Division of Gynecology and Human Reproduction Physiopatology, Istituito di Ricovero e Cura a Carattere Scientifico (Scientific Institute for Research, Hospitalization and Healthcare) (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Front Endocrinol (Lausanne). 2024 Sep 26;15:1416121. doi: 10.3389/fendo.2024.1416121. eCollection 2024.
Gender-affirming hormone therapy (GAHT) and gender-affirming surgery (GAS) may be desired by transgender and gender-diverse (TGD) individuals who want to affirm their gender identity. Testosterone is the basis of GAHT for transgender individuals assigned female at birth (AFAB), whereas GAS can involve hysterectomy, bilateral salpingectomy, bilateral oophorectomy (BO), thorax masculinization, and phalloplasty. Our study aimed to evaluate the effects of GAHT on the bone health of TGD AFAB individuals who have undergone or not undergone BO.
This was a single-center, longitudinal study with retrospectively collected data. TGD AFAB GAHT-naïve individuals were enrolled and underwent dual-energy X-ray absorptiometry scans and laboratory tests (hormonal and bone metabolism parameters) at baseline and after 5 and 10 years of GAHT.
Two hundred and forty-three TGD AFAB people were included in this study. Seventy-five subjects had completed data for 5 years and 19 subjects for 10 years of GAHT. At baseline, low bone density (Z-score < -2.0) was found in 2.5% (6/243) of subjects for lumbar spine (LS), whereas total hip (TH) and femoral neck (FN) Z-scores and laboratory tests were within the normal female range. After stratifying by physical activity, the physically active group showed significantly higher LS BMD and Z-scores (p ≤ 0.05). Five years after the start of GAHT, a significant reduction in LS (p ≤ 0.05), TH (p ≤ 0.001), and FN (p ≤ 0.01) Z-scores was detected. A significant reduction in the Z-scores of all three bone sites was observed only in the subgroup that had undergone BO. After 5 years of GAHT, estradiol levels were significantly decreased compared to those in baseline (p ≤ 0.001). Significantly higher estradiol levels were detected in the 5-year no-BO subgroup compared to those in the 5-year BO subgroup (p ≤ 0.001). A significant reduction in LS and TH Z-scores were observed after 10 years of GAHT. At this time, estradiol levels were significantly decreased compared to those in baseline (p ≤ 0.01).
Bone density in TGD AFAB individuals is comparable to that in their peers prior to GAHT and BO, but those subjects who underwent BO had a reduced Z-score at LS, FN, and TH after 5 years and at LS after 10 years of GAHT.
性别肯定激素治疗（GAHT）和性别肯定手术（GAS）可能是跨性别和性别多样化（TGD）个体所期望的，他们希望肯定自己的性别认同。对于出生时被分配为女性的跨性别者（AFAB），睾丸激素是 GAHT 的基础，而 GAS 可能涉及子宫切除术、双侧输卵管切除术、双侧卵巢切除术（BO）、胸部男性化和阴茎成形术。我们的研究旨在评估 GAHT 对已经或未进行 BO 的 TGD AFAB 个体骨健康的影响。
这是一项单中心、纵向研究，数据为回顾性收集。招募了 GAHT 初治的 TGD AFAB 个体，并在基线时以及 GAHT 后 5 年和 10 年进行双能 X 线吸收法扫描和实验室检查（激素和骨代谢参数）。
本研究共纳入 243 名 TGD AFAB 人群。75 名受试者完成了 5 年的数据，19 名受试者完成了 10 年的数据。基线时，243 名受试者中有 2.5%（6/243）的腰椎（LS）骨密度（Z 评分< -2.0）较低，而总髋（TH）和股骨颈（FN）Z 评分和实验室检查均在正常女性范围内。按身体活动水平分层后，身体活跃组的 LS 骨密度和 Z 评分显著更高（p≤0.05）。GAHT 开始后 5 年，LS（p≤0.05）、TH（p≤0.001）和 FN（p≤0.01）Z 评分显著降低。仅在接受 BO 的亚组中观察到所有三个骨部位的 Z 评分显著降低。GAHT 后 5 年，雌二醇水平与基线相比显著降低（p≤0.001）。5 年无 BO 亚组的雌二醇水平显著高于 5 年 BO 亚组（p≤0.001）。GAHT 后 10 年，LS 和 TH 的 Z 评分显著降低。此时，与基线相比，雌二醇水平显著降低（p≤0.01）。
TGD AFAB 个体在接受 GAHT 和 BO 之前的骨密度与同龄人相当，但接受 BO 的个体在接受 GAHT 后 5 年时 LS、FN 和 TH 的 Z 评分以及 10 年后 LS 的 Z 评分降低。
