The Royal Osteoporosis Society (ROS) advises that undergoing gender confirmation can increase the risk of osteoporosis and broken bones, particularly after surgical treatment for gender dysphoria. Hormone replacement treatment should be monitored carefully with bone health reassessed if hormone replacement is stopped or if blood levels become too low.¹⁸

Individual risk varies depending on the pattern of hormone replacement as well as general risk factors. As a trans woman reaches the normal age of menopause, there should be a discussion about whether to continue with HRT.

A bone density scan may not be necessary if hormone treatment is continuing satisfactorily, although osteoporosis treatments may be prescribed if required. Standard lifestyle advice such as a diet to ensure adequate calcium and vitamin D intake, as well as weight-bearing resistance exercise, is also recommended.

Trans women who lose sexual desire may respond to adjusting hormone therapy, for example by adding low-dose testosterone.¹²

Anecdotal advice offered by bloggers or online forums discusses the value of erectile dysfunction treatments. Trans women with penises have said that a phosphodiesterase type 5 inhibitor can improve tumescence and duration, but as PDE-5 inhibitors also require initial arousal, they may not be effective where libido is particularly low.¹⁹