Pro- and Anti-androgenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism.

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Pro- and Anti-androgenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism.

J Clin Endocrinol Metab. 2018 Apr 16;:

Authors: Tack LJW, Craen M, Lapauw B, Goemaere S, Toye K, Kaufman JM, Vandewalle S, T'Sjoen G, Zmierczak HG, Cools M

Abstract
Context: Pro- and anti-androgenic progestins can be used to attenuate endogenous hormonal effects in late-pubertal transgender adolescents (Tanner stage B4/5 and G4/5). Currently, no data are available on the effects of progestins on the development of bone mass or body composition in trans youth.
Objective: To study prospectively the evolution of body composition and bone mass in late-pubertal transgender adolescents using the pro- or anti-androgenic progestins lynestrenol (L) and cyproterone acetate (CA) respectively.
Design and outcome measurements: Forty-four trans boys (Tanner B4/5) and 21 trans girls (Tanner G4/5) were treated with L or CA for 11.6 (4-40) and 10.6 (5-31) months respectively. Anthropometry, grip strength, body composition and bone mass, size and density were determined by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography before start of progestin and before addition of CSH.
Results: Using L, lean mass [+3.2kg (8.6%)] and grip strength [+3kg (10.6%)] significantly increased, which coincided with a more masculine body shape in trans boys. Trans girls showed loss of lean mass [-2.2kg (4.7%)], gain of fat mass [+1.5kg (9.4%)] and decreased grip strength Z-scores. CA limited normal bone expansion and impeded pubertal bone mass accrual, mostly at the lumbar spine [Z-score: -0.765 to -1.145 (P=0.002)]. L did not affect physiological bone development.
Conclusion: Pro- and anti-androgenic progestins induce body composition changes in line with the desired appearance within one year of treatment. Bone health, especially at the lumbar spine, is of concern in trans girls, as bone mass accrual is severely affected by androgen suppressive therapy.

PMID: 29672753 [PubMed - as supplied by publisher]

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