Sex steroids regulate liver fat content and body fat distribution in both men and women: a study in transgender persons

Marieke Tebbens, Moya Schutte, Marian A Troelstra, Eveline Bruinstroop, Renée de Mutsert, Aart J Nederveen, Martin den Heijer, Peter H. Bisschop

Research output: Contribution to journalArticleAcademicpeer-review


CONTEXT: Liver fat content and visceral fat volume are associated with insulin resistance and cardiovascular disease and are higher in men than in women. OBJECTIVE: To determine the effect of estradiol and testosterone treatment on liver fat and visceral fat in transgender persons. DESIGN: Open-label intervention study (SHAMVA) with a 1-year follow-up. SETTING: Gender clinic in a hospital. PATIENTS: 8 trans women and 18 trans men receiving hormone treatment. INTERVENTIONS: Trans women received an antiandrogen and after 6 weeks estradiol was added. Trans men were randomized to receive triptorelin, testosterone, and anastrozole for 12 weeks or triptorelin and testosterone for 12 weeks, followed by only testosterone until week 52. MAIN OUTCOME MEASURES: Liver fat content, visceral and abdominal subcutaneous fat volume, measured by magnetic resonance spectrometry or imaging at baseline, 6, 8, 18, and 58 weeks in transwomen or at baseline; at 6 and 12 weeks in trans men with anastrozole; and at 52 weeks in trans men without anastrozole. RESULTS: In trans women, liver fat content decreased by 1.55% (-2.99 to -0.12) after 58 weeks, compared to week 6. Visceral fat did not change. In trans men with anastrozole, the liver fat content and visceral fat volume did not change. In trans men without anastrozole, after 52 weeks, liver fat content increased by 0.83% (0.14 to 1.52) and visceral fat volume increased by 34% (16 to 51). CONCLUSIONS: Sex hormones regulate liver fat content and visceral fat in men and women.

Original languageEnglish
Pages (from-to)e280-e290
JournalThe Journal of clinical endocrinology and metabolism
Issue number1
Early online date18 Jul 2023
Publication statusPublished - 21 Dec 2023


  • liver fat
  • sex steroids
  • transgender
  • visceral fat

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