(010) ERECTION FUNCTION AND BOTHER IN TRANSGENDER WOMEN TAKING GENDER AFFIRMING HORMONE THERAPY AND AFTER PRE-VAGINOPLASTY BILATERAL ORCHIECTOMY

Abstract

Abstract Introduction Gender-affirming (GA) hormone therapy (GAHT) and bilateral orchiectomy (GABO) significantly reduce gender dysphoria in transgender women (TW). A key source of dysphoria is penile erection. To date, no studies have described erectile function (EF) among TW taking GAHT and after GABO. Objective We aimed to: 1) Evaluate EF among two cohorts of TW before vaginoplasty: One taking only GAHT >6mo., and the other taking GAHT & >6 months post-GABO). 2) Determine the incidence of erections among these cohorts based on whether they do or do not use their penis for sexual activity 3) Query subjects’ interest for any treatment that could eliminate penile erections before vaginoplasty. Methods Pre-vaginoplasty TW on GAHT were surveyed anonymously. Participants were grouped based on GABO status. We queried EF using the Sexual Health Inventory for Men (SHIM) questionnaire at three points (pre-GAHT, >6 months after starting GAHT, and >6 months post-GABO). We also queried the incidence of any erections in these three states, and, whether patients would undergo a procedure that promised to reduce or eliminate erections. Results 31 participants participated (16 GAHT-only; 15 GAHT+GABO). Median age was 37 years (IQR 25.3 Y) and median years on GAHT was 5.5 years (IQR 7.3 Y). 21/31 (68%) reported they do not use their penis for sexual activity. TW on GAHT and GAHT+GABO showed reduced SHIM score, with lowest scores in TW who did not use their penis during sex (Figure 1a). Spontaneous erections were reduced for women who did not use their penis during sex in the GAHT+GABO group, vs. the GAHT-only group, but both groups reported high incidence of erections with arousal and during sex (b). Most TW showed a high interest in any procedure that promised to completely eliminate their erections (c). Conclusions Our study is the first to show that GAHT reduces SHIM scores, but the greatest reduction is in TW who do not use their penis for sexual activity. While GABO significantly reduces spontaneous erections vs. GAHT alone, neither appears to have much effect on erections with sexual arousal or sexual activity. The majority of women reported significant dislike & dysphoria from their erections, and would choose to undergo any reasonable procedure that completely eliminated, or at least reduced, their erections. Further study with larger numbers is warranted. Disclosure No.