Muscle strength, size and composition following 12 months of gender-affirming treatment in transgender individuals: retained advantage for the transwomen

AbstractObjectivesThis study explored the effects of gender-affirming treatment, which includes inhibition of endogenous sex hormones and replacement with cross-sex hormones, on muscle function, size and composition in 11 transwomen (TW) and 12 transmen (TM).MethodsIsokinetic knee extensor and flexor muscle strength was assessed at baseline (T00), 4 weeks after gonadal suppression of endogenous hormones but before hormone replacement (T0), and 3 (T3) and 11 (T12) months after hormone replacement. In addition, at T00 and T12, we assessed lower-limb muscle volume using MRI, and cross-sectional area (CSA) and radiological density using CT.ResultsThigh muscle volume increased (15%) in TM, which was paralleled by increased quadriceps CSA (15%) and radiological density (6%). In TW, the corresponding parameters decreased by −5% (muscle volume) and −4% (CSA), while density remained unaltered. The TM increased strength over the assessment period, while the TW generally maintained or slightly increased in strength. Baseline muscle volume correlated highly with strength (R>0.75), yet the relative change in muscle volume and strength correlated only moderately (R=0.65 in TW and R=0.32 in TM). The absolute levels of muscle volume and knee extension strength after the intervention still favored the TW.ConclusionCross-sex hormone treatment markedly affects muscle strength, size and composition in transgender individuals. Despite the robust increases in muscle mass and strength in TM, the TW were still stronger and had more muscle mass following 12 months of treatment. These findings add new knowledge that could be relevant when evaluating transwomen’s eligibility to compete in the women’s category of athletic competitions.

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Muscle Strength, Size, and Composition Following 12 Months of Gender-affirming Treatment in Transgender Individuals

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz247 ◽

2019 ◽

Vol 105 (3) ◽

pp. e805-e813 ◽

Cited By ~ 7

Author(s):

Anna Wiik ◽

Tommy R Lundberg ◽

Eric Rullman ◽

Daniel P Andersson ◽

Mats Holmberg ◽

...

Keyword(s):

Muscle Mass ◽

Muscle Function ◽

Treatment Initiation ◽

Hormone Replacement ◽

Knee Extensor ◽

Muscle Volume ◽

Muscle Size ◽

Thigh Muscle ◽

Cross Sectional ◽

One Year

Abstract Context As many sports are divided in male/female categories, governing bodies have formed regulations on the eligibility for transgender individuals to compete in these categories. Yet, the magnitude of change in muscle mass and strength with gender-affirming treatment remains insufficiently explored. Objective This study explored the effects of gender-affirming treatment on muscle function, size, and composition during 12 months of therapy. Design, settings, participants In this single-center observational cohort study, untrained transgender women (TW, n = 11) and transgender men (TM, n = 12), approved to start gender-affirming medical interventions, underwent assessments at baseline, 4 weeks after gonadal suppression of endogenous hormones but before hormone replacement, and 4 and 12 months after treatment initiation. Main outcome measures Knee extensor and flexor strength were assessed at all examination time points, and muscle size and radiological density (using magnetic resonance imaging and computed tomography) at baseline and 12 months after treatment initiation. Results Thigh muscle volume increased (15%) in TM, which was paralleled by increased quadriceps cross-sectional area (CSA) (15%) and radiological density (6%). In TW, the corresponding parameters decreased by –5% (muscle volume) and –4% (CSA), while density remained unaltered. The TM increased strength over the assessment period, while the TW generally maintained their strength levels. Conclusions One year of gender-affirming treatment resulted in robust increases in muscle mass and strength in TM, but modest changes in TW. These findings add new knowledge on the magnitude of changes in muscle function, size, and composition with cross-hormone therapy, which could be relevant when evaluating the transgender eligibility rules for athletic competitions.

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Associations of the Stair Climb Power Test With Muscle Strength and Functional Performance in People With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Physical Therapy ◽

10.2522/ptj.20100091 ◽

2010 ◽

Vol 90 (12) ◽

pp. 1774-1782 ◽

Cited By ~ 25

Author(s):

