The dose-dependent effect of estrogen on bone mineral density in trans girls
Main finding · Lumbar spine HAZ score changeResult — go to the resultDifference 0.54 95% CI 0.05–1.04Authors' conclusion
Higher estrogen dosage is associated with a greater increase in lumbar spine BMD Z-scores. Increasing dosage up to 2 mg estradiol is insufficient to optimize BMD and approximately 4 mg may be required for adequate serum concentrations.
Study context
- Population
- Trans girls treated with gonadotropin-releasing hormone agonist (GnRHa) for ≥1 year before gender-affirming hormonal treatment (GAHT) with estrogen
- Participants
- 87 participants
- Exposure
- Regular-dose estradiol vs 6 mg estradiol vs EE after GnRHa puberty suppression
- Regularn = 59reference
- 6 mgn = 13
- EEn = 15
- Outcome
- Change in lumbar spine height-adjusted bone mineral density (BMD) Z-scores (HAZ) on DXA
- Follow-up
- 2 years HT
Main finding
Lumbar spine HAZ score change
Difference
0.54
95% CI 0.05–1.04
Change by group
Regular
0.14
95% CI −0.01–0.28
6 mg
0.42
95% CI 0.13–0.72
EE
0.68
95% CI 0.20–1.15
EEvs Regular
difference 0.54 (95% CI 0.05–1.04)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Regular | 6 mg | EE |
|---|---|---|---|
| Lumbar spine HAZ difference vs baseline at start of PS · after 2 years HT | −0.64 (95% CI −0.79–-0.49) | −0.20 (95% CI −0.50–0.09) | 0.17 (95% CI −0.16–0.50) |
- Lumbar spine HAZ difference vs baseline at start of puberty suppression (PS): HAZ approached baseline with 6 mg or EE but not regular
Lumbar spine HAZ change during PS · 2.3 ± 0.7 years PS
- Decrease in lumbar spine HAZ during PS
- 0.69 (95% CI −0.82 to −0.56)
Original publication
The dose-dependent effect of estrogen on bone mineral density in trans girls. Eur J Endocrinol. Published 17 August 2023. doi:10.
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