Change in Visceral Fat and Total Body Fat and the Effect on Cardiometabolic Risk Factors During Transgender Hormone Therapy (original) (raw)
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The Journal of Sexual Medicine, 2011
Introduction. Cross-sex hormone therapy (CSHT) is known to lead to alterations in the serum lipid profile. However, the available reports in the literature are problematic, because of methodological limitations. AIMS: To assess changes in the fasting serum lipid profile during CSHT, including long-term follow-up. Methods. Retrospective chart analysis of all 89 male-to-female (MtF) and 80 female-to-male (FtM) transsexuals who underwent standard CSHT at the Department of Gynecologic Endocrinology of the Medical University of Vienna (university hospital, tertiary care center), from 1995 to 2009. Main Outcome Measures. The results of the lipid profile were analyzed, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the TC-to-HDL ratio, at the time of treatment initiation (time point "0") and at 3, 12, 24, and 60 months after the start of CSHT. Results. The mean age of patients about to commence CSHT was 35.7 Ϯ 11.4 years (MtF) and 26.0 Ϯ 6.3 years (FtM). For MtF transsexuals, consistent follow-up for 24 and 60 months was available in 83 (93.3%) and 58 (65.2%) patients, respectively; for FtM transsexuals, follow-up was available in 57 (71.3%) and 39 (48.8%) patients, respectively. When testing for an association between the lipid parameters and the time after treatment initiation, significant increases for TG (P < 0.001), TC (P = 0.021), and HDL (P = 0.001) were found for MtF transsexuals, whereas TG, TC, and LDL (P < 0.001) increased and HDL (P < 0.001) decreased in FtM patients. Conclusion. Both MtF and FtM transsexuals experience alterations in the serum lipid profile because of CSHT, with the changes in FtM patients possibly more relevant in terms of atherogenesis. Ott J, Aust S, Promberger R, Huber JC, and Kaufmann U. Cross-sex hormone therapy alters the serum lipid profile: A retrospective cohort study in 169 transsexuals.
Alterations in Lipids and Adipocyte Hormones in Female-to-Male Transsexuals
International journal of endocrinology, 2010
Testosterone therapy in men and women results in decreased high-density lipoprotein cholesterol (HDL) and increased low-density lipoprotein cholesterol (LDL). We sought to determine whether testosterone therapy has this same effect on lipid parameters and adipocyte hormones in female-to-male (FTM) transsexuals. Twelve FTM transsexuals provided a fasting lipid profile including serum total cholesterol, HDL, LDL, and triglycerides prior to and after 1 year of testosterone therapy (testosterone enanthate or cypionate 50-125 mg IM every two weeks). Subjects experienced a significant decrease in mean serum HDL (52 +/- 11 to 40 +/- 7 mg/dL) (P < .001). The mean LDL (P = .316), triglyceride (P = .910), and total cholesterol (P = .769) levels remained unchanged. In a subset of subjects, we measured serum leptin levels which were reduced by 25% but did not reach statistical significance (P = .181) while resistin levels remained unchanged. We conclude that testosterone therapy in FTM trans...
European journal of endocrinology, 2017
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 is 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%...
Metabolism, 1999
We prospectively studied the effects of cross-sex hormone administration on fat cell size and in vitro lipolytic activity in subcutaneous abdominal and gluteal fat biopsies obtained from 19 male-to-female (M-F) transsexuals and 17 female-to-male (F-M) transsexuals. The amount of subcutaneous fat at the abdominal and gluteal levels was quantified with the use of magnetic resonance imaging (MRI). Before cross-sex hormone administration, M-F transsexuals had less subcutaneous fat with smaller fat cells compared with F-M transsexuals, with a higher baseline in vitro lipolytic activity expressed as glycerol release per milligram of triglyceride (TG) in the abdominal region (P < .05). Before cross-sex hormone treatment, no differences in lipolytic activity stimulated with arterenol (ART), isoproterenol (ISO), or ISO + insulin (INS) were observed between groups or regions. After a 1-year treatment with estrogens and antiandrogens in M-F transsexuals, subcutaneous fat areas on MRI and fat cell size were increased (P < .001) and reductions were observed in the basal lipolytic activity of gluteal and abdominal fat biopsies (P < .05). Following administration of testosterone to F-M transsexuals, subcutaneous fat and fat cell size at the gluteal and abdominal depots were decreased (P < .01) and basal lipolysis was increased significantly at the abdominal level (P < .05) but not at the gluteal level. In both M-F and F-M transsexuals, no effect of sex hormone administration was observed on stimulated lipolytic activities, in conclusion, regional sex differences in the amount of subcutaneous fat, adipocyte size, and in vitro basal lipolytic activity were demonstrated that could be largely reversed by cross-sex hormone treatment in adult subjects, providing evidence for their dependence on the sex steroid milieu.
