Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data

IntroductionAs far as we know, no studies to date have investigated the psychobiological correlates of sexual distress (SD) nor the impact of hormonal treatment (HT) on SD in transgender persons.AimTo evaluate the psychobiological correlates of SD and assess the effects of HT on SD in transgender persons without gender-affirming surgery.MethodsA consecutive series of 301 transgender persons (160 transwomen and 141 transmen) was considered for the cross-sectional study, and a subset of 72 subjects was studied in a 2-year follow-up. A physical examination was performed. Blood samples were drawn for determination of cortisol levels. Subjects completed psychometric measures. During 2 years of HT, the evaluation of SD was prospectively repeated.Main Outcome MeasurePsychobiological correlates of SD in transgender population. Changes in SD during gender affirming hormonal treatment.Clinical ImplicationsKnowing how hormonal treatment influence SD will help care providers when counseling transgender people.Strengths & LimitationsTo the authors’ knowledge, this is the first study prospectively evaluating the impact of gender affirming hormonal treatment on sexual distress in transgender individuals. The main limitations are represented by the small size of the sample and the use of questionnaires validated only in the cisgender population.ResultsSD showed a positive correlation with body uneasiness (P < .0001) and with dissatisfaction toward gender-related body parts or shapes (all P < .05). In addition, SD correlated positively with general psychopathology (P < .0001), alexithymia, social anxiety, and humiliation scales (all P < .05). In transmen, SD was positively associated with autism levels (P < .005), as well as with cortisol levels (P < .02). A significant correlation between SD and perceived discrimination was observed in transwomen (P < .05). In transwomen, SD was positively associated with hair density and negatively with breast growth (both P < .05). Finally, in transmen, a negative correlation was found between SD and hair density (P < .05). When the impact of HT on SD was evaluated, a significant reduction of SD was observed across time in both transwomen and transmen (P = .001 and P = .01, respectively).ConclusionsThe present results support the efficacy of HT in reducing SD in transgender persons.Ristori J, Cocchetti C, Castellini G, et al. Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data. J Sex Med 2020;17:142–151.     

The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence,Treatment, and Regrets

Background

Over the past decade, the number of people referred to gender identity clinics has rapidly increased. This raises several questions, especially concerning the frequency of performing gender-affirming treatments with irreversible effects and regret from such interventions.

Bone mineral density, fracture, and vitamin D in adolescents and young women using depot medroxyprogesterone acetate

Study ObjectiveTo evaluate bone mineral density (BMD) in adolescents and young adults treated with depot medroxyprogesterone acetate (DMPA).Design, Setting, ParticipantsEighty-three healthy subjects, 13-20 years old, who received at least 3 DMPA injections in an urban adolescent clinic and underwent dual energy x-ray absorptiometry (DXA) were evaluated by chart review.Main Outcome MeasuresAnthropometric data, DMPA use, BMD of the spine and hip, fracture history, and vitamin D status were collected.ResultsSubjects were a median age of 16.4 years old (range 13-20 years) when DMPA was initiated. The median number of DMPA injections was 5 (range 3-18) before the first DXA. At the spine and hip, respectively, BMD was normal (Z-score > ?1.0 SD) for most subjects (79%, 86%). Subjects who received > 5 injections were more likely to have low spinal BMD (Z-score ≤ ?2.0 SD) at first DXA (P = .018). In 15 subjects with repeat DXA measurements, after an additional median 6 injections, spinal BMD Z-score decreased by ?0.33 ± 0.10 (mean ± SD, P = .004), as did absolute BMD at the hip (?0.019 ± 0.007 g/cm², P = .014). History of fracture was not associated with initial or subsequent BMD measurements. Most (12/13, 92.3%) subjects with vitamin D measurements were deficient (25-hydroxy vitamin D < 20 ng/mL).ConclusionsMost subjects on DMPA had normal BMD at first DXA. Low spinal BMD was associated with longer DMPA use, and some BMD measurements declined with prolonged use. Fracture history is not an absolute contraindication to DMPA use in this population. Studies are needed to determine possible benefits of vitamin D supplementation in DMPA users.     

