• Dexa Scan question

Posted: **Sun Jul 27, 2025 5:56 am**

I see my primary care doctor in a few days. She specializes in gender affirming care and she manages my TRT. I've stopped TRT a week ago and I'm going to discuss alternatives and request a Dexa bone density test. My insurance thankfully cover it and the copay isn't too bad. There were two versions of the test listed. One for lower extremities such as legs,hips, and pelvis, and one for upper extremities such as the torso and arms. Is it better to get both, do they recommend both? Or is one scan such as the lower extremities enough to determine a accurate baseline to track bone loss over time?

Posted: **Sun Jul 27, 2025 6:32 am**

Interesting question, I'm not certain what the best answer is...

As a wheelchair user I'm at risk mostly in my lower body because of non-load bearing in my hips and legs. So for me they have always done the hip joint and femur.

According to some stuff I've seen on the historical eunuchs, particularly the Chinese and Castrati, there is some evidence of having it more in the upper body, neck and shoulders, basically because they had plenty of load bearing in general, but since the upper body has less, that is where it happens. (essentially the same cause as "Grandma Hunch")

However actually talking with Jesus, he says we really don't have a lot of data on modern eunuchs, and ideally it might be best to do both, just to develop more data if you are willing to share it... Downside of doing both is that while a DEXA scan is very low dose X-rays, it is still some exposure and doing both tests means more dose.

WheelyFixed

Posted: **Sun Jul 27, 2025 8:46 am**

WheelyFixed wrote: Sun Jul 27, 2025 6:32 am Interesting question, I'm not certain what the best answer is...

As a wheelchair user I'm at risk mostly in my lower body because of non-load bearing in my hips and legs. So for me they have always done the hip joint and femur.

According to some stuff I've seen on the historical eunuchs, particularly the Chinese and Castrati, there is some evidence of having it more in the upper body, neck and shoulders, basically because they had plenty of load bearing in general, but since the upper body has less, that is where it happens. (essentially the same cause as "Grandma Hunch")

However actually talking with Jesus, he says we really don't have a lot of data on modern eunuchs, and ideally it might be best to do both, just to develop more data if you are willing to share it... Downside of doing both is that while a DEXA scan is very low dose X-rays, it is still some exposure and doing both tests means more dose.

WheelyFixed

I think we are getting radiation no matter what. I can see it being both and thankfully my copay isn't that high for the dexa scans. The other scans and tests were a lot more expensive. I asked Microsoft Copilot about what would come next, and it said that I would likely be brought back in 6 weeks for more bloodwork and to evaluate my condition. Then again in 6 weeks, and then in 6-12 months. Then annual bone scans or what ever my insurance covers. Blood work might be once or twice a year. It's a lot better than every 3 months and weekly needles, and more blood draws. Low dose E patches might be the best option. I won't know that answer for some time.

Posted: **Mon Jul 28, 2025 7:19 am**

WheelyFixed wrote: Sun Jul 27, 2025 6:32 am Interesting question, I'm not certain what the best answer is...

As a wheelchair user I'm at risk mostly in my lower body because of non-load bearing in my hips and legs. So for me they have always done the hip joint and femur.

According to some stuff I've seen on the historical eunuchs, particularly the Chinese and Castrati, there is some evidence of having it more in the upper body, neck and shoulders, basically because they had plenty of load bearing in general, but since the upper body has less, that is where it happens. (essentially the same cause as "Grandma Hunch")

However actually talking with Jesus, he says we really don't have a lot of data on modern eunuchs, and ideally it might be best to do both, just to develop more data if you are willing to share it... Downside of doing both is that while a DEXA scan is very low dose X-rays, it is still some exposure and doing both tests means more dose.

WheelyFixed

I noticed that you are on a moderate dose of estradiol instead of the lowest dose possible approach. Did the starter dose feel like it wasn't enough, or is that what most doctors are recommending for eunuchs?

Posted: **Mon Jul 28, 2025 8:54 am**

Nick2023 wrote: Mon Jul 28, 2025 7:19 am I noticed that you are on a moderate dose of estradiol instead of the lowest dose possible approach. Did the starter dose feel like it wasn't enough, or is that what most doctors are recommending for eunuchs?

The dose I'm on is what my TG doc is recommending for me, not sure what might be suggested for other eunuchs. Keep in mind that because of my SCI, I'm at higher risk for bone issues than a TAB is, and that may be a factor in her recommendations... She said she wants me in the "normal" range for a pre-menopausal cis-woman, and has lowered my dose several times. (need to update my sig, currently I'm on the 0.75mg/day patch)

I probably should post more over in the AI thread, but I have been talking w/ (our) Jesus, and asked him about that thread. He said he is running it by some of his contacts w/ serious expertise to see what they think about it. One of the areas he said he particularly wanted confirmation on was the medication dosage suggestions (he isn't an MD, his contact is...)

WheelyFixed

Posted: **Mon Jul 28, 2025 11:42 am**

WheelyFixed wrote: Mon Jul 28, 2025 8:54 am
Nick2023 wrote: Mon Jul 28, 2025 7:19 am I noticed that you are on a moderate dose of estradiol instead of the lowest dose possible approach. Did the starter dose feel like it wasn't enough, or is that what most doctors are recommending for eunuchs?
The dose I'm on is what my TG doc is recommending for me, not sure what might be suggested for other eunuchs. Keep in mind that because of my SCI, I'm at higher risk for bone issues than a TAB is, and that may be a factor in her recommendations... She said she wants me in the "normal" range for a pre-menopausal cis-woman, and has lowered my dose several times. (need to update my sig, currently I'm on the 0.75mg/day patch)

I probably should post more over in the AI thread, but I have been talking w/ (our) Jesus, and asked him about that thread. He said he is running it by some of his contacts w/ serious expertise to see what they think about it. One of the areas he said he particularly wanted confirmation on was the medication dosage suggestions (he isn't an MD, his contact is...)

WheelyFixed

Oh very cool, the AI is a valuable tool. I see my Dr tomorrow to discuss stopping TRT and starting low dose HRT. I'll likely have to wait a month to clean my system out before I can start. Life is too busy for hormone withdraws right now which is a big factor in my decision but I might be in for mild symptoms. I'll know the verdict in a few weeks.

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