Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bone mass, BMD maintenance, and lifetime decrease. As compared with women, men are more frequently affected by secondary osteoporosis. Therefore, in all osteoporotic men, a complete clinical history should be collected and a careful physical examination should be done, in order to find clues of a possible underlying diseases and, ultimately, to guide laboratory testing. Currently, the pharmacological therapy of male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide. Hypogonadal patients may be treated with testosterone replacement therapy. Given that the fractures related to mortality are higher in men than in women, treating male subjects with osteoporosis is of the utmost importance in clinical practice, as it may impact on mortality even more than in women.

Transgender and gender-diverse (TGD) individuals continue to experience harassment and discrimination across various aspects of life, significantly impacting their physical and mental health. The scarcity of data on their general health, particularly regarding dietary habits, remains a challenge in developing effective healthcare strategies for this population. To address this gap, we analyzed selected dietary habits, physical activity (PA), and body mass index (BMI) among Italian TGD adults compared to the Italian general population (IGP). An online anonymous survey was conducted via the Computer Assisted Web Interviewing technique from June 2020 to June 2021. Participants were enrolled through clinical centers and TGD organizations. Data from 959 TGD adults were analyzed using chi-squared tests and logistic regression models. Key findings indicated that approximately 70% of TGD individuals consumed fewer servings of fruit and vegetables (FV) than recommended (five or more servings per day). Although red meat consumption was lower overall, a greater percentage of TGD individuals reported consuming more than three servings per week. Additionally, 58% of TGD participants indicated that they did not engage in any PA, compared to 36% of the IGP. Notably, significant differences in BMI were identified, with higher rates of overweight and obesity among TGD individuals assigned female at birth. These results underscore the urgent need for tailored nutritional guidelines and inclusive public health strategies to meet the specific health needs of the Italian TGD population. Expanding access to targeted interventions could contribute to improving overall well-being in this marginalized group.

Purpose: Transgender and gender diverse (TGD) individuals have various medical needs, but limited healthcare professionals’ expertise remains a major barrier to care. Data on the preparedness of Italian endocrinologists to provide TGD care are scarce. This study assessed Italian endocrinologists’ knowledge, clinical practice, and educational needs in gender-affirming care. Methods: A nationwide survey developed by the Association of Medical Endocrinologists (AME), with support from the Italian Society for Gender, Identity and Health, was distributed to all AME members in 2023. Multivariable logistic regression identified factors associated with knowledge, self-reported ability to manage gender-affirming hormone therapy (GAHT) and interest in further education. Results: Overall, 703 endocrinologists completed the survey. Only 8.4% reported frequent clinical involvement with TGD patients, and fewer than 15% considered themselves able to initiate and monitor GAHT. Previous education in gender-affirming care was the strongest determinant of knowledge (OR 14.3) and self-reported ability to manage GAHT (OR 4.4). Younger age was associated with greater knowledge but not with perceived clinical competence. Nevertheless, 90.4% expressed interest in further education. Conclusion: Italian endocrinologists show substantial gaps in preparedness for transgender care. Structured education in gender-affirming care is strongly associated with greater knowledge and self-reported ability to manage GAHT, supporting the implementation of educational programs to improve access to competent endocrine care for TGD individuals.