Bone Mineral Density Increases in Trans Persons After 1 Year of Hormonal Treatment: A Multicenter Prospective Observational Study: A Multicenter Prospective Observational Study

Chantal M. Wiepjes, Mariska C. Vlot, Maartje Klaver, Nienke M. Nota, Christel J. M. de Blok, Renate T. de Jongh, Paul Lips, Annemieke C. Heijboer, Alessandra D. Fisher, Thomas Schreiner, Guy T'Sjoen, Martin den Heijer

Research output: Contribution to journalArticleAcademicpeer-review

60 Citations (Scopus)


Sex steroids are important determinants of bone acquisition and bone homeostasis. Cross-sex hormonal treatment (CHT) in transgender persons can affect bone mineral density (BMD). The aim of this study was to investigate in a prospective observational multicenter study the first- year effects of CHT on BMD in transgender persons. A total of 231 transwomen and 199 transmen were included who completed the first year of CHT. Transwomen were treated with cyproterone acetate and oral or transdermal estradiol; transmen received transdermal or intramuscular testosterone. A dual-energy X-ray absorptiometry (DXA) was performed to measure lumbar spine (LS), total hip (TH), and femoral neck (FN) BMDbefore and after 1 year of CHT. In transwomen, an increase in LS (+3.67%, 95% confidence interval [CI] 3.20 to 4.13%, p <0.001), TH (+0.97%, 95% CI 0.62 to 1.31%, p <0.001), and FN (+1.86%, 95% CI 1.41 to 2.31%, p <0.001) BMD was found. In transmen, TH BMD increased after 1 year of CHT (+1.04%, 95% CI 0.64 to 1.44%, p <0.001). No changes were observed in FN BMD (- 0.46%, 95% CI - 1.07 to 0.16%, p = 0.144). The increase in LS BMD was larger in transmen aged >= 50 years (+4.32%, 95% CI 2.28 to 6.36%, p = 0.001) compared with transmen aged <50 years (+0.68%, 95% CI 0.19 to 1.17%, p = 0.007). In conclusion, BMD increased in transgender persons after 1 year of CHT. In transmen of postmenopausal age, the LS BMD increased more than in younger transmen, which may lead to the hypothesis that the increase in BMD in transmen is the result of the aromatization of testosterone to estradiol. (C) 2017 American Society for Bone and Mineral Research
Original languageEnglish
Pages (from-to)1252-1260
Number of pages9
JournalJournal of bone and mineral research
Issue number6
Publication statusPublished - 1 Jun 2017


  • DXA

Cite this