The general consensus is to use bone scans to monitor bone density 1 to 2 years into treatment with gender affirming hormones, to check bone health after use of puberty blockers. There is no agreement on the necessity of baseline bone scans before starting treatment as bone mineral density generally falls in the expected range of the pre-treatment gender. It is our view that bone scans are not necessary unless there are specific risk factors, such as family history of non-traumatic bone fractures, or when risk factors for osteoporosis exist.