Arterial Hypertension as a Complication of Triptorelin Treatment in Adolescents with Gender Dysphoria

Abstract

Background: Adolescents with gender dysphoria are treated with gonadotropin releasing hormone analogues (GnRHa) as part of the gender reassignment procedure. The mid- and long-term health effects of this treatment are not known. Cases: Three cases of arterial hypertension were observed in natal girls with gender dysphoria during GnRHa treatment with triptorelin. Hypertension was demonstrated by ambulatory blood pressure monitoring (ABPM). In the first case, GnRHa therapy was stopped and blood pressure normalized. On restart, hypertension reoccurred and anti-hypertensive medication was initiated while continuing GnRHa. In the second patient, GnRHa was discontinued leading to normalization of blood pressure. In the third case GnRHa was continued and anti-hypertensive medication was prescribed. Conclusion: Early GnRHa treatment in adolescents with gender dysphoria using GnRHa is important for their emotional and social well-being but may induce arterial hypertension, possibly due to estrogen depletion. The clinical implications of our observation for the medical treatment of gender dysphoria patients need to be investigated. Also, vigilance for high blood pressure in other pediatric populations treated with GnRHa is warranted, preferably using ABPM.