Physical Changes, Laboratory Parameters, and Bone Mineral Density During Testosterone Treatment in Adolescents with Gender Dysphoria

In a study of 62 adolescents diagnosed with gender dysphoria, testosterone treatment following gonadotropin-releasing hormone agonist (GnRHa) therapy was found to effectively induce virilization, with voice deepening occurring within 3 months for 85% of participants and increased hair growth on extremities and facial hair following. The median duration of testosterone treatment was 12 months. Side effects included prevalent acne between 6 and 12 months, increased body mass index (BMI) and systolic blood pressure, decreased high-density lipoprotein (HDL) cholesterol, and significant increases in hematocrit, hemoglobin, prolactin, androstenedione, and dehydroepiandrosterone sulfate. Vitamin D deficiency was observed in 32-54% of the adolescents throughout treatment, and bone mineral density (BMD) z-scores decreased after 12 to 24 months of testosterone treatment. The study concluded that while testosterone is effective for virilization in transgender male adolescents, there are potential long-term side effects such as increased hematocrit, decreased HDL cholesterol, and decreased BMD z-scores that require further investigation. The study's strengths include a standardized treatment regimen and a comprehensive set of safety parameters, but it was limited by the lack of a control group and the short follow-up duration.