ArticleFrontiers in nutrition2026
Nutritional status, body composition and bone health in treatment-naïve transgender and gender-diverse adolescents.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Gonadotropin-releasing hormone analogue (GnRHa)-induced gonadal suppression is an established component of gender-affirming care for transgender and gender-diverse (TGD) adolescents. Impaired bone health has been documented in treatment-naïve TGD adolescents prior to GnRHa intervention, yet its nutritional determinants remain poorly characterized. Objective: To characterize nutritional status, body composition, and bone mineral density (BMD) in treatment-naïve TGD adolescents prior to GnRHa initiation, and to identify predictors of lumbar spine BMD z-scores. Methods: This retrospective cross-sectional study included 147 treatment-naïve TGD adolescents (59 AMAB[TGD-Female] and 88 AFAB[TGD-Male]) attending a national pediatric gender clinic. Assessments included anthropometrics, body composition, 24-h dietary calcium intake (compared to the age-specific dietary reference intake [DRI]), micronutrient status, physical activity, sleep duration, and lumbar spine BMD z-scores by dual-energy X-ray absorptiometry. Multiple linear regression identified predictors of BMD z-score, with sex assigned at birth included as a covariate. Descriptive analyses were conducted by sex assigned at birth. Results: The median age was 15.5 years (IQR, 14.1-16.7), and 83.7% were fully pubertal. The median daily calcium intake was 400 mg/d (31% of the DRI), with 99.3% consuming below the DRI. Vitamin D deficiency/insufficiency was present in 91.5% of participants. Of the 102 participants with complete micronutrient data, 63.7% had ≥ 2 nutritional deficiencies. Body composition assessment revealed a below-average muscle-to-fat ratio in both groups (median z-score -0.74) and a higher fat mass percentage in AFAB compared to AMAB adolescents (28.6% vs. 17.4%; Conclusion: Treatment-naïve TGD adolescents exhibit nutritional deficiencies, unfavorable body composition, and reduced BMD prior to GnRHa initiation, particularly those assigned male at birth. BMI z-scores and sex assigned at birth independently predicted BMD, highlighting the need for targeted pre-treatment nutritional and lifestyle interventions.
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