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Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study

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Abstract

The aim of this study was to explore the effect of long-term cross-sex hormonal treatment on cortical and trabecular bone mineral density and main biochemical parameters of bone metabolism in transsexuals. Twenty-four male-to-female (M-F) transsexuals and 15 female-to-male (F-M) transsexuals treated with either an antiandrogen in combination with an estrogen or parenteral testosterone were included in this cross-sectional study. BMD was measured by DXA at distal tibial diaphysis (TDIA) and epiphysis (TEPI), lumbar spine (LS), total hip (HIP) and subregions, and whole body (WB) and Z-scores determined for both the genetic and the phenotypic gender. Biochemical parameters of bone turnover, insulin-like growth factor-1 (IGF-1) and sex hormone levels were measured in all patients. M-F transsexuals were significantly older, taller and heavier than F-M transsexuals. They were treated by cross-sex hormones during a median of 12.5 years before inclusion. As compared with female age-matched controls, they showed a significantly higher median Z-score at TDIA and WB (1.7±1.0 and 1.8±1.1, P<0.01) only. Based on the WHO definition, five (who did not comply with cross-sex hormone therapy) had osteoporosis. F-M transsexuals were treated by cross-sex hormones during a median of 7.6 years. They had significantly higher median Z-scores at TEPI, TDIA and WB compared with female age-matched controls (+0.9±0.2 SD, +1.0±0.4 SD and +1.4±0.3 SD, respectively, P<0.0001 for all) and reached normal male levels except at TEPI. They had significantly higher testosterone and IGF-1 levels (p<0.001) than M-F transsexuals. We conclude that in M-F transsexuals, BMD is preserved over a median of 12.5 years under antiandrogen and estrogen combination therapy, while in F-M transsexuals BMD is preserved or, at sites rich in cortical bone, is increased to normal male levels under a median of 7.6 years of androgen treatment in this cross sectional study. IGF-1 could play a role in the mediation of the effect of androgens on bone in F-M transsexuals.

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Acknowledgements

We thank Dr. Philippe Kress for his invaluable contribution to the preparation of the manuscript.

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Authors and Affiliations

  1. Osteoporosis Unit, University Hospital of Berne, CH-3010, Berne, Switzerland

    Adrian G. Ruetsche, Renato Kneubuehl & Kurt Lippuner

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  1. Adrian G. Ruetsche
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  2. Renato Kneubuehl
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  3. Martin H. Birkhaeuser
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  4. Kurt Lippuner
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Correspondence to Kurt Lippuner.

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Ruetsche, A.G., Kneubuehl, R., Birkhaeuser, M.H. et al. Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study. Osteoporos Int 16, 791–798 (2005). https://doi.org/10.1007/s00198-004-1754-7

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  • DOI: https://doi.org/10.1007/s00198-004-1754-7

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