Author ORCID Identifier

Date of Award

Summer 7-26-2023

Degree Type


Degree Name

Master of Science (MS)



First Advisor

Dr. Anita Nucci

Second Advisor

Kate Wiley

Third Advisor

Jessica White

Fourth Advisor

Dr. Kellie Mayfield


Background: The recent increase in the prevalence of metabolic syndrome (MetS) parallels trends in rates of obesity. However, the distribution of weight-related health risks between men and women is not equivalent and the prevalence of risk factors for MetS in adults receiving gender affirming hormone therapy (GAHT) is unknown. The objective of this study is to describe MetS risk status before and after feminizing or masculinizing therapy in an urban transgender/gender nonconforming population.

Methods: A retrospective review of demographic characteristics, anthropometric data, hormone levels, and risk factors for MetS (adiposity, insulin resistance, abnormal triglyceride metabolism, abnormal cholesterol metabolism, and hypertension) was conducted in adults receiving care at a gender clinic in a large urban hospital. The Third Report of the National Cholesterol Education Program on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was used to determine risk for MetS (low, moderate, high). Differences in MetS risk factor levels and risk scores were examined by therapy type as well as pre- and post-therapy.

Results: Data from 28 adults (median age 30.5 years [Interquartile range; 25.5, 37.5], 68% Black/African American, 4% Hispanic) were included in the analysis. The majority of the population (57%) received feminizing treatment. Of the MetS risk factor levels examined (BMI, systolic and diastolic blood pressure, glucose, Hemoglobin A1c, triglyceride and high-density lipoprotein [HDL] cholesterol) no significant difference was found between therapy types during either the pre- or post-therapy periods. Significant differences were observed between pre-therapy and post-therapy levels of triglycerides (60.0 ± 7.8 vs. 92.4 ± 7.8, respectively; P=0.003) and HDL cholesterol (54.8 ± 2.1 vs. 44.8 ± 2.5, respectively; P=0.012) for participants in the masculinizing treatment group. Participants in the feminizing treatment group were found to have significant differences in systolic blood pressure (129.8 ± 3.1 vs. 123.9 ± 3.0, respectively; P=0.028) between the pre-therapy and post-therapy periods. An association between HDL cholesterol risk score (determined based on sex assigned at birth) and therapy type was observed in participants post-treatment. The majority of individuals receiving masculinizing therapy (86%) are categorized as high risk after therapy while the majority of individuals receiving feminizing therapy (92%) are at low risk (P=0.002).

Conclusions: This study demonstrates the health effects that may result from GAHT, a vital therapeutic practice for this population. MetS risk was similar between treatment types during the pre-therapy and post-therapy periods. However, within group analysis demonstrated significant shifts in triglyceride and HDL levels (masculinizing) and systolic blood pressure (feminizing) over the course of treatment. Twenty-five percent of the participants are living with HIV, which increases the risk of developing MetS. The increased risk of developing MetS in this population may warrant earlier and more thorough lifestyle and dietary interventions to adequately prevent and manage disease progression.


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