Standard hormone therapy is inadequate for bone density in premature ovarian insufficiency

To assess standard dose hormone therapy (HT) and bone mass in premature ovarian insufficiency (POI), 239 women with POI, 132 using standard estrogen dose HT and 107 women without HT, were evaluated. All underwent bone mineral density (BMD) evaluation in the lumbar spine (LS) and total femur (TF). Mean age, age at last period and body mass index (BMI) for the untreated and for the HT groups were 38.1?±?6.1 and 36.8?±?7.3 years; 31.4?±?7.3 and 30.7?±?7.2 years; 26.6?±?7.1 and 25.8?±?4.6?kg/m², respectively, (p=NS). The women taking standard dose HT started treatment at the age of 33.8?±?6.3 years and had been on hormone treatment for 3 years at the time of the bone densitometry examination. The BMD in LS was 1.06?±?0.15 and 1.00?±?0.17?g/cm² (p?=?0.003); the BMD in TF was 0.92?±?0.19 and 0.91?±?0.13?g/cm² (p?=?0.039), respectively, for the untreated and HT groups. A 45% altered BMD (osteopenia/osteoporosis) in LS was verified in women without treatment and 60.1% in those using the standard dose TH (p?=?0.01). The BMD in TF was altered in 32.3% in those without HT and 36.4% in the HT users (p?=?0.34). In conclusion, standard dose HT was not adequate to reduce impaired bone mass in the spine and femur of women with POI.     

Does Gender-Affirming Hormonal Treatment Affect 30-Year Cardiovascular Risk in Transgender Persons? A Two-Year Prospective European Study (ENIGI)

BackgroundCardiovascular (CV) implications of long-term gender affirming hormonal treatment (GAHT) in transgender individuals still remain largely unknown.AimTo evaluate changes in the 30-year Framingham cardiovascular disease (CVD) risk in a large cohort of transgender individuals after the start of GAHT.MethodsIn a multicenter prospective study, a consecutive series of 309 participants (165 transmen and 144 transwomen) was evaluated during a 2-year follow-up. Prospectively, after the start of GAHT a physical examination was performed and blood samples were drawn. CVD risk was calculated for each person, according to the Framingham 30-year CVD risk estimate.Main Outcome MeasureChanges in CV risk factors and 30-year Framingham CVD risk during GAHT.Clinical ImplicationsIn transmen testosterone-induced lipid profile alterations may have a clinical relevance on the individual long-term CVD risk.Strengths & LimitationsThe strength of the present study is the possibility to predict long-term CV outcomes in transgender individuals receiving GAHT based on a short observation; whereas the main limitation is that CVD risk prospective changes mainly represent the expression of risk factors changes during GAHT.ResultsIn transwomen a significant decrease in triglycerides, total cholesterol and LDL-cholesterol was observed during the 2-year follow-up (P < .05), whereas unfavorable lipid changes – such as increased total cholesterol, triglycerides, and LDL cholesterol levels and decreased HDL cholesterol levels (P < .05)- occurred after the start of GAHT in transmen. These changes in risk factors led to an increase in the risk of general and hard CVD events based on lipid profile over time in transmen (P = .001 and P = .005, respectively). No significant changes in general and hard CVD risk based on lipid profile were observed in transwomen over time.ConclusionsOur findings confirmed the unfavorable lipid changes in transmen after the start of GAHT even during a longer follow-up, empathizing the potential clinical impact of these modifications on individual long-term CVD risk.Cocchetti C, Castellini G, Iacuaniello D, et al. Does Gender-Affirming Hormonal Treatment Affect 30-Year Cardiovascular Risk in Transgender Persons? A Two-Year Prospective European Study (ENIGI). J Sex Med 2021;18:821–829.     

Gender-Affirming Hormone Therapy Modifies the CpG Methylation Pattern of the ESR1 Gene Promoter After Six Months of Treatment in Transmen

