ESPE Abstracts

Background: Gonadotropin-releasing hormone agonists (GnRHa) are common treatment in adolescents with gender dysphoria to prevent development of unwanted physical changes. However, the safe use of GnRHa is debated in the media and objective literature is sparse. Specifically, there is a lack of literature comparing between different Tanner stadia, since it is debatable whether GnRHa treatment is effective in adolescents who have almost gone through puberty (Tanner stadia 4/5).

Aim: To gain more insight into the effects of GnRHa-treatment in adolescents with gender dysphoria in different Tanner stadia. This will help determine to what extent monitoring is useful and improve medical care.

Methods: A retrospective study was performed assessing the electronic medical files of adolescents treated with GnRHa in the Radboud Expert Centre Sex & Gender for 0,5-2 years with follow-up every three months. So far, 85 patients were included.

Outcomes: Population description, biometrics (age, pubertal development, height, weight, BMI, blood pressure, bone mineral density), biochemistry (hormones, renal/liver function, overall health parameters), and reported side-effects.

Preliminary Results: 57 trans males (TM), 26 trans females (TF), and 2 non-binary patients (NB) were included, of which 32,9% had psychiatric comorbidity and 41,2% were overweight/obese at start of treatment. Tanner stadia were reported for 65 of these patients; 36 patients had Tanner 2/3 and 29 patients had Tanner 4/5. 43,5% of TM reported menstruation at start of treatment and another 21,1% were treated with oral contraceptives. After start of treatment gonadotrophin levels were effectively suppressed in TM/NB, but not completely in TF. However, side-effects (flushes, local side-effects, mood swings, headaches, and sadness) were significantly more common in Tanner 4/5, while there was no significant effect on height velocity or pubertal development in this group. Effects were limited on overall health parameters.

Conclusion: Our study showed that GnRHa-treatment is effective and safe on the short term. No adverse effects on blood pressure, renal/liver function and blood count were found. However, side-effects are commonly reported, especially in patients with Tanner 4/5 at start of treatment, while the effectiveness on physical changes and pubertal development in this group is debatable. Furthermore, patients experience a high number of risk factors at start of treatment, such as obesity, insufficient dairy intake, low vitamin D levels and psychiatric comorbidities, for which additional support and monitoring is necessary.