Changes in Bone Marrow Adipose Tissue in Transgender and Gender Non-Conforming Youth Undergoing Pubertal Suppression: A Pilot Study |
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| Institution: | 1. Division of Endocrinology, Cincinnati Children''s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States;2. Division of Adolescent and Transition Medicine, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, United States;3. Department of Radiology, Boston Children''s Hospital, Boston, MA, United States;4. Department of Radiology, Cincinnati Children''s Hospital Medical Center and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA;5. Division of Biostatistics and Epidemiology, Cincinnati Children''s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States;6. Division of Adolescent and Transition Medicine, Cincinnati Children''s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States;7. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children''s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States;8. Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States;1. Department of Basic Medicine, Zhangzhou Health Vocational College, Zhangzhou, 363000 Fujian Province, China;2. Department of Orthopaedic Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, 363000 Fujian Province, China;1. Department of Neurosurgery, University of Alabama at Birmingham, 1802 6th Avenue South, FOT 1001, AL 35233, USA;2. Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, AL, USA;3. School of Medicine, University of Alabama at Birmingham, AL, USA;4. Department of Radiology, University of Alabama at Birmingham, AL, USA;5. Department of Surgery, University of Alabama at Birmingham, AL, USA;1. Guangzhou Medical University, Guangzhou 511436, PR China;2. College of Traditional Chinese Medicine, Jinan University Guangzhou 510632,China;3. The First affiliated Hospital, Jinan University Guangzhou 510632, China;4. Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, PR China;5. Department of Rehabilitation, Foresea Life Insurance Guangzhou General Hospital, Guangzhou 510010, China;6. Department of Rehabilitation, General Hospital of Southern Theatre Command of People''s Liberation Army, Guangzhou 510010,China;1. Centro de Investigación en Alimentación y Desarrollo, A.C. Coordinación de Nutrición, Hermosillo, Sonora, México;2. Departamento de Ciencias de la Salud, Universidad Autónoma de Ciudad Juárez, Instituto de Ciencias Biomédicas, Ciudad Juárez, Chihuahua, México;3. Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México;1. Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico;2. Universidad Nacional Autónoma de México, Mexico City, Mexico;3. Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez |
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| Abstract: | Pubertal suppression with gonadotropin-releasing hormone (GnRH) agonists in transgender and gender non-conforming (TGNC) youth may affect acquisition of peak bone mass. Bone marrow adipose tissue (BMAT) has an inverse relationship with bone mineral density (BMD). To evaluate the effect of pubertal suppression on BMAT, in this pilot study we prospectively studied TGNC youth undergoing pubertal suppression and cisgender control participants with similar pubertal status over a 12-month period. BMD was measured by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Magnetic Resonance T1 relaxometry (T1-R) and spectroscopy (MRS) were performed to quantify BMAT at the distal femur. We compared the change in BMD, T1-R values, and MRS lipid indices between the two groups. Six TGNC (two assigned female and four assigned male at birth) and three female control participants (mean age 10.9 and 11.7 years, respectively) were enrolled. The mean lumbar spine BMD Z-score declined by 0.29 in the TGNC group, but increased by 0.48 in controls (between-group difference 0.77, 95% CI: 0.05, 1.45). Similar findings were observed with the change in trabecular volumetric BMD at the 3% tibia site (-4.1% in TGNC, +3.2% in controls, between-group difference 7.3%, 95% CI: 0.5%-14%). Distal femur T1 values declined (indicative of increased BMAT) by 7.9% in the TGNC group, but increased by 2.1% in controls (between-group difference 10%, 95% CI: -12.7%, 32.6%). Marrow lipid fraction by MRS increased by 8.4% in the TGNC group, but declined by 0.1% in controls (between-group difference 8.5%, 95% CI: -50.2%, 33.0%). In conclusion, we observed lower bone mass acquisition and greater increases in BMAT indices by MRI and MRS in TGNC youth after 12 months of GnRH agonists compared with control participants. Early changes in BMAT may underlie an alteration in bone mass acquisition with pubertal suppression, including alterations in mesenchymal stem cells within marrow. |
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