Change in grip strength in trans people and its association with lean body mass and bone density
Open accessAbstract
OBJECTIVE: Gender-affirming hormonal treatment (HT) in trans people changes physical appearance. Muscle mass and strength are important aspects of physical appearance, but few data exist on the effect of HT on grip strength and muscle mass. This study aimed to investigate the change in grip strength in trans people during the first year of HT and to study the possible determinants of this change and the associations between changes in grip strength, lean body mass and bone mineral density (BMD). DESIGN AND METHODS: A multicenter, prospective study was performed, including 249 transwomen and 278 transmen. Grip strength, lean body mass and BMD were measured at baseline and after 1 year. RESULTS: After 1 year of HT, grip strength decreased with -1.8 kg (95% CI -2.6; -1.0) in transwomen and increased with +6.1 kg (95% CI +5.5; +6.7) in transmen. No differences in grip strength change was found between age groups, BMI groups, hormonal administration routes or hormone concentrations. In transmen, increase in grip strength was associated with increase in lean body mass (per kg increase in grip strength: +0.010 kg, 95% CI +0.003; +0.017), while this was not found in transwomen (per kg increase in grip strength: +0.004 kg, 95% CI -0.000; +0.009). Change in grip strength was not associated with change in BMD in transwomen and transmen. CONCLUSIONS: After 1 year of HT, grip strength decreased in transwomen, and increased in transmen. In transmen only, change in grip strength was associated with change in lean body mass.
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Aside from the three prospective studies, data were extracted from medical charts (nine of which were from the same research group), posing a risk of selective data reporting and publication bias.
“Aside from these three studies, data were extracted from medical charts (nine of which were from the same research group,15 17 19 36–41) posing a risk of selective data reporting and publication bias.”
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 [17]
The Materials and methods section (Study design and study population; page not provided) identifies this paper as part of a multicenter prospective cohort, with measurements taken at baseline and follow-up. That contradicts its apparent inclusion among studies whose data were extracted from medical charts. The paper does not establish the citing sentence’s count of nine studies or its publication-bias assessment. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThree large ENIGI studies published in 2018 and 2019 contained much novel data, but also included many participants from previous studies, making it impossible to accurately state the number of unique participants.
“Three large studies from the ENIGI group published in 2018 and 201915 17 19 contained much novel data, but also included many participants from previous studies making it impossible to accurately state the number of unique participants.”
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 [17]
The Study design and study population section (page not available) identifies this as an ENIGI cohort study and reports 527 participants in its analyses. It does not establish how many participants appeared in earlier studies or say that the number of unique participants across the cited studies cannot be determined. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe large ENIGI study was the only study in which the limits of agreement would indicate a change in strength at the 95% CI.
“The large ENIGI study17 was the only study in which the limits of agreement would indicate a change in strength at the 95% CI.”
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 [17]
The Study design section identifies this as an ENIGI study, and the Results > Grip strength section reports changes in both groups with 95% confidence intervals excluding zero. The paper does not report limits of agreement or compare its findings with other studies to establish that it was the only one meeting the claimed criterion; its reported 95% CIs are not limits of agreement. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDespite modest reduction in strength, transgender women retained a 17% grip strength advantage over transgender men measured at baseline.
“Despite this modest reduction in strength, transgender women retained a 17% grip strength advantage over transgender men measured at baseline.”
From Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage (2021) · cites this paper as [70]
Table 1 (Results > Characteristics; page unavailable) reports grip strength of 40.0 kg for transgender women after treatment and 33.1 kg for transgender men at baseline, supporting the comparison despite the women's modest decline. The gap is 17% of the women's 40.0 kg value, but approximately 21% of the men's baseline value; the stated 17% advantage over baseline transgender men therefore depends on an unstated denominator. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHandgrip strength in transgender women was approximately the 25th percentile for males but over the 90th percentile for females, both before and after hormone treatment.
“handgrip strength in transgender women was in approximately the 25th percentile for males but was over the 90th percentile for females, both before and after hormone treatment.”
From Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage (2021) · cites this paper as [70]
The Discussion reports that, after 12 months of hormone treatment, transwomen’s median grip strength was at the 95th percentile for age-matched females. But it assigns the 25th percentile for age-matched males to transmen, not transwomen, and does not give both percentile comparisons for transwomen before treatment. The Results report that transwomen’s grip strength decreased during treatment, but do not establish the claimed pretreatment percentiles. (LLM, conf=0.90)
Experimental — accuracy not yet measured
In 249 transgender women, grip strength decreased by 4% after 12 months of cross-hormone treatment, with no variation between testosterone level, age or BMI tertiles.
