Exercise and Diet

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In general it is recommended for trans women to start with HRT with small amounts of fat so that any new fat will grow in a female pattern. Reducing fat by eating at a caloric deficit may be a necessary part of transition for some people.

Weight loss correlated significantly with decreases in the circumference of the waist and hips, and decreases in WHR in men and women. At comparable levels of weight loss, men had greater decreases in the waist, and smaller decreases in the hips than women, resulting in greater decreases in WHR. [1]

You can also improve the appearance of WHR by doing exercises targeting muscles in the lower body, in particular the glutes and quads.

Guide on lifting for better proportions: https://www.setforset.com/blogs/news/how-to-get-wider-hips-and-improve-waist-to-hip-ratio

Exercise and a good diet is also a crucial component of maintaining higher IGF levels which will increase the rate at which cells grow and cycle over, giving a greater benefit from the effects of HRT.[2]

Diet

Weight manipulation

Maintaining weight

Maintaining your weight is as simple as balancing your calorie intake with your calorie expenditure, which depends on factors such as your height, weight and level of physical activity. A rough estimate of your maintenance calories can be calculated online or very roughly by multiplying your body weight in kg by 30.

Losing weight

To lose weight, you need to keep your calorie expenditure below your calorie intake. One kilogram of adipose tissue contains approximately 7700 kcal. [3] A safe rate of weight loss is around 0.5-1kg per week, which equates to a deficit of 550-1100kcal. Exceeding this rate can lead to symptoms such as fatigue, dizziness, poor immune function and even hair loss. [4] While losing weight, it is also important to maintain a relatively high protein intake and to exercise regularly to avoid losing muscle mass along with fat tissue. [5][6]

If long term weight loss is desired, then it so be done so slowly as studies suggest that slower steady weight loss improves long term results. [7][8][9]

The two main ways to increase a calorie deficit are to reduce calorie intake and to exercise. While a combination of the two is the preferred way to achieve a calorie deficit, only reducing intake will work, while keeping intake high and adding large amounts of exercise is not advisable.

When trying to lose weight, it is important to monitor progress regularly, as daily weight fluctuations can usually be attributed to water weight or other factors such as bloating. If, after a period of time (e.g. a week), body weight does not decrease by the expected amount, the calorie deficit may need to be adjusted downwards in steps of 150-250 kcal until the desired rate is achieved.

Gaining weight

Macro nutrients

Protein

It's necessary to eat high amounts of protein[10] to promote healthy tissue regeneration, muscle growth and high IGF, all of which are important for achieving a more feminine body shape.

Protein intake should be at least 0.8g/kg of body weight, but 1g/kg is generally recommended for minimal physical activity.[11] For higher intensity physical activity intake should be at least 1.5g/kg and up to 2.2g/kg is recommended. [12][13][14][15][16][17]

Increasing protein intake can also contribute to fat loss, even when there is a calorie surplus [18][19][20], due to the thermic effect of protein, which means that proteins contribute 15-30% less to the effective calories for the body's metabolism compared to fats. [21]

Protein consumption should be optimally distributed throughout the day, ideally over up to four meals, to optimise utilisation for anabolic processes such as muscle building [22]. Any excess protein will be used as energy in the metabolism and therefore cannot contribute to tissue growth.

