Body Composition and Physical Fitness in Transgender Versus Cisgender Individuals: A Systematic Review with Meta-Analysis

This systematic review and meta-analysis, involving 52 studies with 6,485 participants, compared body composition and physical fitness between transgender and cisgender individuals. The findings reveal that transgender women have similar physical fitness levels to cisgender women, with comparable fat mass and strength, although they possess higher lean mass. Transgender men, however, have higher fat mass and lower lean mass and strength compared to cisgender men. Gender-affirming hormone therapy (GAHT) in transgender women leads to increased fat mass and decreased lean mass and strength over 1-3 years, while transgender men experience reduced fat mass and increased lean mass and strength. The study challenges the assumption of inherent athletic advantages for transgender women over cisgender women and suggests that policies regarding transgender athletes should be evidence-based and nuanced, rather than imposing blanket bans.