Transgender Adolescents Research Articles

Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review.

Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb. PRR1-10.2196/57931.

Clinical profiles and care of transgender children and adolescents who receive specialized consultations: do individuals who are assigned female at birth differ?

ContextClinical data on transgender children and adolescents are scarce, and sample sizes often do not allow for comparisons according to sex assigned at birth. Besides, most gender identity clinics have pointed to a recent switch in favor of an increase in the number of adolescents assigned females at birth (AFAB) over assigned males at birth (AMAB).MethodWe collected data on sociodemographic characteristics, and psychiatric and social vulnerabilities according to sex assigned at birth for all youths who were treated at the French largest gender identity clinic. In addition, management modalities for gender transition were discussed in multidisciplinary concertation meetings.ResultsWe collected data from 239 youths [162(68%) AFAB, 74(32%) AMAB, and 3(1%) intersex; mean age = 14.5(± 3.16) years]. The distribution of age at referral was better explained by two clusters (C1: N = 61, mean age = 11.3 years, with more AMAB; C2: N = 175, mean age = 15.9 years with more AFAB). 215(91%) youths had gender incongruence, with 32% reporting it before puberty. School drop-out, suicidality, depression, and anxiety were common and occurred significantly more often in the AFAB group. 178(74%) youths experienced social transition within the family, and 144(61%) at school [mean age = 15.13(± 2.06) years]. The social transition was more frequent in the AFAB group. Twenty-six (11%) youths received puberty blockers [mean age = 13.87(± 2.31) years], and 105(44%) received gender-affirming hormones [mean age = 16.87(± 1.4) years]. AMABs were more likely to take puberty blockers, and there was no difference in the proportion of AMAB and AFAB taking gender-affirming hormones. Surgical requests (mainly torsoplasty) were very rare.ConclusionAge at referral should be considered when exploring gender incongruence. During adolescence, we found that gender incongruence has substantial social and psychological effects, particularly on AFAB youths, possibly explaining their higher referral rates to specialized centers, as in other specialized clinics around the world.

Nonmedical Gender-Affirming Supports and Resources Most Desired by Transgender and Non-Binary Adolescents

Nonmedical Gender-Affirming Supports and Resources Most Desired by Transgender and Non-Binary Adolescents

Timing of puberty suppression in transgender adolescents and sexual functioning after vaginoplasty.

Sexual function in transgender adolescents after puberty suppression has been a topic of recent clinical and scientific questions. This study aimed to explore the long-term effects of early treatment with puberty suppression on sexual functioning of transfeminine individuals after vaginoplasty. This retrospective cohort study included 37 transfeminine individuals treated with a gonadotropin-releasing hormone agonist (puberty suppression), estrogen, and vaginoplasty (penile inversion technique or intestinal vaginoplasty) at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, between 2000 and 2016. Experiences regarding sexual functioning and difficulties were assessed with a self-developed questionnaire ~1.5years after genital gender-affirming surgery and compared between early (Tanner stage G2-3) and late (Tanner stage G4-5) treatment with puberty suppression. Following surgery, 91% of transfeminine individuals was able to experience sexual desire, 86% experienced arousal, and 78% could attain an orgasm. Seventy-five percent of transfeminine individuals who had not experienced an orgasm pre-surgery were able to experience one post-surgery. Of all participants, 62% reported having tried penile-vaginal intercourse post-surgery. The majority reported the presence of one or multiple sexual challenges. There were no significant differences in postoperative sexual function or sexual difficulties between groups treated with early versus late puberty suppression. With these findings, more adequate and tailored information on the expected effects of early endocrine gender-affirming treatment (including puberty suppression) can be given by healthcare professionals. This is the first study that has assessed sexual functioning of transgender individuals treated with puberty suppression, and has differentiated between the pubertal stage at treatment initiation. Limitations were the small cohort size and retrospective study design. This study focuses on sexual functioning, however, it is important to realize sexual wellbeing is multifactorial and encompasses more than genital functioning or the ability to have certain sexual experiences. This study found that post-vaginoplasty transfeminine individuals after both early and late suppression of puberty have the ability to experience sexual desire and arousal, and to achieve orgasms. Outcomes are comparable to previous findings in those who started treatment in adulthood.

Differences in cardiorespiratory fitness by gonadotropin-releasing hormone agonist treatment before and after testosterone in transgender adolescents.

There are known sex differences in cardiorespiratory fitness (CRF). Little is known about the impact of pubertal blockade with a gonadotropin-releasing hormone agonist (GnRHa) followed by hormone therapy on CRF for transgender adolescents. We aimed to 1) determine the effect of GnRHa monotherapy on CRF and mitochondrial function and associations with metabolomic profiles and 2) evaluate changes after 1 and 12 mo of testosterone therapy among transgender adolescents. Participants assigned female at birth (n = 19, baseline age of 15.0 ± 1.0 yr) from two groups: GnRHa+ (n = 8) and GnRHa- (n = 11) were examined at baseline and 1- and 12-mo post-testosterone therapy in a longitudinal observational study to assess cardiorespiratory fitness, mitochondrial respiration, and metabolic profile. Fasted morning labs included assessment of metabolomics and peripheral blood mononuclear cell mitochondrial respiration and degree of mitochondrial coupling (respiratory control ratio, RCR). A graded cycle ergometer test was performed. Baseline differences were evaluated between groups. Changes were compared with mixed linear regression models evaluating time (baseline, 1 mo, and 12 mo), group (GnRHa treatment yes/no), and their interaction. At baseline GnRHa+ individuals had higher relative V̇o2peak (30.1 ± 4.83 vs. 25.24 ± 4.47 mL/kg/min, P = 0.042) than GnRHa- individuals. In regression models, GnRHa+ individuals had a significant increase in peak watts (P = 0.011) and total exercise time (P = 0.005) after 12 mo of testosterone (P = 0.012) but not GnRHa- individuals. GnRHa+ individuals have significantly higher RCR under carbohydrate (P = 0.0007) and lipid (P = 0.0002) conditions than GnRHa+ individuals. Pretreatment with GnRHa positively influences peak CRF and mitochondrial respiration in adolescent transgender males undergoing testosterone therapy.NEW & NOTEWORTHY This study demonstrates differences in exercise capacity and mitochondrial respiration at baseline based on whether or not individuals had feminizing puberty blocked. Individuals who had puberty blocked had greater improvements in cardiopulmonary exercise testing parameters after 12 mo of testosterone than those who went through feminizing puberty.

Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group

Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group

Mental Health during Medical Transition in a US and Canadian Sample of Early Socially Transitioned Transgender Youth

PurposeThis study aimed to shed light on the mental health of a unique group of medically transitioning transgender adolescents: those who had made a binary social transition during childhood and who, in general, had not experienced substantial gender-incongruent puberty. MethodsStudy participants were part of a broader longitudinal study comprising 3 groups: transgender youth, their cisgender siblings, and unrelated cisgender peers. Using multilevel models, we compared self-reported and parent-reported levels of anxiety and depressive symptoms among transgender youth at 3 stages: before youth had begun puberty blockers; after they had begun blockers; and after they had begun hormone therapy. We also compared age-based mental health trajectories in transgender and cisgender youth. ResultsIn this sample of transgender youth who sought and received gender-affirming medical care, participants experienced stable and relatively low levels of psychological distress across stages of medical transition and across time. There was one exception: transgender girls showed increased, followed by decreased, parent-reported depressive symptoms over time. In contrast, cisgender girls showed increases in internalizing symptomatology (with the exception of parent-reported anxiety) as they got older, and cisgender boys showed decreased self-reported anxiety and increased, followed by decreased, parent-reported depressive symptoms. By mid-adolescence, levels of anxiety and depressive symptoms among transgender girls and transgender boys generally fell between those of cisgender girls and cisgender boys. DiscussionResults demonstrate that transgender youth who are socially and medically supported in their gender identity can experience stable and positive mental health throughout the notoriously challenging developmental period of adolescence.

Disordered Eating in Early Adolescence: Disparities Among Minoritised Youth.

Disordered eating in early adolescence impacts development, with long-term health implications. Minoritised adolescents might be at higher risk of disordered eating due to minority stress, but most research has focused on White, heterosexual, cisgender individuals; less is known about disordered eating among minoritised adolescents. We examined sexual, gender, racial, and ethnic identities in relation to disordered eating in early adolescence. Using 2-year follow-up data from adolescents ages 10-14 in the Adolescent Brain Cognitive Development Study (N = 9385), we examined associations between sexual, gender, racial, and ethnic identities and past-2 week disordered eating (preoccupation with weight, weight control behaviors, and binge eating). Compared to heterosexual peers, gay/bisexual adolescents had higher odds of all three outcomes (AOR 1.90-3.32); those "questioning" their sexual identity had higher odds of preoccupation with weight (AOR 1.82) and binge eating (AOR 2.53). Compared to cisgender adolescents, transgender adolescents had higher odds of binge eating (AOR 2.62); those "questioning" their gender identity had higher odds of preoccupation with weight (AOR 2.45). Adolescents whose racial identity was categorised as "Another" had higher odds of preoccupation with weight (AOR 1.46) and weight control behaviors (AOR 1.58) compared to White adolescents. Finally, Hispanic adolescents had higher odds of all disordered eating outcomes than non-Hispanic adolescents (AOR 1.25-1.59). This study is among the first to reveal disparities in disordered eating among minoritised early adolescents. Further examination of these disparities can inform future interventions. Healthcare providers are encouraged to screen for disordered eating, recognising that minoritised early adolescents may be at risk.

Self-harm, suicidal ideation, depression and peer relationships in transgender and gender diverse adolescents accessing specialist mental health services.

There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%-2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK. This cross-sectional study explored data from 170 young people participating in the Beating Adolescent Self-Harm (BASH) trial. Baseline data about self-harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152). In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression. Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers.

7978 Metabolic Outcomes in Transgender Youth Receiving Affirming Hormonal Therapy

Abstract Disclosure: M. Salama: None. R. Basmaci: None. T. Rajjo: None. O. Chuzhyk: None. A.N. Lteif: None. A. Al Nofal: None. Objective: Heightened societal acceptance of transgender youth and increased awareness of their unmet medical needs have led to a rise in referrals for hormonal therapy. There is limited literature available on the metabolic outcomes of hormone therapy on transgender youth. We investigated how the different metabolic markers of cardiovascular disease change after the initiation of gender-affirming hormonal therapy in transgender adolescents. Methods: A Retrospective, observational cohort study based on chart review of all children with gender dysphoria (under 18 years of age) who were evaluated in the Pediatric Endocrinology Clinic in a tertiary care center between January 2015 and December 2022. Children's demographic information, baseline weight, height, BMI, hematocrit, lipid profile, ALT, prolactin, and HbA1C levels were obtained before and after the initiation of gender-affirming hormonal therapy. The Wilcoxon signed-rank test was employed for paired analysis, while the chi-square test was used as appropriate. Results: We identified 106 transgender youth who were included in the analysis, with a median age at the start of hormonal therapy of 16 years (IQR: 15-17); comprising 68 trans-males (64%) and 38 trans-females (36%). The median treatment duration was 34 months (IQR: 18-54). Among trans-males, ALT levels increased post-treatment (mean difference 6.851 U/L, p < 0.001), as did BMI Z scores (mean difference 0.257, p < 0.001) and LDL-C (mean difference 12.734 mg/dl, p = 0.002), triglycerides (mean difference 10.18 mg/dl, p = 0.009), non-HDL-C (mean difference 12.8 mg/dl, p = 0.002), and total cholesterol (mean difference 10.18 mg/dl, p = 0.02). No significant differences were observed in HbA1C and HDL-C post-treatment. Among transfemales, BMI Z-scores were higher post-treatment (mean difference 0.27, p = 0.007), with increased total cholesterol (mean difference 19.88 mg/dl, p = 0.008), LDL-C (mean difference 12.6 mg/dl, p = 0.02), and HDL-C (mean difference 11.38 mg/dl, p < 0.001). Other variables did not significantly differ pre-and post-treatment. Ten transfemales with measured prolactin levels pre- and post-treatment showed no statistically significant differences. Conclusion: This pilot study revealed increased BMI Z scores following the commencement of hormone therapy in both trans-male and trans-female youths. Moreover, masculinizing treatment led to increased ALT levels. Furthermore, the cardiometabolic profile exhibited diverse alterations, particularly higher LDL-C levels in both cohorts. These findings underscore the necessity for close monitoring of these parameters during the treatment of transgender youth. Larger prospective randomized controlled trials are essential to comprehensively assess the impact of gender-affirming therapy on transgender youth. Presentation: 6/2/2024

Oocyte Cryopreservation in Transgender and Gender-Diverse Individuals With or Without Prior Testosterone Use.

To evaluate oocyte cryopreservation among transgender and gender-diverse adolescents and young adults with or without prior testosterone exposure, we performed a retrospective cohort study of all patients younger than age 35 years referred for oocyte cryopreservation through our formal fertility-preservation program from 2014 to 2023. The number of patients referred and pursuing fertility preservation increased over time. Among the 93 patients referred, 37 pursued oocyte cryopreservation (31 testosterone-naïve and six testosterone-exposed). Among the latter, neither length of time on testosterone before presentation nor duration off testosterone before retrieval (minimum 2 months) were associated with the number of mature oocytes frozen. When comparing testosterone-naïve with testosterone-exposed individuals, there was no difference in number of oocytes retrieved (median 28 vs 32, P=0.43) or mature oocytes frozen (21 vs 21, P=0.95).

Development and validation of the Transgender Adolescent Stress Survey-Dysphoria.

Transgender and nonbinary adolescents (TNBA) may experience gender dysphoria arising from incongruities between their body and their gender. Prior dysphoria measures have largely focused on clinical diagnosis with little regard to comparability of forms for people assigned male or female at birth, overall psychometric performance, or applicability to nonbinary populations. This study develops and validates the Transgender Adolescent Stress Survey-Dysphoria (TASS-D), intended to address these gaps. The current study recruited a U.S. national sample of TNBA (N = 444, aged 12-17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% nonbinary, 9.5% agender). The item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Scale development included factor analysis, item response theory modeling, measurement invariance testing, and reliability analyses. Associations were examined between the TASS-D and existing measures of gender dysphoria (convergent validity), gender minority stress (divergent validity), and behavioral health outcomes (criterion validity). TASS-D and its subscales (body distress and gender expression burden) were significantly and strongly associated with gender dysphoria; significantly but weakly associated with gender minority stress; and significantly associated with most indicators of psychological distress including depressive, anxiety, and posttraumatic stress symptoms, suicidal behaviors and nonsuicidal self-injury. The TASS-D is a reliable and valid measure of gender dysphoria for TNBA, offering notable benefits over existing measures: It is psychometrically sound, inclusive of all gender identities, and does not assume that respondents identify binarily or desire medical transition as a terminal goal.

Use of Telemedicine Services Is Associated with Longer ime to TInitiation of Hormone Therapy in Transgender Teens and Young Adults.

Purpose: This is a retrospective chart review examining factors, which may contribute to timing of receipt of prescription for testosterone or estrogen-based interventions for transgender adolescents and young adults who do not receive such a prescription at their first medical appointment. Methods: A total of 176 patient records were available; of this a minority received a prescription for hormone therapy at first medical appointment. Of the remaining 108 unique individuals, 49 received a prescription at a subsequent medical. Results: Participants seen through virtual health care had a significantly longer time in care prior to receipt of estrogen or testosterone prescription (331 days vs. 220 days, p = 0.046). No other significant relationships were found. Conclusion: Patients who utilize telemedicine services for gender-related health care purposes and who did not receive a prescription for estrogen or testosterone at their initial medical encounter have a longer lead time to receipt of hormone therapy.

Gender Identity Disparities in Early Adolescent Sleep: Findings from the Adolescent Brain Cognitive Development Study.

Purpose: Our aim was to examine associations between transgender identity and sleep disturbance in a demographically diverse, national sample of U.S. early adolescents. Methods: We conducted a cross-sectional analysis of the Adolescent Brain Cognitive Development Study from Year 3 (2019-2021, n = 10,277, 12-13 years) to investigate the association between transgender identity and caregiver-reported measures of their adolescent's sleep, assessed by the Sleep Disturbance Scale for Children. Results: Transgender adolescents had a higher risk of overall sleep disturbance and symptoms of insomnia and excessive sleepiness. Furthermore, per caregiver report, transgender adolescents were more likely to have shorter sleep duration categories; particularly concerning is the significant risk of <5 hours of sleep for transgender adolescents compared with their cisgender peers. Conclusion: These findings indicate that transgender adolescents had worse caregiver-reported sleep outcomes compared to cisgender peers. This study highlights the need for screenings and interventions targeted at improving sleep among transgender adolescents.

Mental health and timing of gender-related events among transgender and gender-diverse children and adolescents seeking gender-affirming consultation and care

Transgender and gender-diverse (TGD) youth encounter unique challenges affecting their mental health, largely related to societal stigma and gender dysphoria. Limited research considers the specific needs of TGD youth. This study examined demographic and developmental factors, including the ages at which gender-related events occur, and their relationship to mental health among TGD youth seeking gender-affirming consultation and care (GACC). We examined the medical records of 674 TGD children and adolescents, comparing demographics, gender-related events, and mental health across gender groups. The total sample comprised 261 patients assigned male at birth, and 413 patients assigned female at birth. Non-binary individuals reported higher rates of psychopathology compared to binary transgender patients, with transgender boys exhibiting higher rates than transgender girls. Seeking GACC at a more advanced pubertal stage and older age was associated with an increased likelihood of psychopathology. Later recollection of first gender incongruence memory was correlated with higher rates of depression and anxiety. Finally, socioeconomic status was linked to GACC healthcare-seeking behaviors. These findings underscore the importance of recognizing the diverse experiences and needs of TGD youth seeking GACC services, highlighting that early identification and access to care may be crucial for improving mental health outcomes.

Depression and anxiety in transgender and non-binary adolescents: prevalence and associations between adolescent and caregiver reports.

Though adolescent and caregiver reports were low to moderately correlated, youth reports were consistently higher, suggesting the importance of interventions to increase caregiver understanding of TNB adolescent mental health. • Transgender/non-binary adolescents are at high risk for mental health concerns and caregivers are essential to coordinate care. • This study expands the diagnostic mental health sub-categories examined in transgender/non-binary adolescents, noting elevated symptoms of separation and social anxiety. • Transgender/non-binary adolescents reported more symptoms of depression, generalized anxiety, separation anxiety, and social anxiety than caregivers.

Urinary Tract Infection in a Transgender Male: A Primary Care Approach

Navigating health care as a transgender adolescent presents a multitude of unique challenges that warrant careful consideration. Transgender individuals often encounter barriers such as a lack of knowledgeable health care providers, limited access to gender-affirming care, and concerns about confidentiality, safety, and acceptance. This case report of a transgender male with a history of a urinary tract infection examines the issues facing transgender adolescents in their pursuit of appropriate and sensitive health care and the need for normalizing gender-affirming medical care.

Transgender Adolescent School Climate, Mental Health, and Adult Social Support

This cross-sectional study describes gender differences in adolescent school climate, health, and social supports, including who depressed or anxious youth seek help from.

The “Cycle” of HIV: Limits of Personal Responsibility in HIV Vulnerability Among Transgender Adolescents and Young Women in Lima, Peru

Globally, transgender women (TW) face a high burden of the HIV epidemic. In Peru, HIV prevalence among TW rises at age 25, indicating a need to understand HIV vulnerability as adolescents reach adulthood. The life course of TW is often marked by abuse, discrimination and poverty fueled by transphobic stigma. Approaches to the HIV epidemic among TW and adolescents emphasize problem behaviors such as unprotected sex and substance. However, there has been a call for HIV research and interventions to understand and leverage community strengths. This qualitative study utilized a transgender-oriented, strength-based, intersectional and feminist approach to understand the strengths and protective health behaviors among 17 transgender adolescents and young women (TAYW) age 16–24 in Lima, Peru. Most participants re-located to Lima from the Amazon due to familial rejection, and engaged in obligatory sex work. TAYW demonstrated self-knowledge, motivation for education, efforts to secure employment, strong community networks, legal advocacy, avoiding problem substance use, HIV knowledge and condom use. However, strengths were impeded by multi-level barriers such as familial physical abuse, educational discrimination, and sexual assault which led to increased HIV vulnerability. We created a conceptual model of the “cycle” of HIV to describe the limits of personal responsibility within a vulnerable community denied access to family, education, employment and human rights. We recommend researchers, clinicians and public health workers follow the lead of TAYW at the frontlines of the HIV epidemic, and support beloved communities and enabling environments which may permit protective behaviors to mitigate HIV vulnerability.

The Role of Sex and Gender in Transgender Bone and Other Musculoskeletal Health.

Musculoskeletal changes occur with gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS) used in the care of transgender adolescents and adults. Survey results have shown that orthopaedic surgeons desire to care for transgender individuals but express concern over a knowledge deficit. This article reviews the physiology and pathophysiology that may occur with GAHT and GAS. Transgender women have lower bone mineral density (BMD) prior to GAHT than cisgender men. Limited fracture data would suggest that transgender women >50 years of age have fracture rates similar to those of cisgender women. Transgender men have normal BMD prior to GAHT and are not at an increased risk for fracture compared with cisgender women. The use of puberty-blocking medications in the care of transgender youth does result in a decline in BMD, which returns to baseline with GAHT, but the effect of delaying puberty on maximal BMD and the lifetime fracture risk are unknown. At present, dual x-ray absorptiometry (DXA) is used to measure BMD and assess fracture risk. Attention should be paid to using the appropriate reference group in the interpretation of DXA for transgender individuals. Promote musculoskeletal health by ensuring appropriate calcium, vitamin D, weight-bearing activity, and a healthy lifestyle. Adherence to GAHT needs to be encouraged to avoid bone loss. Data with regard to therapy for osteoporosis in transgender patients have been lacking, but, at present, use of available therapies is expected to be effective. Information with regard to differences in other musculoskeletal health issues such as joint injuries has been lacking in transgender individuals.