Body fat changes in adolescents diagnosed with gender dysphoria and treated with GnRH analogues and cross-sex hormones

Body fat is preferably stored in the hip region in women and in the waist region in men. This results in a peripheral body fat distribution with a low waist-hip ratio (WHR) in women and a central fat distribution with a high... [ view full abstract ]

Body fat is preferably stored in the hip region in women and in the waist region in men. This results in a peripheral body fat distribution with a low waist-hip ratio (WHR) in women and a central fat distribution with a high WHR in men. In adult transgender health care there is increasing knowledge on the effects of cross-sex hormones (CSH) on total body fat and body fat distribution. However, little is known how body fat and its distribution are affected in adolescents diagnosed with gender dysphoria (GD) who are first treated with gonadotropin releasing hormone analogues (GnRHa) solely and subsequently combined with CSH.

The aim of this study is to determine the effects of endocrine treatment on total body fat, android body fat, gynoid body fat and WHR in adolescents with a GD diagnosis during GnRHa monotherapy and subsequently with the... [ view full abstract ]

The aim of this study is to determine the effects of endocrine treatment on total body fat, android body fat, gynoid body fat and WHR in adolescents with a GD diagnosis during GnRHa monotherapy and subsequently with the addition of CSH.

This retrospective study included young adults diagnosed with GD (DSM-IV TR) in their teens and who were treated by a four-step protocol. This four-step protocol included psychological evaluation, treatment with GnRHa, the... [ view full abstract ]

This retrospective study included young adults diagnosed with GD (DSM-IV TR) in their teens and who were treated by a four-step protocol. This four-step protocol included psychological evaluation, treatment with GnRHa, the addition of CSH from the age of 16 and gonadectomy from the age of 18 with cessation of GnRHa. At the start of GnRHa treatment, at the start of the addition of CSH and at the age of 22 body composition was measured using Dual Energy X-ray Absorptiometry (DXA) (Hologic Discovery A, Hologic Inc., USA). In addition, waist and hip circumferences were measured with a measure tape. All statistical analyses were performed with STATA 13.1. For all analyses, missing data were excluded. Since all data were not normally distributed, medians and ranges were reported and Wilcoxon rank tests were used. All participants signed informed consent.

Outcome measures include total body fat, android fat percentage, gynoid fat percentage and WHR in adolescents with a GD diagnosis during GnRHa monotherapy and subsequently with the addition of CSH. [ view full abstract ]

Outcome measures include total body fat, android fat percentage, gynoid fat percentage and WHR in adolescents with a GD diagnosis during GnRHa monotherapy and subsequently with the addition of CSH.

24 transwomen and 31 transmen were included. GnRHa were started at a median age of 15.1 years (13.3-18.0), CSH were added at a median age of 17.6 years (15.4-19.1). In transwomen, during GnRHa monotherapy total body fat (TBF)... [ view full abstract ]

24 transwomen and 31 transmen were included. GnRHa were started at a median age of 15.1 years (13.3-18.0), CSH were added at a median age of 17.6 years (15.4-19.1).
In transwomen, during GnRHa monotherapy total body fat (TBF) increased with +6% (0-12) (p=0.01), percentage gynoid fat increased with +8% (2-13) (p=0.01) whereas the percentage android fat increased with +4% (0-11) (p=0.01). When estrogens were added till the age of 22, these increases were +3% (-2-12) (p=0.03), +3% (-2-9) (p=0.01) and +1% (-5-17) (p=0.20), respectively. From start of GnRHa monotherapy till the age of 22, WHR decreased with 0.05 (-0.1-0.2) (p=0.05).
In transmen, during GnRHa monotherapy TBF increased with +3% (1-7) (p<0.01), percentage android fat increased with +2% (-1-11) (p=0.01) and percentage gynoid fat with +3% (1-7) (p<0.01). However after the addition of androgens until the age of 22, TBF decreased with -6% (-16-5) (p<0.01), percentage android fat with -2% (-19-13) (p=0.03) and percentage gynoid fat with -8% (-16;-1) (p<0.01). From the start of GnRHa monotherapy till the age of 22, WHR increased with 0.03 (-0.2-0.1) (p=0.09).

Conclusion and Discussion. During endocrine treatment TBF, gynoid fat and android fat increased in transwomen. This increase was most pronounced during GnRHa monotherapy coinciding with a higher increase in gynoid fat than in... [ view full abstract ]

Conclusion and Discussion.
During endocrine treatment TBF, gynoid fat and android fat increased in transwomen. This increase was most pronounced during GnRHa monotherapy coinciding with a higher increase in gynoid fat than in android fat. In addition, there was a trend in WHR reduction. These changes may reflect a more feminized phenotype of body fat distribution. In contrast, TBF in transmen decreased during testosterone suppletion with a larger decrease of gynoid fat than android fat. Together with a trend of WHR increase, these changes suggest a masculinized body fat distribution phenotype.
Sex steroids mediate the sex differences in the metabolism, accumulation and distribution of adipose tissues. This may partially be explained by varying amounts of the estrogen-, progesterone- and androgen receptors present in adipose tissues in men and women. A sex steroid profile matching the karyotype results in a sex typical distribution of body fat. Alteration of sex steroid hormone levels and/or balance between androgens and estrogens causes a change in fat deposition. This may explain why the loss of androgens in transwomen had a greater effect than the presence of estrogens. Indeed, taking together that testosterone more markedly affected body fat in transmen, suggests a dominant role for androgens.