Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology and Population Health

Weight gain and obesity rates in transgender and gender-diverse adults before and during hormone therapy

Subjects

Abstract

Background

Obesity rates and weight changes in adults on gender-affirming hormone therapy are lacking or limited by small sample sizes, duration, and location.

Subjects/methods

This longitudinal study followed the body mass index and body weights of 470 transgender and gender-diverse adult patients (247 transfeminine and 223 transmasculine; mean age, 27.8 years) seen at a Federally Qualified Health Center and an academic endocrinology practice, both in Washington DC USA. Body weight and body mass index were recorded at baseline and at multiple follow-up clinical visits up to 57 months after the initiation of gender-affirming hormone therapy. The outcomes of this study were the changes to body weight and obesity rates following hormone therapy.

Results

Within 2–4 months of starting gender-affirming hormone therapy, the mean body weight increased in the transmasculine group by 2.35 (1.15–3.55) kg and further increased beyond 34 months. Among the transfeminine group, the mean body weight was stable for the first 21 months of hormone therapy and then began to steadily increase, particularly in those under 30 years old. The prevalence of obesity at baseline was 25% in the transfeminine group and 39% in the transmasculine group. Following the initiation of hormone therapy, rates of obesity ranged from 42 to 52% among the transmasculine group and 21 to 30% among transfeminine group. Following 11–21 months of hormone therapy, weight gain ≥5 kg was seen among 21% of transfeminine individuals and 30% of transmasculine individuals.

Conclusions

As compared with transfeminine individuals, transmasculine individuals have greater rates of obesity and weight gain before and during hormone therapy. Body weight and body mass index should be routinely monitored before and after the initiation of gender-affirming hormone therapy. Multidisciplinary weight-reduction interventions should be promoted where appropriate.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: % Change in body weight compared to baseline and mean body mass index across time in gender-diverse patients on hormone therapy.

References

  1. 1.

    Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2017;5:301–11.

    CAS  Article  Google Scholar 

  2. 2.

    Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol. 2017;5:291–300.

    CAS  Article  Google Scholar 

  3. 3.

    Haslam DW, James WP. Obesity. Lancet. 2005;366:1197–209.

    Article  Google Scholar 

  4. 4.

    Streed CG Jr, McCarthy EP, Haas JS. Association between gender minority status and self-reported physical and mental health in the United States. JAMA Intern Med. 2017;177:1210–2.

    Article  Google Scholar 

  5. 5.

    Dragon CN, Guerino P, Ewald E, Laffan AM. Transgender medicare beneficiaries and chronic conditions: exploring fee-for-service claims data. LGBT Health. 2017;4:404–11.

    Article  Google Scholar 

  6. 6.

    van Velzen DM, Paldino A, Klaver M, Nota NM, Defreyne J, Hovingh GK, et al. Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen. J Clin Endocrinol Metab. 2019;104:1937–47.

    Article  Google Scholar 

  7. 7.

    Deutsch MB, Bhakri V, Kubicek K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol. 2015;125:605–10.

    CAS  Article  Google Scholar 

  8. 8.

    Elbers JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol. 2003;58:562–71.

    CAS  Article  Google Scholar 

  9. 9.

    Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, et al. Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-year follow-up data. J Clin Endocrinol Metab. 2016;101:4260–9.

    CAS  Article  Google Scholar 

  10. 10.

    Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, et al. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med. 2014;11:3002–11.

    Article  Google Scholar 

  11. 11.

    Quiros C, Patrascioiu I, Mora M, Aranda GB, Hanzu FA, Gómez-Gil E, et al. Effect of cross-sex hormone treatment on cardiovascular risk factors in transsexual individuals. experience in a specialized unit in catalonia. Endocrinol Nutr. 2015;62:210–6.

    Article  Google Scholar 

  12. 12.

    Van Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S, Toye K, et al. Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case-controlled study (ENIGI). Eur J Endocrinol. 2015;172:163–71.

    Article  Google Scholar 

  13. 13.

    Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher AD, Toye K, et al. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: Results from the european network for the investigation of gender incongruence. J Sex Med. 2014;11:1999–2011.

    CAS  Article  Google Scholar 

  14. 14.

    Mueller A, Zollver H, Kronawitter D, Oppelt PG, Claassen T, Hoffmann I, et al. Body composition and bone mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist. Exp Clin Endocrinol Diabetes. 2011;119:95–100.

    CAS  Article  Google Scholar 

  15. 15.

    Bates D, Machler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. Journal of Statistical Software. 2015;67:1–48.

    Article  Google Scholar 

  16. 16.

    Giltay EJ, Toorians AW, Sarabdjitsingh AR, de Vries NA, Gooren LJ. Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals. J Endocrinol. 2004;180:107–12.

    CAS  Article  Google Scholar 

  17. 17.

    Klaver M, de Blok CJM, Wiepjes CM, Nota NM, Dekker MJHJ, de Mutsert R, et al. Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study. Eur J Endocrinol. 2018;178:163–71.

    CAS  Article  Google Scholar 

  18. 18.

    Mueller A, Haeberle L, Zollver H, Claassen T, Kronawitter D, Oppelt PG, et al. Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals. J Sex Med. 2010;7:3190–8.

    CAS  Article  Google Scholar 

  19. 19.

    Suppakitjanusant P, Ji Y, Stevenson MO, Chantrapanichkul P, Sineath RC, Goodman M, et al. Effects of gender affirming hormone therapy on body mass index in transgender individuals: A longitudinal cohort study. J Clin Transl Endocrinol. 2020;21:100230 https://doi.org/10.1016/j.jcte.2020.100230. eCollection 2020

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Emi Y, Adachi M, Sasaki A, Nakamura Y, Nakatsuka M. Increased arterial stiffness in female-to-male transsexuals treated with androgen. J Obstet Gynaecol Res. 2008;34:890–7.

    Article  Google Scholar 

  21. 21.

    Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief. 2020;1-8.

  22. 22.

    Guss CE, Williams DN, Reisner SL, Austin SB, Katz-Wise SL. Disordered Weight Management Behaviors, Nonprescription Steroid Use, and Weight Perception in Transgender Youth. J Adolesc Health. 2017;60:17–22.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

MI, DG, and ES designed the study. MK and KB collected the study data. SL performed the statistical analyses. MI drafted the paper. All authors read and contributed to the final paper.

Corresponding author

Correspondence to M. S. Irwig.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kyinn, M., Banks, K., Leemaqz, S.Y. et al. Weight gain and obesity rates in transgender and gender-diverse adults before and during hormone therapy. Int J Obes (2021). https://doi.org/10.1038/s41366-021-00935-x

Download citation

Search

Quick links