SAT677 Use Of An Anti-obesity Medication In A Transgender Woman Pursuing Body Mass Index Requirements For Gender-affirming Surgery
Authors: Taormina John Michael , Gilden Adam Howard , Iwamoto Sean J 
Published: October 2023

Disclosure: J.M. Taormina: None. A.H. Gilden: None. S.J. Iwamoto: None.

Introduction: Obesity prevalence is higher in transgender and gender diverse (TGD) adults compared to the general population. TGD people experience gender minority stress and disparities in lifestyle factors, socioeconomic status and medical comorbidities that likely contribute to excess weight. Gender-affirming hormone therapy (GAHT) has also been associated with increased body weight; oral estrogen with an antiandrogen is associated with increased fat mass and decreased lean mass. Many surgery centers enforce body mass index (BMI) requirements for gender-affirming surgeries (GAS) that limit access for TGD patients with obesity. The most effective and affirming weight management strategies for TGD patients have yet to be determined. Bariatric surgery has been identified as a treatment to address obesity prior to GAS; however, surgical weight loss can delay GAS for 3 years. While anti-obesity medications (AOMs) are effective, literature is needed supporting their use in TGD patients prior to GAS. Clinical Case: We report the case of a 40-year-old transgender woman with BMI 39.6 kg/m2, prediabetes, mixed hyperlipidemia, hypertension, non-alcoholic steatohepatitis (NASH) and congenital solitary kidney who presented for weight loss to qualify for gender-affirming bilateral breast augmentation. Her surgeon required a presurgical BMI &lt;35.0 kg/m2. She had no prior GAS or bariatric procedures. She was taking intramuscular estradiol valerate, oral progesterone, spironolactone, and omeprazole without a history of prior AOM use. She was counseled on lifestyle modification, including recommendations for a reduced calorie diet, regular aerobic and resistance physical activity and sleep hygiene. Given history of prediabetes and NASH and superior mean weight loss with semaglutide compared to other FDA-approved AOMs, she was started on semaglutide 0.25 mg subcutaneously weekly with monthly dose escalation. In 3 months, she lost 17.7 kg or 13.9% total body weight with BMI 34.1 kg/m2. Complications addressed during treatment included acute kidney injury from poor water intake as a potential medication side effect; medication supply issues; limited engagement in physical activity due to lack of social safety, body dysmorphia and wish to limit upper body muscle mass for her desired body contour. Clinical Lessons: This case highlights (1) the need for increased access to affirming weight management services for TGD patients with obesity pursuing GAS and (2) the potential role of AOMs in assisting TGD patients in reaching presurgical BMI targets. Whether BMI requirements for GAS lead to improved surgical outcomes needs additional research. Perspectives on and the impacts of BMI requirements for GAS deserve exploration. Further studies are also needed to evaluate the needs of TGD patients in weight loss interventions and the effects of weight loss and AOMs on GAHT management.

Presentation: Saturday, June 17, 2023