SUN-124 Impact of GnRH Agonist Therapy on Bone Density in a Eunuch Individual

Abstract Disclosure: G. Reddy: None. H. Tabassum: None. K.L. Vinales: None. Eunuch individuals are those assigned male at birth who wish to eliminate masculine physical features, including genitals or genital function, and identify as eunuchs. Recently, the World Professional Association for Transgender Health (WPATH) published Standard of Care 8 (SOC8), recognizing this overlooked group of gender-diverse individuals. Chemical or surgical castration may be considered when there is a high risk of self-harm (e.g., self-surgery). Complications of such interventions include osteoporosis, depression, and metabolic syndrome. Gonadotropin-releasing hormone (GnRH) agonists are an option for chemical castration, though their side effects in the eunuch population remain less studied. We present a unique case exploring the impact of GnRH agonist therapy on bone density in a eunuch. A 66-year-old nonbinary male with a history of gender-affirming hormonal therapy, including estradiol and goserelin, presented for continuation of therapy. The patient reported a strong aversion to the effects of testosterone and was not using the prescribed estradiol. Previously, he had not revealed his identity as a eunuch, fearing denial of care. The patient’s primary goal was testosterone suppression due to significant dysphoria related to erections and mood instability from elevated testosterone levels. He was considering self-castration. His desire for orchiectomy was noted, with no need for fertility preservation. After further inquiry, the patient disclosed his gender identity as a eunuch. A formal psychosocial evaluation was conducted to assess treatment goals and expectations. Following WPATH SOC8 and after ethical committee review, he was maintained on goserelin therapy alone. Initial assessment prior to therapy showed estradiol at 22 pg/mL and testosterone at 885 ng/dL. A baseline DEXA scan was unremarkable, as were serial mammograms. After two years on goserelin therapy, estradiol levels decreased to <10 pg/mL, and testosterone levels dropped to <50 ng/dL, as expected, with improvement in dysphoria and depression. A follow-up DEXA scan revealed an 11.8% decline in bone mineral density (BMD) at the left hip, though T-scores remained within the normal range, and the patient reported no history of fractures. Previous studies have portrayed the effect of goserelin therapy on BMD. A study in cisgender women with endometriosis exhibited a 4.3% average decrease in vertebral trabecular BMD after 6 months of goserelin therapy. In this case, while the patient experienced significant reductions in BMD at both the hip and lumbar spine, normal T-scores imply that these changes are not yet indicative of osteoporosis or increased fracture risk. The timeframe for significant impact on T-scores remains uncertain. Regular BMD screening is crucial for patients undergoing long-term gonadal suppression to detect early signs of osteopenia or osteoporosis and enable timely intervention. Presentation: Sunday, July 13, 2025