Body composition and markers of cardiometabolic health in transgender youth compared to cisgender youth: a cross-sectional study

Abstract

ContextUp to 1.8% of adolescents identify as transgender and many more seek care, yet the impact of gender affirming hormone therapy (GAHT) on cardiometabolic health is unknown.\n\nObjectiveTo determine insulin sensitivity and body composition among transgender females (TF) and males (TM) on estradiol or testosterone, compared to cisgender females (CF) and males (CM).\n\nDesignPilot, cross-sectional study conducted from 2016-2018.\n\nSetting. Academic regional transgender referral center.\n\nParticipantsTransgender adolescents on either testosterone or estradiol for at least 3 months were recruited. Nineteen TM were matched to 19 CM and 42 CF on pubertal stage and body mass index (BMI). Eleven TF were matched to 23 CF and 13 TF to 24 CM on age and BMI.\n\nMain Outcome Measure(s)1/[fasting insulin] and body composition (dual-energy absorptiometry, DXA).\n\nResultsTotal body fat was lower in TM than CF (29{+/-}7 vs. 33{+/-}7%, p=0.002) and higher than CM (28{+/-}7 vs. 24{+/-}9%, p=0.047). TM had higher lean mass than CF (68{+/-}7 vs. 64{+/-}7%, p=0.002) and lower than CM (69{+/-} vs. 73{+/-}8%, p=0.029). Insulin sensitivity was not different between the groups.\n\nTF had lower body fat than CF (31{+/-}7 vs. 35{+/-}8%, p=0.033) and higher than CM (28{+/-}6 vs. 20{+/-}10, p=0.001). TF had higher lean mass than CF (66{+/-}6 vs. 62{+/-}7%, p=0.032) and lower than CM (69{+/-}5 vs. 77{+/-}9%, p=0.001). TF were more insulin resistant than CM (0.078{+/-}0.025 vs. 0.142{+/-}0.064, p=0.011).\n\nConclusionsTransgender adolescents on GAHT have significant differences in body composition compared to cisgender controls, with a body composition intermediate between BMI-matched cisgender males and females. These changes in body composition may have consequences for the cardiometabolic health of transgender adolescents.\n\nPrecisTransgender youth on gender affirming hormone therapy have differences in their percent fat and lean mass compared to cisgender (non-transgender) youth.