Testosterone therapy linked to BMI gains in adolescent transgender males
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A cohort of transgender male adolescents on testosterone therapy had a significant increase in BMI during a mean follow-up of nearly 1 year, a trend not seen in a cohort of BMI-matched cisgender females, according to study data.
“Our data show that over time, this cohort of transgender male adolescents on testosterone had a trend of continued increase in BMI,” Anna Valentine, MD, a fellow in pediatric endocrinology and diabetes at Children’s Hospital Colorado, told Healio. “Our comparison group of cisgender females, who were matched by initial BMI, actually showed the opposite trend, highlighting that this trend of increasing BMI is not necessarily one that is being seen in adolescents who were assigned female at birth with no exposure to testosterone, even in a cohort that was more likely to be overweight or obese at the beginning of the observation period.”
Valentine and colleagues conducted a retrospective study with a cohort of transgender males aged 14 to 21 years from a large pediatric academic center serving transgender and gender-diverse youths. All participants were on testosterone therapy from 2014 to 2018 and were seen at least twice during that period. BMI changes in the transgender male cohort were compared with a cohort of cisgender females of the same age range seen at 13 primary care centers. All of the female participants had no chronic conditions and were matched by initial BMI to the pre-testosterone BMI of the transgender male cohort. The change in BMI was presented as a percentile in the study using the CDC’s growth charts from 2000. The study’s findings were published in Transgender Health.
There were 42 transgender males included in the study (mean age, 16.6 years; 88% white) and 82 matched cisgender females (mean age, 15.5 years; 23.1% white). The mean follow-up time was 10.8 months in the transgender male cohort and 12.7 months for the cisgender female group.
The transgender group had a mean increase in BMI of 1.28 percentiles from visit to visit, whereas the cisgender cohort had a 0.7 percentiles decrease. From baseline through the final follow-up, there was a 3.29 percentiles increase in BMI among transgender males and a 1.77 BMI percentiles decrease among cisgender females. During the full follow-up period, the transgender group had a 0.2 increase in BMI z score vs. a 0.05 decrease in z score for the cisgender group. The prevalence of obesity in both cohorts was 26.2%, higher than the national average of 20.6%.
The two groups had no differences in baseline lipid parameters. After testosterone exposure, the transgender male cohort had a decrease in HDL (P < .01). There were no other lipid parameter changes observed.
“We were surprised that HDL was the only cholesterol type with a significant change over time,” Valentine said. “Studies following adult transgender males have shown increases in triglycerides and LDL cholesterol after a year of testosterone therapy. Studies in transgender adolescents, including ours, are emerging that show that the pattern of change in lipids may not be the same as in adults.”
Valentine said providers should inform transgender patients and their families about the possible effects of testosterone therapy prior to treatment. She added that more studies are needed to evaluate testosterone’s impact on cardiometabolic health.
“It will also be important going forward to try to parse out other influences, such as medication use, mental illness and lifestyle habits, that may all be playing a role,” Valentine said.
For more information:
Anna Valentine, MD, can be reached at anna.valentine@childrenscolorado.org.
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