Bone Densitometry in Transgender and Gender Non-Conforming (TGNC) Individuals: 2019 ISCD Official Position

Rosen, Harold N.; Hamnvik, Ole-Petter R; Jaisamrarn, Unnop; Malabanan, Alan O.; Safer, Joshua D.; Tangpricha, Vin; Wattanachanya, Lalita; Yeap, Swan Sim

doi:10.1016/j.jocd.2019.07.004

Cited by 46 publications

(38 citation statements)

References 34 publications

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“…In support, no increase in fracture rates was observed over 12 months of testosterone suppression [54]. Current advice, including that from the International Society for Clinical Densitometry, is that transgender women, in the absence of other risk factors, do not require monitoring of BMD [52,57]. This is explicable under current standard treatment regimes, given the established positive effect of estrogen, rather than testosterone, on bone turnover in males [58].…”

Section: Anthropometricsmentioning

confidence: 96%

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

2020

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Males enjoy physical performance advantages over females within competitive sport. The sex-based segregation into male and female sporting categories does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been scrutinized. Here, we review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage and thus delivers fair and safe competition. We report that the performance gap between males and females becomes significant at puberty and often amounts to 10–50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations should consider this evidence when reassessing current policies regarding participation of transgender women in the female category of sport.

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Section: Anthropometricsmentioning

confidence: 96%

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

2020

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“…[9] This result is similar to the results of previous studies. [15] The exact reason is still unclear, but some authors had speculated that the initial lower muscle strength of transgender women before the treatment resulted in the lower BMD. [16] In trans women, estrogen therapy seems to maintain bone mineralization homeostasis despite testosterone withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Effect of Cross-Sex Hormones on Body Composition, Bone Mineral Density, and Muscle Strength in Trans Women

2021

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Background Cross-sex hormone therapy (CHT) changes the physical characteristics of transgender women to match their gender identity and expression. This study aimed to determine the effects of feminizing cross-sex hormones on body composition, bone mineral density (BMD) and muscle strength in transgender women. Methods A prospective observational study assessed 11 participants who underwent feminizing CHT. Dual energy X-ray absorptiometry (DXA), and handgrip strength were measured before CHT and after 6-months of CHT. Fat mass, lean body mass (LBM), and BMD were measured by DXA and handgrip strength was measured by hand-dynamometer. Results Regional body fat in the trunk, legs, and gynoid region increased by 18%, 27.4%, and 27.2%, respectively after 6 months of CHT. Total body fat increased by 16.2%, while the fat mass ratio decreased by 7.2%. Although body fat increased, the android/gynoid fat ratio decreased; BMD in the lumbar spine significantly increased by 3.9% ( P =0.0051), but changes in the femoral neck ( P =0.1969) and total femur ( P =0.4769) were not significant. Changes in LBM ranged from −3% (trunk) to −8% (arm region). Right-hand grip strength also significantly decreased by 7.7% ( P =0.0467). Conclusions After 6 months of CHT, transgender women showed a general increase in fat mass and a decreased in overall LBM and handgrip strength. Increase in fat mass percentage were more remarkable in gynoid region, leading to a more “female” body fat distribution.

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“…In support, no increase in fracture rates was observed over 12 months of testosterone suppression 52 . Current advice, including that from the International Society for Clinical Densitometry, is that transgender women, in the absence of other risk factors, do not require monitoring of BMD 50,55 .…”

Section: Anthropometricsmentioning

confidence: 99%

Transgender Women in The Female Category of Sport: Is the Male Performance Advantage Removed by Testosterone Suppression?

Hilton¹,

Lundberg²

2020

Preprint

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Sex dimorphism starts during early embryogenesis and is further manifested in response to hormones during puberty. As this leads to physical divergence that is measurably different between sexes, males enjoy physical performance advantages over females within competitive sport. While this advantage is the underlying basis of the segregation into male and female sporting categories, these sex-based categories do not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been collectively scrutinized. Here, we aim to review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage. In this review, we report that the performance gap between males and females amounts to 10-50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 1 year of treatment. Thus, current evidence shows that the biological advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations may therefore be compelled to reassess current policies regarding participation of transgender women in the female category of sport.

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Bone Densitometry in Transgender and Gender Non-Conforming (TGNC) Individuals: 2019 ISCD Official Position

Cited by 46 publications

References 34 publications

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage

Effect of Cross-Sex Hormones on Body Composition, Bone Mineral Density, and Muscle Strength in Trans Women

Transgender Women in The Female Category of Sport: Is the Male Performance Advantage Removed by Testosterone Suppression?

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