Preservation of bone mineral density after 10 years of cross-sex hormonal treatment in trans persons

Cross-sex hormonal treatment (CHT) in trans persons affects bone mineral density (BMD) on short term. However, long-term follow-up studies investigating the effects of CHT on BMD are lacking. [ view full abstract ]

Cross-sex hormonal treatment (CHT) in trans persons affects bone mineral density (BMD) on short term. However, long-term follow-up studies investigating the effects of CHT on BMD are lacking.

The aim of this study is to investigate the change in BMD after 10 years of CHT in both trans women and trans men. [ view full abstract ]

The aim of this study is to investigate the change in BMD after 10 years of CHT in both trans women and trans men.

A retrospective cohort study was performed in adult trans women and trans men treated with cross-sex hormones at the VU University Medical Center Amsterdam (the Netherlands) since 1998. Persons were included for analyses if... [ view full abstract ]

A retrospective cohort study was performed in adult trans women and trans men treated with cross-sex hormones at the VU University Medical Center Amsterdam (the Netherlands) since 1998. Persons were included for analyses if they had a dual-energy X-ray absorptiometry (DXA) scan at the start of CHT and a follow-up DXA scan after 10 (range 8 to 12) years of treatment.

Mean change in lumbar spine (LS) BMD expressed as T-score and age-matched Z-scores were analyzed and were stratified for age groups (18 to 30, 31 to 49, and ≥50 years), prior cross-sex hormone use, and the occurrence of... [ view full abstract ]

Mean change in lumbar spine (LS) BMD expressed as T-score and age-matched Z-scores were analyzed and were stratified for age groups (18 to 30, 31 to 49, and ≥50 years), prior cross-sex hormone use, and the occurrence of gender confirmation surgery (GCS) including gonadectomy.

71 trans women (mean age: 37 years, standard deviation (SD)±10 years) and 38 trans men (mean age: 33 years, SD±8 years) were included. In trans women, baseline mean T-score was -0.67 (SD±1.28) and mean Z-score -0.55... [ view full abstract ]

71 trans women (mean age: 37 years, standard deviation (SD)±10 years) and 38 trans men (mean age: 33 years, SD±8 years) were included. In trans women, baseline mean T-score was -0.67 (SD±1.28) and mean Z-score -0.55 (SD±1.34). After 8 to 12 years, mean T-score was -0.65 (SD±1.50) and Z-score -0.36 (SD±1.58). This reflects no change in T-score (+0.02, 95% confidence interval (CI) -0.16 to 0.20), but an increase in Z-score of +0.19 (95% CI 0.00 to 0.37).
In trans men, baseline mean T-score was +0.10 (SD±1.27) and Z-score +0.26 (SD±1.25). After 8 to 12 years, mean T-score was +0.14 (SD±1.12) and mean Z-score +0.55 (SD±1.15). This reflects no change in T-score of +0.04 (95% CI -0.17 to 0.25), but an increase in Z-score of +0.29 (95% CI 0.05 to 0.52).
In both trans women and trans men stratification for age groups, prior hormone use, or GCS did not affect the change in BMD.

In both trans women and trans men, LS BMD was preserved after 8 to 12 years of CHT. However, as most persons were passed the age of peak bone mass achievement, the natural course of BMD is to decrease. Therefore, unchanged... [ view full abstract ]

In both trans women and trans men, LS BMD was preserved after 8 to 12 years of CHT. However, as most persons were passed the age of peak bone mass achievement, the natural course of BMD is to decrease. Therefore, unchanged T-scores and increasing Z-scores might indicate that CHT has positive effects on BMD.