Effects of Gender-Affirming Hormone Treatment on Transgender Musculoskeletal Health

Gender-affirming hormone treatment (GAHT) is an intervention aimed at aligning transgender individuals' hormone levels with their gender identity, thereby alleviating gender dysphoria through modifications to secondary sex characteristics. However, to effectively promote skeletal health, it is crucial to consider the potential adverse effects of GAHT. A previous meta-analysis observed no significant effect of GAHT femoral neck (FN), lumbar spine (LS) or total hip (TH) bone mineral density (BMD) in transgender women. In transgender men, LS BMD showed a significant benefit (ES: 0.04 – 0.06 g•cm-2). However, since that analysis more data have been published and updated methods of meta-analysis have been developed; therefore, an updated systematic review and meta-analysis are warranted. Methods and analysis: Literature published in English up to 31/07/24 will be retrieved by searching 3 electronic databases, cross-referencing and expert review. The primary outcome measures will be changes in FN and LS BMD and lower limb BMD. The risk of bias for each study will be assessed using the Cochrane Risk of Bias instrument for non-randomised control trials (ROBINS-I), while the strength of evidence for each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Standardised effect sizes will be calculated from each study and pooled using the inverse heterogeneity (IVhet) model. Prospero Trial Registration number: CRD42024573102.