Orthopaedic surgery and gender transition

As part of our public consultation into proposed changes to planned orthopaedic surgery, we are keen to hear the views of those who identify as transgender or who have transitioned.  We are committed to ensuring that services in the future take account of the needs of all patients and any feedback received will help us to do this.

If you would be happy to have a conversation with a member the team, please contact: colin.beesting@nhs.net

Why might  trans people be affected by changes to how planned orthopaedic surgery is organised? 

In reviewing current services, we identified groups for who any changes might have an additional impact. Some research suggests:

Trans men (assigned female at birth) and trans women (assigned male at birth) and some non-binary people on HRT may be at risk of osteoporosis because: 

  • The need to take hormones that change the balance of oestrogen and testosterone in the body. 
  • After gender reassignment surgery, the level of hormones may decrease, and this may also affect bone density. 
  • The degree to which either of these factors affect the risk of breaking a bone, however, remains uncertain. 
  • Replacement sex hormones (testosterone for trans men and oestrogen for trans women) are necessary to maintain bone strength and are generally continued long-term. 

(National Osteoporosis Society (2014): Transsexual people and osteoporosis). 


Research has also found:

  • When some male-to-female trans people have their testicles removed it can affect bone density as the body’s natural levels on testosterone are too low. 
  • However, evidence suggests that taking oestrogen instead compensates for the decrease in testosterone. 
  • Some trans men who are unable to take testosterone use Depo-Provera to stop their periods from occurring, and, there is some concern that using Depo-Provera can negatively affect bone density 

(Vancouver Coastal Health, Transcend Transgender Support & Education Society and Canadian Rainbow Health Coalition (2006): Trans people and osteoporosis).


It must be noted that the research available on this issue is limited.

Due to the evidence  above, gender reassignment was scoped in as a ‘protected characteristic’ that may have a disproportionate need. 

If you have any questions about any of this information, please ask your regular healthcare professional for advice or sign-posting to an appropriate service. 

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