December 05, 2017
2 min read

Cross-sex HT induces sex-specific changes in android, gynoid regions

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Transgender women and men initiating cross-sex hormone therapy experienced anthropomorphic changes over 1 year associated with more feminine and masculine body fat distributions, respectively, with baseline BMI influencing the extent of any changes, according to findings published in European Journal of Endocrinology.

Maartje Klaver, MD, of the Center of Expertise on Gender Dysphoria at VU University Medical Center in Amsterdam, and colleagues analyzed data from 179 transgender women and 162 transgender men who initiated cross-sex HT between 2010 and April 2016 and were participating in the European Network for the Investigation of Gender Incongruence. Transgender women were treated with 50 mg daily cyproterone acetate combined with 4 mg daily oral estradiol valerate or a 100 µg per 24-hour transdermal estradiol patch twice weekly. Transgender men received 50 mg daily testosterone gel, testosterone undecanoate 1,000 mg intramuscular injection once per 12 weeks or 250 mg testosterone esters once per 2 weeks. Patients visited an outpatient clinic every 3 months during the first year of HT and underwent whole-body DXA scanning, along with standard anthropometric measurements, at baseline and 1 year after HT.

The cohort was followed for a mean of 377 days.

In transgender women, researchers observed increases in body fat that ranged from a mean 18% (95% CI, 13-23) in the android region to a mean 42% (95% CI, 37-46) in the leg region and a mean 34% (95% CI, 29-38) in the gynoid region.

In transgender men, researchers observed decreases in body fat that ranged from a mean 16% (95% CI, –19 to –14) in the leg region and a mean decrease of 14% in the gynoid region (95% CI, –16 to –12). There was no change observed in the android region for transgender men.

Researchers also found that waist-to-hip ratio decreased in transgender women by a mean of –0.03, mainly due to a mean 3.2-cm increase in hip circumference. Transgender men, however, saw a mean 1.9-cm decrease in hip circumference, which accounted for a mean increase in waist-to-hip ratio of 1.

Transgender women with a higher baseline BMI tended to experience smaller increases in body fat and larger decreases in lean body mass, according to researchers; however, for transgender men, a higher baseline BMI was associated with a larger decrease in body fat and a smaller increase in lean body mass. Age at initiation of therapy was not related to body changes after adjustment for baseline BMI; the use of other medications, including antidepressants and corticosteroids, was also not associated with changes in body measurements, according to researchers. Additionally, type of hormonal therapy or the concentration of estradiol did not affect changes in regional body fat or lean body mass in transgender women; however, transgender men using T esters seemed to experience larger changes in body composition than transgender men using T gel.

“This study provides insight into the effects of cross-sex hormonal therapy on body shape and body composition,” Klaver told Endocrine Today. “Transgender persons starting treatment can now be better informed on the extent to which their bodies will change and on what to expect of the results of treatment. Further, this study showed that higher serum estradiol levels did not result in larger changes in body fat and lean body mass. This is a relevant finding, since in clinical practice, many transwomen wonder whether they would experience larger effects if their hormone dosage would be increased.”

The researchers said future research should focus on whether such changes are also reflected in a changing physical appearance — for example, whether an increase in body fat and decrease in lean body mass in transgender women causes the arm “to look more feminine and to feel softer.” – by Regina Schaffer

For more information:

Maartje Klaver, MD, can be reached at the Center of Expertise on Gender Dysphoria at VU University Medical Center, De Boelelaan 1118, 1081 HZ, Amsterdam; email:

Disclosures: The authors report no relevant financial disclosures.