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 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.
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.
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.
No two bodies are the same but researchers have categorized female bodies into 4 shapes.
Women like Jennifer Lopez or Beyoncé, who possess a hip measurement that is greater than their bust, are considered pear-shaped. While fat distribution varies, pear-shaped females are more likely to gain weight in the hips, buttocks and thighs than in the upper body. According to research, approximately 20% of females fall into this category.
Those like Cameron Diaz who possess a very even distribution of fat among their waist, buttocks, chest and face have a banana or rectangular shape. Banana shapes are the most common body type, encompassing roughly 46% of females.
Apple-shaped women like Adele have shoulders that are comparably broader than their hips. They often possess larger busts, a less defined waist and thin hips and thighs. Fat is mainly distributed in the face, chest and abdomen. About 14% of females fall into this body type category.
An hourglass shape describes a body type with fat that is distributed equally between the upper and lower body, paired with a very narrow waist.
Though this classic hourglass shape is often admired and revered in classic Hollywood actresses like Marilyn Monroe or Sophia Loren, recent research suggests that as little as 8% of females fit this category.