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Hormone treatment increases BMD in transgender patients after 1 year
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Transgender patients who received cross-sex hormone treatment showed higher bone mineral density after 1 year, according to an observational study performed in Europe.
“People who experience gender-related distress might desire gender-affirming treatment with sex steroids,” Chantal M. Wiepjes, MD, of the department of internal medicine and Center of Expertise on Gender Dysphoria at VU University Medical Center, Amsterdam, and colleagues wrote. “Sex steroids are also important determinants of bone acquisition and bone homeostasis. ... Men with aromatase deficiency have been found to have lower bone mass, indicating that estrogen is an important regulator of bone acquisition in men. However, the effect of testosterone on [BMD] is less clear.”
The researchers performed a multicenter, prospective, observational study of 231 male-to-female and 199 female-to-male transgendered patients who were in their first year of cross-sex hormone treatment at centers in Belgium, Norway, Italy and the Netherlands. Patients transitioning from male to female received cyproterone acetate and either oral or transdermal estradiol, whereas those transitioning from female to male received transdermal or intramuscular testosterone. Wiepjes and colleagues used DXA to measure lumbar spine, total hip and femoral neck BMD at baseline and after 1 year of treatment.
Researchers reported that patients transitioning from male to female showed increases in BMD of the lumbar spine (3.67%; 95% CI, 3.2-4.13), total hip (0.97%; 95% CI, 0.62-1.31) and femoral neck (1.86%; 95% CI, 1.41-2.31). In patients transitioning from female to male, total hip BMD increased (1.04%; 95% CI, 0.64-1.44), but there were no changes in femoral neck BMD (–0.46%; 95% CI, –1.07 to 0.16).
Patients transitioning from female to male who were aged 50 years or older showed a greater increase in lumbar spine BMD compared with younger patients (4.32%; 95% CI, 2.28-6.36 vs. 0.68%; 95% CI, 0.19-1.17). Researchers attributed this discrepancy to “the result of the aromatization of testosterone to estradiol.”
“In this study, we found that in both transwomen and transmen, the BMD increased after 1 year of cross-sex hormonal treatment,” Wiepjes told Endocrine Today. “Also, comparable effects between different treatment groups (eg, transdermal vs. oral estradiol, and transdermal or intramuscular testosterone) were found. Although the results of this study indicate positive effects of CHT on BMD in trans persons, only short-term effects are studied. The next research step is to study the long-term effects (ie, after 10 years of hormonal treatment) of CHT on BMD.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures
For more information, contact the authors at m.denheijer@vumc.nl.
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