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Bone density during transition

Adolescence is a crucial period for the build-up of peak bone mass, driven by sex hormones.

Bone mass build-up in puberty

Adolescence is a crucial period for the build-up of peak bone mass, driven by sex hormones. Suppression of puberty with GnRH agonists temporarily inhibits this build-up. Research by Vlot and colleagues (2017) showed that adolescents on puberty blockers developed a delay in bone density (BMAD) that was only partially caught up after the start of cross-sex hormones.

In adults on hormone therapy

In adult trans women on estrogen, bone density is usually maintained. In trans men on testosterone, bone density increases in some places. Risk arises when hormones are stopped without replacement — for example after orchiectomy without estrogen, or with long-term underdosing.

Recommendations for monitoring

International guidelines recommend a DEXA measurement at the start of hormone substitution and periodically during treatment, with extra attention for adolescents on puberty blockers and with long-term hormone use.