Sex hormones initiate profound physical and physiological changes during the pubertal process, but to what extent are they responsible for continuing the body composition changes of late adolescence and what happens to body composition on sudden sex hormone withdrawal?
Thirty-six healthy, phenotypically and chromosomally normal late and post-pubertal individuals aged 15–17 years with gender dysphoria (transgirls – birth-registered males identifying as female n = 11; and transboys – birth-registered females identifying as male n = 25) underwent Tanita body composition analysis at 0, 6 and 12 months during reproductive hormone suppression with Triptorelin as part of the standard therapeutic protocol.
Results and conclusions
In the transgirl cohort, paired t-test analysis demonstrated a significant decrease in height and lean mass standard deviation scores over the 12-month period, going against an expected trajectory over that time. In contrast, oestrogen suppression appeared not to affect the body composition of transboys; their measurements were not significantly different at baseline and after 12 months of treatment. The withdrawal of sex hormone secretion does not appear to have a significant impact on female post-pubertal body composition, in contrast to that seen at the menopause. This suggests that other factors may preserve normal body balance in adolescents in the absence of sex steroids.
We thank the team members from the national Gender Identity Development Service; we also thank Kirpal Adu-Gyamfi and other outpatient staff members for performing the auxological assessments.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This project was conducted as part of a UCL Medical School academic programme.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Conflicts of interest: The authors declare that they have no conflict of interest.
2. Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body composition of reference children from birth to age 10 years. Am J Clin Nutr 1982;35(5 Suppl):1169–75.10.1093/ajcn/35.5.1169Search in Google Scholar PubMed
3. Veldhuis JD, Roemmich JN, Richmond EJ, Rogol AD, Lovejoy JC, et al. Endocrine control of body composition in infancy, childhood, and puberty. Endoc Rev 2005;26:114–46.10.1210/er.2003-0038Search in Google Scholar PubMed
5. Rosenbaum M, Leibel RL. Clinical review 107: Role of gonadal steroids in the sexual dimorphisms in body composition and circulating concentrations of leptin. J Clin Endocrinol Metab 1999;84:1784–9.Search in Google Scholar
6. Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, et al. Childhood body composition in relation to body mass index. Pediatrics 2001;107:344–50.10.1542/peds.107.2.344Search in Google Scholar PubMed
8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Association; 2013. ISBN 978-0-89042-554-1.Search in Google Scholar
9. Butler G, De Graaf N, Wren B, Carmichael P. Assessment and support of children and adolescents with gender dysphoria. Arch Dis Child 2018;103:631–6.10.1136/archdischild-2018-314992Search in Google Scholar PubMed
10. de Vries AL, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex 2012;59:301–20.10.1080/00918369.2012.653300Search in Google Scholar PubMed
11. Delemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Eur J Endocrinol 2006;155:S131–7.10.1530/eje.1.02231Search in Google Scholar
12. Wells JC, Williams JE, Chomtho S, Darch T, Grijalva-Eternod C, et al. Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am J Clin Nutr 2012;96:1316–26.10.3945/ajcn.112.036970Search in Google Scholar PubMed
13. Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, et al. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 1995;73:17–24.10.1136/adc.73.1.17Search in Google Scholar PubMed PubMed Central
15. Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015;100:E270–5.10.1210/jc.2014-2439Search in Google Scholar PubMed
16. Klaver M, de Mutsert R, Wiepjes C, Twisk J, den Heijer M, et al. Early hormonal treatment affects body composition and body shape in young transgender adolescents. J Sex Med 2018;15:251–60.10.1016/j.jsxm.2017.12.009Search in Google Scholar PubMed
17. Schagen S, Cohen-Kettenis P. Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med 2016;13:1125–32.10.1016/j.jsxm.2016.05.004Search in Google Scholar PubMed
18. Cole TJ, Pan H, Butler GE. A mixed effects model to estimate timing and intensity of pubertal growth from height and secondary sexual characteristics. Ann Hum Biol 2014;41:76–83.10.3109/03014460.2013.856472Search in Google Scholar PubMed PubMed Central
19. Carel J-C, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752–62.10.1542/peds.2008-1783Search in Google Scholar PubMed
20. van de Grift TC, Cohen-Kettenis PT, Steensma TD, De Cuypere G, Richter-Appelt H, et al. Body satisfaction and physical appearance in gender dysphoria. Arch Sex Behav 2016;45:575–85.10.1007/s10508-015-0614-1Search in Google Scholar PubMed PubMed Central
21. Shea KL, Gavin KM, Melanson EL, Gibbons E, Stavros A, et al. Body composition and bone mineral density after ovarian hormone suppression with or without estradiol treatment. Menopause 2015;22:1045–52.10.1097/GME.0000000000000430Search in Google Scholar PubMed PubMed Central
22. Isidori AM, GIannetta E, Greco EA, Gianfrilli D, Bonifacio V, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf) 2005;63:280–93.10.1111/j.1365-2265.2005.02339.xSearch in Google Scholar PubMed
23. Montagnese C, Williams JE, Haroun D, Siervo M, Fewtrell MS, et al. Is a single bioelectrical impedance equation valid for children of wide ranges of age, pubertal status and nutritional status? Evidence from the 4-component model. Eur J Clin Nutr 2013;67(Suppl 1):S34–9.10.1038/ejcn.2011.213Search in Google Scholar PubMed
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