Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
Department of Clinical Epidemiology, Leiden University and Medical Center, Leiden, the Netherlands.
J Sex Med. 2018 Feb;15(2):251-260. doi: 10.1016/j.jsxm.2017.12.009.
Transgender adolescents aspiring to have the body characteristics of the affirmed sex can receive hormonal treatment. However, it is unknown how body shape and composition develop during treatment and whether transgender persons obtain the desired body phenotype.
To examine the change in body shape and composition from the start of treatment with gonadotropin-releasing hormone agonists (GnRHa) until 22 years of age and to compare these measurements at 22 years with those of age-matched peers.
71 transwomen (birth-assigned boys) and 121 transmen (birth-assigned girls) who started treatment from 1998 through 2014 were included in this retrospective study. GnRHa treatment was started and cross-sex hormonal treatment was added at 16 years of age. Anthropometric and whole-body dual-energy x-ray absorptiometry data were retrieved from medical records. Linear mixed model regression was performed to examine changes over time. SD scores (SDS) were calculated to compare body shape and composition with those of age-matched peers.
Change in waist-hip ratio (WHR), total body fat (TBF), and total lean body mass (LBM) during hormonal treatment. SDS of measures of body shape and composition compared with age-matched peers at 22 years of age.
In transwomen, TBF increased (+10%, 95% CI = 7-11) while total LBM (-10%, 95% CI = -11 to -7) and WHR (-0.04, 95% CI = -0.05 to -0.02) decreased. Compared with ciswomen, SDS at 22 years of age were +0.3 (95% CI = 0.0-0.5) for WHR, and 0.0 (95% CI = -0.2 to 0.3) for TBF. Compared with cismen, SDS were -1.0 (95% CI = -1.3 to -0.7) for WHR, and +2.2 (95% CI = 2.2-2.4) for TBF. In transmen, TBF decreased (-3%, 95% CI = -4 to -1), while LBM (+3%, 95% CI = 1-4) and WHR (+0.03, 95% CI = 0.01-0.04) increased. Compared with ciswomen, SDS at 22 years of age were +0.6 (95% CI = 0.4-0.8) for WHR, and -1.1 (95% CI = -1.4 to -0.9) for TBF. Compared with cismen, SDS were -0.5 (95% CI = -0.8 to -0.3) for WHR, and +1.8 (95% CI = 1.6-1.9) for TBF.
Knowing body shape and composition outcomes at 22 years of age will help care providers in counseling transgender youth on expectations of attaining the desired body phenotype.
This study presents the largest group of transgender adults to date who started treatment in their teens. Despite missing data, selection bias was not found.
During treatment, WHR and body composition changed toward the affirmed sex. At 22 years of age, transwomen compared better to age-matched ciswomen than to cismen, whereas transmen were between reference values for ciswomen and cismen. Klaver M, de Mutsert R, Wiepjes CM, et al. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 2018;15:251-260.
渴望拥有被认定性别身体特征的跨性别青少年可以接受激素治疗。然而，目前尚不清楚在治疗过程中身体形状和组成如何发展，以及跨性别者是否获得了期望的身体表型。
检查从开始使用促性腺激素释放激素激动剂（GnRHa）治疗到 22 岁时的身体形状和组成的变化，并将 22 岁时的这些测量值与年龄匹配的同龄人进行比较。
本回顾性研究纳入了 71 名跨性别女性（出生时为男性）和 121 名跨性别男性（出生时为女性），他们于 1998 年至 2014 年期间开始治疗。16 岁时开始 GnRHa 治疗，并添加了跨性别激素治疗。从病历中检索人体测量学和全身双能 X 射线吸收法数据。使用线性混合模型回归来检查随时间的变化。计算标准差（SDS）以比较身体形状和组成与年龄匹配的同龄人的差异。
跨性别女性的腰围臀围比（WHR）、总体脂肪（TBF）和总瘦体重（LBM）在激素治疗期间增加（+10%，95%置信区间为 7-11），而总 LBM（-10%，95%置信区间为-11 至-7）和 WHR（-0.04，95%置信区间为-0.05 至-0.02）减少。与 cis 女性相比，22 岁时的 SDS 为 WHR 为+0.3（95%置信区间为 0.0-0.5），TBF 为 0.0（95%置信区间为-0.2 至 0.3）。与 cis 男性相比，SDS 为 WHR 为-1.0（95%置信区间为-1.3 至-0.7），TBF 为+2.2（95%置信区间为 2.2-2.4）。跨性别男性的 TBF 减少（-3%，95%置信区间为-4 至-1），而 LBM（+3%，95%置信区间为 1-4）和 WHR（+0.03，95%置信区间为 0.01-0.04）增加。与 cis 女性相比，22 岁时的 SDS 为 WHR 为+0.6（95%置信区间为 0.4-0.8），TBF 为-1.1（95%置信区间为-1.4 至-0.9）。与 cis 男性相比，SDS 为 WHR 为-0.5（95%置信区间为-0.8 至-0.3），TBF 为+1.8（95%置信区间为 1.6-1.9）。
了解 22 岁时的身体形状和组成结果将有助于护理人员为跨性别青年提供有关获得期望的身体表型的期望方面的咨询。
本研究展示了迄今为止最大的一组在青少年时期开始治疗的跨性别成年人。尽管存在数据缺失，但未发现选择偏差。
在治疗期间，WHR 和身体组成向被认定的性别转变。在 22 岁时，跨性别女性与年龄匹配的 cis 女性相比，与 cis 男性相比，表现更好，而跨性别男性则介于 cis 女性和 cis 男性的参考值之间。
