Change in Visceral Fat and Total Body Fat and the Effect on Cardiometabolic Risk Factors During Transgender Hormone Therapy

Maartje Klaver, Daan van Velzen, Christel de Blok, Nienke Nota, Chantal Wiepjes, Justine Defreyne, Thomas Schreiner, Alessandra Fisher, Jos Twisk, Jaap Seidell, Guy t'Sjoen, Martin den Heijer, Renée de Mutsert

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18 Citations (Scopus)


INTRODUCTION: Excess visceral fat increases the risk of type 2 diabetes and cardiovascular disease and is influenced by sex hormones. Our aim was to investigate changes in visceral fat and the ratio of visceral fat to total body fat (VAT/TBF) and their associations with changes in lipids and insulin resistance after 1 year of hormone therapy in trans persons. METHODS: In 179 trans women and 162 trans men, changes in total body and visceral fat estimated with dual-energy X-ray absorptiometry before and after 1 year of hormone therapy were related to lipids and insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR)] with linear regression analysis. RESULTS: In trans women, total body fat increased by 4.0 kg (95% CI 3.4, 4.7), while the amount of visceral fat did not change (-2 grams; 95% CI -15, 11), albeit with a large range from -318 to 281, resulting in a decrease in the VAT/TBF ratio of 17% (95% CI 15, 19). In trans men, total body fat decreased with 2.8 kg (95% CI 2.2, 3.5), while the amount of visceral fat did not change (3 g; 95% CI -10, 16; range -372, 311), increasing the VAT/TBF ratio by 14% (95% CI 10, 17). In both groups, VAT/TBF was not associated with changes in blood lipids or HOMA-IR. CONCLUSIONS: Hormone therapy in trans women and trans men resulted in changes in VAT/TBF, mainly due to changes in total body fat and were unrelated to changes in cardiometabolic risk factors, which suggests that any unfavorable cardiometabolic effects of hormone therapy are not mediated by changes in visceral fat or VAT/TBF.
Original languageEnglish
Pages (from-to)e153-e164
JournalJournal of clinical endocrinology and metabolism
Issue number1
Publication statusPublished - 1 Jan 2022


  • Adiposity
  • Adult
  • Body Mass Index
  • Cardiometabolic Risk Factors
  • Cardiovascular Diseases/etiology
  • Female
  • Follow-Up Studies
  • Hormone Replacement Therapy/adverse effects
  • Humans
  • Intra-Abdominal Fat/physiopathology
  • Male
  • Obesity/physiopathology
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Transgender Persons/statistics & numerical data
  • Young Adult
  • hormone therapy
  • insulin resistance
  • lipids
  • transgender
  • visceral fat

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