BackgroundBrain sexual differentiation is a process that results from the effects of sex steroids on the developing brain. Evidence shows that epigenetics plays a main role in the formation of enduring brain sex differences and that the estrogen receptor α (ESR1) is one of the implicated genes.AimTo analyze whether the methylation of region III (RIII) of the ESR1 promoter is involved in the biological basis of gender dysphoria.MethodsWe carried out a prospective study of the CpG methylation profile of RIII (−1,188 to −790 bp) of the ESR1 promoter using bisulfite genomic sequencing in a cisgender population (10 men and 10 women) and in a transgender population (10 trans men and 10 trans women), before and after 6 months of gender-affirming hormone treatment. Cisgender and transgender populations were matched by geographical origin, age, and sex. DNAs were treated with bisulfite, amplified, cloned, and sequenced. At least 10 clones per individual from independent polymerase chain reactions were sequenced. The analysis of 671 bisulfite sequences was carried out with the QUMA (QUantification tool for Methylation Analysis) program.OutcomesThe main outcome of this study was RIII analysis using bisulfite genomic sequencing.ResultsWe found sex differences in RIII methylation profiles in cisgender and transgender populations. Cismen showed a higher methylation degree than ciswomen at CpG sites 297, 306, 509, and at the total fragment (P ≤ .003, P ≤ .026, P ≤ .001, P ≤ .006). Transmen showed a lower methylation level than trans women at sites 306, 372, and at the total fragment (P ≤ .0001, P ≤ .018, P ≤ .0107). Before the hormone treatment, transmen showed the lowest methylation level with respect to cisgender and transgender populations, whereas transwomen reached an intermediate methylation level between both the cisgender groups. After the hormone treatment, transmen showed a statistically significant methylation increase, whereas transwomen showed a non-significant methylation decrease. After the hormone treatment, the RIII methylation differences between transmen and transwomen disappeared, and both transgender groups reached an intermediate methylation level between both the cisgender groups.Clinical ImplicationsClinical implications in the hormonal treatment of trans people.Strengths & LimitationsIncreasing the number of regions analyzed in the ESR1 promoter and increasing the number of tissues analyzed would provide a better understanding of the variation in the methylation pattern.ConclusionsOur data showed sex differences in RIII methylation patterns in cisgender and transgender populations before the hormone treatment. Furthermore, before the hormone treatment, transwomen and transmen showed a characteristic methylation profile, different from both the cisgender groups. But the hormonal treatment modified RIII methylation in trans populations, which are now more similar to their gender. Therefore, our results suggest that the methylation of RIII could be involved in gender dysphoria.Fernández R, Ramírez K, Gómez-Gil E, et al. Gender-Affirming Hormone Therapy Modifies the CpG Methylation Pattern of the ESR1 Gene Promoter After Six Months of Treatment in Transmen. J Sex Med 2020;17:1795–1806.     

A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome

Study ObjectiveTo evaluate whether there are any differences in bone mineral density (BMD) between normal weight and obese adolescents suffering from polycystic ovary syndrome (PCOS) with oligo/amenorrhea.DesignProspective cohort study.SettingAdolescent gynecology clinic in a general service hospital.ParticipantsSubjects consisted of adolescents between 16 to 18 years of age presenting with oligo/ amenorrhea with ultrasound morphology of polycystic ovaries ± evidence of hyperandrogenism over 24 months. Controls consisted of consecutive eumenorrheic patients within the same age group.InterventionsAll underwent full hormonal profile assessment, and dual energy X-ray absorptiometry and peripheral quantitative computed tomography scans.Main Outcome MeasuresAreal and volumetric BMD parameters.ResultsOf 37 adolescents with PCOS, 12 (32%) were obese with BMI ≥25, of which 9/12 (75%) were hyperandrogenic. The control group consisted of 40 normal weight eumenorrheic girls. The PCOS group overall had lower lumbar spine BMD values as compared to the controls (0.91 vs 0.97 g/ cm², P = 0.033). The normal weight PCOS group had lower BMD at the spine (0.90 vs 0.97 g/ cm², P = 0.027), trochanter (0.66 vs 0.71 g/ cm², P = 0.039) as well as volumetric distal tibial core sites (268 vs 296 mg/ cm³) as compared to eumenorrheic controls, but there were no significant BMD differences between the obese PCOS group and the eumenorrheic controls.ConclusionsNormal weight PCOS adolescents with oligo/amenorrhea have marginally lower BMD values than controls, but obese PCOS adolescents have BMD values compatible with eumenorrheic adolescents.     

Treatment with teriparatide in a patient with pregnancy-associated osteoporosis

Introduction.?The decrease of BMD during a physiological pregnancy can in rare cases be intensified and lead to dramatic microarchitectural changes, which causes an increase incidence of fractures, preferably at the spine. This dramatic clinical picture is called pregnancy-associated osteoporosis.

Case history.?We present the case of a 40-year-old woman (gravida IV, para II) with acute back pain right after delivery due to four fractures of the spine. The diagnosis was confirmed by dual-energy X-ray absorptiometry measurement result (T-score??4.1 SD (0.598?g/cm²) at the lumbar spine (L1–L4), T-score??1.5 SD (0.759?g/cm²) at the total hip). Due to the severity of symptoms, a therapy with teriparatide (20?mg daily) was started for a period of 18 months.