Carbohydrates
Fat
  1. ↑ https://pubmed.ncbi.nlm.nih.gov/1595579/
  2. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869853/
  3. ↑ WISHNOFSKY, M. (1958, September). Caloric Equivalents of Gained or Lost Weight. The American Journal of Clinical Nutrition, 6(5), 542–546. https://doi.org/10.1093/ajcn/6.5.542
  4. ↑ "Is It Bad to Lose Weight Too Quickly?".
  5. ↑ Vink, R. G., Roumans, N. J. T., Arkenbosch, L. A. J., Mariman, E. C. M., & van Baak, M. A. (2016, January 27). The effect of rate of weight loss on long‐term weight regain in adults with overweight and obesity. Obesity, 24(2), 321–327. https://doi.org/10.1002/oby.21346
  6. ↑ Kreitzman, S., Coxon, A., & Szaz, K. (1992, July). Glycogen storage: illusions of easy weight loss, excessive weight regain, and distortions in estimates of body composition. The American Journal of Clinical Nutrition, 56(1), 292S-293S. https://doi.org/10.1093/ajcn/56.1.292s
  7. ↑ Atkinson, R., Fuchs, A., Pastors, J., & Saunders, J. (1992, July). Combination of very-low-calorie diet and behavior modification in the treatment of obesity. The American Journal of Clinical Nutrition, 56(1), 199S-202S. https://doi.org/10.1093/ajcn/56.1.199s
  8. ↑ Paisey, R. B., Frost, J., Harvey, P., Paisey, A., Bower, L., Paisey, R. M., Taylor, P., & I. Belka. (2002, April). Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes. Journal of Human Nutrition and Dietetics, 15(2), 121–127. https://doi.org/10.1046/j.1365-277x.2002.00342.x
  9. ↑ Feig, E. H., & Lowe, M. R. (2017, August 28). Variability in Weight Change Early in Behavioral Weight Loss Treatment: Theoretical and Clinical Implications. Obesity, 25(9), 1509–1515. https://doi.org/10.1002/oby.21925
  10. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988204/
  11. ↑ Wu, G. (2016). Dietary protein intake and human health. Food & Function, 7(3), 1251–1265. https://doi.org/10.1039/c5fo01530h
  12. ↑ Helms, E. R., Zinn, C., Rowlands, D. S., & Brown, S. R. (2014, April). A Systematic Review of Dietary Protein During Caloric Restriction in Resistance Trained Lean Athletes: A Case for Higher Intakes. International Journal of Sport Nutrition and Exercise Metabolism, 24(2), 127–138. https://doi.org/10.1123/ijsnem.2013-0054
  13. ↑ Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., Aragon, A. A., Devries, M. C., Banfield, L., Krieger, J. W., & Phillips, S. M. (2017, July 11). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine, 52(6), 376–384. https://doi.org/10.1136/bjsports-2017-097608
  14. ↑ Ribeiro, A. S., Nunes, J. P., & Schoenfeld, B. J. (2019, April 26). Should Competitive Bodybuilders Ingest More Protein than Current Evidence-Based Recommendations? Sports Medicine, 49(10), 1481–1485. https://doi.org/10.1007/s40279-019-01111-y
  15. ↑ Stokes, T., Hector, A., Morton, R., McGlory, C., & Phillips, S. (2018, February 7). Recent Perspectives Regarding the Role of Dietary Protein for the Promotion of Muscle Hypertrophy with Resistance Exercise Training. Nutrients, 10(2), 180. https://doi.org/10.3390/nu10020180
  16. ↑ Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., Aragon, A. A., Devries, M. C., Banfield, L., Krieger, J. W., & Phillips, S. M. (2017, July 11). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine, 52(6), 376–384. https://doi.org/10.1136/bjsports-2017-097608
  17. ↑ Bandegan, A., Courtney-Martin, G., Rafii, M., Pencharz, P. B., & Lemon, P. W. (2017, February 8). Indicator Amino Acid–Derived Estimate of Dietary Protein Requirement for Male Bodybuilders on a Nontraining Day Is Several-Fold Greater than the Current Recommended Dietary Allowance. The Journal of Nutrition, 147(5), 850–857. https://doi.org/10.3945/jn.116.236331
  18. ↑ Antonio, J., Ellerbroek, A., Silver, T., Orris, S., Scheiner, M., Gonzalez, A., & Peacock, C. A. (2015, October 20). A high protein diet (3.4 g/kg/d) combined with a heavy resistance training program improves body composition in healthy trained men and women – a follow-up investigation. Journal of the International Society of Sports Nutrition, 12(1). https://doi.org/10.1186/s12970-015-0100-0
  19. ↑ Antonio, J., Ellerbroek, A., Silver, T., Vargas, L., Tamayo, A., Buehn, R., & Peacock, C. A. (2016). A High Protein Diet Has No Harmful Effects: A One-Year Crossover Study in Resistance-Trained Males. Journal of Nutrition and Metabolism, 2016, 1–5. https://doi.org/10.1155/2016/9104792
  20. ↑ Antonio, J., Peacock, C. A., Ellerbroek, A., Fromhoff, B., & Silver, T. (2014, August 15). The effects of consuming a high protein diet (4.4 g/kg/d) on body composition in resistance-trained individuals. Journal of the International Society of Sports Nutrition, 11(1). https://doi.org/10.1186/1550-2783-11-19
  21. ↑ Pesta, D. H., & Samuel, V. T. (2014). A high-protein diet for reducing body fat: mechanisms and possible caveats. Nutrition & Metabolism, 11(1), 53. https://doi.org/10.1186/1743-7075-11-53
  22. ↑ Schoenfeld, B. J., & Aragon, A. A. (2018, January 5). How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution. Journal of the International Society of Sports Nutrition, 15(1). https://doi.org/10.1186/s12970-018-0215-1
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