LB066 - RESOLUTION OF SEVERE ANOREXIA NERVOSA FOLLOWING TESTOSTERONE TREATMENT IN FIVE TRANSGENDER MALE ADOLESCENTS. INTRODUCING THE CONCEPT OF DYSPHOREXIA

LB066

RESOLUTION OF SEVERE ANOREXIA NERVOSA FOLLOWING TESTOSTERONE TREATMENT IN FIVE TRANSGENDER MALE ADOLESCENTS. INTRODUCING THE CONCEPT OF DYSPHOREXIA

F. J. Martinez-Martin^1,*, B. Santana-Ojeda², I. Hernandez-Hernandez², C. Arnas-Leon², R. J. de Leon-Durango², I. Molinero-Marcos², A. Kuzior¹, C. Acosta-Calero³, M. D. P. Perez-Garcia⁴, A. Hernandez-Lazaro⁵

¹Endocrinology & Nutrition, Hospitales Universitarios San Roque, ²Endocrinology & Nutrition, HUGC Doctor Negrin, ³Cardiology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, ⁴Family & Community Medicine, Centro de Salud San Gregorio, Telde, ⁵Servei d'Endocrinologia i Nutrició, Hospital Parc Taulí, Sabadell, Spain

Rationale: We report five cases of transgender male adolescents whose anorexia nervosa rapidly resolved after initiation of gender-affirming hormone therapy (GAHT) with testosterone, introducing the concept of dysphorexia.

Methods: Review of the patients’ clinical records and relevant literature.

Results: Five transgender male adolescents with severe gender dysphoria did not receive LHRH agonist treatment at Tanner stage II for various reasons (lack of parental consent in three cases, lack of access to gender care services in one, and autism associated with failure to communicate gender dysphoria in one). All subsequently developed a severe eating disorder diagnosed as anorexia nervosa, requiring admission to a specialized unit and enteral feeding, with nadir BMI <14 kg/m². All patients described dysphoria related to menses and breast development as a major reason for food restriction, and three accepted nasogastric feeding only after GAHT had been proposed.

After barriers to GAHT were removed, patients began transdermal testosterone treatment up to 60 mg/day, preceded in two cases by puberty blockade with LHRH agonists. One year later, eating habits had normalized in all patients, BMI was >19 kg/m², serum testosterone levels were within the normal male range, and no nutritional deficiencies remained except low vitamin D and/or vitamin B9 in two patients.

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Conclusion: In transgender male adolescents with severe gender dysphoria, a severe eating disorder (proposed name: dysphorexia¹), clinically consistent with anorexia nervosa may be triggered by the desire to avoid feminizing pubertal development, including menses and breast development. In such patients, GAHT with testosterone may be highly effective. In our extensive clinical experience with transgender youth, we have not observed comparable presentations in female patients.

References: 1 DOI: 10.53902/SOJDEC.2021.01.000502

Disclosure of Interest: None declared