SAT-782 Raloxifene as a Bridging Therapy for Low Bone Density in a Young Non-Binary Individual

Abstract Disclosure: A. Quiring: None. T. Chun: None. Clinical Case: A 19-year-old individual assigned female at birth was evaluated in 2017 for low bone density. At age 10, they underwent a total hysterectomy with bilateral oophorectomy for the treatment of a large yolk sac tumor involving the ovaries and uterus. Estrogen therapy was attempted multiple times for puberty induction, but they were dissatisfied with its emotional effects, stating, “I didn’t feel like myself.” Bone densitometry in 2017 revealed a Z-score of -2.6 at the spine, and a plain X-ray from 2013 suggested a possible T7 vertebral fracture. As they were not interested in estrogen therapy, they were advised to take calcium (150 mg TID) and vitamin D (50,000 IU weekly, Drisdol). In 2021, the patient came out as gender nonbinary and adopted they/them pronouns. At that time, they had been inconsistently taking calcium citrate, had discontinued vitamin D, and wished to restart their bone health regimen. They also expressed interest in testosterone microdosing, but their parents did not support gender-affirming hormone therapy. In 2022, raloxifene 60 mg daily was introduced to improve bone density while avoiding feminizing effects. The possibility of testosterone therapy was revisited but initially deferred due to parental objections. Later, however, the patient expressed renewed interest in testosterone, both for bone health and as a gender-affirming hormonal therapy. Later, AndroGel 20.25 mg per actuation (1.60%) was prescribed at a dose of one pump weekly and gradually increased. A bone densitometry scan in 2024 showed improved lumbar spine bone density, with a T-score of -2.3 compared to -2.9 in 2022, suggesting a positive response to treatment. Clinical Lessons: Maintaining bone health in non-binary individuals presents unique challenges, particularly when ovarian function is lost and estrogen therapy is not pursued. This case highlights the potential role of selective estrogen receptor modulators (SERMs) like raloxifene as a bridging treatment to improve bone density while respecting the patient’s gender identity. In situations where family and environmental support for gender-affirming care is limited, SERMs may offer a valuable alternative until a more specific hormonal regimen, such as testosterone therapy, can be initiated. Presentation: Saturday, July 12, 2025