Transgender (trans) people and osteoporosis 

Undergoing gender confirmation can affect your risk of osteoporosis and broken bones.

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.

Sex hormones and bone health

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. But osteoporotic fractures are frequent in both sexes.

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

Not necessarily. As 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, but there may 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 healthy diet with enough calcium is important as well as, adequate vitamin D. Weight bearing and resistance exercise too, is important in maintaining 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.

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Content reviewed: March 2018

(Updated December 2021)