Effect of Puberty Suppression and Gender Affirming Hormone Treatment Depends upon Prior Extent of Pubertal Development in Young Transgender Adolescents
Authors' conclusion
The effect of PS on body composition is more pronounced in 'in puberty' trans adolescents, and 'in puberty' trans boys are more responsive to GAHT, showing greater increases in MM and LM. In trans girls, the most significant increase in FM, along with reduction in LM and MM, occurs during PS, whereas no substantial changes were observed during subsequent GAHT. This suggests that any effect on physical performance may depend on pubertal development at the start of intervention.
Study context
- Population
- Adolescents starting puberty suppression (PS) under 15yr at a national gender service; 127 subsequently received gender-affirming hormone therapy (GAHT)127 with GAHT data
- Participants
- 201 adolescents
- Exposure
- Body composition change on PS and GAHT by birth-assigned sex and pubertal stage at start
- Trans boysn = 139
- Trans girlsn = 62
- Outcome
- Change in anthropometric parameters and body composition (height, weight, BMI, total lean, fat and muscle mass; Tanita analyzer) during PS and GAHT
Methodological detailsnational gender service
- National gender service
Main finding
As reported in the abstract
during PS
- 'In puberty' trans boys: total FM increase on PS
- 2.49 kg (95% CI 1.66;3.33)
- 'In puberty' trans boys: total LM increase on PS
- 2.41 kg (95% CI 1.85;2.97)
- 'Completing puberty' trans boys: total FM increase on PS
- 1.80 kg (95% CI 1.21;2.39)
- 'Completing puberty' trans boys: total LM increase on PS
- 0.97 kg (95% CI 0.63;1.30)
- 'Completing puberty' trans girls: total FM increase on PS, the greatest
- 4.27 kg (95% CI 1.50;7.03)
Observational data: associations, not effects.
Further findings
FM and LM z-scores after 3 years of PS (trans boys)
- 'In puberty' trans boys: mean FM z-score increased from baseline
- 0.70 to 1.2
- 'In puberty' trans boys: mean LM z-score decreased
- 0.98 to 0.5
- 'Completing puberty' trans boys: mean LM z-score decreased
- 1.16 to 0.80
Body composition change during GAHT
kg
- 'In puberty' trans boys: greater increase of total LM
- 6.28 (95% CI 3.54;9.02)
- 'In puberty' trans boys: greater increase of total MM
- 6.08 (95% CI 3.64;8.51)
- 'In puberty' and 'completing puberty' trans boys: no further increase in total FM
- Trans girls: body composition only changed slightly during GAHT
Original publication
Effect of Puberty Suppression and Gender Affirming Hormone Treatment Depends upon Prior Extent of Pubertal Development in Young Transgender Adolescents. Horm Res Paediatr. Published 15 August 2025. doi:10.
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