Table 2.

Key Considerations and Recommendations for Orthopaedic Surgeons and Specialists

Consideration	Recommendation
Risk for decreased bone mineral density in pediatric patients and delayed physeal closure	Survey pediatric transgender patients’ bone health
TW athletes have an increased risk of insufficiency fractures	BMD screening in TW patients
Higher risk of bone loss and low bone mineral density in patients who have gonadectomies and cease hormone therapy	BMD evaluation in individuals with risk factors for osteoporosis and those who stop sex hormone therapy after gonadectomy
TW athletes undergoing estrogen therapy have an increased risk of VTE.	Recommend VTE prophylaxis with any surgical procedure given elevated risk
Athletics are a protective health factor and inclusion policies are changing.	Orthopaedic care providers should remain advocates of their transgender athletes.
Both TW athletes receiving hormone therapy and TM athletes may be at increased risk for ligamentous injury (e.g., ACL injury).	Ensure modifiable risk factors are addressed (e.g., landing pattern modification).