Abstract
This study seeks to evaluate the long-term effects of pharmacologic therapy on the bone markers and bone mineral density of transgender patients and to provide a basis for understanding its potential implications on therapies involving implant procedures. Following the referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and well-defined PICOT (Problem/Patient/Population, Intervention, Comparison, Outcome, Time) questionnaires, a literature search was completed for articles in English language, with more than a 3 year follow-up reporting the long-term effects of the cross-sex pharmacotherapy on the bones of adult transgender patients. Transgender demographics, time under treatment, and treatment received were recorded. In addition, bone marker levels (calcium, phosphate, alkaline phosphatase, and osteocalcin), bone mineral density (BMD), and bone turnover markers (Serum Procollagen type I N-Terminal pro-peptide (PINP), and Serum Collagen type I crosslinked C-telopeptide (CTX)) before and after the treatment were also recorded. The considerable variability between studies did not allow a meta-analysis. All the studies were completed in European countries. Transwomen (921 men to female) were more frequent than transmen (719 female to male). Transwomen’s treatments were based in antiandrogens, estrogens, new drugs, and sex reassignment surgery, meanwhile transmen’s surgeries were based in the administration of several forms of testosterone and sex reassignment. Calcium, phosphate, alkaline phosphatase, and osteocalcin levels remained stable. PINP increased in transwomen and transmen meanwhile, CTX showed contradictory values in transwomen and transmen. Finally, reduced BMD was observed in transwomen patients receiving long-term cross-sex pharmacotherapy. Considering the limitations of this systematic review, it was concluded that long-term cross-sex pharmacotherapy for transwomen and transmen transgender patients does not alter the calcium, phosphate, alkaline phosphatase, and osteocalcin levels, and will slightly increase the bone formation in both transwomen and transmen patients. Furthermore, long-term pharmacotherapy reduces the BMD in transwomen patients.
Highlights
The term “transgender” describes a population experiencing incongruence between their physical sex characteristics and their gender identity [1]
Publications reporting the biological effects of cross-sex pharmacologic therapy in the bone markers, bone metabolism, and bone mineral density of transgender patients;
Study Conclusions Related to Bone Structure, Bone Metabolism and Bone Mineral Density (BMD)
Summary
The term “transgender” describes a population experiencing incongruence between their physical sex characteristics (assigned gender) and their gender identity (the extent to which people experience themselves to be like others of one gender) [1]. Patients experiencing gender dysphoria present with different requests; these patients include subjects requiring a transition to the opposite sex with the support of different medical specialists, those who aspire to live outside stereotypic roles without biological transformation, individuals who need medical care for health issues other than gender, and patients who require psychiatric support [3] Those subjects who wish to transition to the opposite sex usually receive pharmacotherapy to increase their secondary sexual characteristics and may undergo surgical procedures for gender reassignment [4]. BMD is estimated with Dual X-ray Absorptiometry (DEXA) and for the evaluation of active bone remodeling, BTMs are evaluated in serum and/or urine [19] This allows for the prediction of the risk of osteoporosis, and the monitoring of treatment progression (effects of the therapy on bone metabolism and structure) [20]. To provide a theoretical basis for a better understanding of the implications of the long-term pharmacologic therapy in the adult transgender patient on therapies involving orthopedic or dental implants
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