Long-Term Testosterone Administration Increases Visceral Fat in Female to Male Transsexuals 1
The Journal of Clinical Endocrinology & Metabolism, 1997
The amount of intraabdominal (visceral) fat is an important determinant of disturbances in lipid and glucose metabolism. Crosssectional studies in women have found associations between high androgen levels and visceral fat accumulation. The causal relation between these phenomena is unknown. We, therefore, studied prospectively the effect of testosterone administration on body fat distribution in 10 young, nonobese, female to male transsexuals undergoing sex reassignment. Before, after 1 yr, and after 3 yr of testosterone administration, magnetic resonance images were obtained at the level of the abdomen, hip, and thigh to quantify both sc and visceral fat depots. After 1 yr of testosterone administration, sc fat depots at all levels showed significant reductions compared to baseline measurements. The mean visceral fat area did not change
The Journal of Clinical Endocrinology & Metabolism, 2017
Context: The degree to which changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) relate to corresponding changes in plasma sex steroids is not known. Objective: We examined whether changes in VAT and SAT areas assessed by computed tomography were associated with changes in sex hormones [dehydroepiandrosterone sulfate (DHEAS), testosterone, estradiol, estrone, and sex hormone binding globulin (SHBG)] among Diabetes Prevention Program participants. Design: Secondary analysis of a randomized trial. Participants: Overweight and glucose-intolerant men (n = 246) and women (n = 309). Interventions: Intensive lifestyle change with goals of weight reduction and 150 min/wk of moderate intensity exercise or metformin administered 850 mg twice a day or placebo. Main Outcome Measures: Associations between changes in VAT, SAT, and sex hormone changes over 1 year. Results: Among men, reductions in VAT and SAT were both independently associated with significant increases in total testosterone and SHBG in fully adjusted models. Among women, reductions in VAT and SAT were both independently associated with increases in SHBG and associations with estrone differed by menopausal status. Associations were similar by race/ethnicity and by randomization arm. No significant associations were observed between change in fat depot with change in estradiol or DHEAS. Conclusions: Among overweight adults with impaired glucose intolerance, reductions in either VAT and SAT were associated with increased total testosterone in men and higher SHBG in men and women. Weight loss may affect sex hormone profiles via reductions in visceral and subcutaneous fat.
Transwomen and the Metabolic Syndrome: Is Orchiectomy Protective?
Transgender Health, 2016
Background: Male-to-female transsexual women or transwomen who undergo cross-sex hormone treatments experience increased health-related risks (e.g., increased rates of cardiovascular disease and premature death). Yet, the exact mechanism by which altering biochemistry leads to metabolic impairment remains unclear. While much attention has been paid to cross-sex hormone therapy, little is known about the metabolic risk associated with orchiectomy. Methods: To address the above limitation, we prospectively enrolled 12 transwomen: 4 who had undergone bilateral orchiectomy and 8 who had not. Both groups were using cross-sex hormones. Glucose tolerance was assessed using a standard 75g oral glucose tolerance test. Hepatic steatosis was assessed by 1 H magnetic resonance spectroscopy. The amount of subcutaneous and visceral abdominal fat was determined from a single abdominal axial image at the level between the vertebral L2 and L3 bodies. Baseline venous fasting blood sampling was performed for measurement of hemoglobin A1c, glucose, insulin, sex hormones, and sex hormone binding globulin. Results: The major novel findings were: (1) orchiectomy and cross-sex hormone therapy is associated with less hepatic steatosis and insulin resistance; (2) orchiectomy may be metabolically protective, and (3) circulating concentrations of sex hormones may be a major determinant of metabolic health in transwomen. Conclusions: To our knowledge, this is the first study to suggest an independent and protective role of orchiectomy on the metabolic health of transwomen.
Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects
Clinical Endocrinology, 2003
objective Sex differences are found in most components of the insulin resistance syndrome and the associated cardiovascular risk profile. These differences are attributed to sex-specific sex steroid profiles, but the effects of sex steroids on the individual components of the insulin resistance syndrome remain incompletely understood.design Prospective, intervention study.subjects In 37 young (age range 16–36 years), nonobese [body mass index (BMI) < 29], transsexual subjects, effects of ethinyl oestradiol (100 µg/day) + cyproterone acetate (100 mg/day) administration were evaluated in 20 male-to-female transsexuals and of testosterone-ester administration [250 mg intramuscularly (i.m.)/2 weeks] in 17 female-to-male transsexuals.measurements We studied lipid spectrum, postheparin hepatic lipase (HL) and lipoprotein lipase (LPL) activity, blood pressure, glucose utilization (by euglycaemic hyperinsulinaemic clamp), and fat areas (by magnetic resonance imaging) at baseline and during 1-year cross-sex hormone administration.results Oestrogens + antiandrogens increased high-density lipoprotein (HDL)-cholesterol and decreased LDL-cholesterol, and HL activity, which are considered beneficial. But this combination also increased triglycerides, blood pressure, subcutaneous fat and visceral fat, and decreased the LDL-particle size, LPL activity and insulin sensitivity, which are all considered detrimental. Testosterone reduced HDL-cholesterol and the LDL-particle size, and increased triglycerides and HL activity. An android fat distribution was induced (i.e. decreased subcutaneous and increased visceral fat). Blood pressure, total and LDL-cholesterol, LPL activity and insulin sensitivity were mainly unaffected.conclusions The effects of cross-sex hormone treatment – in the dosages used in this study – in healthy, nonobese, young transsexual subjects do not show unequivocally that female sex steroids, given in large amounts to male subjects, have beneficial effects on cardiovascular profile and that high dose testosterone administration to female subjects is detrimental with respect to cardiovascular risk.
Transgender Health, 2021
Up to 1.8% of youth identify as transgender; many will be treated with a gonadotropin-releasing hormone agonist (GnRHa). The impact of GnRHa on insulin sensitivity and body composition in transgender youth is understudied. We aimed to evaluate differences in insulin sensitivity and body composition in transgender youth on GnRHa therapy compared with cisgender youth. Methods: Transgender participants were matched to cisgender participants on age, body mass index, and sex assigned at birth. Transgender males (n = 9, ages 10.1-16.0 years) on GnRHa (meanstandard deviation duration of exposure: 20.9-19.8 months) were compared with cisgender females (n = 14, ages 10.6-16.2). Transgender females (n = 8, ages 12.6-16.1) on GnRHa (11.3-7 months) were compared with cisgender males (n = 17, ages 12.5-15.5). Differences in insulin sensitivity (1/[fasting insulin], homeostatic model of insulin resistance [HOMA-IR]), glycemia (hemoglobin A1C [HbA1c], fasting glucose), and body composition (dual-energy X-ray absorptiometry) were evaluated using a mixed linear regression model. Results: Transgender males had lower 1/fasting insulin and higher HOMA-IR (p = 0.031, p = 0.01, respectively), fasting glucose (89-4 vs. 79-13 mg/dL, p = 0.012), HbA1c (5.4-0.2 vs. 5.2-0.2%, p = 0.039), and percent body fat (36-7 vs. 32-5%, p = 0.042) than matched cisgender females. Transgender females had lower 1/fasting insulin and higher HOMA-IR (p = 0.028, p = 0.035), HbA1c (5.4-0.1% vs. 5.1-0.2%, p = 0.007), percent body fat (31-9 vs. 24-10%, p = 0.002), and lower percent lean mass (66-8 vs. 74-10%, p < 0.001) than matched cisgender males. Conclusion: Transgender youth on a GnRHa have lower estimated insulin sensitivity and higher glycemic markers and body fat than cisgender controls with similar characteristics. Longitudinal studies are needed to understand the significance of these changes. Clinical Trial.gov ID: NCT02550431.