High dose estrogen treatment increases bone mineral density in male-to-female transsexuals receiving gonadotropin-releasing hormone agonist in the absence of testosterone

Abstract

Objective: To study the effect of estrogen (E) on the male skeleton in the absence of testosterone (T). Design: Retrospective analyses of 40 middle-aged transsexuals treated with subcutaneous injections of gonadotropin-releasing hormone agonist every 4 weeks and oral 17-beta-estradiol-valerat 6 mg/day over two years until reassignment surgery. Methods: The bone mineral density (BMD) in the femoral neck and lumbar spine (L2 -L4) was measured with dual-energy X-ray absorptiometry at the beginning of cross-sex hormone treatment, after 12 and 24 months, and serum T, E, sex hormone-binding globulin (SHBG), calcitonin (CAL), osteocalcin (OSC), and urinary free deoxypyridinoline (DPD) were measured. Results: After 12 months, a significant increase in BMD in the lumbar spine from 1.2 to 1.234 g/cm 2 and after 24 months to 1.274 g/cm 2 was observed. There was a significant increase in BMD in the femoral neck area from 1.068 to 1.109 g/cm 2 after 24 months. There was a significant decrease in serum T levels from 18.65 to 0.57 nmol/l after 12 months, and to 0.62 nmol/l after 24 months, a significant increase in SHBG levels from 50.09 to 125 nmol/l after 12 months, and to 130 nmol/l after 24 months, and a significant increase in serum E levels from 73.42 to 881.6 pmol/l after 12 months, and to 923.62 pmol/l after 24 months of cross-sex hormone treatment. Serum levels of CAL, OSC and urinary DPD were unchanged. Conclusion: We conclude that high dose E treatment is able to increase BMD significantly in the femoral neck and lumbar spine independently of serum T levels in middle-aged men. There is no risk of osteoporosis developing in male-to-female transsexuals receiving GnRHa when there is an adequate E substitution.

The impact of testosterone administration to female-to-male transsexuals on insulin resistance and lipid parameters compared with women with polycystic ovary syndrome

“…We conclude that BMI is a more important determinant of IR in PCOS women than high T levels. Testosterone predominantly had a deleterious effect on lipid profiles, which confirms findings from other studies in PCOS women (16,49,(50)(51)(52)(53).…”

When Injustice Gets Old: A Systematic Review of Trans Aging

“…Related themes included the dearth of educated health, mental health, and social care professionals (including the lack of geriatric care specialists who are familiar with trans physiology) (Berreth, 2003;Blank et al, 2009;Cook-Daniels, 2008a;Witten, 2002b); the denial of insurance coverage for trans-specific health care issues (Minter, 2002;Williams & Freeman, 2007;Witten & Eyler, 2006); the failure of care providers to differentiate trans issues from other health care issues and, by extension, the denial of insurance coverage for non-trans-specific health care issues (Berreth, 2003;Blank et al, 2009;Cook-Daniels, 2006;Haber, 2009;Knochel, 2011;OPHA, 2004;Williams & Freeman, 2007;Witten, 2003a;Witten & Eyler, 2006;Witten & Whittle, 2004); and, with minor exceptions, the lack of knowledge vis-à-vis the relationship between aging and gender transition (Berreth, 2003;Blank et al, 2009;Ferron, Young, Boulanger, Rodriguez, & Moreno, 2010;Haber, 2009;OPHA, 2004;Persson, 2009;Williams & Freeman, 2007;Witten, 2002b;Witten & Eyler, 2006;Witten & Whittle, 2004). Exceptions included articles exploring the long-term risks of contragender hormone use on bone density and prostate health (Mueller et al, 2005;van Kesteren et al, 1996;Witten & Eyler, 2007), and those exploring the impact of hormone treatment on hormone-related tumors (Mueller & Gooren, 2008;Persson, 2009). …”

Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen–nanodiamond hydrogel

“…It is important to note that endogenous E2 is critical in maintaining bone mineral density at all ages and in both genders (56)(57)(58)(59). The undesired effects of E2 in males, such as suppression of testosterone, were observed only at high doses of 2 ∼ 6 mg daily, while lower doses of E2 significantly promoted bone formation without such side effects (57). Low doses Fig.…”