A systematic review and meta-analysis published in the journal of JAMA Pediatrics found that puberty suppression in transgender and gender-diverse adolescents temporarily slows bone development, particularly at the lumbar spine. While absolute bone mineral density remained stable during puberty suppression, it increased modestly after gender-affirming hormone therapy, with partial recovery of bone health when compared to peers.

Puberty represents a key window for achieving peak bone mass, which plays an important role in determining fracture risk later in life. As the use of puberty blockers and gender-affirming hormone therapy continues to expand in gender-diverse youth, understanding their long-term effects on skeletal health has become increasingly important.

A new systematic review and meta-analysis has found that while pubertal suppression with temporarily slows bone mineral accrual in transgender and gender-diverse (TGD) adolescents, subsequent gender-affirming hormone therapy (GAHT) promotes substantial recovery in bone health. However, researchers say the extent of long-term “catch-up” remains uncertain, underscoring the importance of careful monitoring during treatment.