Monday, June 19, 2017

No Bones About It

Okay so I’m using a pun to get your attention, but this is a serious topic for everyone on Cross Gender Hormones… Have you had a bone mineral density scan?

Hun? What’s that?

Well your body needs either estrogen or testosterone for healthy bones without or if the levels are not high enough your bones lose calcium and weaken.
Bone health and osteoporosis
Center for Transgender Excellence
Primary authors: Asa Radix, MD, MPH and Madeline B. Deutsch, MD, MPH

Adaptation of recommendations for osteoporosis screening to transgender populations is complicated by existing recommendations that vary widely for non-transgender people, including lack of consensus about screening for non-transgender men, and no U.S. national level recommendations on the frequency of screening.

Osteoporosis screening is currently age- and sex- based, and also individualized on the basis of risk factors. There are a number of lifestyle, genetic, endocrinologic, hematologic, rheumatoid and autoimmune diseases, as well as medications that contribute to osteoporosis. Known risk factors for osteoporosis include Caucasian or Asian race, older age, alcohol >10 drinks/week, low body mass index, smoking, chronic corticosteroid use, hypogonadism, rheumatoid arthritis, hyperparathyroidism, immobility, vitamin D deficiency and HIV infection.[1,2]

Osteoporosis risk in transgender women
In one study, researchers found that transgender women had factors which may contribute to an increased risk of osteoporosis, independent of and existing prior to hormone use, such as reduced levels of physical activity, lower muscle mass and grip strength, and lower levels of vitamin D.[3] Studies investigating BMD in transgender women receiving hormones have shown both lower, higher and no change in bone density after initiating hormones.[4-11] The differences in results may be due to the regimens used (some used unopposed androgen blockers for a period of time before initiating hormones) and length of follow-up. Known risk factors for osteoporosis include underutilization of hormones after gonadectomy or use of androgen blockers without or with insufficient estrogen. GnRH analogues also may result in short term decrease in bone mineral density (ie, GnRH analogues without concurrent estrogen, and when estrogen added, or blockers stopped bone density returns to normal).

Osteoporosis risk in transgender men
Most published studies to date have shown either no change, or an increase in bone mineral density in transgender men treated with testosterone. Risk factors for osteoporosis in this population include oophorectomy before age 45 without optimal hormone replacement.[4,6,9-13]
Recommended screening for transgender women and men

There is insufficient evidence to guide recommendations for bone density testing in transgender women or men. Transgender people (regardless of birth-assigned sex) should begin bone density screening at age 65. Screening between ages 50 and 64 should be considered for those with established risk factors for osteoporosis. Transgender people (regardless of birth assigned sex) who have undergone gonadectomy and have a history of at least 5 years without hormone replacement should also be considered for bone density testing, regardless of age (Grading: X C W).
So have you had a bone density scan?

I have and I am schedule for my next scan before my next endo appointment; if you haven’t had one yet I would suggest that you talk to your healthcare provider for one. It is not only a good idea for trans people but also cisgender people over 50.

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