Marc Roig ◽

Janice J. Eng ◽

Donna L. MacIntyre ◽

Jeremy D. Road ◽

W. Darlene Reid

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Muscle Strength ◽

Functional Performance ◽

Knee Extensor ◽

Chronic Obstructive ◽

Flexor Muscle ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Power Test ◽

Muscle Torque

Background The Stair Climb Power Test (SCPT) is a functional test associated with leg muscle power in older people. Objective The purposes of this study were to compare the results of the SCPT in people with chronic obstructive pulmonary disease (COPD) and people who were healthy and to explore associations of the SCPT with muscle strength (force-generating capacity) and functional performance. Design The study was a cross-sectional investigation. Methods Twenty-one people with COPD and a predicted mean (SD) percentage of forced expiratory volume in 1 second of 47.2 (12.9) and 21 people who were healthy and matched for age, sex, and body mass were tested with the SCPT. Knee extensor and flexor muscle torque was assessed with an isokinetic dynamometer. Functional performance was assessed with the Timed “Up & Go” Test (TUG) and the Six-Minute Walk Test (6MWT). Results People with COPD showed lower values on the SCPT (28%) and all torque measures (∼32%), except for eccentric knee flexor muscle torque. In people with COPD, performance on the TUG and 6MWT was lower by 23% and 28%, respectively. In people with COPD, the SCPT was moderately associated with knee extensor muscle isometric and eccentric torque (r≥.46) and strongly associated (r=.68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r≥.66); however, no significant relationship between the SCPT and measures of functional performance was found. Limitations The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings. Conclusions The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT is only moderately associated with muscle torque and thus cannot be used as a simple surrogate for muscle strength in people with COPD.

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Velocity-specific knee strength between professional and under-17 female volleyball player

South African Journal of Physiotherapy ◽

10.4102/sajp.v75i1.478 ◽

2019 ◽

Vol 75 (1) ◽

Author(s):

Alexandre R.M. Pelegrinelli ◽

Laís F. Dela Bela ◽

Mariana F. Silva ◽

Lucas C.R. Rodrigues ◽

João P. Batista ◽

...

Keyword(s):

Muscle Strength ◽

Knee Extensor ◽

Peak Torque ◽

Total Work ◽

Flexor Muscle ◽

Mean Power ◽

Cross Sectional ◽

Significant Group ◽

Surface Maps ◽

Volleyball Players

Background: Many studies have investigated isokinetic performance in volleyball players but not through surface maps.Objectives: The goals of this study were to assess velocity-specific isokinetic knee extensor–flexor muscle strength and to compare the isokinetic knee extensor–flexor muscles between professional (PRO) and under-17 (U17) female volleyball players.Method: This cross-sectional laboratory study was developed with two groups: PRO (n = 12), medianage = 21.3 years, and U17 (n = 9), medianage = 15 years. Peak torque, total work, mean power, angle of peak torque, hamstring–quadriceps torque ratio (H–Q ratio) and torque–angle–velocity surface maps were analysed from knee extension–flexion at 60, 120 and 300 degrees per second (°/s).Results: Significant differences were identified for extensor peak torque between PRO x = 202.3 Newton metre (N·m) (standard deviation [SD] = 24.4) and U17 x = 141.6 N·m (30.1) at 60 °/s (p < 0.001; d = 2.21) as well as flexor peak torque (PRO x = 75.7 N·m [10.3] and U17 x = 57.7 N·m [11.4]) at 120 °/s (p < 0.001; d = 1.65) for the dominant limb. There were also significant group differences for total work and mean power at all velocities for extension and flexion. Surface maps demonstrated higher torque at lower speeds for both groups with smaller torque changes across velocities for flexion.Conclusion: Different groups of female volleyball players showed contrasting concentric knee muscle strength across isokinetic velocities.Clinical implications: These results demonstrate the importance of specific strength training for different age groups, even within the same sport, and provide insight into muscle strength.

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Functional performance is associated with both knee extensor and flexor muscle strength in patients scheduled for total knee arthroplasty: A cross-sectional study

Journal of Rehabilitation Medicine ◽

10.2340/16501977-1940 ◽

2015 ◽

Vol 47 (5) ◽

pp. 454-459 ◽

Cited By ~ 9

Author(s):

B Skoffer ◽

U Dalgas ◽

I Mechlenburg ◽

K SÃ¸balle ◽

T Maribo

Keyword(s):

Total Knee Arthroplasty ◽

Muscle Strength ◽

Knee Arthroplasty ◽

Functional Performance ◽

Knee Extensor ◽

Cross Sectional Study ◽

Sectional Study ◽

Flexor Muscle ◽

Cross Sectional ◽

Total Knee

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Hypertrophy of chronically unloaded muscle subjected to resistance exercise

Journal of Applied Physiology ◽

10.1152/japplphysiol.01051.2003 ◽

2004 ◽

Vol 96 (4) ◽

pp. 1451-1458 ◽

Cited By ~ 79

Author(s):

P. A. Tesch ◽

J. T. Trieschmann ◽

A. Ekberg

Keyword(s):

