Impact of Puberty Suppression Timing on Breast Volume in Trans Women
Overview
This study evaluated breast volume and satisfaction in trans women who started puberty suppression (PS) early or late in puberty or began gender-affirming hormone therapy (GAHT) in adulthood. Breast volume was generally small across groups, with no significant advantage of early PS on breast size after adjusting for fat percentage. Despite limited breast size, most participants reported satisfaction with their breast development.
Background
Trans women often undergo GAHT, including anti-androgens and estrogen, to induce feminization and alleviate gender dysphoria. Breast development is a key outcome but tends to be smaller and differently positioned compared to cis women. Testosterone exposure during male puberty may cause irreversible changes that limit breast development, prompting investigation into whether early puberty suppression improves outcomes. Puberty suppression with GnRHa halts testosterone production, potentially preventing structural changes that affect breast growth.
Data Highlights
Group
Number of Participants
Median Breast Volume (mL)
Breast Satisfaction (%)
Early PS (Tanner G2-3)
23
Not specified; baseline median 115 mL overall
57%
Late PS (Tanner G4-5)
17
47 mL larger than early PS before fat correction; 4 mL difference after correction
76%
Adult GAHT without PS
20
Comparable to early and late PS groups
70%
Key Findings
Median breast volume across all groups was 115 mL, corresponding to less than an A cup size.
Late puberty suppression group had a 47 mL larger breast volume than early PS group before fat percentage adjustment, but this difference was negligible after adjustment.
Breast volume in the adult GAHT group was similar to both early and late PS groups.
68% of all participants were satisfied with their breast size, with the highest satisfaction in the late PS group (76%).
Early initiation of puberty suppression was not associated with larger breast volume after GAHT.
Despite limited breast size, most trans women reported satisfaction with breast development.
Clinical Implications
Early puberty suppression does not appear to confer an advantage in breast volume development after GAHT in trans women. Clinicians should counsel patients that breast size may remain limited regardless of PS timing, but satisfaction with breast development is generally high. This information can guide expectations and decisions regarding potential breast augmentation.
Conclusion
The timing of puberty suppression prior to GAHT does not significantly influence breast volume in trans women. Most trans women achieve satisfactory breast development despite limited breast size.
References
Hannema et al 2023 -- Influence of Timing on Breast Volume in Trans Women
by Lidewij S Boogers, Sebastiaan A Sardo Infirri, Asma Bouchareb, Benthe A M Dijkman, Danithsia Helder, Christel J M de Blok, Niels P T J Liberton, Martin den Heijer, A S Paul van Trotsenburg, Koen M A Dreijerink, Chantal M Wiepjes, Sabine E Hannema
