Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

HORMONAL THERAPY AND BONE HEALTH IN TRANSGENDER WOMEN

Mehmet Yılmaz

Mardin Artuklu University, Faculty of Medicine, Department of Gynecology and Obstetrics, Mardin, Türkiye

Yılmaz M. Hormonal Therapy and Bone Health in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.11-17.

ABSTRACT

Bone health in transgender women is of particular importance due to the effects of gender-affirming hormone therapy (GAHT). While estrogen replacement increases bone mineral density (BMD) by suppressing osteoclast activity, long-term use of testosterone suppressants may negatively affect bone health. Prior to GAHT, BMD in transgender women has been shown to be lower than in cisgender men, and this is associated with decreased physical activity, vitamin D deficiency, and inadequate muscle mass. While improvements in BMD are observed in the lumbar spine and femur regions in the early period of GAHT, risks such as loss of bone microstructure density and weakening of trabecular bones continue in the long term. However, variables such as lifestyle factors, low physical activity levels, and smoking are additional risk factors that significantly affect bone health. Within the scope of clinical practice, individualized GAHT protocols, monitoring bone health with regular DXA scans, and adequate calcium and vitamin D intake are recommended. A multidisciplinary approach is required to optimize bone health in transgender women. The current literature supports the benefits of hormone therapy but suggests that individualized treatment plans are critical to reducing fracture risks and bone loss. Research highlights the need for more data to evaluate the effectiveness of hormone protocols and lifestyle interventions. This study highlights the importance of multidisciplinary treatment strategies and personalized approaches to improve bone health in transgender women.

Keywords: Transgender women; Bone health; Gender-affirming hormone therapy; Estrogen; Bone broken

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