Impact of Hormonal Treatment and Puberty Blockade on Weight, BMI, and Lipids in Transgender Youth
Overview
This national Danish cohort study of 219 transgender adolescents found that overweight, obesity, and dyslipidemia were common before hormone therapy (HT). During GnRHa monotherapy, weight tended to decline but BMI and lipid profiles remained stable. After initiation of sex steroids, trans boys experienced decreases in BMI and HDL and increases in triglycerides, while trans girls showed increased HDL without worsening lipid profiles.
Background
Transgender adolescents often receive gonadotropin-releasing hormone analogs (GnRHa) to block puberty and sex steroids to induce secondary sexual characteristics. Body mass index (BMI) and lipid profiles are important markers of cardiovascular risk, which is a concern in this population. Prior studies have reported high rates of overweight and obesity in transgender youth, particularly trans boys, and mixed effects of hormone therapy on BMI and lipids. Understanding these changes is critical to managing long-term cardiovascular health in transgender adolescents.
Data Highlights
Parameter
Trans Boys Pre-HT (%)
Trans Girls Pre-HT (%)
Overweight (BMI 1-2 SDS)
26.8
5.7
Obesity (BMI ≥ 2 SDS)
22.0
5.7
Total Cholesterol above normal
12.5
6.1
LDL above normal
21.8
12.5
Triglycerides above normal
3.4
6.3
HDL below normal
9.0
18.4
Key Findings
Before hormone therapy, 48.8% of trans boys and 11.4% of trans girls were overweight or obese.
BMI SDS correlated positively with total cholesterol, LDL, and triglycerides, and negatively with HDL.
During GnRHa monotherapy, weight SDS tended to decline, but BMI SDS and lipid profiles showed no consistent changes.
After starting sex steroids, trans boys showed decreased weight SDS, BMI SDS, and HDL, with increased triglycerides.
Trans girls experienced increased HDL after sex steroid initiation, with no significant worsening of lipid profiles.
Dyslipidemia was prevalent before HT and worsened slightly during sex steroid therapy in trans boys but not in trans girls.
Clinical Implications
Clinicians should monitor BMI and lipid profiles closely in transgender adolescents before and during hormone therapy, especially in trans boys who may experience worsening dyslipidemia after sex steroid initiation. Early identification and management of overweight, obesity, and lipid abnormalities are important to mitigate long-term cardiovascular risk. Hormone therapy protocols may need to incorporate cardiovascular risk assessment and counseling.
Conclusion
Overweight, obesity, and dyslipidemia are common in transgender youth prior to hormone therapy. While BMI remains stable during puberty blockade, sex steroid therapy in trans boys is associated with modest worsening of lipid profiles, underscoring the need for ongoing cardiovascular monitoring in this population.
References
Danish National Cohort Study 2016-2023 -- Impact of Hormonal Treatment and Puberty Blockade on Body Weight, BMI, and Lipid Levels in Danish Transgender Youth
by Kjersti Kvernebo Sunnergren, Pernille Badsberg Norup, Mette Ewers Haahr, Annamaria Giraldi, Anne Katrine Pagsberg, Peter Christiansen, Lise Aksglaede, Line Cleemann, Anders Juul, Katharina M Main
