Blood pressure dynamics after pubertal suppression with gonadotropin-releasing hormone analogs followed by estradiol treatment in transgender female adolescents: a pilot study

Abstract

Objectives The benefits of gonadotropin-releasing hormone analogues (GnRHa) in the treatment of central precocious puberty are well established, and their use is regarded as both safe and effective. Possible adverse effects on blood pressure (BP) and cardiac outcomes, body composition, bone health and brain development, however, continue to be of some concern. The aim of this study was to analyze BP changes in transgender female adolescents before and after receiving GnRHa and after adding estrogen treatment. Methods This was a retrospective pilot study. We analyzed systolic BP (SBP) and diastolic BP (DBP) before and after GnRHa initiation and after adding estrogen. Results Nineteen transgender female adolescents received GnRHa and 15 continued to estrogen treatment. Their baseline SBP and DBP percentiles did not change significantly after either GnRHa or the addition of estrogen treatment. Conclusions Blood pressure is apparently not affected by GnRHa or GnRHa + estrogen treatment in transgender female adolescents. Further larger studies are indicated to confirm these findings.

Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review

“…Studies were published from 2006 to 2022 with the majority published in 2020–2022 (n=29). Studies were conducted in the Netherlands (n=17),23–39 the US (n=15),40–54 the UK (n=6),55–60 Canada (n=4),61–64 three in Belgium65–67 and Israel68–70 and one in Brazil71 and Germany72 (online supplemental table S2).…”

“…The 50 studies included 11 cohorts comparing adolescents experiencing gender dysphoria/incongruence receiving puberty suppression with a comparator,35 39–42 45 49 50 52 56 72 8 cross-sectional with a comparator23 33 37 47 51 53 60 71 and 31 pre-post single group studies 24–32 34 36 38 43 44 46 48 54 55 57–59 61–70. More than half of studies (n=29) used retrospective chart review.…”

“…One cross-sectional study was rated high quality,37 25 moderate quality23 24 29–32 34–36 39 48–51 54–59 64 65 67–69 and 24 low quality 25–28 33 38 40–47 52 53 60–63 66 70–72. Of the 11 cohort studies, which were the only studies to include a comparator and assess outcomes over time, only 5 were rated moderate quality (figure 2, online supplemental table S4).…”

“…Twelve pre-post studies measured body mass index (BMI), and in 10 studies there was no evidence of a clinically significant change in BMI and/or BMI SD score 29 30 32 34 55 57 65 67–69. In one study, BMI increased for birth-registered males but not females 58.…”

“…Three studies assessed cholesterol markers, one after GnRH-a (no changes),34 one after cyproterone acetate (decrease in high-density lipoprotein (HDL) and triglycerides)67 and one after lynestrenol (decrease in HDL, increase in low-density lipoprotein) 65. Three studies assessing GnRH-a reported blood pressure: two found similar systolic and diastolic blood pressure before and after treatment,34 68 and one found a non-clinically significant increase in diastolic but not systolic blood pressure 69. Two studies measured markers of diabetes (fasting glucose, HbA1c and/or insulin) and noted no changes 65 67…”