The Impact of Gender Affirming Hormone Therapy on Physical Performance

    Ada S Cheung, Sav Zwickl, Keith L. Miller, Brendan J Nolan, Alex Fang Qi Wong, Patrice Jones, Nir Eynon
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    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.
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