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Bone Densitometry in Transgender and Gender Non-Conforming (TGNC) Individuals: 2019 ISCD Official Position
Harold N Rosen1, Ole-Petter R Hamnvik2, Unnop Jaisamrarn3
1Division of Endocrinology and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Summary
Bone mineral density (BMD) monitoring in transgender and gender nonconforming (TGNC) individuals is not typically needed with standard hormone therapy. However, prolonged hypogonadism may warrant BMD assessment for bone loss risk.
Area of Science:
- Endocrinology
- Bone Health
- Transgender Healthcare
Background:
- Guidelines for bone mineral density (BMD) testing and Z-score calculation in transgender and gender nonconforming (TGNC) individuals are not well-established.
- Understanding bone health in TGNC populations requires clear protocols for monitoring and interpretation of BMD results.
Purpose of the Study:
- To review the literature and provide recommendations for bone mineral density (BMD) assessment in transgender and gender nonconforming (TGNC) individuals.
- To clarify indications for BMD testing and appropriate reference databases for Z-score calculation in TGNC populations.
Main Methods:
- Comprehensive literature review of studies pertaining to bone mineral density (BMD) in transgender and gender nonconforming (TGNC) individuals.
- Analysis of existing data regarding hormone therapy, hypogonadism, and bone health in TGNC populations.
- Evaluation of appropriate reference data for calculating Z-scores in TGNC individuals.
Main Results:
- Standard gender-affirming hormone therapy generally maintains or increases bone mineral density (BMD), negating routine monitoring for bone loss based solely on TGNC status.
- TGNC individuals experiencing prolonged hypogonadism (>1 year) may benefit from baseline and potentially follow-up BMD measurements to assess bone loss or failure of bone accrual.
- Z-scores for transgender individuals should use reference data matching their gender identity; for gender nonconforming individuals, data from birth-assigned sex is recommended.
Conclusions:
- Routine bone mineral density (BMD) monitoring is not indicated for transgender and gender nonconforming (TGNC) individuals on standard gender-affirming hormone treatment.
- Bone mineral density (BMD) assessment is recommended for TGNC individuals with significant periods of hypogonadism or other conditions predisposing to osteoporosis.
- Utilizing gender identity-congruent reference data for Z-score calculation is crucial for accurate interpretation of BMD in TGNC individuals.
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