Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study

Klaver, Maartje; Blok, Christel J.M. de; Wiepjes, Chantal M.; Nota, Nienke M.; Dekker, Marieke; Mutsert, Renée de; Schreiner, Thomas; Fisher, Alessandra D.; T’Sjoen, Guy; Heijer, Martin den

doi:10.1530/eje-17-0496

Cited by 130 publications

(133 citation statements)

References 17 publications

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“…Peripherally, the interaction with estradiol may explain the different effects of T on women metabolism [ 92 ]. Additionally, cross-sex hormonal therapy of male-to-female transsexuals increases the amount of subcutaneous adipose tissue accrual relative to intra-abdominal adipose tissue whereas more masculine body fat distribution with a lower hip circumference has been observed in trans males [ 93 ].…”

Section: Sex Hormones In Endocrine Gender-related Differencesmentioning

confidence: 99%

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Lauretta

Sansone

et al. 2018

International Journal of Endocrinology

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Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, “gender” refers to a sociocultural sphere of the individual, whereas “sex” only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how they can affect the human pathophysiology. The path to a tailored medicine in which every patient is able to receive early diagnosis, risk assessments, and optimal treatments cannot exclude the importance of gender. In this review, we have focused our attention on the involvement of sex hormones and gender on different endocrine diseases.

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Section: Sex Hormones In Endocrine Gender-related Differencesmentioning

confidence: 99%

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Lauretta

Sansone

et al. 2018

International Journal of Endocrinology

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“…Trans women (birth-assigned males, female identity) receive estrogens to induce feminization, resulting, for example, in breast growth (1) and changes in body composition. (2) Trans men (birth-assigned females, male identity) are treated with testosterone, which, among others, stimulates lowering of the voice (3) and growth of body hair. (4) Sex steroids also play important roles in the acquisition and homeostasis of bone.…”

Section: Introductionmentioning

confidence: 99%

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Wiepjes

Blok

Staphorsius

et al. 2019

Journal of Bone and Mineral Research

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Concerns about bone health in transgender people using gender‐affirming hormonal treatment (HT) exist, but the fracture risk is not known. In this nationwide cohort study, we aimed to compare the fracture incidence in transgender people using long‐term HT with an age‐matched reference population. All adult transgender people who started HT before 2016 at our gender‐identity clinic were included and were linked to a random population‐based sample of 5 age‐matched reference men and 5 age‐matched reference women per person. Fracture incidence was determined using diagnoses from visits to hospital emergency rooms nationwide between 2013 and 2015. A total of 1089 trans women aged <50 years (mean 38 ± 9 years) and 934 trans women aged ≥50 years (mean 60 ± 8 years) using HT for median 8 (interquartile range [IQR] 3–16) and 19 (IQR 11–29) years, respectively, were included. A total of 2.4% of the trans women aged <50 years had a fracture, whereas 3.0% of the age‐matched reference men (odds ratio [OR] = 0.78, 95% confidence interval [CI] 0.51–1.19) and 1.6% of the age‐matched reference women (OR = 1.49, 95% CI 0.96–2.32) experienced a fracture. In trans women aged ≥50 years, 4.4% experienced a fracture compared with 2.4% of the age‐matched reference men (OR = 1.90, 95% CI 1.32–2.74) and 4.2% of the age‐matched reference women (OR = 1.05, 95% CI 0.75–1.49). A total of 1036 trans men (40 ± 14 years) using HT for median 9 (IQR 2–22) years were included. Fractures occurred in 1.7% of the trans men, 3.0% of the age‐matched reference men (OR = 0.57, 95% CI 0.35–0.94), and 2.2% of the age‐matched reference women (OR = 0.79, 95% CI 0.48–1.30). In conclusion, fracture risk was higher in older trans women compared with age‐matched reference men. In young trans women, fracture risk tended to be increased compared with age‐matched reference women. Fracture risk was not increased in young trans men. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

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“…Prospective studies from the ENIGI cohort have reported that estradiol concentration did not predict breast development or more feminine changes in body composition in transfeminine individuals. 2,17 However, higher estradiol concentrations have been associated with a higher lumbar spine bone mineral density. 18 Ultimately, the best assessment of hormonal efficacy is the clinical response.…”

Section: Discussionmentioning

confidence: 99%

“…This results in development of feminine physical characteristics, including softening of skin, a decrease in facial and body hair growth, breast development, and changes in body composition manifested by body fat redistribution and decreased muscle mass. 1,2 Estradiol is most commonly administered via the oral or transdermal route, 3 and oral estradiol valerate is the most common first-line feminising treatment in clinicians experienced in transgender healthcare in Australia. 4 Several consensus guidelines give recommendations for estradiol concentrations to allow titration of estradiol therapy.…”

Section: Introductionmentioning

confidence: 99%

Relationships between body mass index with oral estradiol dose and serum estradiol concentration in transgender adults undergoing feminising hormone therapy

Nolan

Brownhill²,

Bretherton

et al. 2020

Therapeutic Advances in Endocrinology

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Aim: Feminising hormone therapy with estradiol is used to align an individual’s physical characteristics with their gender identity. Given considerable variations in doses of estradiol therapy administered as gender-affirming hormone therapy (GAHT), we aimed to assess if body mass index (BMI) correlated with estradiol dose/concentration and assess the correlation between estradiol dose and estradiol concentrations. Methods: In a retrospective cross-sectional study, we analysed transgender individuals attending a primary or secondary care clinic in Melbourne, Australia who were prescribed oral estradiol valerate for at least 6 months and had estradiol dose and concentration available. Estradiol concentration was measured by immunoassay. Outcomes were the correlation between estradiol dose and BMI, and estradiol dose and estradiol concentration. Results: Data were available for 259 individuals {median age 25.8 [interquartile range (IQR) 21.9, 33.5] years}. Median duration of estradiol therapy was 24 (15, 33) months. Median estradiol concentration was 328 (238, 434) pmol/l [89 (65, 118) pg/ml] on 6 (4, 8) mg estradiol valerate. Median BMI was 24.7 (21.8, 28.6) kg/m2. There was a weak positive correlation between estradiol dose and estradiol concentration ( r = 0.156, p = 0.012). There was no correlation between BMI and estradiol concentration achieved ( r = −0.063, p = 0.413) or BMI and estradiol dose ( r = 0.048, p = 0.536). Estradiol concentrations were within the target range recommended in consensus guidelines in 172 (66%) individuals. Conclusion: Estradiol dose was only weakly correlated with estradiol concentration, suggesting significant interindividual variability. Prescription of estradiol dose should not be based upon an individual’s BMI, which did not correlate with estradiol concentration achieved. In all, 66% of individuals achieved estradiol concentrations recommended in Australian consensus guidelines with a relatively high oral estradiol dose.

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Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study

Abstract: CHT causes a more feminine body fat distribution and a lower WHR in transwomen and a more masculine body fat distribution with a lower hip circumference in transmen.

Cited by 130 publications

References 17 publications

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Relationships between body mass index with oral estradiol dose and serum estradiol concentration in transgender adults undergoing feminising hormone therapy

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