Bones

No, not Bones on Star Trek, but your bones; have you had them check lately?

Cross-Sex Hormonal Treatment Increases Bone Mineral Density in Transgender Patients
MD All Specialties
By Caitlyn Fitzpatrick
April 1, 2016

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.

Okay, the research shows that CSHT has positive results for trans people, but… we all show be checked by having a bone density scan. On the University of California, San Francisco Center of Excellent for Transgender Health they write that,

Osteoporosis has been reported in both older transmen and transwomen, and is frequently associated with poor compliance with the hormone regimen. (Grade B)

Some patients prefer to stop hormonal therapy; for post-gonadectomy patients under age 50, this is not recommended due to bone loss, and potential symptoms similar to menopause in both transwomen and transmen. (Grade A, B, C)
[…]
Additional screenings to consider in older patients

Transwomen patients on feminizing hormone therapy: Mammograms are recommended for transwomen when patients have been using estrogen for at least 30 years AND are at least 50 years of age, unless there is a strong family history of early breast or ovarian cancer. (Grade C)

Follow USPSTF guidelines for prostate screening. PSA is not useful if patient is on estrogen. (Grade B)

Transmen without hysterectomy: Pelvic exams every 1-3 years for patients over age 40 or with a family history of uterine or ovarian cancer; increase to every year if polycystic ovarian syndrome (PCOS) (see MedlinePlus) is present. Consider hysterectomy and oophorectomy if the patient's health will not be adversely affected by surgery, or if the patient is unable to tolerate pelvic exams. (Grade B, C)

Transmen: Consider bone density screening if age > 60 and if taking testosterone for < 5-10 years; if taking testosterone for > 5-10 years, consider at age 50+, earlier if additional risk factors for osteoporosis are present; recommend supplemental calcium and vitamin D in accordance with current osteoporosis prevention guidelines to help maintain bone density. Note that this may be applied to transmen at ages younger than typical starting age for osteoporosis prevention treatment due to the unknown effect of testosterone on bone density. (Grade B, C)

So after about seven years on CSHT your doctor should be ordering a bone density scan. You don’t want to find out the hard way when you slip and fall breaking your hip.