Puberty Blockers Temporarily Slow Bone Growth, Recovery Seen With Hormone Therapy: JAMA (medicaldialogues.in)

submitted 2 weeks ago by TRAHR@quokk.au to c/science@mander.xyz

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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.

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[-] TRAHR@quokk.au 9 points 2 weeks ago

If trans children were allowed to access HRT they would not need to be on blockers. This is forced onto them by cis people.

[-] LibertyLizard@slrpnk.net 12 points 2 weeks ago

Not necessarily always the case. Some people might want more time to understand and explore their identity before their body is irreversibly changed.

[-] TRAHR@quokk.au 4 points 2 weeks ago

Most of the time however it is because we must cater to cis people refusing to accept that we know our own bodies. And we half these half cocked compromises so their sensibilities aren’t hurt.

[-] astropenguin5@lemmy.world 10 points 2 weeks ago

Ok but also puberty happens well before the brain is even mostly formed properly. I'm kinda ok with giving kids time to make life altering decisions. Imo puberty blockers should be given to anyone even questioning their gender that wants them, so they have time to explore and choose before they have the 'wrong' puberty.

[-] TRAHR@quokk.au 4 points 2 weeks ago

Most children have established gender dysphoria by 7 years. We don’t need to wait until we have a “mostly properly formed brain” to understand ourselves on one of the most basic levels.

https://www.newswise.com/articles/most-gender-dysphoria-established-by-age-7-study-finds

[-] astropenguin5@lemmy.world 2 points 2 weeks ago

Fair, tbh I'm not the most educated on this subject.

Really at the end of the day it should just be down to the person/child and their doctor. And puberty blockers should be an available option. There's so many different situations we really shouldn't be making blanket statements anyway

[-] LibertyLizard@slrpnk.net 5 points 2 weeks ago

Yeah I don't disagree with the broader point but I think what you write might be erasing some people's experiences a bit. That's all I'm saying.

[-] TRAHR@quokk.au 7 points 2 weeks ago

But if you allow children to get on HRT when they want, the ones what want it could and the ones that want to wait still could.

By allowing choices instead of removing them because cis people are worried we don’t know what we want, despite study after study showing basically no one regrets it you help everyone.

[-] 11111one11111@lemmy.world -3 points 2 weeks ago

I hope you understand you are being downvoted for being so fuckin abrassiv3 in both your comments and not for the rhetoric of your post.

[-] TRAHR@quokk.au 2 points 2 weeks ago* (last edited 2 weeks ago)

We’re sick of pandering to you. These are our lives and our bodies, and you’re fucking them up.

[-] 11111one11111@lemmy.world 0 points 1 week ago

Jesus fuck what the fuck did anyone do to you here that is instigating you being a fucking asshole to everyone who chimes in. All you are doing is making people think you are dumb as a fuckin brick.

[-] TRAHR@quokk.au 2 points 1 week ago* (last edited 1 week ago)

I hope you understand you are being downvoted for being so fuckin abrassiv3 in both your comments.

[+] lemmysmash@piefed.social -13 points 2 weeks ago

I still can't comprehend how a person could willingly take their (or their kids'!) overall healthy body, break it literally to the bones, and then keep patching it to restore some of its normal functioning. I'm all in for gender diversity, but this is just beyond fucked, sorry.

[-] astropenguin5@lemmy.world 15 points 2 weeks ago

You are vastly overrating the effects here.
Do you understand how detrimental gender dysphoria is to one's mental health? It generally causes pretty bad depression and often suicidality if not able to be improved, and especially in those forced to be closeted. Going through the wrong puberty makes this even worse, so being able to delay that to allow a child to more fully form their sense of self is valuable.

If I ever have a kid (if I have kids) going through that I would much rather take the slight risk of delayed bone growth to let them make the best informed decision they can about their gender, and so they aren't depressed for years and potentially kill themselves. Bone strength problems are also usually treatable with other things too.

[+] lemmysmash@piefed.social -8 points 2 weeks ago

So the plan is:

delay depression / mask mental health challenges
fuck up physical health
wait until depression comes back, multiplied by the poor physical health
"you're adult now, darling, deal with it as you wish"

Yeah, this makes perfect sense.

