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

Lloyd J. W. Tack, Margarita Craen (UGent) , Bruno Lapauw (UGent) , Stefan Goemaere (UGent) , Kaatje Toye (UGent) , Jean Kaufman (UGent) , SARA VANDEWALLE (UGent) , Guy T'Sjoen (UGent) , Hans-Georg Zmierczak (UGent) and Martine Cools (UGent)
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Abstract
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.

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Chicago
Tack, Lloyd J. W., Margarita Craen, Bruno Lapauw, Stefan Goemaere, Kaatje Toye, Jean Kaufman, SARA VANDEWALLE, Guy T’Sjoen, Hans-Georg Zmierczak, and Martine Cools. 2018. “Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism.” Journal of Clinical Endocrinology & Metabolism 103 (6): 2147–2156.
APA
Tack, L. J. W., Craen, M., Lapauw, B., Goemaere, S., Toye, K., Kaufman, J., VANDEWALLE, S., et al. (2018). Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 103(6), 2147–2156.
Vancouver
1.
Tack LJW, Craen M, Lapauw B, Goemaere S, Toye K, Kaufman J, et al. Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM. 2018;103(6):2147–56.
MLA
Tack, Lloyd J. W. et al. “Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism.” JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM 103.6 (2018): 2147–2156. Print.
@article{8607211,
  abstract     = {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.},
  author       = {Tack, Lloyd J. W. and Craen, Margarita and Lapauw, Bruno and Goemaere, Stefan and Toye, Kaatje and Kaufman, Jean and VANDEWALLE, SARA and T'Sjoen, Guy and Zmierczak, Hans-Georg and Cools, Martine},
  issn         = {0021-972X},
  journal      = {JOURNAL OF CLINICAL ENDOCRINOLOGY \& METABOLISM},
  number       = {6},
  pages        = {2147--2156},
  title        = {Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism},
  url          = {http://dx.doi.org/10.1210/jc.2017-02316},
  volume       = {103},
  year         = {2018},
}

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