Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism.

Autor:	Tack LJW; Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium., Craen M; Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium., Lapauw B; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium.; Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium., Goemaere S; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium.; Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium., Toye K; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium.; Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium., Kaufman JM; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium., Vandewalle S; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium., T'Sjoen G; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium., Zmierczak HG; Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium.; Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium., Cools M; Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2018 Jun 01; Vol. 103 (6), pp. 2147-2156.
DOI:	10.1210/jc.2017-02316
Abstrakt:	Context: Progestins can be used to attenuate endogenous hormonal effects in late-pubertal transgender (trans) 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 trans adolescents using the proandrogenic or antiandrogenic 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 to 40) and 10.6 (5 to 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 the start of progestin and before addition of cross-sex hormones. Results: Using L, lean mass [+3.2 kg (8.6%)] and grip strength [+3 kg (10.6%)] significantly increased, which coincided with a more masculine body shape in trans boys. Trans girls showed loss of lean mass [-2.2 kg (4.7%)], gain of fat mass [+1.5 kg (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: Proandrogenic and antiandrogenic progestins induce body composition changes in line with the desired appearance within 1 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.
Databáze:	MEDLINE
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