Body composition, metabolic syndrome, and lifestyle in treatment‐naïve gender‐diverse youth in Israel

Summary Background There is a scarcity of published studies evaluating transgender/gender‐diverse youth before initiating gender‐affirming hormones. Aim To study the body composition, metabolic syndrome (MetS) components and lifestyle habits in treatment‐naïve transgender youth. Methods Cross‐sectional study evaluating 153 transgender youth median age 15.7 years, 94 transgender males who attended The Israeli Children and Adolescents Gender Clinic between 6/2021–12/2022. Clinical, metabolic data and lifestyle habits (diet, physical activity and sleep patterns) were retrieved from the medical files. Body composition was determined by bioelectrical impedance analysis. Body mass index and muscle‐to‐fat ratio z‐scores were calculated by sex designated at birth. Results Weight categories differed between genders, with a greater proportion of subjects classified as underweight among transgender females, and a greater proportion affected by overweight/obese/severe obese among transgender males ( p = 0.035). The odds for MetS components were increased by 2.2 for every 1 standard deviation decrease in the muscle‐to‐fat ratio z‐score (95%CI: 1.45 to 3.26, p < 0.001). About one‐third of the cohort did not meet any of the three lifestyle recommendations. Transgender males had increased odds for MetS components by 3.49 (95%CI: 1.63 to 7.44, p = 0.001). Conclusions Treatment‐naïve transgender‐male adolescents have an imbalance between muscle and adipose tissue, which places them at increased susceptibility for MetS components even prior to hormonal treatment.