[-] Sas@piefed.blahaj.zone 10 points 2 weeks ago

Where are your first, 3rd and 4th point coming from? You don't delay depression. You try to give them time to figure which the right puberty for them is to avoid depression of going through the wrong one. You don't give puberty blockers to then let them go through their chromosomal puberty anyways.

[-] lemmysmash@piefed.social -4 points 2 weeks ago

Yes, but then you go through the depression of fucked up hormonal system, fucked up bones (as we see now), and fucked up shitton of other organs.

[-] Sas@piefed.blahaj.zone 7 points 2 weeks ago

Yeah nah that's not how it works, troll

[-] lemmysmash@piefed.social -2 points 2 weeks ago

Whatever, block me.

[-] ShrimpCurler@lemmy.dbzer0.com 8 points 2 weeks ago

Looks like you have no idea what gender dysphoria is or what the current science says about handling it.

[-] lemmysmash@piefed.social -2 points 2 weeks ago

Science was once using this:

Look: instantaneous cure! For sale by all druggists!

You obviously can do whatever the fuck you want with your body. But the OPs article proves once again that one must think with their own head before pumping their body with "the current thing".

[-] ShrimpCurler@lemmy.dbzer0.com 6 points 2 weeks ago

That's the beauty of science, it's self improving...

This article specifically, is a meta review of studies that have already been available and all experts in the field should already know (I'm no expert and I've known about this for years) that puberty blockers do this. As with pretty much everything anyone does, there's always a cost and a benefit and you should always weigh them up carefully with big life altering decisions. For people with gender dysphoria some delayed bone growth is no big deal compared to being allowed to be themselves.

[-] lemmysmash@piefed.social -1 points 2 weeks ago

That's my point, I don't see a benefit of solving one thing at the expense of another to be strong enough, because in the end both suffer anyway.

This is very common treatmemt in modern medicine — not just for this particular case, but in general, e.g. a very simplified case: let's kill your liver a little with the pill to treat your headache a little.

And with hormonal things it's just the next level of messing up with your body — simply because of the sheer amount of different systems affected by a simple hormonal shift. And again, it's not specific to this particular topic, something like hormonal contraception, for example, is another case from the same cohort. Does it prevent unwanted pregnancies? — Yes, it does. Is it worth messing up with your body to avoid some other kinds of contraception? Eeeh... up to you, up to you.

[-] ShrimpCurler@lemmy.dbzer0.com 2 points 2 weeks ago

Everything has side effects... It's not your position to say weather they're worth it or not.

All the research shows quality of life increasing with gender affirming care. So, you're suggesting that a temporary delay in bone growth is worth a long term reduction in quality of life...

[-] lemmysmash@piefed.social 0 points 2 weeks ago

I'm not in a position to dictate my opinion as a call to action for others, yes. But I'm in a position to say that for me it sounds incomprehensible and fucked up. And this is precisely what I said in my original comment.

[-] a_non_monotonic_function@lemmy.world 11 points 2 weeks ago

Is your plan to let them be miserable and die from suicide shortly afterward?

Claiming that this is about some sort of diversity is pretty fucked. You got to talk to some trans folks one day.

[-] rowinxavier@lemmy.world 6 points 2 weeks ago

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.

[-] TRAHR@quokk.au 5 points 2 weeks ago

Oh shut up.

[-] lemmysmash@piefed.social -4 points 2 weeks ago

Why would I? I'm free to express my opinion on things as long as I'm not harassing anyone (which I'm not). You disagree and don't want to see it? Block button to the rescue.

[-] apotheotic@beehaw.org 4 points 2 weeks ago

Their body is not overall healthy. If they are transgender it is incredibly likely that they are suffering from gender dysphoria, which is a debilitating and usually fatal condition if left untreated. Hormone replacement therapy is the treatment.

[-] rimu@piefed.social 1 points 1 week ago

can’t comprehend how

A lot of people choose not to comment when they don't understand what's going on. Or if they comment, they ask questions.

There's good reasons for that.

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