Female Body Shape and Different Body Types

Typically, persons assigned female at birth (AFAB) and who go through an estrogen-influenced puberty tend to store fat more easily and in regions of the body such as the hips, buttocks and thighs. This can give a curvier and more voluptuous appearance which is something many transgender women may seek body contouring for. Though it’s possible to achieve a feminine form through a variety of surgical and lifestyle choices, there are limitations which we’ll cover below.

The Difference Between Androgenic and Estrogenic Body Forms

The pubertal development you undergo determines a general bone structure you will have as an adult. Alterations in the bony framework are unlikely with hormone therapy and surgical modification of the pelvis comes with significant risks that can outweigh the benefits based on current surgical techniques.

Androgenic Body Forms (assigned male at birth, pass through a testosterone-influenced puberty)

• Increased subcutaneous fat deposition along the abdomen and flanks
• Narrow pelvic brims (see figure A below)
• Lower body fat than estrogenic forms
• Waist-to-hip ratio (WHR) remain in the ratio of 0.85 to 0.95 (differences in fat deposition lead to varying degrees of WHR)
• Gluteal form has a ‘flatness’ or concavity (see figure C below)

Estrogenic Body Forms (assigned female at birth, pass through an estrogen-influenced puberty)

• Greater proportion of fat deposited in the gluteal areas and hips
• Wider pelvic brims (see figure B above)
• 10% more body fat compared to androgenic forms
• Waist-to-hip ratio (WHR) remain in the ratio of 0.65 to 0.80 (The WHR varies due to differences in fat deposition)
• Gluteal form has a ‘fuller’ round shape (See figure D above)

The Effect of Hormone Therapy on Body Physique

It has long been assumed that the hormone estrogen was largely responsible for the difference in fat distribution. While every body produces estrogen, levels tend to be significantly higher in people who are AFAB. As a result, they develop breasts and are more prone to store subcutaneous fat around the hips and thighs, giving them a more “hourglass” shape. Persons AMAB tend to produce far less estrogen and they are more prone to store visceral fat around the vital organs – known as “belly” fat.

In order to counteract, or attempt to reduce the physiologic changes that have occurred during and after puberty, transwomen and transfeminine folk may take estrogen or estradiol. The hormones help to achieve a feminization through introduction of breast development, altered fat distribution, softening skin and altering mood. Patients may also take testosterone blockers such as spironolactone, gonadotropin-releasing hormone agonists, leuprolide, finasteride, and progesterone.

Although Dr. Mosser doesn’t require anyone to be on HRT for body contouring or top surgery, being on estrogen for a year prior may have a positive effect on fat distribution and gluteal shape.

Feminizing Body Contouring

Multiple studies have sought to define the ‘ideal’ feminine aesthetic of the waist, hips and buttocks. WHR (mentioned previously) is used to compare the narrowest aspect of the space between the ribs to the widest aspect of the buttocks. Although an absolute number is not agreed upon, most tend to suggest that 0.7 is an approximate WHR ideal and approaches to body contouring in transwoman aim to reach that number.

As you can see in the above figures, gluteal forms differ. An AMAB gluteal form tends to have a flatness or concavity at the mid-lateral buttock, and a relative absence of lateral hip fullness. A smooth inward sweep of the waist and lower back are characteristic of a more feminine form. Therefore, approaches in body contouring for transwomen aim at increasing the fatty tissue in the gluteal region to highlight a distinct transition from the lower back.

For transwomen, the flank and abdominal fat excess may result in a waistline that is significantly higher than the ideal feminine form. Lowering the waistline through liposuction of these areas can have a significant impact on the fit of feminine clothing, which tends to accentuate the waist. In patients with limited fatty tissue, this area is aggressively aspirated while the areas just above and below are left alone in attempt to create a feminine abdomen. When done appropriately, contouring will accentuate the hourglass silhouette and allow for a smooth transition from mid back to the upper gluteal region.

Different Body Types

No two bodies are the same but researchers have categorized female bodies into 4 shapes.