Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2026

Gender Affirming Hormone Therapy and bone health of trans- and gender-diverse adults and older adults: a systematic review (#20)

Jesse Minshall 1 , Stephanie Than 1 2 , Brendan Nolan 3 4 5 , Jesse Zanker 2 6
  1. Geriatric Medicine Unit, Western Health, Melbourne, Victoria, Australia
  2. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
  3. Trans Health Research Group, The University of Melbourne, Melbourne, Victoria, Australia
  4. Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  5. Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  6. Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia

Aims

The trans-and gender-diverse (TGD) population is growing and ageing. Bone health is affected by sex hormones which are integral to the medical transition undertaken by many TGD individuals for gender affirmation. This systematic review aims to determine the impact of gender affirming hormone therapy (GAHT) on bone outcomes in TGD adults and older adults.

 

Methods

A systematic search of EMBASE, PsychINFO and Medline was conducted up to May 2025 to identify studies evaluating the bone health of adults on GAHT with, or without gender-affirming surgery. Abstracts and full texts were screened by three reviewers and full texts extracted by one reviewer with sample cross-checks. The Newcastle-Ottawa Scale tool was used to assess risk of bias and narrative synthesis was performed.

 

Results

A total of 5525 articles were screened and 36 met inclusion criteria for extraction. Only four studies stratified for age. No studies specifically examined the impact of GAHT on the bone health of adults aged >65 years. Pre-GAHT commencement, trans women had poorer bone health compared with members of their sex recorded at birth, in contrast to trans men. Long-term, GAHT may have a neutral or possibly positive effects on bone health in both transwomen and transmen but findings were inconsistent in studies of persons who underwent gender affirming surgery that included gonadectomy, which likely confounded long-term follow-up studies.

 

Conclusions

High quality research to guide bone health management of older TGD people is limited and required to ensure person-centred care of this priority population.