ESPE Abstracts

Background: Obesity as a risk factor and predictor for cardiovascular outcomes is of particular interest in gender-affirming healthcare, as hormone therapy can negatively impact lipid profiles and alter body fat percentages. Transgender and gender diverse (TGD) populations are at a higher risk for obesity than cisgender populations. This trend is already visible in adolescents. The reasons for this disparity are multifaceted and require further investigation.

Methods: Prospective cross-sectional cohort study of transgender patients at the outpatient clinic for Pediatric Endocrinology at the Vienna General Hospital from 01/2022 to 07/2022. Patients were included in the World Health Organization’s 2021/22 Health-Behavior in School-aged Children (HBSC) survey as a separate cohort. 32 patients were included via the outpatient clinic, and a further 53 self-identified through the survey. Answers of the total 85 TGD adolescents were then compared to the nationwide Austrian sample containing 10 058 participants.

Results: TGD adolescents reported significantly lower levels of physical activity than the larger Austrian sample, both in instances of vigorous activity (P = 0.002) and any physical activity lasting >60 minutes (P <0.001) per week. No statistically significant difference in self-reported eating behavior was reported. TGD participants also showed significantly worse self-reported mental health than their cisgender peers. They reported significantly lower rates of overall life satisfaction (P <0.001) and positive affect (P <0.001), were more likely to show signs of depression (P <0.001), and reported more feelings of loneliness (P <0.001). Regarding body image, TGD participants were also more likely to describe themselves as “too large” (P = 0.001).

Discussion: The results of this study point to the complexity of healthcare needs in the TGD adolescent population. The interconnectedness of mental health and obesity is well described, and also evident in our data. We find that there is still room to theorize and understand two specific aspects of gendered embodiment in future research. The first is the complex relationship between gender diversity and body image. Gender dysphoria can be associated with body dysmorphia more generally, and TGD people have been shown to be at risk for eating disorders, though eating behaviors did not differ significantly in our sample. The second aspect surrounds exercise and social inclusion in gender minorities. Currently, the reasons for the marked difference in exercise behaviors between TGD adolescents and the national sample are unclear. More work is needed to explore these complex dynamics, while remaining sensitive to the lived experiences of our TGD patients.