TLDR Gender-affirming hormone therapy improves physical performance in trans men to the level of cisgender men, while in trans women, it increases fat mass and decreases muscle mass, with no advantage in physical performance after 2 years.
The review examines the impact of gender-affirming hormone therapy (GAHT) on physical performance in transgender individuals. In nonathletic trans men starting testosterone therapy, muscle mass and strength increased within 1 year, and by 3 years, physical performance improved to the level of cisgender men. In nonathletic trans women, feminizing hormone therapy increased fat mass by approximately 30% and decreased muscle mass by approximately 5% after 12 months, and steadily declined beyond 3 years. After 2 years of GAHT, no advantage was observed for physical performance measured by running time or in trans women. By 4 years, there was no advantage in sit-ups. Limited evidence suggests that physical performance of nonathletic trans people who have undergone GAHT for at least 2 years approaches that of cisgender controls. Further controlled longitudinal research is needed in trans athletes and nonathletes.
31 citations
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September 2020 in “Clinical endocrinology” Some antiandrogens may lower testosterone better than others, but it's unclear which is best for feminization in transgender women; more research is needed.
204 citations
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May 2014 in “The Journal of Sexual Medicine” Hormone therapy for trans individuals is effective and generally safe in the short term.
105 citations
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June 2010 in “The journal of sexual medicine” Testosterone undecanoate increases lean mass and causes various physical changes in female-to-male transsexuals.
June 2023 in “Clinical and Experimental Dermatology” Gender-affirming hormone therapy changes hair growth in transgender people, with feminizing therapy reducing hair and masculinizing therapy increasing it, but sometimes additional treatment is needed.
May 2023 in “Journal of drugs in dermatology” Most transgender patients getting laser hair removal before gender-affirming surgery are already on hormone therapy, which might affect the hair removal process.
December 2025 in “International Journal of Innovative Technologies in Social Science” Transgender individuals face unique skin issues, often due to hormone therapy, requiring specialized and stigma-free dermatologic care.
15 citations
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September 2021 in “Frontiers in Endocrinology” Hormone therapy increases the risk of heart-related issues in transgender women and may affect heart health in transgender men.
1 citations
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November 2023 in “Medicina” Hormone therapy improves mental well-being in transgender individuals but requires ongoing health monitoring.
