Bone Mineral Density Changes in Transsexual Persons: a Systematic Review and Meta-Analysis

Abstract

Introduction Both estrogen and testosterone are important in maintaining bone health. It is known that those in the transsexual population undergo significant changes in their body composition and bone mass due to the hormonal changes, either from male-to-female or female-to-male after sex reassignment surgery. Objective This meta-analysis aimed to explore the bone mineral changes in transsexual female individuals before and after following either genital reassignment surgery or cross-sex hormonal therapy or both. We additionally performed a systemic review of the bone mineral change in transsexual male individuals. Method A comprehensive search of the MEDLINE and EMBASE databases was performed from inception through October 2017. The inclusion criterion was observational studies evaluating the bone mineral density change in transsexual persons. The pooled mean difference (MD) of bone mineral density (BMD) and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare the changes between transsexual persons and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. Result Data were extracted from 5 observational studies involving 322 subjects. Pooled results from trans women compared to age-matched male controls demonstrated a statistically significant lower BMD at the lumbar spine (MD= -0.08; 95% CI: -0.14 to -0.01, p-value=0.02, I2 =87%) and hip (MD= -0.16; 95% CI: -0.20 to -0.12, p-value Conclusion To the best of our knowledge, this is the first systematic review and meta-analysis investigating the bone mineral density change in transsexual persons. We found a statistically significant decrease in BMD at hip and spine among transsexual female individuals compared to the male control groups. The result of our meta-analysis suggested that low bone mineral density could be found in transsexual female individuals.