Results.?After end of therapy, the T-score had significantly increased at the lumbar spine as well as at the hip (T-score of??2.1 (0.813?g/cm²) and??0.6 (0.864?g/cm²), respectively. The relative increase of BMD at the spine and total hip was 36% and 13.8%, respectively.

Discussion.?Our report demonstrates the successful use of teriparatide underlined by the increase of bone mineral density and the improvement of clinical symptoms in a case of severe pregnancy-associated osteoporosis for the first time.     

Changes in bone mass and body composition after bariatric surgery

Abstract

Aim: To analyze the effects of body weight loss on bone mineral density (BMD) on hip (Hip BMD) and lumbar spine (Lumbar BMD) after six months of bariatric surgery. Bariatric surgery is an effective treatment for morbid obesity. Nonetheless, there are scant data on the effect of weight bearing on bone structure.

Material and methods: Seventeen obese women aged 41.2?±?11.3 yrs. who underwent Roux-en-Y gastric bypass (RYGB) were included. Body composition assessments were performed through dual-energy X-ray absorptiometry immediately before and after 6-months RYGB. Data collected pre- and post-RYGB included total body weight, body mass index (BMI), lean body mass (LM), fat mass (FM) and bone mineral content. The pre- (PRE) and post-operative (POST) results were compared.

Results: Lumbar BMD POST presented a non-significant loss of 1.8% whereas Hip BMD POST showed a significant loss of 17.8%. The analysis demonstrated that BMI and LM PRE explained 26% and 49%, respectively, of Hip BMD PRE variability. In addition, LM POST explained 30% of hip BMD POST variability and was not significant for Lumbar BMD POST.

Conclusions: Obesity and rapid weight loss showed direct influence in Hip BMD after six months of bariatric surgery. However, its effect on the lumbar spine area was smaller due to the higher capacity of the spine to dissipate loads through its curvature.     

Association of tibolone and fluoride displays a pronounced effect on bone mineral density in postmenopausal osteoporotic women.

A double-blind, placebo-controlled, randomized, prospective two-center study was carried out to assess the effects of tibolone + fluoride versus placebo + fluoride therapy on trabecular and cortical bone in postmenopausal osteoporotic women. Ninety-four subjects (mean age 61.1 years, postmenopausal 13.5 years on average) with low bone mineral density (BMD) at baseline were randomized to 2.5 mg of tibolone (Org OD 14, Livial) plus 26.4 mg of fluoride (Fluocalcic) or placebo plus 26.4 mg of fluoride daily over 2 years; 55 (58.5%) subjects completed the study, the main reason for discontinuation being untoward gastrointestinal effects. BMD at the lumbar spine was measured by both dual photon absorptiometry (DPA) and dual-energy X-ray absorptiometry (DXA), and at the hip by DXA at 6-month intervals. Baseline values (DXA, g/cm2) for tibolone + fluoride and placebo + fluoride groups were 0.733 and 0.744 for the lumbar spine, and 0.761 and 0.788 for the hip. Change from baseline and percentage change from baseline were calculated for the intent-to-treat and completers groups. An analysis of variance (ANOVA) model or Wilcoxon test was used for statistical evaluation. There was a mean increase in BMD at the lumbar spine measured by DPA of 25.3% and 12.3% in tibolone + fluoride and placebo + fluoride groups, respectively (p = 0.01); with DXA, respective changes were 32.6% and 14.0% (p = 0.013). Data on BMD at the hip showed mean increases of 7.9% and 2.6% for the tibolone + fluoride and placebo + fluoride groups, respectively. We conclude that combined tibolone + fluoride treatment induces a highly significant increase in BMD at the lumbar spine without simultaneous loss of the cortical bone allowing for a meaningful reduction of the fluoride dose when given in combination with tibolone.     

Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis

STUDY OBJECTIVE: To evaluate the bone density of adolescents with endometriosis treated with a GnRH-agonist and "add-back" therapy with norethindrone acetate. DESIGN: Retrospective chart review. SETTING: Pediatric gynecology clinic at a tertiary care center. PARTICIPANTS: 36 adolescents, ages 13 to 21 years, with endometriosis. MAIN OUTCOME MEASURES: Bone mineral density (BMD, g/cm(2)) by dual energy x-ray absorptiometry (DXA); BMD Z-scores of hip and spine. RESULTS: The mean BMD Z-score at the total hip was -0.24 +/- 1.0, with a range of -2.4 to 1.7. At this site, 6 subjects had a BMD Z-score between -1.0 and -2.0 SD, while 2 had a Z-score < or = -2.0 SD. The mean BMD Z-score at the lumbar spine was 0.55 +/- 1.1, with a range of -2.8 to 1.4. At the spine, 11 subjects had a BMD Z-score between -1.0 and -2.0 SD, while 3 had a Z-score < or = -2.0 SD. There was no correlation noted between duration of therapy with the GnRH-agonist plus add-back and BMD at the hip or spine. CONCLUSION: BMD at the hip was normal in most adolescents with endometriosis who were receiving a GnRH-agonist plus add-back therapy with norethindrone acetate. Almost one third of subjects exhibited skeletal deficits at the spine. These data suggest that BMD should be carefully monitored in adolescents receiving treatment with GnRH agonists.     

Visual Conformity With Affirmed Gender or “Passing”: Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People

BackgroundVisual conformity with affirmed gender (VCAG) or “passing” is thought to be an important, but poorly understood, determinant of well-being in transgender people. VCAG is a subjective measure that is different from having an inner sense of being congruent with one's gender identity.AimWe examined the frequency and determinants of VCAG and explored its association with mental health outcomes in a cohort of transgender adults.MethodsThe “Study of Transition, Outcomes & Gender (STRONG)” is a cohort of transgender individuals recruited from 3 Kaiser Permanente health plans located in Georgia, Northern California and Southern California. A subset of cohort members completed a survey between 2015 and 2017. VCAG was assessed as the difference between 2 scales: scale 1 reflecting the person's sense of how they are perceived by others, and scale 2 reflecting the person's desire to be perceived. Participants were considered to have achieved VCAG when their scale 1 scores were equal to or exceeded their scale 2 scores. The frequency of VCAG and their independent associations with anxiety and depression symptoms were explored using data from 620 survey respondents including 309 transwomen and 311 transmen. Based on self-described gender identity, none of the participants identified as nonbinary or gender fluid.OutcomesVCAG, depression, and anxiety.ResultsVCAG was achieved in 28% of transwomen and 62% of transmen and was more common in persons who reported greater sense of acceptance and pride in their gender identity as measured on the Transgender Congruence Scale. Another factor associated with greater likelihood of VCAG was receipt of gender-affirming surgery, but the association was only evident among transmen. Participants who achieved VCAG had a lower likelihood of depression and anxiety with prevalence ratios (95% confidence intervals) of 0.79 (0.65, 0.96) and 0.67 (0.46, 0.98), respectively.Clinical ImplicationsVCAG may serve as an important outcome measure after gender-affirming therapy.Strengths and LimitationsStrengths of this study include a well-defined sampling frame and use of a novel patient-centered outcome of interest. Cross-sectional design and uncertain generalizability of results are the limitations.ConclusionThese results, once confirmed by prospective studies, may help better characterize the determinants of well-being in the transgender community, facilitating the design of interventions to improve the well-being and quality of life of this vulnerable population.To M, Zhang Q, Bradlyn A, et al. Visual Conformity With Affirmed Gender or “Passing”: Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People. J Sex Med 2020;17:2084–2092.     

Bone Accretion in Adolescents Using the Combined Estrogen and Progestin Transdermal Contraceptive Method Ortho Evra: A Pilot Study

