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Daan M van Velzen, Nienke M Nota, Suat Simsek, Elfi B Conemans, Guy T’Sjoen, and Martin den Heijer


Transgender individuals sometimes report a lack of physical change during hormone treatment, such as alterations in muscle tone or fat distribution. Identifying characteristics of this subgroup could be a step toward individualizing hormone therapy in transgender individuals. Therefore, we study the variation of changes in body composition and characteristics associated with a lack of change.

Design and methods:

Body composition measures were recorded in 323 transmen and 288 transwomen at every visit from the start of hormone therapy to a maximum of 24 months follow-up. Absence of change was defined as transmen with a decrease in lean body mass or transwomen with a decrease in fat percentage.


A lack of change at 24 months was observed in 19 of 94 (20.2%) transmen and in 9 of 96 (9.4%) transwomen. The risk of not achieving change in body composition was related to lower testosterone levels and less suppression of LH in transmen (OR: 0.67, 95% CI: 0.48–0.94 per SD increase in testosterone and OR: 1.36, 95% CI: 1.01–1.83 per SD increase in LH).


There is a large variation in body composition changes during hormone therapy, with a substantial proportion of individuals with no measurable effects. In transmen, serum testosterone and LH were associated with a lack of change, but serum hormone levels were not associated with body composition changes in transwomen. The results provide a rationale for individualizing hormone therapy in transmen, by considering individual effects rather than solely relying on a standardized dosage of hormone therapy.

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Theresa A Stangl, Chantal M. Wiepjes, Justine Defreyne, Elfi B Conemans, Alessandra D Fisher, Thomas Schreiner, Guy T'Sjoen, and Martin Denheijer

Context: Individuals with gender dysphoria can receive gender-affirming hormone therapy. Different guidelines mention a severe risk of liver injury within the first months after the start of treatment with anabolic androgenic steroids, antiandrogens, and oral contraceptives, which is potentially fatal.

Objective: The incidence of liver injury in a transgender population using gender-affirming hormone therapy.

Design: Multicentre prospective study with 1933 transgender individuals, who started with hormone therapy between 2010 and 2020.

Methods: The following parameters were analysed before hormone therapy, after 3 months, and after 12 months of hormone therapy: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Both male and female reference values were considered. Liver injury was defined as either an elevation of 2x upper limit of normal (ULN) of ALP, 3xULN of ALT, or 3x ULN of AST.

Results: 889 transgender women and 1044 transgender men were included in the analysis. The incidence of liver injury within 12 months after start of hormone therapy, without attribution to alcohol abuse, medical history, or co medication was 0.1% and 0.0% in transgender women according to female and male reference intervals respectively, and 0.6% and 0.4% in transgender men (female and male reference intervals).

Conclusion: The incidence of liver injury is found to be very low. We therefore conclude that liver enzyme monitoring within the frame of the risk of liver injury due to hormone therapy is not necessary in a transgender population.

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Lutske Lodewijk, Pim J Bongers, Jakob W Kist, Elfi B Conemans, Joanne M de Laat, Carla R C Pieterman, Anouk N A van der Horst-Schrivers, Ciska Jorna, Ad R Hermus, Olaf M Dekkers, Wouter W de Herder, Madeleine L Drent, Peter H Bisschop, Bas Havekes, Inne H M Borel Rinkes, Menno R Vriens, and Gerlof D Valk


Currently, little is known about the prevalence of thyroid tumors in multiple endocrine neoplasia type 1 (MEN1) patients and it is unclear whether tumorigenesis of these thyroid tumors is MEN1-related. The aim of the study was to assess the prevalence of thyroid incidentalomas in MEN1 patients compared with nonMEN1 patients and to verify whether thyroid tumorigenesis is MEN1-related.


A cross-sectional study.


The study included two groups: patients with MEN1 and a matched non-MEN1 control group without known thyroid disease, who underwent an ultrasound of the neck for the localization of parathyroid adenoma. Ninety-five MEN1 patients underwent ultrasound of the neck and were matched on gender and age with non-MEN1 patients. The prevalence of thyroid incidentalomas described in the ultrasound report was scored. Multinodular goiters, solitary nodes, and cysts were scored as incidentalomas. Presence of nuclear menin expression was evaluated by menin immunostaining of the thyroid tumors.


In the MEN1 group, 43 (45%) patients had a thyroid incidentaloma compared with 48 (51%) in the non-MEN1 group, of which 14 (15%) and 16 (17%), respectively, were solitary nodes. Menin was expressed in the nuclei of all evaluated thyroid tumors.


MEN1 patients do not have a higher prevalence of thyroid incidentalomas compared with primary hyperparathyroidism patients without the diagnosis of MEN1. Menin was expressed in the thyroid tumors of MEN1 patients.