Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen

Chantal M. Wiepjes, Renate T. de Jongh, Christel J.M. de Blok, Mariska C. Vlot, Paul Lips, Jos W.R. Twisk, Martin den Heijer

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Concerns about the effects of gender-affirming hormonal treatment (HT) on bone mineral density (BMD) in transgender people exist, particularly regarding the decrease in estrogen concentrations in transmen. Although it is known that HT is safe for BMD in the short term, long-term follow-up studies are lacking. Therefore this study aimed to investigate the change in BMD during the first 10 years of HT, to determine whether HT is safe and if assessing BMD during HT is necessary. A follow-up study was performed in adult transgender people receiving HT at the VU University Medical Center Amsterdam between 1998 and 2016. People were included if they were HT naive and had a dual-energy X-ray absorptiometry (DXA) scan at the start of HT. Follow-up DXA scans performed after 2, 5, and/or 10 years of HT were used for analyses. The course of BMD of the lumbar spine during the first 10 years of HT was analyzed using multilevel analyses. A total of 711 transwomen (median age 35 years; IQR, 26 to 46 years) and 543 transmen (median age 25 years; IQR, 21 to 34 years) were included. Prior to the start of HT, 21.9% of transwomen and 4.3% of transmen had low BMD for age (Z-score < –2.0). In transwomen lumbar spine BMD did not change (+0.006; 95% CI, –0.005 to +0.017), but lumbar spine Z-score increased by +0.22 (95% CI, +0.12 to +0.32) after 10 years of HT. Also in transmen lumbar spine BMD did not change (+0.008; 95% CI, –0.004 to +0.019), but lumbar spine Z-score increased by +0.34 (95% CI, +0.23 to +0.45) after 10 years of HT. This study showed that HT does not have negative effects on BMD, indicating that regularly assessing BMD during HT is not necessary. However, a high percentage of low BMD was found prior to HT, especially in transwomen. Therefore, evaluation of BMD before start of HT may be considered.

Original languageEnglish
Pages (from-to)447-454
Number of pages8
JournalJournal of Bone and Mineral Research
Volume34
Issue number3
Early online date7 Dec 2018
DOIs
Publication statusPublished - Mar 2019

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Bone Density
Safety
Bone and Bones
Spine
Therapeutics
Transgender Persons
Photon Absorptiometry
Multilevel Analysis
Estrogens

Keywords

  • BONE
  • DXA
  • GENDER-AFFIRMING HORMONAL TREATMENT
  • OSTEOPOROSIS
  • TRANSGENDER

Cite this

Wiepjes, C. M., de Jongh, R. T., de Blok, C. J. M., Vlot, M. C., Lips, P., Twisk, J. W. R., & den Heijer, M. (2019). Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen. Journal of Bone and Mineral Research, 34(3), 447-454. https://doi.org/10.1002/jbmr.3612
Wiepjes, Chantal M. ; de Jongh, Renate T. ; de Blok, Christel J.M. ; Vlot, Mariska C. ; Lips, Paul ; Twisk, Jos W.R. ; den Heijer, Martin. / Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen. In: Journal of Bone and Mineral Research. 2019 ; Vol. 34, No. 3. pp. 447-454.
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abstract = "Concerns about the effects of gender-affirming hormonal treatment (HT) on bone mineral density (BMD) in transgender people exist, particularly regarding the decrease in estrogen concentrations in transmen. Although it is known that HT is safe for BMD in the short term, long-term follow-up studies are lacking. Therefore this study aimed to investigate the change in BMD during the first 10 years of HT, to determine whether HT is safe and if assessing BMD during HT is necessary. A follow-up study was performed in adult transgender people receiving HT at the VU University Medical Center Amsterdam between 1998 and 2016. People were included if they were HT naive and had a dual-energy X-ray absorptiometry (DXA) scan at the start of HT. Follow-up DXA scans performed after 2, 5, and/or 10 years of HT were used for analyses. The course of BMD of the lumbar spine during the first 10 years of HT was analyzed using multilevel analyses. A total of 711 transwomen (median age 35 years; IQR, 26 to 46 years) and 543 transmen (median age 25 years; IQR, 21 to 34 years) were included. Prior to the start of HT, 21.9{\%} of transwomen and 4.3{\%} of transmen had low BMD for age (Z-score < –2.0). In transwomen lumbar spine BMD did not change (+0.006; 95{\%} CI, –0.005 to +0.017), but lumbar spine Z-score increased by +0.22 (95{\%} CI, +0.12 to +0.32) after 10 years of HT. Also in transmen lumbar spine BMD did not change (+0.008; 95{\%} CI, –0.004 to +0.019), but lumbar spine Z-score increased by +0.34 (95{\%} CI, +0.23 to +0.45) after 10 years of HT. This study showed that HT does not have negative effects on BMD, indicating that regularly assessing BMD during HT is not necessary. However, a high percentage of low BMD was found prior to HT, especially in transwomen. Therefore, evaluation of BMD before start of HT may be considered.",
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Wiepjes, CM, de Jongh, RT, de Blok, CJM, Vlot, MC, Lips, P, Twisk, JWR & den Heijer, M 2019, 'Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen' Journal of Bone and Mineral Research, vol. 34, no. 3, pp. 447-454. https://doi.org/10.1002/jbmr.3612

Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen. / Wiepjes, Chantal M.; de Jongh, Renate T.; de Blok, Christel J.M.; Vlot, Mariska C.; Lips, Paul; Twisk, Jos W.R.; den Heijer, Martin.

In: Journal of Bone and Mineral Research, Vol. 34, No. 3, 03.2019, p. 447-454.

Research output: Contribution to JournalArticleAcademicpeer-review

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