title: Bone in trans persons.
abstract: OBJECTIVE
  We provide an update of bone health in trans persons on cross-sex hormonal therapy. This drastic hormonal reversal will have direct but also indirect effects on bone, through body composition changes.
  
  
  RESULTS
  Recent evidence suggests that trans women, even before the start of any hormonal intervention, already have a lower bone mass, a higher frequency of osteoporosis, and a smaller bone size vs. natal men. During cross-sex hormonal treatment, bone mass was maintained or gained in trans women. In trans men, bone metabolism seemed to increase during short-term testosterone therapy, but no major changes have been found in bone density. On long-term testosterone therapy, larger cortical bone size was observed in trans men vs. natal women.
  
  
  CONCLUSIONS
  Follow-up of bone health and osteoporosis prevention in trans persons is important. We advise active assessment of osteoporosis risk factors including the (previous) use of hormonal therapy. Based on this risk profile and the intended therapy, bone densitometry may be indicated. Long-term use of antiandrogens or gonadotropin-releasing hormone agonists alone should be monitored as trans women may have low bone mass, even prior to treatment. Therapy compliance with the cross-sex hormones is of major concern, especially after gonadectomy. Large-scaled, multicenter, and long-term research is needed to determine a well tolerated dosage of cross-sex hormonal treatment, also in elderly trans persons.
authors.affiliation: aDepartment of Endocrinology bCenter for Sexology and Gender, Ghent University Hospital, Ghent, Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: Van Caenegem
authors.forename: Guy
authors.initials: G
authors.lastname: TʼSjoen
mesh_terms: D001823:Body Composition; D015519:Bone Density; D005260:Female; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D013739:Testosterone / Q000627:therapeutic use; D063106:Transgender Persons
chemical_list: D013739:Testosterone; D007986:Luteinizing Hormone