Assessment of Anthropometric Development of Transgender and Gender Non Binary Youth Assigned Female at Birth Across Prepubertal and Pubertal Growth

Objective: Growth and final height are impacted by many factors including sex steroids. Increasing numbers of transgender and gender non binary youth who are assigned female at birth (transmasculine (TM) youth) avoid puberty with endogenous hormones by utilizing gender affirming hormone therapies (GAHT) including GnRH analogs (puberty blockers) followed by masculinizing GAHT using androgens. A high percentage of TM youth seem to attain their adult height early. However, few studies have systematically assessed growth variations in TM youth, and little is known about the effects of therapies on height outcomes. The goal of this study is to assess growth patterns in TM youth before and after GAHT (including GnRH analog therapy and various types of masculinizing GAHT). Methods: This was an IRB approved retrospective cohort study of 182 TM youth seen at a pediatric academic medical center, seen between 2013-2018 with the diagnosis of gender dysphoria. Information regarding growth, demographics, androgen levels and bone age (if performed), as well as GAHT was collected. Control data were US cis-female population norms. Pre- and early pubertal growth patterns were assessed from a subset of TM patients who had detailed growth records available at least 12 years of age or earlier. Growth patterns were examined before and after GAHT. Descriptive statistics were used to describe the data. The Chi-square Test of Association was used to assess differences between those who attained height early and versus their peers with normal growth curves. A one-way repeated-measures ANOVA was used to test for the differences between height distributions over time. Results: One hundred eighty two TM patients met inclusion criteria. While their aggregate data generally fell within standardized CDC female growth curves, for those patients who had height measurements from 12 years of age or earlier, a pattern of early growth deceleration was observed. Thirty six, of 106 (34.0%) patients displayed decelerating growth patterns, crossing more than 2 major growth curves downward over time. The mean loss in height percentiles was 20.3 ± 18.7% (mean ± S.D). Height percentiles were also examined in a larger group of patients (n=125) receiving GAHT. The mean height percentiles after GAHT displayed conservation from prior to GAHT (1.8 ± 7.2%.). Conclusions: One third of the TM youth were found to display early height deceleration resulting in major negative shifts in the growth percentiles prior to beginning therapy. The later addition of GnRH analog therapy and GAHT appear to preserve remaining growth. These findings highlight a need for early identification of TM youth and monitoring of growth as a critical component of care. Patients with early height deviations may benefit from referral to specialists for evaluation of growth as well as for provision of options to preserve growth.

Name thesis:degree_name

M.S. (Master of Science)

Level thesis:degree_level

Masters

Discipline thesis:degree_discipline

Bioinformatics (UMKC)

Grantor dc:publisher

University of Missouri -- Kansas City

Year dc:date.issued

2019

Author dc:creator

• Grimstad, Frances

Advisor dc:contributor.advisor

• Gaddis, Monica Louise, 1955-

Language dc:language.iso

en_US

Handle dc:identifier.uri

https://hdl.handle.net/10355/69015

OAI identifier oai:identifier

oai:mospace.umsystem.edu:10355/69015