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Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study

Gender‐affirming hormone therapy aligns physical characteristics with an individual's gender identity, but sex hormones regulate bone remodeling and influence bone morphology. We hypothesized that trans men receiving testosterone have compromised bone morphology because of suppression of ovaria...

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Autores principales: Bretherton, Ingrid, Ghasem‐Zadeh, Ali, Leemaqz, Shalem Y, Seeman, Ego, Wang, Xiaofang, McFarlane, Thomas, Spanos, Cassandra, Grossmann, Mathis, Zajac, Jeffrey D, Cheung, Ada S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305455/
https://www.ncbi.nlm.nih.gov/pubmed/34981566
http://dx.doi.org/10.1002/jbmr.4497
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author Bretherton, Ingrid
Ghasem‐Zadeh, Ali
Leemaqz, Shalem Y
Seeman, Ego
Wang, Xiaofang
McFarlane, Thomas
Spanos, Cassandra
Grossmann, Mathis
Zajac, Jeffrey D
Cheung, Ada S
author_facet Bretherton, Ingrid
Ghasem‐Zadeh, Ali
Leemaqz, Shalem Y
Seeman, Ego
Wang, Xiaofang
McFarlane, Thomas
Spanos, Cassandra
Grossmann, Mathis
Zajac, Jeffrey D
Cheung, Ada S
author_sort Bretherton, Ingrid
collection PubMed
description Gender‐affirming hormone therapy aligns physical characteristics with an individual's gender identity, but sex hormones regulate bone remodeling and influence bone morphology. We hypothesized that trans men receiving testosterone have compromised bone morphology because of suppression of ovarian estradiol production, whereas trans women receiving estradiol, with or without anti‐androgen therapy, have preserved bone microarchitecture. We compared distal radial and tibial microarchitecture using high‐resolution peripheral quantitative computed tomography images in a cross‐sectional study of 41 trans men with 71 cis female controls, and 40 trans women with 51 cis male controls. Between‐group differences were expressed as standardized deviations (SD) from the mean in age‐matched cisgender controls with 98% confidence intervals adjusted for cross‐sectional area (CSA) and multiple comparisons. Relative to cis women, trans men had 0.63 SD higher total volumetric bone mineral density (vBMD; both p = 0.01). Cortical vBMD and cortical porosity did not differ, but cortices were 1.11 SD thicker (p < 0.01). Trabeculae were 0.38 SD thicker (p = 0.05) but otherwise no different. Compared with cis men, trans women had 0.68 SD lower total vBMD (p = 0.01). Cortical vBMD was 0.70 SD lower (p < 0.01), cortical thickness was 0.51 SD lower (p = 0.04), and cortical porosity was 0.70 SD higher (p < 0.01). Trabecular bone volume (BV/TV) was 0.77 SD lower (p < 0.01), with 0.57 SD fewer (p < 0.01) and 0.30 SD thicker trabeculae (p = 0.02). There was 0.56 SD greater trabecular separation (p = 0.01). Findings at the distal radius were similar. Contrary to each hypothesis, bone microarchitecture was not compromised in trans men, perhaps because aromatization of administered testosterone prevented bone loss. Trans women had deteriorated bone microarchitecture either because of deficits in microstructure before treatment or because the estradiol dosage was insufficient to offset reduced aromatizable testosterone. Prospective studies are needed to confirm these findings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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spelling pubmed-93054552022-07-28 Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study Bretherton, Ingrid Ghasem‐Zadeh, Ali Leemaqz, Shalem Y Seeman, Ego Wang, Xiaofang McFarlane, Thomas Spanos, Cassandra Grossmann, Mathis Zajac, Jeffrey D Cheung, Ada S J Bone Miner Res Original Articles Gender‐affirming hormone therapy aligns physical characteristics with an individual's gender identity, but sex hormones regulate bone remodeling and influence bone morphology. We hypothesized that trans men receiving testosterone have compromised bone morphology because of suppression of ovarian estradiol production, whereas trans women receiving estradiol, with or without anti‐androgen therapy, have preserved bone microarchitecture. We compared distal radial and tibial microarchitecture using high‐resolution peripheral quantitative computed tomography images in a cross‐sectional study of 41 trans men with 71 cis female controls, and 40 trans women with 51 cis male controls. Between‐group differences were expressed as standardized deviations (SD) from the mean in age‐matched cisgender controls with 98% confidence intervals adjusted for cross‐sectional area (CSA) and multiple comparisons. Relative to cis women, trans men had 0.63 SD higher total volumetric bone mineral density (vBMD; both p = 0.01). Cortical vBMD and cortical porosity did not differ, but cortices were 1.11 SD thicker (p < 0.01). Trabeculae were 0.38 SD thicker (p = 0.05) but otherwise no different. Compared with cis men, trans women had 0.68 SD lower total vBMD (p = 0.01). Cortical vBMD was 0.70 SD lower (p < 0.01), cortical thickness was 0.51 SD lower (p = 0.04), and cortical porosity was 0.70 SD higher (p < 0.01). Trabecular bone volume (BV/TV) was 0.77 SD lower (p < 0.01), with 0.57 SD fewer (p < 0.01) and 0.30 SD thicker trabeculae (p = 0.02). There was 0.56 SD greater trabecular separation (p = 0.01). Findings at the distal radius were similar. Contrary to each hypothesis, bone microarchitecture was not compromised in trans men, perhaps because aromatization of administered testosterone prevented bone loss. Trans women had deteriorated bone microarchitecture either because of deficits in microstructure before treatment or because the estradiol dosage was insufficient to offset reduced aromatizable testosterone. Prospective studies are needed to confirm these findings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). John Wiley & Sons, Inc. 2022-01-22 2022-04 /pmc/articles/PMC9305455/ /pubmed/34981566 http://dx.doi.org/10.1002/jbmr.4497 Text en © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Bretherton, Ingrid
Ghasem‐Zadeh, Ali
Leemaqz, Shalem Y
Seeman, Ego
Wang, Xiaofang
McFarlane, Thomas
Spanos, Cassandra
Grossmann, Mathis
Zajac, Jeffrey D
Cheung, Ada S
Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study
title Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study
title_full Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study
title_fullStr Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study
title_full_unstemmed Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study
title_short Bone Microarchitecture in Transgender Adults: A Cross‐Sectional Study
title_sort bone microarchitecture in transgender adults: a cross‐sectional study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305455/
https://www.ncbi.nlm.nih.gov/pubmed/34981566
http://dx.doi.org/10.1002/jbmr.4497
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