Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment

Abstract

Introduction Establishing the influence of long-term, gender-affirming hormonal treatment (HT) on bone mineral density (BMD) in transgender individuals is important to improve the therapeutic guidelines for these individuals. Aim To examine the effect of long-term HT and gonadectomy on BMD in transgender individuals. Methods 68 transwomen and 43 transmen treated with HT who had undergone gonadectomy participated in this study. Dual-energy x-ray absorptiometry (DXA) scans were performed to measure BMD at the lumbar spine and total hip. Laboratory values related to sex hormones were collected within 3 months of performing the DXA scan and analyzed. Main Outcome Measure BMD and levels of sex hormones in transwomen and transmen. Results In transwomen, the mean BMD values at the lumbar spine and total hip at the first DXA scan were, respectively, 0.99 ± 0.15 g/cm2 (n = 68) and 0.94 ± 0.28 g/cm2 (n = 65). In transmen, the mean BMD values at the lumbar spine and total hip at the first DXA scan were, respectively, 1.08 ± 0.16 g/cm2 (n = 43) and 1.01 ± 0.18 g/cm2 (n = 43). A significant decrease in total hip BMD was found in both transwomen and transmen after 15 years of HT compared with 10 years of HT (P = .02). Conclusion In both transwomen and transmen, a decrease was observed in total hip bone mineral density after 15 years of HT compared to the first 10 years of HT.

Bone health in transgender people: a narrative review

“…Cross-sectional studies show that lumbar spine and femur neck BMD after many years of GAHT in transmen are in line with the reference population included in the studies [ Table 2(a) ]. 45 , 65 , 67 According to Dobrolinśka et al , 51 total hip BMD was highest between 10 and 15 years of GAHT and significantly lower after 15 years. This long-term data, even if it resulted from a cross-sectional study, suggest that GAHT has no negative effect on bone.…”

“…The prevalence of osteoporosis (according to male reference) is around 20% in transwomen after more than 10 years of GAHT. 45 , 51 , 64 …”

Osteoporosis and Bone Health in Transgender Individuals

“…Results from cross-sectional studies including trans women on longer-term (> 3 years) GAHT are more equivocal. Some studies showed higher hip and femoral neck aBMD in trans women on long-term GAHT as compared to cis men [15,16], although in general, Z-scores remain normal after up to 12.5 years of GAHT [17][18][19]. In contrast, another study showed lower spine, hip and radius aBMD and lower Z-scores in 23 trans women after 8 years of GAHT as compared to cis men [20], and low bone mass has been described in up to 40% of trans women after long-term GAHT [20][21][22].…”

Die Transgendersprechstunde – was gibt es zu beachten?

“…Zudem sollte eine Knochendichtemessung veranlasst werden, insbesondere bei einer geplan-ten pubertätsunterdrückenden Therapie mittels GnRH-a [3,8]. Vor allem die Anwendung von GnRH-a, aber auch die langjährige Anwendung von CHT kann zu einem Verlust von Knochendichte führen [11,12].…”