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Revue Endocrine Society : peu de changement de densité osseuse sous hormones, presque aucune donnée sur les fractures

Effet des stéroïdes sexuels sur la santé osseuse des personnes transgenres : revue systématique et méta-analyse

Revues systématiques & des données probantesHormones croisées
Authors
Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, Mohammad Hassan Murad
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2017
Source
https://doi.org/10.1210/jc.2017-01642

Summary

This review was one of the evidence reviews behind the Endocrine Society's 2017 guideline on treating gender dysphoria (distress about one's sex). The Mayo Clinic team combined 13 studies (639 people, mostly adults) that measured bone density before and after cross-sex hormones. Testosterone in females made no measurable difference to spine or hip bone density over one to two years. Estrogen in males slightly raised spine bone density. Only one study looked at broken bones (none in a year), and only one looked at teenagers given puberty blockers (drugs that pause puberty) and then hormones. That study found males had lower spine bone density at age 22 than before treatment. The authors said the effect on the risk of broken bones is uncertain. The review is reassuring about short-term bone density in adults, but cannot show long-term safety, fracture risk, or safety for teenagers.

Key findings

  • La revue a combiné 13 études couvrant 639 personnes : 392 nées hommes et 247 nées femmes.
  • Chez les femmes sous testostérone, la densité osseuse du bas de la colonne vertébrale et de la hanche n'a pas changé de façon mesurable après un ou deux ans.
  • Chez les hommes sous œstrogènes, la densité osseuse du bas de la colonne vertébrale a légèrement augmenté après un an et un peu plus après deux ans.
  • Une seule étude, portant sur 53 hommes et 53 femmes, s'est intéressée aux fractures, et n'en a trouvé aucune en 12 mois.
  • Une seule étude portait sur des adolescents ayant reçu des bloqueurs de puberté puis des hormones, et elle a trouvé que les hommes avaient une densité osseuse de la colonne vertébrale plus basse à 22 ans qu'avant le traitement.
  • Les auteurs ont dit que la plupart des preuves provenaient d'études présentant un risque modéré d'être trompeuses, et que l'effet sur le risque de fracture est incertain.
  • La revue a été réalisée pour l'Endocrine Society, selon un plan établi avec ses experts, afin d'étayer sa recommandation de 2017.

Abstract

BACKGROUND: The impact of sex steroids on bone health in transgender individuals is unclear.

METHODS: A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CIs).

RESULTS: Thirteen studies evaluating 639 transgender individuals were identified [392 male-to-female (MTF), 247 female-to-male (FTM)]. In FTM individuals and compared with baseline values before initiation of masculinizing hormone therapy, there was no statistically significant difference in the lumbar spine, femoral neck, or total hip bone mineral density (BMD) when assessed at 12 and 24 months. In MTF individuals and compared with baseline values before initiation of feminizing hormone therapy, there was a statistically significant increase in lumbar spine BMD at 12 months (0.04 g/cm2; 95% CI, 0.03 to 0.06 g/cm2) and 24 months (0.06 g/cm2; 95% CI, 0.04 to 0.08 g/cm2). Fracture rates were evaluated in a single cohort of 53 MTF and 53 FTM individuals, with no events at 12 months. The body of evidence is derived mostly from observational studies at moderate risk of bias.

CONCLUSION: In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.

Conclusion

In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.