Cross-Sex Hormonal Treatment Increases Bone Mineral Density in Transgender Patients

Estrogen has a positive impact on bone mineral density (BMD), and although it’s known that testosterone increases bone size, its effect on BMD is unclear.

Chantal M Wiepjes, PhD student, and colleagues from VU University Medical Center in Amsterdam, Netherlands set out to uncover how cross-sex hormonal treatment (CSHT) in transgender patients impacts BMD. Their findings were presented during a poster session at the Endocrine Society’s annual meeting (ENDO 2016) in Boston, Massachusetts.

Using 205 adults who completed one year of CSHT, the researchers examined male-to-female (MtF) and female-to-male (FtM) transitions. The 98 MtF and 107 FtM participants underwent a dual-energy X-ray absorptiometry to measure lumbar spine BMD at baseline and after one year of the CSHT.

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FtMs received intramuscular testosterone undecanoate (1000mg/12 weeks), testosterone gel (50mg/day), or testosterone esters intramuscular (250mg/two weeks). MtFs had oral estradiol valerate (2 to 4mg/day) or an estradiol patch (200ug/week) — most of these participants also received cyproteronacetate (50mg/day) at the same time.

After one year, the average lumbar spine BMD in FtMs went from 1.02 g/cm² to 1.03 g/cm² — an average 1.12% increase. The mean lumbar BMD also increased in MtFs from 0.98 g/cm² to 1.01 g/cm² – an average 3.71%.

“After one year CSHT the spine BMD increased in both groups, but more in MtFs,” the authors concluded. “This confirms the role of estrogen on bone in biological males.”

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