Body Composition and Markers of Cardiometabolic Health in Transgender Youth on Gonadotropin-Releasing Hormone Agonists

Natalie J Nokoff; Sharon L Scarbro; Kerrie L Moreau; Philip Zeitler; Kristen J Nadeau; Daniel Reirden; Elizabeth Juarez-Colunga; Megan M Kelsey

doi:10.1089/trgh.2020.0029

Body Composition and Markers of Cardiometabolic Health in Transgender Youth on Gonadotropin-Releasing Hormone Agonists

Transgend Health. 2021 Apr 16;6(2):111-119. doi: 10.1089/trgh.2020.0029. eCollection 2021 Apr.

Authors

Natalie J Nokoff^{1

2}, Sharon L Scarbro^{3

4

5}, Kerrie L Moreau^{2

6

7}, Philip Zeitler¹, Kristen J Nadeau^{1

2}, Daniel Reirden¹, Elizabeth Juarez-Colunga^{4

8}, Megan M Kelsey^{1

2}

Affiliations

¹ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³ Department of Community and Behavioral Health, University of Colorado Denver Colorado School of Public Health, Aurora, Colorado, USA.
⁴ Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado, USA.
⁵ Rocky Mountain Prevention Research Center, University of Colorado Denver Colorado School of Public Health, Aurora, Colorado, USA.
⁶ Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Veteran Affairs (VA) Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA.
⁸ Department of Biostatistics and Informatics, University of Colorado Denver Colorado School of Public Health, Aurora, Colorado, USA.

Abstract

Purpose: Up to 1.8% of youth identify as transgender; many will be treated with a gonadotropin-releasing hormone agonist (GnRHa). The impact of GnRHa on insulin sensitivity and body composition in transgender youth is understudied. We aimed to evaluate differences in insulin sensitivity and body composition in transgender youth on GnRHa therapy compared with cisgender youth. Methods: Transgender participants were matched to cisgender participants on age, body mass index, and sex assigned at birth. Transgender males (n=9, ages 10.1-16.0 years) on GnRHa (mean±standard deviation duration of exposure: 20.9±19.8 months) were compared with cisgender females (n=14, ages 10.6-16.2). Transgender females (n=8, ages 12.6-16.1) on GnRHa (11.3±7 months) were compared with cisgender males (n=17, ages 12.5-15.5). Differences in insulin sensitivity (1/[fasting insulin], homeostatic model of insulin resistance [HOMA-IR]), glycemia (hemoglobin A1C [HbA1c], fasting glucose), and body composition (dual-energy X-ray absorptiometry) were evaluated using a mixed linear regression model. Results: Transgender males had lower 1/fasting insulin and higher HOMA-IR (p=0.031, p=0.01, respectively), fasting glucose (89±4 vs. 79±13 mg/dL, p=0.012), HbA1c (5.4±0.2 vs. 5.2±0.2%, p=0.039), and percent body fat (36±7 vs. 32±5%, p=0.042) than matched cisgender females. Transgender females had lower 1/fasting insulin and higher HOMA-IR (p=0.028, p=0.035), HbA1c (5.4±0.1% vs. 5.1±0.2%, p=0.007), percent body fat (31±9 vs. 24±10%, p=0.002), and lower percent lean mass (66±8 vs. 74±10%, p<0.001) than matched cisgender males. Conclusion: Transgender youth on a GnRHa have lower estimated insulin sensitivity and higher glycemic markers and body fat than cisgender controls with similar characteristics. Longitudinal studies are needed to understand the significance of these changes. Clinical Trial.gov ID: NCT02550431.

Keywords: assigned sex; body composition; gender dysphoria; gonadotropin-releasing hormone agonist; insulin resistance; transgender.

Associated data

ClinicalTrials.gov/NCT02550431

Abstract

Associated data

Grants and funding