ObjectiveTo date, there are no data regarding the effect of the transdermal combined estrogen and progestin contraceptive Ortho Evra on bone mineral content (BMC) and bone mineral density (BMD). We examined the effects of transdermally delivered ethinyl estradiol and norelgestromin on whole body (WB) BMC and BMD of the hip and lumbar spine (LS) of adolescent girls.MethodsIn a matched case-control study, girls (n = 5) who applied Ortho Evra for days 1-21 followed by days 22-28 free of medication for 13 cycles (about 12 months) were compared with 5 age- and ethnicity-matched control girls. Evaluations of calcium intake; bone-protective physical activity; bone densitometry (DXA, QDR 4500A, Hologic); bone formation markers serum osteocalcin (OC) and bone-specific alkaline phosphatase (BAP); bone resorption marker urinary N-telopeptide (uNTX); insulin growth factor-1 (IGF-1); and sex hormone binding globulin (SHBG) were carried out at initiation, 6 months, and 12 months. Changes from baseline were compared using mixed models, adjusting for follow-up comparisons using the Holm Test (sequential Bonferroni).ResultsThere were no significant differences (SD) between groups at baseline in age, gynecologic age, WBBMC, hip BMD, and LSBMD. Girls on Ortho Evra did not change significantly in WBBMC (12-month mean increase 0.2% ± 0.8%), whereas controls did (3.9% ± 1.8%, P ≤ .001, adjusted P = .002), with SD between the 2 groups (P = .007, adjusted P = .036). Adolescents on Ortho Evra did not change significantly in hip BMD (12-month mean increase 0.5% ± 0.6%), whereas controls did (2.7% ± 0.6%, P ≤ .001, adjusted P = .004), with SD between the 2 groups (P = .024) prior to adjustment for multiple comparisons, but no SD after adjustment (P = .096). Similarly, although the increase in LSBMD within the control group after 12 months (mean increase 2.8% ± 1.0%) was statistically significant (P = .009, adjusted P = .044), the change within the treatment group (12-month mean increase 0.8% ± 0.8%) was not. However, percent LSBMD changes after 12 months did not significantly differ between the 2 groups before or after adjustment for multiple comparisons. Calcium intake and bone-protective physical activity did not significantly predict BMC and BMD changes of study participants. There was a significantly greater increase in SHBG levels in the treatment group after 6 months (P = .003, adjusted P = .013) and 12 months (P ≤ .001, adjusted P ≤ .001) than in controls. Changes in levels of OC, BAP, uNTX, and IGF-1 were not significantly different between the 2 groups.ConclusionsOrtho Evra use attenuates bone mass acquisition in young women who are still undergoing skeletal maturation. This attenuation may be attributed in part to increased SHBG levels, which reduce the concentrations of free estradiol and free testosterone that are available to interact with receptors on the bone. Clinical implications remain to be determined in studies with a larger number of adolescents.     

Comparison of bone mineral density and its variables between premenopausal and postmenopausal women

Objectives

To compare the bone mineral density (BMD) and its variables in premenopausal and postmenopausal women.

Methods

In this cross sectional study, 62 premenopausal and 62 postmenopausal apparently healthy women were evaluated by a questionnaire. The dietary intake of calcium was evaluated by 24 hours recall method and using table for proximate principle of common Indian food by Indian Council of Medical Research (ICMR). BMD at lumbar spine, femoral neck and Ward’s triangle were measured by dual energy X-ray absorptiometry (DXA). A correlation between BMD and various variables were calculated for each of the two groups.

Results

The mean age of premenopausal and postmenopausal women was 32.46±7.8 and 51.74±7.1 years respectively. The body mass index (BMI), height and weight were comparable in both the groups. The daily intake of calcium was significantly higher in premenopausal women (p<0.01). Approximately, 17% of the postmenopausal women and 9.6% of the premenopausal women were having osteoporosis; 28.56% of the postmenopausal women and 43.54% of the premenopausal women were having osteopenia at the lumbar spine. The BMD at lumber spine was found to be statistically significantly higher in premenopausal women than that in postmenopausal women (p=0.03). BMD at lumbar spine, femoral neck and Ward’s triangle were positively correlated with height, weight, BMI in premenopausal as well in postmenopausal women.

Conclusion

A significant number of women had osteopenia during premenopausal period and osteoporosis in postmenopausal phase. By increasing awareness towards bone health in second and third decade, morbidity of osteoporosis can be reduced.     

Postmenopausal women with osteoporosis may be associated with high endothelin-1

Aim. We aimed to find out if there was any difference of the endothelin-1 (ET-1) and asymmetric dimethylarginine (ADMA) levels between osteoporotic and non-osteoporotic healthy postmenopausal women and whether there were any associations between ET-1 and ADMA levels and bone mineral density (BMD).

Methods. A total of 75 healthy postmenopausal women were enrolled in the study. BMD was measured at lumbar spine (LS) and femur neck (FN). Serum ET-1 and ADMA levels were measured by ELISA. In this population, 41 (54%) women had BMD t-scores ≥ 2.5 at the LS and/or FN defined as osteoporosis and 34 (46%) of them had normal BMDs (non-osteoporotic group).

