Osteoporosis: Are Trans Men At Risk?

Trans men who take testosterone over a long time period may be at increased risk for osteoporosis, a condition that is marked by a significant decrease in bone density, causing bones to become weak and brittle. However, researchers have come to different conclusions regarding this risk. For example, in 2012 researchers concluded that bone density decreased after oophorectomy and administration of testosterone while another group of researchers reported either no change or an increase in bone mineral density in transgender men treated with testosterone.

Who is at risk?

While we are all at risk for osteoporosis as we age, there are heightened risk factors for some trans men. Risk factors for osteoporosis in this population include:

• Use of Depo-Provera to stop periods. Studies of cis gender women have shown that Depo-Provera negatively affects bone density.
• Oophorectomy before age 45 without optimal hormone replacement. For those who have had their ovaries removed, the body's natural levels of estrogen are too low to protect bone density. Stopping testosterone, taking too low a dose, or repeatedly going on and off testosterone may negatively affect bone density when used for a long period of time.

You can reduce your risks for osteoporosis by:

• Taking testosterone as prescribed. Don't miss doses, cut down, or stop without first talking to a trans-experienced nurse or doctor.
• Eating a healthy and balanced diet.
• Cutting down or stopping smoking; avoiding secondhand smoke.
• Doing weight bearing activities, as well as activities that increase strength, balance, flexibility, and coordination.
• Limiting alcohol and caffeine intake.

Should I Get Screened for Osteoporosis?

The most common bone density scan is called DEXA (Dual Energy X-ray Absorptiometry). The test involves lying on a table while a small x-ray detector scans your spine, one hip, or both. No injections are used and it is not painful.

• No testosterone, ovaries not removed: get tested after age 60 (sooner if other risks).
• Taking testosterone for > 5 years: get tested after age 50 (sooner if other risk factors).
• Ovaries removed, not taking testosterone at all or only taking it occasionally: get tested, no matter what your age

If your DEXA scan is normal, repeat scanning in 2–3 years is recommended.

Source: Trans People and Osteoporosis [pdf]