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Bone Health in the Transgender Population.

Micol S Rothman1, Sean J Iwamoto1,2

  • 1Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA.

Clinical Reviews in Bone and Mineral Metabolism
|August 28, 2019
PubMed
Summary
This summary is machine-generated.

Sex steroids significantly impact bone density. While estrogen therapy can improve bone density in transgender women, testosterone therapy shows minimal direct effects on bone density in transgender men, highlighting knowledge gaps in optimizing bone health for transgender adults.

Keywords:
Body compositionDXAOsteoporosisPuberty blockadeSex steroidsTransgender

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Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Transgender Health

Background:

  • Sex steroids, especially estrogen, are vital for peak bone density.
  • Transgender women often present with low bone density before hormone therapy.
  • Transgender men typically do not exhibit low bone density pre-therapy.

Purpose of the Study:

  • To review the effects of gender-affirming hormone therapy on bone density in transgender individuals.
  • To identify current knowledge gaps in managing bone health for transgender adults.
  • To discuss best practices for bone health optimization, DXA scan interpretation, and fracture risk assessment in this population.

Main Methods:

  • Literature review of studies on sex steroids and bone density.
  • Analysis of bone density changes in transgender women undergoing estrogen therapy.
  • Examination of bone density changes in transgender men undergoing testosterone therapy.

Main Results:

  • Estrogen therapy is associated with improved bone density in transgender women.
  • Testosterone therapy shows limited direct impact on bone density in transgender men.
  • Androgens may influence bone health indirectly through body composition changes (fat and lean mass).

Conclusions:

  • Further research is needed to establish optimal bone health management strategies for transgender adults.
  • Understanding the nuances of hormone therapy effects on bone density is crucial for clinical practice.
  • Standardized approaches to DXA interpretation and fracture risk assessment in transgender populations are required.