The efficacy and safety of pubertal induction using 17beta-estradiol in transgirls.

The efficacy and safety of pubertal induction using 17beta-estradiol in transgirls.

J Clin Endocrinol Metab. 2017 Apr 14;:

Authors: Hannema SE, Schagen SEE, Cohen-Kettenis PT, Delemarre-van de Waal HA

Abstract
Introduction.: Puberty suppression using GnRH agonists, followed by induction of desired sex characteristics using sex steroids, is recommended by current guidelines as the treatment of choice for gender dysphoric adolescents although little evidence is available.
Aim.: To evaluate the efficacy and safety of estrogen treatment for pubertal induction in transgirls (female-identifying adolescents assigned male at birth).
Methods.: 28 Adolescents treated with oral estrogen for at least 1 year were included. Tanner stages, anthropometry, laboratory parameters, bone age and body composition were evaluated.
Results.: Breast development started within 3 months in 83% of adolescents and after 3 years 86% had Tanner breast stage 4-5. Hip circumference increased and waist-to-hip ratio decreased. Median serum estradiol was 100 pmol/L (range 24-380) on the standard adult dose of 2 mg 17beta-estradiol. Adult height standard deviation score (SDS) was +1.9 (for females). BMI SDS, lean body mass percentage, fat percentage and blood pressure did not change. No abnormalities of creatinine or liver enzymes were detected and hematocrit and HbA1c did not change. One individual developed hyperprolactinemia during high dose ethinylestradiol treatment to limit growth.
Conclusions.: Pubertal induction using estradiol is effective but an adult dose of 2 mg does not always result in appropriate serum estradiol levels. Especially in the presence of elevated LH and low bone mineral density a higher dose should be considered. Monitoring of renal function, liver enzymes, haematocrit and HbA1c during pubertal induction with estradiol is not necessary. Further studies are needed to establish effective and safe methods to limit growth.

PMID: 28419243 [PubMed - as supplied by publisher]

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