From the Guidelines
GnRH agonist implant therapy is generally considered safe for delaying puberty, but it may have long-term effects on bone health, such as reduced peak bone mass accrual.
Key Points
- The use of GnRH agonists in delaying puberty has been shown to be reversible and allows individuals to consider their gender identity and make decisions about gender-affirming hormone therapy 1.
- Adverse effects of GnRH agonist therapy include reduced height velocity and potentially reduced peak bone mass accrual, although height appears to accelerate when gender-affirming hormone therapy is commenced 1.
- GnRH agonist treatment regimens can cause significant bone loss, particularly with long-term use, but bone loss may recover slowly after treatment discontinuation 1.
- The degree of gonadal impairment due to cancer treatment can negatively affect peak bone mass and bone health, highlighting the importance of careful management and monitoring 1.
Long-term Safety Data
- Studies have demonstrated that GnRH agonist therapy can reduce suicidality and improve psychological function in transgender adolescents 1.
- However, the long-term effects of GnRH agonist therapy on bone health are a concern, and further research is needed to fully understand the risks and benefits 1.
- In the context of childhood cancer, GnRH agonists may be used to preserve final adult height and delay menarche, but careful consideration of the potential effects on bone health is necessary 1.
From the Research
Long-term Safety Data for GnRH Agonist Implant Therapy
The long-term safety data for GnRH agonist implant therapy in delaying puberty is a topic of interest in the medical community. Several studies have investigated the effects of GnRH agonist therapy on children with central precocious puberty (CPP).
- The studies suggest that GnRH agonist therapy is effective in delaying puberty and improving final adult height in children with CPP 2, 3, 4.
- The therapy has been shown to be safe, with no significant long-term complications reported in most studies 2, 3, 5.
- However, some studies have reported potential adverse effects, such as changes in body mass index (BMI) and bone mineral density (BMD) 2, 3.
- The use of GnRH agonist implants has been shown to be effective in delaying puberty, with one study reporting a significant increase in height gain and no effect on BMD or BMI 3.
- Another study reported that GnRH agonist therapy was associated with a high prevalence of polycystic ovarian syndrome in CPP patients, but the cause of this association is unclear 2.
- The psychosocial effects of GnRH agonist therapy on CPP patients are not well studied, but some studies have reported decreases in psychosocial problems after therapy 2.
Factors Influencing Treatment Selection
The selection of GnRH agonist therapy for CPP patients depends on several factors, including:
- Route of administration: GnRH agonist implants can be administered via intramuscular or subcutaneous injection 5.
- Duration of action: GnRH agonist implants can have a duration of action ranging from one to 12 months 5.
- Cost: The cost of GnRH agonist therapy can vary depending on the specific product and administration route 5.
- Patient and caregiver preferences: The selection of GnRH agonist therapy should take into account the individual needs and concerns of the patient and their caregiver 5.
Long-term Effects and Adverse Drug Reactions
The long-term effects and adverse drug reactions associated with GnRH agonist therapy in CPP patients have been reviewed in several studies 2, 6.
- The studies suggest that GnRH agonist therapy is generally safe and effective, but potential adverse effects, such as changes in BMI and BMD, should be monitored 2, 6.
- The use of GnRH agonist therapy has been associated with a high prevalence of polycystic ovarian syndrome in CPP patients, but the cause of this association is unclear 2.
- Further studies are needed to fully understand the long-term effects and adverse drug reactions associated with GnRH agonist therapy in CPP patients 6.