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. 2024 Feb;47(2):401-410.
doi: 10.1007/s40618-023-02156-7. Epub 2023 Jul 14.

Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study

C Ceolin  1   2 , A Scala  3   4 , M Dall'Agnol  5 , C Ziliotto  5 , A Delbarba  6 , P Facondo  6 , A Citron  5 , B Vescovi  3 , S Pasqualini  3 , S Giannini  7   4 , V Camozzi  8   4 , C Cappelli  6 , A Bertocco  5 , M De Rui  5 , A Coin  5 , G Sergi  5   4 , A Ferlin  3   4 , A Garolla  3   4 ; Gender Incongruence Interdisciplinary Group (GIIG)
Collaborators, Affiliations

Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study

C Ceolin et al. J Endocrinol Invest. 2024 Feb.

Abstract

Purpose: Preliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity).

Methods: Medical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ).

Results: 14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 (p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people.

Conclusions: Body composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT.

Keywords: Body composition; Bone metabolism; Fat mass; Lean mass; Transgender.

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Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Distribution of BMD values in transgender and cisgender people. Lumbar spine, total hip, and femoral neck sites were considered. ***p < 0.001, AFAB assigned female at birth, AMAB Assigned Male At Birth, BMD bone mass density
Fig. 2
Fig. 2
Serum 25-OHD values in transgender and cisgender population and cutoff as: ≤ 25; 25–50; 50–75; > 75 nmol/L. ***p < 0.001
Fig. 3
Fig. 3
Distribution of ASMMI and FMI in transgender and cisgender people
See this image and copyright information in PMC

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