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Bone Microarchitecture in Transgender Adults: A Cross-Sectional Study
Ingrid Bretherton1,2, Ali Ghasem-Zadeh1, Shalem Y Leemaqz3
1Department of Medicine, The University of Melbourne, Heidelberg, Australia.
Summary
Gender-affirming hormone therapy impacts bone health differently in trans men and trans women. Trans men on testosterone showed no bone compromise, while trans women on estradiol had reduced bone microarchitecture.
Area of Science:
- Endocrinology
- Bone Biology
- Transgender Health
Background:
- Sex hormones critically regulate bone remodeling and morphology.
- Gender-affirming hormone therapy (GAHT) involves administering sex hormones to align physical characteristics with gender identity.
- Potential effects of GAHT on bone microarchitecture are not fully understood.
Purpose of the Study:
- To investigate the effects of GAHT on bone microarchitecture in trans men and trans women.
- To compare bone microarchitecture in trans men and trans women with their respective cisgender controls.
Main Methods:
- Cross-sectional study comparing bone microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT).
- Included 41 trans men (vs. 71 cisgender women) and 40 trans women (vs. 51 cisgender men).
- Analyzed distal radial and tibial microarchitecture, adjusting for age and cross-sectional area.
Main Results:
- Trans men on testosterone showed no compromise in bone microarchitecture; some parameters like cortical thickness were even greater than cisgender women.
- Trans women on estradiol exhibited significantly lower total and cortical volumetric bone mineral density (vBMD), increased cortical porosity, and deteriorated trabecular bone structure compared to cisgender men.
- Bone changes in trans women may be due to pre-treatment deficits or insufficient estradiol dosage.
Conclusions:
- Contrary to hypotheses, trans men on GAHT did not show compromised bone microarchitecture, possibly due to testosterone aromatization.
- Trans women on GAHT demonstrated poorer bone microarchitecture, suggesting potential issues with treatment efficacy or pre-existing bone health.
- Further prospective studies are required to validate these findings and elucidate mechanisms.
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