“examination of 249 transgender women revealed a decrease of − 4% in grip strength after 12 months of cross-hormone treatment, with no variation between different testosterone level, age or BMI tertiles”
From Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage (2021) · cites this paper as [70]
The study population section reports 249 transwomen, and the Results > Grip strength section reports a 1.8 kg decrease after 12 months with no difference across age or BMI groups. Table 1 gives a baseline grip strength of 41.8 kg, making the decrease approximately 4%. However, the Results explicitly say testosterone-concentration analyses could not be performed in transwomen, so the claimed absence of variation across testosterone tertiles is unsupported; age and BMI were analyzed as groups, not tertiles. Page numbers are unavailable in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredFive longitudinal studies investigated the muscular strength of transwomen.
“Five longitudinal studies16 17 37 40 41 investigated the muscular strength of transwomen.”
The largest ENIGI study (n=249) and one other study found significant reductions in hand grip strength (4.3% and 7.1%, respectively) after 12 months on GAHT (p<0.001).
“The largest of the three (n=249) ENIGI studies17 and one other study41 found significant (p<0.001) reductions (4.3% and 7.1%, respectively) after 12 months on GAHT.”
Studies in non-athletic transwomen undergoing gender-affirming hormone treatment report changes in lean body mass, muscle cross-sectional area, muscular strength, and haemoglobin and/or haematocrit.
“However, studies in non-athletic transwomen undergoing GAHT also report changes in lean body mass (LBM),15 muscle cross-sectional area (CSA),16 muscular strength17 and haemoglobin (Hgb)18 and/or haematocrit (HCT).19”
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 [70]
Compared with cisgender men, hormone-naive transwomen demonstrate 6.0%-11.4% lower muscle cross-sectional area.
“6.0%–11.4% lower muscle CSA”
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 [17]
The Methods (DXA; page unavailable) describe measuring arm and leg lean body mass, while the Results (Grip strength; page unavailable) report changes after hormone treatment. Searches for 6.0%–11.4%, muscle cross-sectional area, and a baseline comparison with cisgender men found no passage supporting the claimed difference. (LLM, conf=0.75)
Experimental — accuracy not yet measuredCompared with cisgender men, hormone-naive transwomen demonstrate approximately 10%-14% lower handgrip strength.
“~10%–14% lower handgrip strength.17 41 60”
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 [17]
The Results > Grip strength section (page unavailable) reports a 1.8 kg decrease in transwomen after one year of hormone therapy, not a baseline comparison with cisgender men. Searches for hormone-naive baseline strength, male reference values, and the 10%–14% figure found no passage establishing the claimed difference. (LLM, conf=0.75)
Experimental — accuracy not yet measuredHormone-naive transwomen and cisgender men have similar testosterone levels.
“hormone-naive transwomen and cisgender men have similar testosterone levels.16 17 19 42”
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 [17]
The Results (Characteristics, Table 1) describe transwomen before hormone therapy, but the available passage does not give their baseline testosterone values or compare them with cisgender men. Searches for baseline testosterone and a cisgender-men comparison found no passage in our copy establishing that their levels were similar. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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SPORTS AND PERFORMANCE IN THE TRANSGENDER POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
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Medical Care of Transgender Athletes and Policy Implications: ACSM Contemporary Issue Statement
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- Authors
- Scharff, M., Wiepjes, C. M., Klaver, M., Schreiner, T., T’Sjoen, G., & den Heijer, M.
- Affiliations
- Amsterdam University Medical Centers (NL)
- Oslo University Hospital (NO)
- 3Department of Endocrinology & Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- 1Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
- Venue
- Endocrine Connections
- Publisher
- Bioscientifica
- Published
- 2019-07
- Volume
- 8
- Issue
- 7
- Pages
- 1020-1028
- ISSN
- 2049-3614 (ISSN-L)
- PMC
- PMC6652261
- OpenAlex
- W2953424733
- Cited by
- 64
- References
- 24
- Citations by year
- 2026: 4 · 2025: 18 · 2024: 9 · 2023: 15 · 2022: 7 · 2021: 6 · 2020: 5
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Endocrine Connections (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by-nc)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- grip strength, transgender people, gender-affirming hormone therapy, lean body mass, bone mineral density, muscle strength, transgender women, transgender men, sex hormones, physical appearance
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