Results. The mean value of ET-1 serum level in patients was 0.42 ± 0.30, 0.28 ± 0.12 fmol/ml in osteoporotic and non-osteoporotic groups, respectively (p = 0.018). In non-osteoporotic group, there was an only significant positive correlation was found between BMD (g/cm²) and total t-scores at the lumbar region and ET-1 level. In osteoporotic group, no correlation was found between BMD and total t-scores and ET-1 levels. Serum ADMA level was not significantly different between osteoporotic and non-osteoporotic postmenopausal women (p > 0.05).

Conclusions. ET-1 may be a physiologic regulator in non-osteoporotic healthy postmenopausal women. Osteoporotic postmenopausal women had higher ET-1 levels than non-osteoporotic postmenopausal women. ADMA seems not to have effect on bone in postmenopausal women.     

Tibolone and osteoporosis

Background We conducted a 5-year prospective, observational, controlled study to assess the effects of tibolone 1.25 mg/day on bone mineral density (BMD) in postmenopausal women with osteopenia or osteoporosis. Methods The subjects were 420 women, an average of 66.4 years old, who had been postmenopausal between 8 and 19 years when enrolled in the study. Of the 420 women enrolled, 346 agreed to take tibolone for 5 years. The 74 who refused tibolone took only calcium/vitamin D supplements and served as the control group. BMD was measured in the lumbar spine and total hip region at baseline and annually by dual-energy X-ray absorptiometry (DXA). Results At the first two follow-up visits, women taking tibolone had a significant increase in BMD at the spine (P < 0.001) and at the hip (P < 0.001) when compared to baseline values and when compared to BMD values for the control group, which decreased from baseline. In the final 3 years of the study, BMD values (spine and hip) continued to decrease in the control group and also tended to decrease in the tibolone group, but at the end of the fifth year, mean BMD in the tibolone group was still higher than BMD before the start of tibolone treatment (P < 0.05). Calculations showed that if women taking tibolone continued to lose BMD at the same rate as during the final 3 years of the study, after 11 years of tibolone treatment the average patient would have the same BMD as she had when treatment started. Conclusion This 5-year observational study provides evidence that tibolone is effective in increasing BMD in postmenopausal women with osteopenia and osteoporosis during the first 2 years of treatment, but because BMD starts to decline in the third year, it is vital that postmenopausal women start treatment with tibolone as early as possible, so that bone mineral density levels are kept high as long as possible.     

Effects of Hormone Replacement Therapy on Low Bone Mineral Density in Adolescents and Young Women with Hypogonadism: Comparison of Oral and Transdermal 17 Beta-Estradiol Administration

Study ObjectiveTo evaluate the effects of physiological dose 17 beta-estradiol (E₂) replacement on low bone mineral density (BMD) and compare the results of oral and transdermal (TD) E₂ administration in adolescents and young women with hypogonadismDesign, Setting, and ParticipantsWe retrospectively reviewed the medical records of patients aged 15 to 24 years who were diagnosed with hypogonadism, who had begun receiving oral or TD E₂ replacement, and whose initial dual-energy X-ray absorptiometry scan detected a lumbar spine BMD Z-score of -1 or lower between 2014 and 2018. The patients were divided into 2 groups according to the E₂ route of administration as those who received 2 mg orally (Group 1) and 0.1 mg TD (Group 2).InterventionsNoneMain Outcome MeasureBMD scans of the patients at baseline and repeated within 2 years after E₂ replacementResultsIn total, 43 patients who met the inclusion criteria were included in the study. Two groups did not differ for BMD scores at baseline. A significant improvement in BMD was observed with physiological dose E₂ replacement in both groups. Mean BMD Z-score increased by +0.7 (95% CI, 0.47-0.93) in response to TD E₂ administration, compared with +0.41 (95% CI, 0.25-0.58) during oral E₂ replacement (P = .037).ConclusionWe conclude that physiological dose E₂ replacement, even within a short period of 2 years, has a significant beneficial effect on bone mass acquisition on the lumbar spine. Our study also demonstrates the possible superiority of TD E2 replacement over the oral route in increasing lumbar spine BMD.     

Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures

Introduction

Hormone treatment induces feminization of the body in transwomen and masculinization in transmen. However, the effect of hormone treatment on facial characteristics is still unknown.

Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents

Background

Transgender adolescents aspiring to have the body characteristics of the affirmed sex can receive hormonal treatment. However, it is unknown how body shape and composition develop during treatment and whether transgender persons obtain the desired body phenotype.