Should transgender individuals worry about bone density?

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Yes, it is important for transgender people to monitor their bone mineral density, especially if they are undergoing cross-sex hormone therapy.

Sex hormones, like estrogen and testosterone, are essential for good bone health. Both hormones protect the bones and keep them strong. When hormone levels are lower than they should be, bones are at greater risk for fractures and osteoporosis.

A bone mineral density test is one way to assess how healthy your bones are. People with low bone density have more fragile bones that are more likely to break.

When a transgender person decides to transition, they often start with cross-sex hormone therapy. Taking hormones associated with their desired gender helps them develop characteristics of that gender. For example, a transgender man (transitioning from female to male) takes testosterone preparations to bring hormone levels up to physiological levels in males. As a result, menstrual periods stop and physical changes, like facial and body hair, start to develop.

Transwomen (transitioning from male to female) take estrogen along with medications that decrease testosterone levels. After a while, body and facial hair become less prominent, penis and testicle size decreases, and breasts may form.

Cross-sex hormone therapy lasts for a person’s entire life. However, if they do not take enough hormones, or if they decide to stop hormone therapy altogether, their bones can weaken. This can be a concern for the long-term.

For example, in 2019, the Journal of Sexual Medicine published a study of 68 transwomen and 43 transmen who were undergoing hormone therapy and had had their ovaries or testes surgically removed. Bone density tests were conducted, and the researchers found that in both groups, a “significant decrease” had occurred in the hip area between the 10th and 15th years of hormone therapy.

If you are concerned about your bone mineral density and osteoporosis risk, ask your doctor about a bone density test. Such tests are fairly routine. The most common test is the central DXA test, which is similar to an x-ray. Also, be sure to take your hormones exactly as your doctor prescribes.

Here are some other ways to keep your bones healthy: