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Cross-Sex Hormone Therapy and Bone Health

Cross-Sex Hormone Therapy and Bone HealthTransgender people who undergo cross-sex hormone therapy should keep an eye on their bone mineral density and osteoporosis risk.

That’s because hormones, like estrogen and testosterone, play a crucial role in keeping our bones healthy.

Cross-sex hormone therapy is one way transgender individuals develop some of the physical traits of their desired gender.

For example, when a person takes the female sex hormone estrogen for a male-to-female transition, they might develop breasts and lose facial hair.

Conversely, a person making a female-to-male transition takes testosterone, a male sex hormone. They may see increases in muscle mass and body hair.

Hormone therapy helps maintain these characteristics, so transgender people usually take hormones for life. But if they don’t take the appropriate amount, or if they completely stop therapy, their bones may lose some of that hormonal protection, putting them at risk for low bone mineral density.

In fact, research suggest that transgender people who undergo hormone therapy over the long term may see a substantial decrease in bone mineral density in their hip between 10 and 15 years of therapy.

When bones become less dense, they are more likely to break. Eventually, a person can develop osteoporosis (“porous bone”) and experience more fractures, even from a mild impact. Other symptoms of osteoporosis are lower back pain, a hunched back, and loss of height.

If you’re taking hormones, ask your doctor about osteoporosis screening. A bone mineral density test is a painless, easy way to assess your bone health.


American Academy of Family Physicians


(Last updated: July 19, 2017)

International Society for Sexual Medicine

“What is cross-sex hormone therapy?”

The Journal of Sexual Medicine

Dobrolińska, Magdalena, MD, et al.

“Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment”

(Published online: July 17, 2019)

Mayo Clinic


(June 19, 2019)

“Bone Density”

(Page last updated: September 12, 2019)

National Institute of Arthritis and Musculoskeletal and Skin Diseases

“Bone Mass Measurement: What the Numbers Mean”

(Last reviewed: October 2018)

National Osteoporosis Society

“Transsexual people and osteoporosis”

(October 2014)