# Bone Density, Structure, and Estimated Strength in Transgender Youth Receiving Pubertal Suppression in Early Puberty

> **NIH NIH F32** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $27,261

## Abstract

PROJECT SUMMARY/ABSTRACT
 Access to and demand for gender-affirming medical therapy for gender non-conforming youth have
increased, but understanding of the ramifications of these therapies on bone development and skeletal health
has lagged behind. Current guidelines recommend treatment of gender dysphoria as early as Tanner Stage 2
with gonadotropin-releasing hormone agonists for puberty suppression, but little is known about the skeletal
effects of this intervention. Puberty is a key period of skeletal vulnerability, as rapid longitudinal bone growth
coupled with a lag in mass accrual results in decreased bone strength and increased fracture incidence. Peak
bone mass, achieved during puberty and young adulthood, largely determines age-related fractures in later life.
One European group has demonstrated attenuation of bone mineral density (BMD) accrual after pubertal
suppression in older transgender adolescents that did not recover despite subsequent gender-affirming
hormone therapy. Major determinants of bone health such as body composition, vitamin D status, weight-
bearing exercise, and dietary calcium intake were not assessed. The skeletal effects of puberty suppression in
early pubertal transgender youth have never been reported. The objective of this fellowship proposal is to
examine measures of bone mass and quality during pubertal suppression in early pubertal
transgender youth and to correlate these bone measures with major determinants of bone health. Dr.
Lee has designed the proposed longitudinal observational cohort study, during which she will collect and
analyze anthropometric, laboratory, and imaging data. We hypothesize that BMD, bone microarchitecture,
and bone strength estimates will have attenuated accrual in early pubertal transgender youth after one
year of pubertal suppression when compared to puberty-matched, non-transgender, control youth. Dr.
Lee's proposed research to test this this hypothesis will concurrently provide training in the use and
interpretation of pediatric bone densitometry (Aim 1) and high-resolution peripheral quantitative computed
tomography (Aim 2). She will additionally perform complex longitudinal data analyses to determine the
relationships between major determinants of skeletal development and bone mass, microarchitecture, and
strength (Aim 3). These results will inform current clinical practices and lead to longer-term studies and
investigations of interventions to mitigate the expected lag in skeletal development during pubertal
suppression. Ultimately, this research will positively contribute to the clinical care of transgender youth.
 Dr. Lee is training to become a physician-scientist at the intersection of bone metabolism and gender-
affirming therapy, a highly relevant area in need of rigorous investigation. Her mentorship team is comprised of
experts in endocrinology, radiology, epidemiology, and biostatistics. They will ensure that Dr. Lee fulfills her
training goals in advanced skeletal i...

## Key facts

- **NIH application ID:** 10269888
- **Project number:** 5F32HD098763-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Janet Yi Man Lee
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $27,261
- **Award type:** 5
- **Project period:** 2019-07-01 → 2021-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10269888

## Citation

> US National Institutes of Health, RePORTER application 10269888, Bone Density, Structure, and Estimated Strength in Transgender Youth Receiving Pubertal Suppression in Early Puberty (5F32HD098763-02). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10269888. Licensed CC0.

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