Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study

Abstract

Purpose Preliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity). Methods Medical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ). Results 14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 (p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people. Conclusions Body composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT.

Physical Activity, Anxiety, Depression, and Body Image in Trans Individuals: An Exploratory Study

“…Similar results related to the levels of PA in transgender samples were also found in another studies. In the recent work by Ceolin and colleagues [53], the transgender individuals reported values of PA between 525.00 and 2772.00 METS, with no statistically relevant differences between the trans and cis sample. Data from the Minnesota Transgender Youth Survey also revealed that the majority of individuals (50.2%) are physically active for at least 60 min on 3 or more days per week [54].…”

Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview

“…A recent trial, the COMET study [97], collected an extensive set of parameters, spanning from clinical and laboratory data (such as phospho-calcic and hormonal blood tests and densitometric variables) to lifestyles (including smoking habits), in a sample of 125 transgender individuals (78 assigned females at birth and 47 assigned males at birth) before gender-affirming hormone therapy initiation. According to its findings, 14.3% of the transgender sample (versus 6.2% of controls matched by sex assigned at birth and age) reported low bone mineral density, which was found to be due to body composition and lifestyle factors.…”