{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:32:35Z","timestamp":1793413955212,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T00:00:00Z","timestamp":1517443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T00:00:00Z","timestamp":1517443200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Transgender adolescents aspiring to have the body characteristics of the affirmed sex can receive hormonal treatment. However, it is unknown how body shape and composition develop during treatment and whether transgender persons obtain the desired body phenotype.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To examine the change in body shape and composition from the start of treatment with gonadotropin-releasing hormone agonists (GnRHa) until 22 years of age and to compare these measurements at 22 years with those of age-matched peers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>71 transwomen (birth-assigned boys) and 121 transmen (birth-assigned girls) who started treatment from 1998 through 2014 were included in this retrospective study. GnRHa treatment was started and cross-sex hormonal treatment was added at 16 years of age. Anthropometric and whole-body dual-energy x-ray absorptiometry data were retrieved from medical records. Linear mixed model regression was performed to examine changes over time. SD scores (SDS) were calculated to compare body shape and composition with those of age-matched peers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>Change in waist-hip ratio (WHR), total body fat (TBF), and total lean body mass (LBM) during hormonal treatment. SDS of measures of body shape and composition compared with age-matched peers at 22 years of age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In transwomen, TBF increased (+10%, 95% CI = 7\u201311) while total LBM (\u221210%, 95% CI = \u221211 to \u22127) and WHR (\u22120.04, 95% CI = \u22120.05 to \u22120.02) decreased. Compared with ciswomen, SDS at 22 years of age were +0.3 (95% CI = 0.0\u20130.5) for WHR, and 0.0 (95% CI = \u22120.2 to 0.3) for TBF. Compared with cismen, SDS were \u22121.0 (95% CI = \u22121.3 to \u22120.7) for WHR, and +2.2 (95% CI = 2.2\u20132.4) for TBF. In transmen, TBF decreased (\u22123%, 95% CI = \u22124 to \u22121), while LBM (+3%, 95% CI = 1\u20134) and WHR (+0.03, 95% CI = 0.01\u20130.04) increased. Compared with ciswomen, SDS at 22 years of age were +0.6 (95% CI = 0.4\u20130.8) for WHR, and \u22121.1 (95% CI = \u22121.4 to \u22120.9) for TBF. Compared with cismen, SDS were \u22120.5 (95% CI = \u22120.8 to \u22120.3) for WHR, and +1.8 (95% CI = 1.6\u20131.9) for TBF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>Knowing body shape and composition outcomes at 22 years of age will help care providers in counseling transgender youth on expectations of attaining the desired body phenotype.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>This study presents the largest group of transgender adults to date who started treatment in their teens. Despite missing data, selection bias was not found.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>During treatment, WHR and body composition changed toward the affirmed sex. At 22 years of age, transwomen compared better to age-matched ciswomen than to cismen, whereas transmen were between reference values for ciswomen and cismen.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2017.12.009","type":"journal-article","created":{"date-parts":[[2018,2,3]],"date-time":"2018-02-03T04:42:58Z","timestamp":1517632978000},"page":"251-260","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":85,"title":["Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents"],"prefix":"10.1093","volume":"15","author":[{"given":"Maartje","family":"Klaver","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9e","family":"de Mutsert","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology , Leiden, \u00a0 the Netherlands"},{"name":"Leiden University and Medical Center , Leiden, \u00a0 the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal M.","family":"Wiepjes","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos W.R.","family":"Twisk","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"den Heijer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Center of Expertise on Gender Dysphoria , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost","family":"Rotteveel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Amsterdam, \u00a0 The Netherlands"},{"name":"Division of Endocrinology , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani\u00ebl T.","family":"Klink","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Amsterdam, \u00a0 The Netherlands"},{"name":"Division of Endocrinology , Amsterdam, \u00a0 The Netherlands"},{"name":"VU University Medical Center , Amsterdam, \u00a0 The Netherlands"},{"name":"Department of Pediatrics , Ghent, \u00a0 Belgium"},{"name":"Division of Pediatric Endocrinology , Ghent, \u00a0 Belgium"},{"name":"Ghent University Hospital , Ghent, \u00a0 Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,2,1]]},"reference":[{"key":"2023012309142358500_bib1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1530\/eje.1.02231","article-title":"Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects","volume":"155","author":"Delemarre-van de Waal","year":"2006","journal-title":"Eur J Endocrinol"},{"key":"2023012309142358500_bib2","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.beem.2007.04.007","article-title":"Sexual dimorphism of body composition","volume":"21","author":"Wells","year":"2007","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"2023012309142358500_bib3","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1038\/oby.2009.399","article-title":"Sex differences in regional body fat distribution from pre- to postpuberty","volume":"18","author":"Taylor","year":"2010","journal-title":"Obesity"},{"key":"2023012309142358500_bib4","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00431-004-1586-7","article-title":"Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice?","volume":"164","author":"Fredriks","year":"2005","journal-title":"Eur J Pediatr"},{"key":"2023012309142358500_bib5","article-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2000"},{"key":"2023012309142358500_bib6","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jclinepi.2013.03.017","article-title":"Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis","volume":"66","author":"Twisk","year":"2013","journal-title":"J\u00a0Clin Epidemiol"},{"key":"2023012309142358500_bib7","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1136\/adc.51.3.170","article-title":"Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty","volume":"51","author":"Tanner","year":"1976","journal-title":"Arch