Transgender men or women age 20 and above who plan on having their ovaries or testes removed in the next 6 months.Exclusion• Patients who stop taking estrogen or testosterone during the follow up period • Patients on concomitant medication(s) affecting bone density (at baseline or during follow up period): bisphosphonates, systemic glucocorticoids, chemotherapy• Patients with medical conditions that affect bone density
In transgender medicine, we are completely reversing sex hormone levels. Sex hormones play a major role in regulating bone health. In order to ensure that the bone health of transgender individuals is not being harmed in the long term, we must ensure that the service we are providing is able to maintain bone health. In particular, there is evidence that transgender individuals are at risk of bone loss following gender affirming surgery where the ovaries or testes are removed. This study aims to determine whether current hormone regimens given to transgender patients after gender affirming surgery are sufficient for maintaining bone density.
We will prospectively examine the bone health before and one to three years after gender affirming surgery in a cohort of transgender patients. Methods to examine bone health will include bone turnover markers, and bone mineral density exam. Changes in bone density and bone markers will be correlated to their hormonal regimen and hormone levels. This will provide insight as to whether current hormone regimens need to be revised in order to optimize bone health in transgender individuals.
Research participants will have two study visits; the first visit will be before their surgery, and the second visit, at least 1 year after their surgery. Both study visits will involve a bone density test (like an x-ray), a questionnaire and possibly some blood tests.
How will this research help LGBT people and communities?
The findings from this research project will directly benefit the transgender community. Findings from our study will further our understanding of the relationship between bone health and hormone therapies pre and post surgery. With this information, health care providers will be able to chose hormone regimens that ensure the best bone health for this population. Furthermore, findings from our study will empower health care providers with important knowledge about the hormone therapy that they are prescribing. Since many providers have fear of side effects and risks of hormone therapy and may avoid prescribing hormones altogether, studies like ours will provide much needed guidance for treating transgender patients which will ultimately help improve access to care. The more information there is providing safety data for clinicians, the more they will be willing to prescribe this much needed therapy.
We offer 2 TTC tokens for your travel to each study visit if you wish. For those who have to come fasting for their appointment, we will offer a $7 gift card to have breakfast afterwards in the hospital café.
Name: Raymond Fung
Michael Garron Hospital Community Based Research Fund