Effects of Puberty Suppression and Sex Steroids on Weight, BMI, and Lipid Profiles in Danish Transgender Adolescents

CONTEXT: Cardiovascular health of the transgender population receiving hormone therapy (HT) has been a concern.

OBJECTIVE: To investigate weight, body mass index (BMI), and lipid profiles in a national cohort of transgender adolescents starting HT before 18 years of age.

METHODS: In this observational study, 164 trans boys and 55 trans girls were followed longitudinally during HT. Gonadotropin-releasing hormone analog (GnRHa) was initiated either before or alongside sex steroid therapy. Anthropometry and lipid profiles were analyzed at the start of HT and at routine visits.

RESULTS: Before HT, overweight (BMI 1-2 standard deviation score [SDS]) and obesity (BMI ≥ 2 SDS) were found in 26.8% and 22.0% of trans boys, and in 5.7% and 5.7% of trans girls, respectively. BMI SDS correlated positively with total cholesterol, low-density lipoprotein (LDL), and triglycerides, and negatively with high-density lipoprotein (HDL). In trans boys and girls, high percentages had lipids above normal reference intervals; total cholesterol (12.5% and 6.1%), LDL (21.8% and 12.5%), and triglycerides (3.4% and 6.3%), and HDL below normal reference intervals (9.0% and 18.4%), respectively. During GnRHa monotherapy, there was a trend toward declining weight SDS, but BMI SDS and lipid profiles did not change consistently. After initiation of sex steroids, weight SDS, BMI SDS, and HDL decreased along with increased triglycerides in trans boys, and HDL increased in trans girls.

CONCLUSION: Overweight, obesity, and dyslipidemia were common in transgender adolescents before HT initiation. BMI did not deteriorate, but dyslipidemia worsened slightly during sex steroid therapy in trans boys but not in trans girls.