Transgender/Trans people (people with gender identity disorder) have an intense desire to live and be accepted as a member of the opposite sex of their birth gender.

You may be uncomfortable with your gender (gender dysphoria) and wish to have treatment to make your body correspond to that of your preferred sex. This gender confirmation treatment might involve surgery or sex hormone therapy.

Sex hormones and bones

Sex hormones are important in regulating the growth of the skeleton and for maintaining the strength of bones. The female hormone oestrogen and the male hormone testosterone have positive effects on bone in both men and women.

These sex hormones are responsible for changes in bone growth and development during childhood and adolescence. Later in life, though, levels of these hormones will decline naturally.

Some drug treatments or surgery might affect hormone levels too and low levels of particularly oestrogen can result in a continuing bone mineral loss and an increased risk of breaking a bone (fracture).

In general, women are more at risk of developing osteoporosis because the reduction of sex hormone at the menopause is more rapid and profound than the age-related decline in testosterone in men. Nevertheless, osteoporotic fractures are frequent in both sexes.

Does treatment for gender identity disorder increase the risk of osteoporosis?

Surgical treatment for gender dysphoria removes the natural source of sex hormones and will result in osteoporosis unless hormone therapy, sometimes called cross-sex hormone treatment, is taken. If the level of these hormones is inadequate, the risk of osteoporosis will be increased.

To help maintain your bone strength, your hormone replacement treatment (testosterone for trans men and oestrogen for trans women) will be monitored carefully, and may be continued long-term. If your hormone replacement is stopped or your levels of replacement become too low, your doctor may need to reassess your bone health.

Your individual risk of fracture will depend on your particular pattern of hormone replacement alongside any other general risk factors for osteoporosis you may have. To assess your individual risk, your doctor or other health professionals assisting you, will consider your bone density in combination with all the other risk factors that research has shown are linked to an increased risk of fracture. This might be referred to as a 'fracture risk assessment'.

When a trans woman reaches the normal age that menopause would occur, a decision will be made about continuing treatment. This decision will depend on your feelings and having discussions with your consultant.

The long-term effects of these medications on the risk of breaking a bone aren't yet fully known.

Some recent research shows that children/young people treated with drug treatments that reduce hormone levels may delay reaching a peak or maximum bone mass.

For more information on other risk factors, read the 'All about osteoporosis and bone health' book from the charity or see our website.

Should I have a bone density scan to see if I might have problems with my bones?

Hot necessarily. So long as you are continuing your hormone treatment you'll be doing the best for your bone health.

Scanning can be useful in some situations, you might need to discuss this with the doctor who's looking after you.

The scan itself is simple, painless and safe.

Will I have any adverse effects because of taking cross-sex hormone replacement therapy?

There aren't too many side effects. Most people are comfortable on the hormones they are prescribed however there might be small risks. You might want to discuss any worries with your doctor.

Hormone therapy should only be used with medical supervision where its effects can be monitored.

Will I need an additional treatment to reduce my fracture risk?

If you have an increased risk of fracture, then your doctor might recommend an osteoporosis drug treatment to reduce this risk.

These treatments are only available from GPs or consultants.

Lifestyle factors too can influence your bone health. A well-balanced helthy diet with enough calcium is important as well as, adequate vitamin D. Weight bearing and resistance exercise too, is important in antaining healthy bones so it's helpful if you can find a variety of sports activities or exercise that you can enjoy on a regular basis.

For more information on a healthy living for strong bones and osteoporosis drug treatments read the 'All about osteoporosis and bone health' book from the charity or see our website.

Useful Contacts

The Gender Trust
76 The Ridgeway
Astwood Bank
B96 6LX
Tel: 01527 894838
Advice and support for trans people, and for their partners, families, carers, and allied professionals and employers.

Gender Identity Research and Education Society (GIRES)
The Warren,
KT21 2SP
Tel: 01372 801554
Provides information for trans people, their families and the professionals who care for them.