Characterization of bone mineral density in male-to-female transsexuals receiving treatment for reassignment surgery: 15 years of follow-up

Valentini, Ferdinando M.; Aversa, Antonio; Bruzziches, Roberto; Fornari, Rachele; Greco, Emanuela A.; Rossi, Fabio; Brama, Marina; Spera, Giovanni; Migliaccio, Silvia

doi:10.1016/j.jomh.2008.05.001

« Previous Next »journal of men's health
Volume 5, Issue 3 , Pages 227-233, September 2008

Characterization of bone mineral density in male-to-female transsexuals receiving treatment for reassignment surgery: 15 years of follow-up

Ferdinando M. Valentini, MD
- Endocrinology Section, San-Camillo-Forlanini Hospital, Rome, Italy
Antonio Aversa, MD, PhD
- Cattedra di Medicina Interna, Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Viale Policlinico 155 00161, Rome, Italy
- Corresponding author.
Roberto Bruzziches, MD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Rome, Italy
Rachele Fornari, MD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Rome, Italy
Emanuela A. Greco, MD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, and Istituto di Cura Riabilitativo Villa delle Querce, Nemi–Rome, Italy
Fabio Rossi, MD, PhD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Rome, Italy
Marina Brama, PhD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Rome, Italy
Giovanni Spera, MD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Rome, Italy
Silvia Migliaccio, MD, PhD
- Dipartimento di Fisiopatologia Medica, Università di Roma “La Sapienza”, Rome, Italy

Received 12 March 2008; accepted 29 May 2008.

Abstract

Background

Cross-sex hormone treatment in male-to-female (M2F) transsexuals appears reasonably safe. Little is known about its long-term use. The aim of our study was to evaluate the effect of long-term high dose estrogens, plus the antiandrogen cyproterone acetate, on bone composition and on biochemical/hormonal parameters in M2F transsexuals.

Methods

A retrospective analysis was performed on 45 young M2Fs (mean age 39.5 years; body mass index (BMI)=22) receiving estrogens (previously 100μg ethinyl estradiol, now 2–4mg oral estradiol valerate/day or 100μg transdermal estradiol/day) plus the antiandrogen cyproterone acetate 100mg/day. Data were retrieved from 20 subjects after reassignment surgery (mean hormonal treatment duration 15.6 years). A complete hormonal and biochemical assessment, as well as bone biochemical markers (parathyroid hormone (PTH), calcium, phosphorus, alkaline phosphatase and plasma pyridinoline crosslinks), were evaluated. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA).

Results

All subjects had suppressed serum testosterone levels (mean=0.57nmol/l), whereas serum estradiol levels were within the supraphysiological range (mean=880pmol/l). A mild osteopenia at both lumbar spine and femoral neck was observed in 15 out of the 20 (75%) M2Fs (BMD=0.89±0.14 (mean±standard deviation (SD)) g/cm² versus 1.1±0.09, p<0.001; lumbar T-score=−1.39±0.84 versus 0.5±1.10, p<0.0005; femoral T-score=−1.12±0.76 versus 0.08±1.00, p<0.05, respectively). No differences in plasma crosslink levels or in hormonal and biochemical parameters were found between subjects.

Conclusions

Our results indicate that cross-sex hormone treatment of M2Fs, independently of serum testosterone levels, seems acceptably safe over a median treatment period of 15 years in a consistent population of subjects. A protective role for estrogens on bone seems to be present in a minority of subjects.

Keywords: Male-to-female transsexual, Estrogen, Antiandrogen, Bone mineral density