Clinical Scorecard: Impact of Hormonal Treatment and Puberty Blockade on Body Weight, BMI, and Lipid Levels in Danish Transgender Youth
At a Glance
Category
Detail
Condition
Transgender adolescents undergoing hormone therapy and puberty blockade
Key Mechanisms
Gonadotropin-releasing hormone analog (GnRHa) to block endogenous puberty; sex steroids (testosterone or estradiol) to induce secondary sexual characteristics
Target Population
Transgender adolescents under 18 years initiating hormone therapy
Care Setting
National tertiary center specialized in transgender health care in Denmark
Key Highlights
Overweight and obesity were common before hormone therapy initiation, especially in trans boys (26.8% overweight, 22.0% obese).
During GnRHa monotherapy, weight SDS tended to decline but BMI SDS and lipid profiles remained stable.
Sex steroid therapy decreased HDL and increased triglycerides in trans boys; HDL increased in trans girls; dyslipidemia worsened slightly in trans boys but not in trans girls.
Guideline-Based Recommendations
Diagnosis
Comprehensive medical, psychiatric, and psychosocial assessment before hormone therapy initiation.
Evaluation of gender identity and body dysphoria by multidisciplinary team.
Management
Initiate GnRHa from Tanner stage 2 to block endogenous puberty.
Start sex steroid therapy (testosterone or estradiol) usually after 15 years of age to induce secondary sexual characteristics.
Monitor and manage overweight, obesity, and dyslipidemia as part of care.
Monitoring & Follow-up
Regular anthropometric measurements (weight, BMI, BMI SDS) at baseline and routine visits.
Lipid profile monitoring including total cholesterol, LDL, HDL, and triglycerides before and during hormone therapy.
Risks
Increased prevalence of overweight, obesity, and dyslipidemia prior to hormone therapy.
Potential worsening of lipid profiles during sex steroid therapy, especially in trans boys.
Cardiovascular disease risk factors should be closely monitored given associations with visceral fat and dyslipidemia.
Patient & Prescribing Data
219 transgender adolescents (164 trans boys, 55 trans girls) starting hormone therapy before age 18
62.8% of trans boys and 76.4% of trans girls started with GnRHa monotherapy; some initiated sex steroids simultaneously; no statin use or eating disorder diagnoses reported.
Clinical Best Practices
Perform multidisciplinary assessment prior to hormone therapy initiation.
Use GnRHa to delay puberty at Tanner stage 2, followed by sex steroids to induce desired secondary sexual characteristics.
Monitor BMI and lipid profiles longitudinally to detect and manage cardiovascular risk factors.
Address overweight and obesity early, especially in trans boys, to mitigate metabolic risks.
Consider potential lipid profile changes during sex steroid therapy and tailor management accordingly.
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
