 73.6 ± 9.4, P = 0.019); the increase in DBP remained significant after adjusting for the change in BMI standard deviation score (P = 0.047). BP levels were within the normal range and did not meet criteria for pediatric hypertension. DBP percentiles decreased significantly after adding testosterone therapy (from 72.8 ± 10.1 to 56.0 ± 17.5, P = 0.033), only after adjusting for the change in BMI SDS. Systolic BP percentiles did not change significantly during both stages of treatment. No significant correlations were found between BP percentiles and LH and FSH levels.
Conclusion: Our preliminary findings suggest that pubertal suppression with GnRHa increases DBP in transgender male adolescents and that induction of puberty with gender-affirming testosterone treatment restores DBP percentiles. Further studies with larger cohorts are needed to elucidate the effect of BP dynamics in gender dysphoric adolescents on the metabolic and cardiovascular consequences in young adulthood.
19 Sep 2019 - 21 Sep 2019