We know that a lack of hormones affects bone health, but only when it happens in trans kids does it make the front page. Once again the facts get drowned out by hysteria-fueled misinformation. In this blog we take a calm look at the evidence.

Our bodies need hormones. The sex hormones we produce with the commencement of puberty are vital in supporting bone growth and maintaining their strength.

We know that at around the age of 50 when ovaries stop producing oestrogen the phase known as the ‘menopause’ begins and bones start to weaken, putting us more at risk of hip and wrist fractures in older age.

We know that people with severely low testosterone levels can suffer with low bone density.

We know that young people who experience a late puberty will have lower bone density than their peers who began an earlier puberty. We also know that replacing those hormones allows the bones to regain their strength. Once a late pubertal teenager starts puberty, their bones develop in line with those of their peers. No harm done.

We know that when hormone levels are impacted with age, the introduction of hormone replacement therapy (HRT) has the effect of strengthening bones.

We know that when other medicines we may be taking impact our hormone levels, steps need to be taken to protect bone health as people reach their 50s. A great example of this is the depo-provera contraception injection, which studies have shown, can lower oestrogen levels. People who stop the depo injection and allow their oestrogen levels to return, regain their bone density.

This is all common knowledge, and has been for some time.

However, if you allow discussion around a medical intervention for a young trans person, it becomes front page news and, despite this being a medical conversation, everyone has something to say about it.


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The conversation needs to change.

No one is saying that bone health is not an important consideration in the treatment of trans youth. It is important – very. But the question we should be asking is not whether we should delay puberty, but when we should allow the right puberty to start.

Blockers stop hormones, that is their job and it is one that they do very effectively. Hormones facilitate growth and development. It is prolonged periods of time without hormones that are cause for concern, not the blocker itself.

GenderGP operates In line with international guidelines which agree that puberty blockers should be introduced when the young person is ready, and are not needed earlier than Tanner Stage 2, the start of puberty. Then gender-affirming hormones should be introduced when the young person is ready to start puberty.

The result is the one that we should all be aiming for: happy, healthy bones and happy, healthy trans youth.

For more information, please see our Factsheet on bone density scans.


Photo by Cara Shelton on Unsplash