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Cited by 198LGBTQ Health, Identity, and PolicyHormonal and reproductive studiesSexual Differentiation and Disorders

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

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Klaver, M, de Blok, C J M, Wiepjes, C M, Nota, N M, Dekker, M J H J, de Mutsert, R, Schreiner, T, Fisher, A D +2 more·2018·European Journal of Endocrinology
DOI 10.1530/eje-17-0496
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Abstract

Objective: Cross-sex hormonal therapy (CHT) in trans persons affects their total body fat and total lean body mass. However, it is unknown how separate body regions are affected and whether these changes alter body shape. Therefore, the aim of this study was to determine the effects on body fat and lean body mass in separate body regions and on body shape after one year of CHT. Design and methods: In a multicenter prospective study at university hospitals, 179 male-to-female gender dysphoric persons, referred to as transwomen, and 162 female-to-male gender dysphoric persons, referred to as transmen, were included. All underwent whole-body dual-energy X-ray absorptiometry and anthropometric measurements before and after one year of CHT. Results: In transwomen, increases in body fat ranged from +18% (95% CI: 13%;23%) in the android region to +42% (95% CI: 37%;46%) in the leg region and +34% (95% CI: 29%;38%) in the gynoid region. In transmen, changes in body fat ranged from −16% (95% CI: −19;−14%) in the leg region and −14% in the gynoid region (95% CI: −16%;−12) to no change in the android region (+1%, 95% CI: −3%;5%). Waist-to-hip ratio (WHR) decreased in transwomen (−0.03, 95% CI: −0.04;−0.02) mainly due to an increase in hip circumference (+3.2 cm, 95% CI: 2.3;4.0). Transmen have a decrease in hip circumference (−1.9 cm, 95% CI: −3.1;−0.7) resulting in an increase in WHR (+0.01, 95% CI: 0.00;0.02). Conclusions: 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.

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Crossref · 10.1530/eje-17-0496

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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 [15]

    The Study population and study design section (page unavailable) identifies this as a prospective observational study and describes scheduled clinic visits for data collection. That contradicts treating this paper as one of the studies whose data were extracted from medical charts. The paper does not establish the claim about nine studies from one research group or the resulting bias risk. (LLM, conf=0.85)

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  • The large ENIGI study was the only study in which the limits of agreement would indicate a change in lean body mass at the 95% CI.

    “The large ENIGI study15 was the only study in which the limits of agreement would indicate a change in LBM 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 [15]

    The Study population and study design section identifies this as an ENIGI study with 341 participants, larger than previous studies of this topic. The Results section reports changes in total lean body mass for transwomen and transmen with 95% confidence intervals excluding zero. It does not report limits of agreement or establish that this was the only study meeting the citing paper’s criterion. (LLM, conf=0.86)

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  • Three 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 [15]

    The Study population and study design section (page unavailable) identifies this as an ENIGI study and reports 341 participants, a larger body-composition study population than any before it. It does not say that participants overlapped with previous studies or that the number of unique participants across the cited studies cannot be determined. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • After 12 months of treatment, changes in lean body mass are consistently between −3 and −5% on average, with slightly greater reductions in the arm compared with the leg region.

    “studies have found very consistent changes in lean body mass (using dual-energy X-ray absorptiometry) after 12 months of treatment, where the change has always been between − 3 and − 5% on average, with slightly greater reductions in the arm compared with the leg region [68].”

    From Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage (2021) · cites this paper as [68]

    The Results report a 3% decrease in total lean body mass after one year in transwomen, and the regional-results section reports a larger decrease in the arm (6%). But the arm result falls outside the claimed −3% to −5% range, and lean body mass increased by 10% in transmen. The paper therefore does not support the unqualified claim that changes were always within that range. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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”

    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 [15]

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Cites

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Research works printed but not linked: 3

  1. Elbers JMH, Asscheman H, Seidell JC & Gooren LJG. Effects of sex steroids hormones on regional fat depots as assessed by magnetic resonance imaging in transsexuals. American Journal of Physiology 1999 276 317-325.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), Arlington, VA: American Psychiatric Publishing, Inc; 2000.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Text revision (DSM-5); Arlington, VA: American Psychiatric Publishing Inc. 2013

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Authors
Klaver, M., de Blok, C. J. M., Wiepjes, C. M., Nota, N. M., Dekker, M. J. H. J., de Mutsert, R., Schreiner, T., Fisher, A. D., T’Sjoen, G., & den Heijer, M.
Affiliations
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • 1Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
  • 2Department of Clinical Epidemiology, Leiden University and Medical Center, Leiden, the Netherlands
  • Oslo University Hospital (NO)
  • University of Florence (IT)
  • 5Department of Endocrinology & Center for Sexuology and Gender, Ghent University Hospital, Ghent, Belgium
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2018-02
Volume
178
Issue
2
Pages
163-171
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-17-0496
OpenAlex
W2769104611
Cited by
198
References
17
Citations by year
2026: 18 · 2025: 25 · 2024: 30 · 2023: 23 · 2022: 31 · 2021: 30 · 2020: 22 · 2019: 15 · 2018: 3 · 2017: 1
FWCI
16.06
Type
journal article
Language
en
Open access
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
Keywords
body fat distribution, lean body mass, body shape, waist-to-hip ratio, android fat, gynoid fat, hip circumference, transgender women, transgender men, gender dysphoria, dual-energy X-ray absorptiometry
MeSH terms
Adolescent, Adult, Aged, Anthropometry, Body Composition, Estradiol, Female, Humans, Male, Middle Aged, Prospective Studies, Gonadal Steroid Hormones, Testosterone, Absorptiometry, Photon, Body Mass Index, Cyproterone Acetate, Waist-Hip Ratio, Body Fat Distribution, Waist Circumference, Transgender Persons

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