Initial Characterisation of Musculoskeletal Health in Ageing Transgender and Gender Diverse Women

As people grow older, their bodies naturally undergo a slow transformation where bones become more fragile and muscles lose their strength and power. This decline is a primary driver of frailty, falls, and the loss of independence that affects many older adults. For decades, medical science has understood how hormone therapy influences these tissues in younger people, but a significant gap has remained in our knowledge regarding older adults who are transgender. Specifically, there was little to no data on how the long-term use of feminising hormone therapy affects the bones and muscles of transgender women as they age. This uncertainty matters because early signs suggest that this population may face a higher risk of fractures than their cisgender peers, yet without clear evidence of what is happening inside their bodies, doctors cannot offer the best possible care or prevention strategies.

A team of researchers from Manchester Metropolitan University and Hong Kong Baptist University set out to fill this void by conducting the first detailed look at the musculoskeletal health of ageing transgender and gender-diverse women. They recruited forty-eight participants, all aged fifty or older, who had been receiving feminising hormone therapy for at least three months. The group was gathered at two community festivals in the United Kingdom, providing a practical way to reach people who might not otherwise engage with clinical research. The scientists did not rely on self-reported health histories alone; instead, they measured the participants directly. They assessed body composition using a method that sends a tiny, safe electrical current through the body to estimate fat and muscle mass. They checked bone quality by measuring how sound waves travel through the radius in the forearm and the tibia in the shin, a technique that gives a clear picture of bone density without radiation. They also tested physical strength by having participants squeeze a handheld device and jump vertically, while others performed a repeated sit-to-stand test to gauge functional mobility. Finally, they asked the participants to report how much time they spent walking, exercising, or sitting each week.

The results revealed a complex picture of health that challenges some assumptions and highlights urgent areas of concern. The study found that a significant portion of these women showed signs of muscle loss and weakness, a condition known as sarcopenia. While only a small fraction had very low handgrip strength, a much larger group—nearly forty percent—had low power in their leg muscles when jumping, and more than one in five could not complete the repeated sit-to-stand test within a standard time limit. Bone health was also a point of worry; the prevalence of osteoporosis, a disease where bones become dangerously brittle, was found to be higher in this group than in the general population of the United Kingdom. Furthermore, the participants were more likely to be classified as overweight or obese compared to the national average, and they were significantly less active, with only about one in four meeting the standard for being physically active, compared to nearly two-thirds of their age-matched peers in the wider population.

Perhaps the most surprising finding was that the length of time a woman had been on hormone therapy did not appear to be the main factor driving these differences in muscle or bone health. When the researchers analyzed the data, they found no significant link between how long someone had been taking hormones and their physical outcomes. Instead, the study pointed to body mass index and physical activity levels as the strongest predictors of how well the muscles were functioning. This suggests that the daily habits of these individuals, such as how much they move and their body weight, may play a larger role in their musculoskeletal health than the duration of their medical transition. The researchers noted that while the study was a pilot and involved a relatively small number of people, the patterns observed were clear enough to signal a need for further investigation.

The authors conclude that ageing transgender women face a unique set of challenges, carrying a higher burden of muscle weakness, bone fragility, and inactivity than previously documented. These findings do not suggest that hormone therapy is harmful, but rather that the natural ageing process, combined with lifestyle factors, creates a specific health profile that requires attention. The study demonstrates that it is possible to gather this kind of detailed health data from this community through community-based recruitment, but it also makes it clear that larger, long-term studies are now necessary. By understanding that body weight and activity levels are critical levers for health in this population, doctors and policymakers can begin to develop better screening tools and intervention strategies to help these women age with greater strength and independence.