Effects of gender affirming hormone therapy on body mass index in transgender individuals: A longitudinal cohort study

Abstract

Introduction: Many transgender people take hormone therapy to affirm their gender identity. One potential long-term consequence of gender affirming hormone therapy is increased body mass index (BMI), which may be associated with metabolic syndrome, cardiovascular disease and higher mortality. Only a few published studies explored changes in BMI in transgender people taking gender affirming hormone therapy (GAHT).

Objective: To examine the changes in BMI longitudinally in response to GAHT in transgender women and men.

Methods: We conducted a retrospective cohort study of transgender individuals who received GAHT from the endocrinology clinic between January 1, 2000 and September 6, 2018. Subjects who sought GAHT were included if they had two separate measurements of BMI and were excluded if they had a BMI greater than 35 kg/m² or were missing demographic data at entry. We used a linear mixed model to analyze the longitudinal change in BMI.

Results: There were a total of 227 subjects included in this cohort. Among subjects already on GAHT, transgender women were receiving GAHT longer than transgender men (6.59 ± 9.35 vs 3.67 ± 3.43 years, p-value = 0.04). Over the period of 7 years, there was a significant increase in BMI in transwomen who newly initiated GAHT (p-value 0.004). There were no changes in BMI in transgender men and women already on GAHT or in transgender men who newly initiated GAHT in the study.

Conclusion: We conclude that BMI significantly increases in transwomen but not in transmen after initiation of GAHT in a single center based in the United States. In transwomen and transmen, BMI appears to be stable following 3 to 6 years of GAHT. Future investigations should examine the causes for increased BMI in transgender women including type of GAHT, diet and lifestyle, and association with risk of metabolic syndrome and cardiovascular disease.

Keywords: Body mass index; Gender affirming hormone therapy; Transgender.

Fig. 1

Flow diagram of study participants.

Fig. 2

Boxplots for course of BMI levels in four cohorts of transgender men and women receiving gender affirming hormone therapy over the period of 7 years. A: transgender women who entered the cohort after on GAHT for more than 6 months (P-value = 0.064). B: transgender women who entered the cohort prior to starting GAHT (P-value = 0.004). C: transgender men who entered the cohort after on GAHT for more than 6 months (P-value = 0.739). D: transgender men who entered the cohort prior to starting GAHT (P-value = 0.790).