A systematic review and meta-analysis published in the journal of JAMA Pediatrics found that puberty suppression in transgender and gender-diverse adolescents temporarily slows bone development, particularly at the lumbar spine. While absolute bone mineral density remained stable during puberty suppression, it increased modestly after gender-affirming hormone therapy, with partial recovery of bone health when compared to peers.
Puberty represents a key window for achieving peak bone mass, which plays an important role in determining fracture risk later in life. As the use of puberty blockers and gender-affirming hormone therapy continues to expand in gender-diverse youth, understanding their long-term effects on skeletal health has become increasingly important.
A new systematic review and meta-analysis has found that while pubertal suppression with temporarily slows bone mineral accrual in transgender and gender-diverse (TGD) adolescents, subsequent gender-affirming hormone therapy (GAHT) promotes substantial recovery in bone health. However, researchers say the extent of long-term “catch-up” remains uncertain, underscoring the importance of careful monitoring during treatment.
To be clear, people do this all the time with medications for suicidal ideation and depression. Those drugs are less effective at preventing suicide than gender affirming care in trans people. If we want to talk about the harms of a medical intervention we always need to keep the harms of the alternative in mind.
I take Warfarin and could therefore have a major bleed where I just don’t stop bleeding. I take it because if I didn’t I would have clotting which would lead to really bad outcomes like a stroke. The stroke is more likely without warfarin than the bleed is with the warfarin, so that is an overall lower risk.
In the same way, if you look at trans kids who are hitting puberty they have two paths, gender affirming care or not. The not path has lots of extra harms, including but not limited to suicide, self harm, depression, anxiety, and so on. The gender affirming care side has bone density issues during the period of puberty blockers, difficulties with accessing medical care, and much much lower rates of the harms available in the not path. The balance is clear, the experts agree, only a vanishingly small minority of politically and financially motivated people push the other way. The parallels to the climate change “debate” are clear. This is not reasonable and rational disagreement, this is ideological and not science based.
I will keep taking my warfarin and I hope the kids impacted by this keep taking their puberty blockers as long as that is beneficial for them.