Puberty onset and development contribute substantially to adolescents’ bone mass and body composition. Our objective with this study was to examine the effects of gonadotropin-releasing hormone agonists (GnRHa) on these puberty-induced changes among youth with gender dysphoria (GD).

Medical records of the endocrine diversity clinic in an academic children’s hospital were reviewed for youth with GD seen from January 2006 to April 2017 with at least 1 baseline dual-energy radiograph absorptiometry measurement.

At baseline, transgender females had lower lumbar spine (LS) and left total hip (LTH) areal bone mineral density (aBMD) and LS bone mineral apparent density (BMAD) z scores. Only 44.7% of transgender youth were vitamin D sufficient. Baseline vitamin D status was associated with LS, LTH aBMD, and LS BMAD z scores. Post-GnRHa assessments revealed a significant drop in LS and LTH aBMD z scores (transgender males and transgender females) without fractures and LS BMAD (transgender males), an increase in gynoid (fat percentage), and android (fat percentage) (transgender males and transgender females), and no changes in BMI z score.

GnRHa monotherapy negatively affected bone mineral density of youth with GD without evidence of fractures or changes in BMI z score. Transgender youth body fat redistribution (android versus gynoid) were in keeping with their affirmed gender. The majority of transgender youth had vitamin D insufficiency or deficiency with baseline status associated with bone mineral density. Vitamin D supplementation should be considered for all youth with GD.

青春期的开始和发育对青少年的骨量和身体成分有很大贡献。我们本研究的目的是检查促性腺激素释放激素激动剂 (GnRHa) 对患有性别不安 (GD) 青年的青春期引起的这些变化的影响。

对 2006 年 1 月至 2017 年 4 月期间至少 1 次基线双能 X 线吸收测定法测量的 GD 青年患者，审查了学术儿童医院内分泌多样性诊所的医疗记录。

在基线时，变性女性的腰椎 (LS) 和左全髋 (LTH) 面积骨矿物质密度 (aBMD) 和 LS 骨矿物质表观密度 (BMAD) z评分较低。只有 44.7% 的跨性别青年维生素 D 充足。基线维生素 D 状态与 LS、LTH aBMD 和 LS BMAD z评分相关。GnRHa 后评估显示 LS 和 LTH aBMD z评分（跨性别男性和跨性别女性）显着下降，没有骨折和 LS BMAD（跨性别男性），gynoid（脂肪百分比）和 android（脂肪百分比）（跨性别男性）增加和跨性别女性），并且 BMI z分数没有变化。

GnRHa 单一疗法对 GD 青年的骨矿物质密度产生负面影响，没有骨折或 BMI z评分变化的证据。跨性别青年身体脂肪重新分布（机器人与女性）与他们确认的性别保持一致。大多数跨性别青年患有维生素 D 不足或缺乏症，基线状态与骨矿物质密度相关。所有患有 GD 的青年都应考虑补充维生素 D。