Body Composition and Bone Mineral Density in Male-to-Female Transsexuals During Cross-Sex Hormone Therapy Using Gonadotrophin-Releasing Hormone Agonist
Abstract
OBJECTIVE: In transsexual people, cross-sex hormone therapy is an important component of medical treatment and results in a complete change in the sex hormone environment. Steroid hormones plays an important role in developing and maintaining bone mass and body composition in both sexes. The aim of this study was to evaluate changes in body composition and bone mineral density (BMD) during cross-sex hormone therapy in transsexuals using gonadotrophin-releasing hormone agonists and intramuscular oestrogens. METHODS: 84 male-to-female transsexuals (MtFs) were treated with 10 mg oestradiol-17β valerate every 10 days. The study population was treated with subcutaneous injections of 3.8 mg goserelin acetate every 4 weeks to suppress endogenous sex hormone secretion completely. Endocrine parameters, body composition and BMD after 12 months and after 24 months were compared with baseline values. RESULTS: There was a significant decline in gonadotrophins and testosterone, while oestradiol, sex hormone-binding globulin, and high-density lipoprotein levels increased significantly after 12 and 24 months. There was a significant increase in body mass index (BMI), fat mass, and lumbar spine bone mineral density in MtFs during the study period, while lean mass decreased significantly and no effect was observed on femoral bone mineral density. CONCLUSION: There was an increase in BMI associated with a shift from lean mass to fat mass. There appears to be no risk of osteoporosis developing in MtFs when there is adequate oestrogen substitution, even in the absence of testosterone. Furthermore in comparison with hormone regimes using oral medications, the complication rates appear to be lower in patients receiving gonadotrophin-releasing hormone agonists and intramuscular oestrogens.
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Twelve longitudinal studies have examined the effects of testosterone suppression on lean body mass or muscle size in transgender women.
“Including Gooren and Bunck [62], 12 longitudinal studies [53, 63–73] have examined the effects of testosterone suppression on lean body mass or muscle size in transgender women.”
From Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage (2021) · cites this paper as [64]
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Brown, A., Montagner-Moraes, S., Hu, K., Singh, J., Charlton, L., Barrett, J., & Hamilton, B. (2025) · International Journal of Transgender Health · doi:10.1080/26895269.2025.2590036 · Cited by 4 · see citing works
Mélo, A. M., de Souza, C. S. P., Melchior, M. D. O., Sousa‐Neto, M. D., Lopes‐Olhê, F. C., Okano, S. H. P., Lara, L. A. D. S., Magri, L. V., & Mazzi‐Chaves, J. F. (2025) · Clinical Oral Investigations · doi:10.1007/s00784-025-06577-x · Cited by 2 · see citing works
“After one year of GAHT, trans men continued to show volumetric increases in the mandible, chin, and maxilla, consolidating facial masculinization—typical of the androgenic profile that hormonal therapy aims to achieve [39, 41].”
Role of Estrogens and Androgens in Osteoporosis
Laurent, M. R. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.65814-2 · Cited by 3 · see citing works
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Hormontherapie bei Transsexuellen: Osteoporose-Risiko im Auge behalten
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Marshall, Z. (2018) · Memorial University Research Repository (Memorial University)
Role of estrogens and androgens in osteoporosis
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Sieczkowska, S. M., Mazzolani, B. C., Coimbra, D. R., Longobardi, I., Casale, A. R., da Hora, J. D. F. V. M. P., Roschel, H., & Gualano, B. (2025) · medRxiv · doi:10.1101/2025.05.05.25326994
- Authors
- Mueller, A., Zollver, H., Kronawitter, D., Oppelt, P. G., Claassen, T., Hoffmann, I., Beckmann, M. W., & Dittrich, R.
- Affiliations
- Universitätsklinikum Erlangen (DE)
- Venue
- Experimental and Clinical Endocrinology & Diabetes
- Publisher
- Georg Thieme Verlag KG
- Published
- 2010-07-12
- Volume
- 119
- Issue
- 02
- Pages
- 95-100
- ISSN
- 0947-7349 (ISSN-L)
- 1439-3646
- OpenAlex
- W2068523079
- Cited by
- 93
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 11 · 2023: 8 · 2022: 6 · 2021: 7 · 2020: 15 · 2019: 7 · 2018: 8 · 2017: 7 · 2016: 5 · 2015: 6 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Experimental and Clinical Endocrinology & Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- male-to-female transsexuals, gender-affirming hormone therapy, GnRH agonist, goserelin, estradiol valerate, body composition, bone mineral density, fat mass, lean body mass, osteoporosis risk, sex hormone-binding globulin, testosterone suppression, lumbar spine, femoral bone
- MeSH terms
- Adult, Body Composition, Estradiol, Female, Humans, Injections, Intramuscular, Gonadotropin-Releasing Hormone, Male, Middle Aged, Sex Characteristics, Transsexualism, Bone Density, Body Mass Index, Goserelin, Gender-Affirming Procedures
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