Gender-affirming hormone treatment may lead to changes in bone turnover markers in transgender men and women, but overall does not have negative effects on bone health, according to study results published in the Journal of Bone and Mineral Research.

To assess the effects of gender-affirming hormone treatment on bone metabolism in transgender people, researchers followed 132 trans men (median age, 24 years) as they received their first year of testosterone and 121 trans women (median age, 30 years) over their first year of estradiol and antiandrogen therapy.

Each participant was evaluated at baseline and after 1 year of hormone treatment for glycoprotein sclerostin; N-terminal propeptide of type 1 collagen; alkaline phosphatase; C-terminal telopeptide of type 1 collagen; and total hip, femoral neck, and lumbar spine bone mineral density.

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After 1 year of hormone therapy, alkaline phosphatase, C-terminal telopeptide of type 1 collagen, and sclerostin decreased by an average of 19%, 11%, and 8%, respectively, in trans women. There were no differences between older and younger participants in change in bone turnover markers, but the researchers did discover that sclerostin decreased in all trans women except women receiving an estradiol dose in the lowest quartile.

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In trans men, N-terminal propeptide of type 1 collagen, alkaline phosphatase, and sclerostin increased after 1 year of hormone therapy by an average of 33%, 16%, and 15%, respectively. In contrast to the younger age groups, trans men age ≥50 experienced a decrease in all bone turnover markers, which the researchers attributed to their low estrogen concentrations prior to the start of hormone therapy and increased estrogen concentrations during testosterone treatment.

The researchers also reported positive findings for bone mineral density after 1 year of hormone therapy in both trans men and trans women, further supporting the benefit of estrogen on bone formation.

Study limitations include its observational design and the lack of a control group.

The researchers concluded that “1 year of hormonal therapy does not result in deleterious effects on bone health in transgender people.”

Disclosure: This research was supported by a grant from Abbott Diagnostics.

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Vlot MC, Wiepjes CM, de Jongh RT, T’Sjoen G, Heijboer AC, den Heijer M. Gender-affirming hormonal treatment decreases bone turnover in trans women and older trans men [published online May 17, 2019]. J Bone Miner Res. doi:10.1002/jbmr.3762