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Background: Gender dysphoria is associated body-dissatisfaction, abnormal weight and weight-related behaviors.

Objective: Describe the association of gender dysphoria severity and general well-being with Body Mass Index (BMI) and weight related behaviors among transgender males.

Design/Methods: Retrospective review of 118 transgender male patients presenting to initiate gender-affirming medical care in 2017-2020. Gender dysphoria confirmed by an experienced mental health provider. We measured parent and patient reports of patient general well-being [Pediatric Quality of Life Inventory (PedsQL) 4.0 General Well-Being Scale], severity of gender dysphoria [Transgender Congruence Scale (TCS) [n=47 for TCS] and Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA)], weight related intentions, and weight related behaviors.

Results: Mean age 15.7+/-1.5 (range 10.0-19.2) and race/ethnicity- 88.8% White, 7.8% multiracial/other, 2.6% Hispanic, and 0.9% Black. Mean BMI Z-score 1.05+/-1.11. 0.8% of patients had a BMI <5th%tile, 22.9% 85-95th%tiles, and 22.0% >95th%tile. Most patients reported they were about the right weight (42.6%) or slightly overweight (35.2%). 40.4% denied weight-related intentions and 43.1% were trying stay the same weight. 8.6% reported fasting and 2.6% purging to control weight during the previous 30 days. Mean parent PedsQL=63.5+/-15.6 and patient PedsQL=64.3+/-14.3. Parent-Child PedsQL correlation 0.471. Mean dysphoria scores: TCS=2.72+/-0.62 and GIDYQ-AA=1.98+/-0.24.
Lower parent PedsQL scores were associated with higher BMI Z-scores and more patient reports of perceiving the themselves to be overweight and fasting to lose weight. Patient PedsQL General Well Being Scores were not associated with any of our outcomes. Severity of gender dysphoria had a quadratic relationship with BMI (TCS: R2 0.169, Pearson correlation -0.403; GIDYQ-AA: 0.051, -0.227) with higher and lower levels of gender dysphoria associated with a lower BMI Z-score. The relationship between Parent PedsQL and BMI Z-score was no longer significant after adjusting for TCS score.

Conclusion(s): Lower parent PedsQL Well Being scores are associated with increased BMI, self-perception of being overweight, and fasting to lose weight. There is a non-linear relationship between gender dysphoria and BMI. Further research is needed to determine if the non-linear relationship between dysphoria and BMI is present in other transgender youth and associated with differences in weight-related behaviors.

Presented at the 2021 PAS Virtual Conference


Behavioral Medicine | Pediatrics

Gender Dysphoria, General Well-Being, BMI, and Weight-Related Behaviors among Adolescent Transgender Males