Musculoskeletal Health in Ageing Transgender and Gender Diverse Women: A Pilot Study

Abstract

Abstract Introduction Age-related declines in bone and muscle health contribute substantially to frailty, falls, and functional loss in older adults. Despite the established musculoskeletal effects of hormone therapy (HT) in younger transgender and gender diverse women (TGDW), data on ageing TGDW do not exist. TGDW ≥50 years receiving feminising HT exhibit an 80% higher fracture incidence than cisgender adults. This pilot study explored the practicality of community-based recruitment of TGDW receiving HT and provided the first characterisation of musculoskeletal health in this population. Methods Cross-sectional pilot study recruited forty-eight TGDW aged ≥50 years undergoing feminising HT through two UK community festivals. Body composition (bioelectrical impedance analysis), bone quality (quantitative ultrasound of the radius and tibia), muscle strength and power (handgrip dynamometry, countermovement jump, and 5× sit-to-stand test), and physical activity (IPAQ-SF)were analysed using descriptive statistics, one-sample t-tests against clinical thresholds, and regression models exploring associations between HT duration and musculoskeletal outcomes, adjusting for age, BMI, and physical activity level. Results Sarcopenia incidence varied from 9% (handgrip strength) to 38% (countermovement jump power), and 38% of participants recorded counter-movement jump power below sarcopenia thresholds, whilst 21% could not complete the sit-to-stand test. Osteoporosis prevalence (8-13%) was higher than in the UK population (5%). Seventy-three per cent of participants were classified as overweight, and 33% classified as obese, higher than UK population norms (26%). Twenty-three per cent of TGDW were classed as physically active compared to their age-matched population (63%). Regression analyses showed no significant association between hormone therapy duration and musculoskeletal outcomes, whereas BMI (countermovement jump power β = 192.1, p adj =0.01; handgrip β = 0.60, p adj =0.02) was a stronger predictor of function. Conclusion High sarcopenia and osteoporosis prevalence, elevated obesity, and low physical activity highlight areas of concern. Larger longitudinal studies to characterise musculoskeletal ageing using clinical measures are needed. WHAT IS ALREADY KNOWN ON THIS TOPIC Ageing is associated with declines in bone and muscle health, leading to frailty, falls, and functional loss. Transgender and gender-diverse adults (TGDW) receiving feminising hormone therapy (HT) may experience musculoskeletal changes, but data on those aged ≥50 years are absent. WHAT THIS STUDY ADDS Provides the first characterisation of musculoskeletal health in ageing TGDW, highlighting osteoporosis and sarcopenia prevalence, substantial variation in bone quality and muscle function, functional limitations in a subset, elevated BMI and reduced physical activity. Demonstrates the feasibility of multi-domain musculoskeletal assessment in this population and identifies BMI and physical activity as stronger determinants of function than hormone therapy duration. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICY Supports the need for larger longitudinal studies to track musculoskeletal ageing in TGDW. Highlights key modifiable risk factors (BMI, activity) for interventions, informing clinical management and health policy for older TGDW populations.

Affiliated Institutions

• Hong Kong Baptist University HK
• Manchester Metropolitan University GB

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