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Bone Mineral Density Increases in Trans Persons After 1 Year of Hormonal Treatment: A Multicenter Prospective Observational Study.

  • Wiepjes, Chantal M1
  • Vlot, Mariska C1, 2
  • Klaver, Maartje1
  • Nota, Nienke M1
  • de Blok, Christel Jm1
  • de Jongh, Renate T1
  • Lips, Paul1
  • Heijboer, Annemieke C2
  • Fisher, Alessandra D3
  • Schreiner, Thomas4
  • T'Sjoen, Guy5
  • den Heijer, Martin1
  • 1 Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands. , (Netherlands)
  • 2 Department of Clinical Chemistry, VU University Medical Center, Amsterdam, the Netherlands. , (Netherlands)
  • 3 Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy. , (Italy)
  • 4 Department of Endocrinology, Oslo University Hospital, Oslo, Norway. , (Norway)
  • 5 Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium. , (Belgium)
Published Article
Journal of Bone and Mineral Research
Wiley (John Wiley & Sons)
Publication Date
Jun 01, 2017
DOI: 10.1002/jbmr.3102
PMID: 28370342


Sex steroids are important determinants of bone acquisition and bone homeostasis. Cross-sex hormonal treatment (CHT) in transgender persons can affect bone mineral density (BMD). The aim of this study was to investigate in a prospective observational multicenter study the first-year effects of CHT on BMD in transgender persons. A total of 231 transwomen and 199 transmen were included who completed the first year of CHT. Transwomen were treated with cyproterone acetate and oral or transdermal estradiol; transmen received transdermal or intramuscular testosterone. A dual-energy X-ray absorptiometry (DXA) was performed to measure lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD before and after 1 year of CHT. In transwomen, an increase in LS (+3.67%, 95% confidence interval [CI] 3.20 to 4.13%, p < 0.001), TH (+0.97%, 95% CI 0.62 to 1.31%, p < 0.001), and FN (+1.86%, 95% CI 1.41 to 2.31%, p < 0.001) BMD was found. In transmen, TH BMD increased after 1 year of CHT (+1.04%, 95% CI 0.64 to 1.44%, p < 0.001). No changes were observed in FN BMD (-0.46%, 95% CI -1.07 to 0.16%, p = 0.144). The increase in LS BMD was larger in transmen aged ≥50 years (+4.32%, 95% CI 2.28 to 6.36%, p = 0.001) compared with transmen aged <50 years (+0.68%, 95% CI 0.19 to 1.17%, p = 0.007). In conclusion, BMD increased in transgender persons after 1 year of CHT. In transmen of postmenopausal age, the LS BMD increased more than in younger transmen, which may lead to the hypothesis that the increase in BMD in transmen is the result of the aromatization of testosterone to estradiol. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

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