About 1.4% of young people in America report themselves as transgender.

The numbers are based on a report released in June by the Williams Institute at the University of California, Los Angeles School of Law, after analyzing data from the U.S. Centers for Disease Control and Prevention. This estimate is nearly double the organization’s previous figure for that age group from 2017 and contributes to the estimated total of 1.6 million people in the country who identify as transgender.

Dr. Stuart Weinzimer, professor of pediatrics at Yale School of Medicine and director of research for the Yale Gender Program, said: “We call it dysphoria — the extreme discomfort you feel with yourself that your body and identity are out of sync.”

This discomfort can grow during puberty. During this time, physical changes can trigger initial concerns about the gender assigned at birth or amplify long-standing distress.

“One of the primary tasks of adolescence is to develop an identity, including gender identity,” Weinzimer said. “Most people don’t have to think about their gender identity, just like you don’t have to think about your breath. You just do it.” For some, this disconnection can be a mental health barrier: a barrier to the formation of one’s own personality.”

Gender dysphoria can pose serious life-threatening risks, including anxiety, depression, and suicide. The Yale Pediatric Gender Program provides a thorough psychosocial assessment for those experiencing this “break” in gender identity and seeking help. Individuals considering or already pursuing a social transition are seen with their parents or caregivers and are provided with an opportunity to discuss and better understand these experiences. , discuss next steps based on individual goals. In this context, gender-matching hormone therapy (GAHT) may be offered as a possible option.

Like many medicines, GAHT has potential risks and benefits for individuals. For example, patients undergoing testosterone-induced GAHT may develop an unfavorable cholesterol profile that may increase long-term risks to heart health. Potentially increased risk. GAHT may also present other health risks that have not yet been fully investigated. But even knowing the potential risks, the experience of gender dysphoria can be so distinct and overwhelming that GAHT may be the choice.

hormones and bone strength

Bones are living organs. Continuously, bones respond to weight stressors by strengthening themselves. Like a computerized bridge, it is programmed with the senses and the ability to somehow strengthen itself and support the load of traffic above. This means that people can contribute throughout their lives (via the minerals stored in their bones) and draw to support themselves when they get older. The most rapid period for such investments to increase bone strength occurs in late adolescence and usually levels off through the individual’s 20s and 30s, and generally in her 40s. starts to decrease at .

Dr. Thomas Carpenter, Professor of Pediatrics, Orthopedics and Rehabilitation at Yale School of Medicine, said: “The presence of sex hormones during puberty plays an important role in building that strength.”

Under the influence of the male hormone testosterone, a strong outer cylinder called the periosteum thickens. This is why cisgender adult males (assigned and identified as male at birth) tend to have larger, thicker, and stronger bones.

The female sex hormone estrogen inhibits or suppresses the breakdown of bone, which is regularly remodeled, by causing some cells to deposit calcium and other minerals and others to chew and dissolve bone cells. In this way, estrogen slows down the breakdown of bone. This is why cisgender women with low estrogen levels due to menopause are at increased risk of osteoporosis and fractures.

The typical pattern and timing of pubertal development are altered in those who experience GAHT during adolescence, and the effects of these hormonal therapies on bone development processes are not fully understood.

A better picture of bone health

Standard bone densitometry uses an X-ray machine (commonly called DXA), which cannot detect microstructural variations that affect bone quality.

“Bone structure is like having a strong chain with many links,” Carpenter said. “But one thin link can break the chain. We need to determine if those are the weak spots.”

With a grant from WHRY, Dr. Weinzimer collaborated with Dr. Carpenter and Dr. Acquiring images of the dynamic process of bone development. , and architecture, and they are evaluating bone changes during the first year of GAHT in adolescents who identify as transgender.

In addition, this study builds on work initiated by former postdoctoral researcher Apoorva Ravindranath Waikar to catalog metabolic markers of bone health and identify dietary and exercise factors that may promote or impede normal skeletal health. Identify demographic, clinical, and behavioral variables such as; in this population as they get older.

“This study represents an important step in allowing us to see for the first time how these metrics change in people undergoing sex-affirming hormone therapy. is not yet known, but we may find that these measures of variability are very different in this population. there is.”

Possible strategies include dietary and exercise changes or adjustments to hormone therapy.

This study will ultimately help clarify a central clinical question in adolescent GAHT. When initiating these hormonal therapies, are current treatments effective in optimizing skeletal health? And how can we use these data to advise individuals and their families to make the soundest decisions about when to initiate these treatments?

“We know GAHT is life-saving,” said Weinzimer. “We know there are risks, even if they are effective. Identify what those risks are, understand their physiology, and learn how to counteract their negative effects. ”