Muscle Strength ◽

Resistance Exercise ◽

Lower Limb ◽

Weight Bearing ◽

Knee Extensor ◽

Extensor Muscle ◽

Muscle Volume ◽

Electromyographic Activity ◽

Plantar Flexor ◽

Flexor Muscle

In an effort to simulate the compromised function and atrophy of lower limb muscles experienced by astronauts after spaceflight, 21 men and women age 30-56 yr were subjected to unilateral lower limb unloading for 5 wk. Whereas 10 of these subjects performed unilateral knee extensor resistance exercise (ULRE) two or three times weekly, 11 subjects (UL) refrained from training. The exercise regimen consisted of four sets of seven maximal actions, using an apparatus that offers concentric and eccentric resistance by utilizing the inertia of rotating flywheel(s). Knee extensor muscle strength was measured before and after UL and ULRE, and knee extensor and ankle plantar flexor muscle volumes were determined by means of magnetic resonance imaging. Surface electromyographic activity measured after UL inferred increased muscle use to perform a given motor task. UL induced an 8.8% decrease ( P < 0.05) in knee extensor muscle volume. After ULRE and as a result of only ∼16 min of maximal contractile activity over the 5-wk course, muscle volume increased 7.7% ( P < 0.05). Muscle strength decreased 24-32% ( P < 0.05) in response to UL. Group ULRE showed maintained ( P > 0.05) strength. Ankle plantar flexor muscle volume of the unloaded limb decreased ( P < 0.05) in both groups (UL 10.5%; ULRE 11.1%). In neither group did the right weight-bearing limb show any change ( P > 0.05) in muscle volume or strength. The results of this study provide evidence that resistance exercise not only may offset muscle atrophy but is in fact capable of promoting marked hypertrophy of chronically unloaded muscle.

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Relationships of ultrasound measures of intrinsic foot muscle cross-sectional area and muscle volume with maximum toe flexor muscle strength and physical performance in young adults

Journal of Physical Therapy Science ◽

10.1589/jpts.28.14 ◽

2016 ◽

Vol 28 (1) ◽

pp. 14-19 ◽

Cited By ~ 8

Author(s):

Takashi Abe ◽

Kota Tayashiki ◽

Miyuki Nakatani ◽

Hironori Watanabe

Keyword(s):

Young Adults ◽

Muscle Strength ◽

Physical Performance ◽

Cross Sectional Area ◽

Muscle Volume ◽

Sectional Area ◽

Flexor Muscle ◽

Cross Sectional ◽

Muscle Cross Sectional Area ◽

Intrinsic Foot Muscle

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Isokinetic Strength After ACL Reconstruction: Influence of Concomitant Anterolateral Ligament Reconstruction

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211005405 ◽

2021 ◽

pp. 194173812110054

Author(s):

Benoit Gillet ◽

Yoann Blache ◽

Isabelle Rogowski ◽

Grégory Vigne ◽

Bertrand Sonnery-Cottet ◽

...

Keyword(s):

Muscle Strength ◽

Ligament Reconstruction ◽

Knee Extensor ◽

Anterolateral Ligament ◽

Flexor Muscle ◽

Knee Flexor ◽

Strength Recovery ◽

Flexor Muscles ◽

Knee Muscle ◽

Knee Muscle Strength

Background: To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively. Hypothesis: The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively. Study Design: Retrospective cohort study. Level of Evidence: Level 2. Methods: A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping. Results: Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups. Conclusion: The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively. Clinical Relevance: Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.

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Work Ability and Employment in Rheumatoid Arthritis: A Cross-Sectional Study on the Role of Muscle Strength and Lower Extremity Function

International Journal of Rheumatology ◽

10.1155/2018/3756207 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Carolin Berner ◽

Sandra Haider ◽

Igor Grabovac ◽

Thomas Lamprecht ◽

Karl Heinrich Fenzl ◽

...

Keyword(s):

Muscle Strength ◽

Lower Extremity ◽

Work Ability ◽

Employment Status ◽

Knee Extensor ◽

Lower Extremity Function ◽

Cross Sectional ◽

Hand Grip ◽

Extremity Function ◽

Knee Extensor Strength

Objective. The aim of the present study was to assess the association between muscle strength, lower extremity function, employment status, and work ability in RA patients. Methods. One hundred seropositive RA outpatients of working age were included in this cross-sectional study. Employment status was assessed by interview and work ability by the Work Ability Index-Single Item Scale (WAS). Muscle strength was determined using dynamometer measurement of isometric hand grip and knee extensor strength. Lower extremity function was measured using the short physical performance battery (SPPB). Regression models estimate the association between unemployment, work ability and muscle strength, and lower extremity function, controlling for sociodemographic and disease-related factors. Results. Forty-one percent of the RA patients were not gainfully employed, and their median work ability had a good WAS value (7.00 [4.00-7.00]). Patients with better knee extensor strength (OR=1.07, 95% CI [1.02-1.12) and better physical performance (OR=1.71, 95% CI [1.18-2.49]) had a significantly better chance of gainful employment. The odds for hand grip strength remained significant when adjusted for sociodemographic (OR=1.5, 95% CI [1.00-1.09]), but not for disease-specific variables. Better hand grip strength (β=0.25, p=0.039) and better knee extensor strength (β=0.45, p=0.001) as well as better lower extremity function (SPPB) (β=0.51, p<0.001) remained significantly associated with work ability following adjustment for sociodemographic and disease-specific variables. Conclusions. The association of employment status and work ability with parameters of physical fitness suggests that improvement in muscle strength and lower extremity function may positively influence work ability and employment in individuals with RA.

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