Influence of androgen receptor on bone health in transgender adults: insights from the COMET study

Purpose: Previous studies show that transgender and gender-diverse (TGD) individuals, especially those assigned male at birth (AMAB), often have low bone mineral density (BMD) before beginning gender-affirming hormone therapy (GAHT). The reasons for this are not fully understood, and the potential role of androgen receptor (AR) polymorphisms — known to affect bone density in the general population — has not been explored. This study aims to assess the impact of AR polymorphisms on bone health in the TGD population. Methods: This is an observational study involving 135 TGD and 107 cisgender participants. Collected data included hormonal profiles and phospho-calcium metabolism, bone geometry and density (Dual Energy X-ray Absorptiometry and peripheral Quantitative Computed Tomography). For the genetic study related to the AR, genomic DNA was extracted from peripheral blood leukocytes. Results: TGD individuals had lower BMD values compared to their cisgender peers. In a subgroup of 129 in...