Changes in body composition and nutritional requirements of transgender people undergoing gender-affirming hormone therapy
- 25.09.2024
- English Articles
- Marius Frenser
- Tobias Fischer
Peer reviewed / Manuscript (Review) submitted: 21.09.2023; revised version accepted: 8.12.2023
Introduction
The sex of newborns is determined in the first moments of new life on the basis of external sexual characteristics and can vary in the course of life [1]. While the term 'transsexualism' was still used in ICD-10 (F64.0) [2], since ICD-11, the associated diagnosis of 'gender incongruence' (HA60) has been used [3]. In this context, gender incongruence that is associated with suffering is also referred to as gender dysphoria [4]. A corresponding gender adjustment is possible through various interventions, often involving treatment with sex hormones and/ or hormone suppression [5]. The aim of GAHT is to adjust the sex hormone levels of the person in question so that they correspond to the hormone levels associated with gender identity [6]. In Germany, the annual number of gender reassignment surgeries almost tripled between 2012 and 2021 [7]. This development is consistent with the observation of a social change in which transgender and non-binary people are more visible and accepted in society [5, 8, 9].
Nevertheless, there still are deficits in the medical and health care of transgender people in transition and preventive care [8]. The Institute of Medicine (USA) summarizes major gaps in knowledge regarding the health needs of transgender people [10]. A look at the 'DGE/ÖGE reference values for nutrient intake', which form the basis for deriving nutritional recommendations in Germany [11], confirms this finding. There are intake recommendations for "male" and "female" people of different age groups, but not for transgender people, although the implementation of the reference values for nutrient intake "should ensure the vital metabolic, physical and mental functions of almost all healthy people in the population and protect them from diet-related health problems" [11]. In comparison to the USA, where the Academy of Nutrition and Dietetics also provides a tab for LGBTQ[IA+] (lesbian, gay, bisexual, trans, queer; intersexual, asexual) with various target group-specific information and contact persons on its homepage in addition to the "classic" target groups, this does not yet play a role for all nutrition organizations in Germany [12]. ...
Abstract
Gender-affirming hormone therapy (GAHT) is an option for gender reassignment in transgender people. For the target group of transgender persons with and without GAHT, there are no official national or international recommendations for nutrient intake. Using a systematic review, the influence of GAHT on various aspects of health and body composition was examined and nutrient recommendations based on the reference values of the German Nutrition Society (DGE) and the Austrian Nutrition Society (ÖGE) were derived. After one year of GAHT, transgender women and men were between the values of cisgender men and women in terms of fat mass and lean body mass (LBM). For energy intake during the first GAHT year, orientation towards the middle of the existing reference values for cisgender women and men is recommended. An increased protein intake for transgender men appears to be appropriate. Transgender women are advised to increase their intake of calcium and vitamin D. In principle, an individualized nutritional therapy approach is recommended, taking into account target group-specific characteristics and communication.
