DXA Scan Variants in Transgender Patients

Bone Health in the Transgender Population

“…As a result, it is recommended that transgender individuals be treated according to published guidelines for cisgender individuals 34,35 . Given that TABLE I Recommendations for Bone Density Testing in TGNC Individuals* Baseline BMD testing is indicated for TGNC individuals with a history of gonadectomy or antiandrogen use without appropriate GAHT supplementation; hypogonadism with the intention of using GAHT; or other indications for BMD testing not related to GAHT (e.g., prolonged glucocorticoid use) 28 Baseline bone density testing is recommended for transgender youth before initiating GnRHa monotherapy 20 Follow-up BMD testing should be conducted in TGNC individuals at risk of bone loss (or with preexisting low BMD), such as individuals not taking adequate doses of GAHT or planning to discontinue GAHT 18,28,29 TGNC individuals on an appropriate regimen of GAHT with no additional bone loss risk factors younger than 50 years do not need routine BMD testing 18,29 Transgender youth receiving GnRHa monotherapy should undergo BMD testing every 1 to 2 years while receiving GnRHa 12 . Once trans youth have started GAHT in addition to GnRHa, BMD testing should be performed every 1 to 2 years until the ages of approximately 25 or 30 years 13 *BMD 5 bone mineral density, GAHT 5 gender-affirming hormone therapy, GnRHa 5 gonadotropin-releasing hormone analog, and TGNC 5 transgender and gender-nonconforming.…”

“…A single academic center conducted a retrospective study to assess how well the institution was adhering to the ISCD recommendations when performing DXA scans for trans patients 29 . In this study, 67% of the T-scores and Z-scores were calculated incorrectly based on ISCD recommendations, although the ISCD recommendations also state that Z-scores can also be calculated based on the individual's sex at birth, if so requested 28 .…”

Medical considerations in the care of transgender and gender diverse patients with eating disorders

“…While T-scores are calculated using a standardized data set of young women regardless of the sex of the patient, it is standard practice that Z-scores are matched by age, race and sex [ 78 ]. The International Society of Clinical Densitometry recommends that Z-scores be calculated based on the gender identity of the patient, rather than the sex recorded at birth [ 76 ], although clinical practice does not always follow these guidelines [ 79 ]. Given the complex hormonal milieu of many TGD patients, DXA scans can provide additional clinical information regarding bone health for TGD patients with restrictive eating disorders.…”