{
  "abstract": "Objective To compare body composition and physical fitness between transgender and cisgender individuals.Design Systematic review with meta-analysis.Data sources PubMed, Web of Science, Embase and SportDiscus.Eligibility criteria Inclusion criteria comprised studies of transgender individuals comparing body composition or physical fitness pre-to-post gender-affirming hormone therapy (GAHT) or versus cisgender controls.Results 50 studies (n=6099) were included. Transgender women had similar relative fat mass (standardised mean difference (SMD) −0.29, 95% CI −0.63 to 0.05, Grading of Recommendations Assessment, Development and Evaluation (GRADE): very low), relative lean mass (SMD 0.19, 95% CI −0.14 to 0.53, GRADE: low), upper-body strength (SMD 0.92, 95% CI −0.52 to 2.35, GRADE: very low), lower-body strength (SMD −0.10, 95% CI −1.07 to 0.86, GRADE: very low) and maximal oxygen consumption (SMD −0.28, 95% CI −0.81 to 0.25, GRADE: very low) in comparison to cisgender women. Transgender men exhibited higher relative fat mass (SMD 1.09, 95% CI 0.66 to 1.53, GRADE: moderate), lower relative lean mass (SMD −6.42, 95% CI −12.26 to −0.58, GRADE: moderate) and lower upper-body strength (SMD −1.20, 95% CI −1.96 to −0.45, GRADE: moderate) than cisgender men. In transgender women, GAHT was associated with increased fat mass and reduced lean mass and upper-body strength over 1–3 years. Transgender men demonstrated reduced fat mass and increased lean mass and strength following GAHT.Conclusion While transgender women exhibited higher lean mass than cisgender women, their physical fitness was comparable. Current evidence is mostly low certainty and has heterogenous quality but does not support theories of inherent athletic advantages for transgender women over cisgender.PROSPERO registration number CRD42024562210.",
  "authors": [
    {
      "affiliations": [
        "Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil",
        "Center of Lifestyle Medicine",
        "Laboratory of Assessment and Conditioning inRheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP,Universidade de Sao Paulo, Sao Paulo, SP, Brazil"
      ],
      "name": "Sofia Mendes Sieczkowska"
    },
    {
      "affiliations": [
        "Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil",
        "Center of Lifestyle Medicine",
        "Laboratory of Assessment and Conditioning inRheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP,Universidade de Sao Paulo, Sao Paulo, SP, Brazil"
      ],
      "name": "Bruna Caruso Mazzolani"
    },
    {
      "affiliations": [
        "Federal University of Juiz de Fora, School of Physical Education and Sports, Departmentof Sports, Juiz de Fora, MG, Brazil"
      ],
      "name": "Danilo Reis Coimbra"
    },
    {
      "affiliations": [
        "Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil",
        "Center of Lifestyle Medicine",
        "Laboratory of Assessment and Conditioning inRheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP,Universidade de Sao Paulo, Sao Paulo, SP, Brazil"
      ],
      "name": "Igor Longobardi"
    },
    {
      "affiliations": [
        "Center of Lifestyle Medicine",
        "Laboratory of Assessment and Conditioning inRheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP,Universidade de Sao Paulo, Sao Paulo, SP, Brazil"
      ],
      "name": "Andresa Rossilho Casale"
    },
    {
      "affiliations": [
        "School of Medicine, University of Sao Paulo, Institute of Psychiatry, Clinical Hospital, Sao Paulo, SP, Brazil"
      ],
      "name": "José Davi Fajardo Villela Martins Pompílio da Hora"
    },
    {
      "affiliations": [
        "Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil",
        "Center of Lifestyle Medicine",
        "Laboratory of Assessment and Conditioning inRheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP,Universidade de Sao Paulo, Sao Paulo, SP, Brazil"
      ],
      "name": "Hamilton Roschel"
    },
    {
      "affiliations": [
        "Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil",
        "Center of Lifestyle Medicine",
        "Laboratory of Assessment and Conditioning inRheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP,Universidade de Sao Paulo, Sao Paulo, SP, Brazil"
      ],
      "name": "Bruno Gualano"
    }
  ],
  "title": "Body composition and physical fitness in transgender versus cisgender individuals: a systematic review with meta-analysis",
  "uid": "b5683a31-bed1-5ef9-bf8c-79a36c7b36cf"
}