LBSAT133 Dilemmas In The Diagnosis Of Osteoporosis In Transgender Population

Abstract

Abstract Although hormone therapy is associated with an increase in the bone mineral density (BMD) in transgender (TG) women the clinical significance of this on fracture risk is unknown. There are also no clear guidelines to define the interpretation of BMD data by DXA scan in the TG population. We are reporting three cases to illustrate the dilemmas involved in the interpretation of BMD in this population. Case 1 A 30-year-old TG female to male (FTM) was started on testosterone treatment and 12 months later patient noted deepening of voice, facial hair growth and, increased muscle strength. Laboratory: serum testosterone 533 ng/dL, sex hormone binding globulin (SHBG) 23.2 nmol/L, FSH 7.1 mIU/mL, LH 8.2 mIU/mL estradiol 59.3 pg/mL, leptin 24.4 ng/mL. A DXA done 12 months after the initiation of treatment: Male Z scores LS spine -1. 0, femoral neck -0.8, total hip 0.2, forearm -2.8. Female: LS spine -0.6, femoral neck -0.4, total hip 0.9, forearm 0.4. Case 2 A 25-year-old TG FTM was started on testosterone treatment for the last 9 months. Patient developed hair growth on the face and voice changes. Laboratory done 9 months later: serum testosterone 714 ng/dL, SHBG 22.5 nmol/L, FSH 4. 0 mIU/mL, LH 2.37 mIU/mL, estradiol 45.6 pg/mL, leptin 18.5ng/mL. A DXA done 9 months after the treatment: male Z scores LS spine 0.5, femoral neck -0.4, | total hip 0. 0, forearm -2.5. Female: LS spine 1. 0, femoral neck 0.2, total hip 0.8, and forearm -0.1. Case 3 A 29-year-old TG MTF taking estradiol and spironolactone for 8 months and with this treatment she noted breast development and decreased facial hair. Laboratory done 9 months later: estradiol 139 pg/mL, serum testosterone 11.9 ng/dL, SHBG 70.3 nmol/L, FSH 1. 0 mIU/mL, LH 0.87 mIU/mL, leptin 8.2 ng/mL. DXA done 9 months after estradiol treatment: male Z scores A-P spine -2.5, femoral neck -1.6, total hip -1.3, forearm -1.3. Female: LS spine -2. 0, femoral neck -1.3, total hip -1.1, forearm 0.9. Discussion In these three patients when the BMD were analyzed in the current assigned gender and it showed discrepancies and presently there are no guidelines to select the BMD interpretation ie whether to depend on the native gender or current gender. Additionally, it is not clear whether treatment will alter the fracture risk in this population. Further studies are needed. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.