Dis Child"},{"key":"2023012309142358500_bib8","first-page":"240","article-title":"Testicular size: assessment and clinical importance","volume":"7","author":"Prader","year":"1966","journal-title":"Triangle"},{"key":"2023012309142358500_bib9","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1136\/adc.82.2.107","article-title":"Body index measurements in 1996\u20137 compared with 1980","volume":"82","author":"Fredriks","year":"2000","journal-title":"Arch Dis Child"},{"key":"2023012309142358500_bib10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1136\/adc.87.4.341","article-title":"Reference data for bone density and body composition measured with dual energy x ray absorptiometry in white children and young adults","volume":"87","author":"van der Sluis","year":"2002","journal-title":"Arch Dis Child"},{"key":"2023012309142358500_bib11","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1038\/oby.2011.300","article-title":"Fat in android, trunk, and peripheral regions varies by ethnicity and race in college aged women","volume":"20","author":"Stults-Kolehmainen","year":"2012","journal-title":"Obesity"},{"key":"2023012309142358500_bib12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/nutd.2013.5","article-title":"DXA estimates of fat in abdominal, trunk and hip regions varies by ethnicity in men","volume":"3","author":"Stults-Kolehmainen","year":"2013","journal-title":"Nutr Diabetes"},{"key":"2023012309142358500_bib13","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1038\/sj.ijo.0800522","article-title":"Gender differences in body fat content are present well before puberty","volume":"21","author":"Taylor","year":"1997","journal-title":"Int J Obes"},{"key":"2023012309142358500_bib14","author":"Klaver"},{"key":"2023012309142358500_bib15","article-title":"Cross-sex hormone therapy and the effects on fat distribution in transgender persons","author":"Klaver","year":"2016"},{"key":"2023012309142358500_bib16","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.pcl.2016.07.011","article-title":"What the primary care pediatrician needs to know about gender incongruence and gender dysphoria in children and adolescents","volume":"63","author":"de Vries","year":"2016","journal-title":"Pediatr Clin North Am"},{"key":"2023012309142358500_bib17","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.neubiorev.2016.07.036","article-title":"The organizing actions of adolescent gonadal steroid hormones on brain and behavioral development","volume":"70","author":"Schulz","year":"2016","journal-title":"Neurosci Biobehav Rev"},{"key":"2023012309142358500_bib18","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1055\/s-0030-1255074","article-title":"Body composition and bone mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist","volume":"119","author":"Mueller","year":"2011","journal-title":"Clin Endocrinol Diabetes"},{"key":"2023012309142358500_bib19","first-page":"3190","article-title":"Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals","volume":"7","author":"Mueller","year":"2010","journal-title":"J\u00a0Sex Med"},{"key":"2023012309142358500_bib20","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1210\/jc.2009-0345","article-title":"Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline","volume":"94","author":"Hembree","year":"2009","journal-title":"J\u00a0Clin Endocrinol Metab"},{"key":"2023012309142358500_bib21","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1080\/15532739.2017.1293581","article-title":"Barriers and facilitators of physical activity and sport participation among young transgender adults who are medically transitioning","volume":"18","author":"Jones","year":"2017","journal-title":"Int J Transgend"},{"key":"2023012309142358500_bib22","first-page":"781","article-title":"Independent genetic factors determine the amount and distribution of fat in women after the menopause","volume":"82","author":"Samaras","year":"1997","journal-title":"J\u00a0Clin Endocrinol Metab"},{"key":"2023012309142358500_bib23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.yhbeh.2009.03.011","article-title":"The organizational-activational hypothesis as the foundation for a unified theory of sexual differentiation of all mammalian tissues","volume":"55","author":"Arnold","year":"2009","journal-title":"Horm Behav"},{"key":"2023012309142358500_bib24","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1152\/jappl.2001.90.5.1777","article-title":"Genomic scan for genes affecting body composition before and after training in Caucasians from HERITAGE","volume":"90","author":"Chagnon","year":"2001","journal-title":"J\u00a0Appl Physiol"},{"key":"2023012309142358500_bib25","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.genm.2009.02.002","article-title":"Gender differences in insulin resistance, body composition, and energy balance","volume":"6","author":"Geer","year":"2009","journal-title":"Gend Med"},{"key":"2023012309142358500_bib26","first-page":"747","article-title":"Consecutive cyproterone acetate and estradiol treatment in late-pubertal transgender female adolescents","volume":"14","author":"Tack","year":"2017","journal-title":"J\u00a0Sex Med"},{"key":"2023012309142358500_bib27","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1038\/nature05488","article-title":"Abdominal obesity and metabolic syndrome","volume":"444","author":"Despr\u00e9s","year":"2006","journal-title":"Nature"},{"key":"2023012309142358500_bib28","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1152\/physrev.00033.2011","article-title":"Pathophysiology of human visceral obesity: an update","volume":"93","author":"Tchernof","year":"2013","journal-title":"Physiol Rev"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609517318830?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609517318830?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/15\/2\/251\/48602415\/jsm_15_2_251.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/15\/2\/251\/48602415\/jsm_15_2_251.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T09:38:43Z","timestamp":1674466723000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/15\/2\/251\/6980279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,1]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,2,1]]},"published-print":{"date-parts":[[2018,2,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2017.12.009","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2018,2]]},"published":{"date-parts":[[2018,2,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2017.12.009","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}