Dual X-Ray Absorptiometry Scan Procedural Variants in the Transgender Population

Abstract

Transgender and gender non-conforming (TGNC) individuals face numerous barriers to healthcare, which contribute to many health disparities. TGNC persons must initially receive a diagnosis of gender incongruence, previously known as gender dysphoria [1], in order to begin the management of their incongruence with the help of medical interventions such as surgical procedures, and/or hormone replacement therapy (HRT). Despite the expanding use of hormone replacement therapies, the long-term outcomes of HRT on bone health and metabolism, are still relatively unknown. To explore HRT's effects on bone health via measuring bone mineral density, dual-energy x-ray absorptiometry, or DXA, scan has been labeled the gold standard [2]. By using bone densitometry, health care providers are able monitor bone health over time, as well as provide a diagnosis of osteoporosis by using T- and Z-scores. 1. Moser, C., ICD-11 and Gender Incongruence: Language is Important. Arch Sex Behav, 2017. 46: p. 2515-2516. 2. Punda, M. and S. Grazio, [Bone densitometry–the gold standard for diagnosis of osteoporosis]. Reumatizam, 2014. 61(2): p. 70-4. This study's purpose was to analyze what sex and gender was used to calculate T-score and Z-score for individuals who identify as TGNC in the authors’ hospital system. A retrospective chart review was utilized to determine how DXA technicians and physicians are recording, scoring, and reading DXA scans for the TGNC population. The qualitative data was determined as "correct" or "incorrect" based on positions provided from the International Society of Clinical Densitometry (ISCD). 13 DXA scans results were obtained between 11 transgender and gender non-conforming patients. In total, 24 T-scores and Z-scores of the 13 DXA were reviewed and scored. Based off ISCD positions, 58% of the T-score and Z-scores were calculated incorrectly. Like DXA scans, many current healthcare standards and protocols are based on a patient's sex or gender, which may cause confusion amongst healthcare personnel who have not received proper training regarding the TGNC population. This was seen in our present study evaluating standards for bone densitometry in the TGNC population at TUKHS. Ultimately, access to appropriate training regarding gender identity and future research looking to determine HRT's effects on BMD in the TGNC population in the United States is needed to help correct this healthcare disparity.