Effects of sex hormone treatment on the metabolic syndrome in transgender individuals: focus on metabolic cytokines
Open accessAbstract
Context: Hormonal treatment in transgender persons affects many components of the metabolic syndrome (MS). Objective: To determine the role of direct hormonal effects, changes in metabolic cytokines, and body composition on metabolic outcomes. Design, Setting, and Participants: 24 transwomen and 45 transmen from the European Network for the Investigation of Gender Incongruence were investigated at baseline and after 12 months of hormonal therapy. Outcome Measures: Best predictors for changes in components of MS, applying least absolute shrinkage and selection operator regression. Results: In transwomen, a decrease in triglyceride levels was best explained by a decrease in fat mass and an increase in fibroblast growth factor 21 (FGF-21); the decrease in total and low-density lipoprotein cholesterol levels was principally due to a decrease in resistin. A decrease in high-density lipoprotein cholesterol depended on an inverse association with fat mass. In contrast, in transmen, an increase in low-density lipoprotein cholesterol was predicted by a decrease in FGF-21 and an increase in the waist/hip ratio; a decrease in the high-density lipoprotein/total cholesterol ratio depended on a decline in adiponectin levels. In transwomen, worsened insulin resistance and increased early insulin response seemed to be due to a direct treatment effect; however, improvements in hepatic insulin sensitivity in transmen were best predicted by a positive association with chemerin, resistin, and FGF-21 and were inversely related to changes in the waist/hip ratio and leptin and adipocyte fatty acid-binding protein levels. Conclusions: The effects of hormonal therapy on different components of the MS are sex-specific and involve a complex interplay of direct hormonal effects, changes in body composition, and metabolic cytokine secretion.
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Seven of the follow-up studies, including the large ENIGI study, and two studies with high post-GAHT testosterone, showed that total lean body mass was decreased by 3.0%-5.4% following hormone transition (p<0.05).
“Seven of these studies,15 36 39–41 44 51 including the large (n=179) ENIGI study,15 and two studies40 51 with high post-GAHT testosterone (~8 nmol/L), showed that total LBM was decreased by 3.0%–5.4% following hormone transition (p<0.05).”
From How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation (2021) · cites this paper as [39]
The Markers of the MS section reports that lean mass remained unchanged in transwomen and increased in transmen after GAHT, contrary to the attributed decrease. The Patients section describes a cohort of 69, not the n=179 ENIGI study named in the citing sentence. No page numbers are available in our copy. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredTwelve 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 [67]
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- Authors
- Auer, M. K., Ebert, T., Pietzner, M., Defreyne, J., Fuss, J., Stalla, G. K., & T’Sjoen, G.
- Affiliations
- LMU Klinikum (DE)
- University Hospital Leipzig (DE)
- Universitätsmedizin Greifswald (DE)
- Ghent University Hospital (BE)
- University Medical Center Hamburg-Eppendorf (DE)
- Max Planck Institute of Psychiatry (DE)
- Corresponding author
- Auer, Matthias K
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2017-12-05
- Volume
- 103
- Issue
- 2
- Pages
- 790-802
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2775773328
- Cited by
- 75
- References
- 52
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 10 · 2023: 9 · 2022: 12 · 2021: 9 · 2020: 10 · 2019: 6 · 2018: 3
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Keywords
- metabolic syndrome, transgender people, sex hormone therapy, FGF21, resistin, adiponectin, chemerin, leptin, adipocyte fatty acid-binding protein, body composition, fat mass, triglycerides, cholesterol, insulin resistance, hepatic insulin sensitivity, sex differences
- MeSH terms
- Adult, Body Composition, Europe, Female, Humans, Insulin Resistance, Longitudinal Studies, Male, Gonadal Steroid Hormones, Cohort Studies, Cytokines, Metabolic Syndrome, Transgender Persons
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