Objective:

To evaluate the effects of standardized feminizing gender-affirming hormone therapy (GAHT) using GnRH agonists and estrogens on metabolic and bone parameters in assigned male at birth (AMAB) individuals.

Approach:

Key Findings:

• Body mass index, fat mass index, and visceral adipose tissue did not change significantly under GAHT (p=0.14; p=0.14; p=0.73).
• Lean mass indices decreased significantly by -0.66 kg/m2 at 12 months (p<0.001).
• Plasma HDL-cholesterol increased significantly by 0.18 mmol/L (p<0.001).
• The percentage of participants with low BMD (Z-score < -2.0 SD) decreased from 41% at baseline to 27% by 12 months.
• BMD at the lumbar spine increased by +0.03 g/cm2 (p<0.001).
• Greater E2 rise and attainment of target plasma E2 concentrations (> 300 pmol/L) were not significantly associated with changes in metabolic outcomes.

Interpretation:

GAHT did not adversely affect surrogate markers of cardiovascular and bone health in the studied population.

Conclusion:

The study suggests that feminizing GAHT using GnRH agonists does not lead to negative metabolic or bone health outcomes in adult transgender women.

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