Abstract
Several steps in the transitioning process may affect sexual desire, including hormone therapy and gender affirming surgery. Testosterone therapy in transgender men (TM) generally leads to increased sexual desire, masturbation, sexual fantasies and arousal. Studies in transgender women (TW) are often inconclusive. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Upon first clinical contact, psychological questionnaires were completed. Sexual desire was prospectively assessed in 766 participants (401 TW, 364 TM) by the Sexual Desire Inventory (SDI) during a three-year follow-up period, starting at the initiation of hormone treatment (HT). Sex steroids were measured at each visit. Data were analyzed cross-sectionally and prospectively. Baseline SDI scores were comparable in TW and TM (P=0.342). In TW, SDI scores decreased from 39.0 [23.0 – 54.5] (baseline) to 33.0 [16.3 – 49.8] (12 months) (-4.77, P<0.001), returning to scores comparable to baseline after 18 months (P=0.114). After 36 months, SDI scores were higher than baseline scores (51.5 [39.5 – 61.0], P=0.003). In TM, total SDI scores increased from 40.0 [17.0 – 52.0] at baseline to 55.0 [40.5 – 67.0] (+14.61, P<0.001) after 12 months, remaining stable over the following year and returning to scores comparable to baseline scores (58.0 [23.0 – 62.0], P=0.250) after 36 months. People with a partner (P<0.001) and TW with lower levels of self-reported gender dysphoria (Utrecht Gender Dysphoria Scale) (ρ=0.336, P=0.002) reported higher SDI scores. Prospective SDI scores were not influenced by prospective changes in serum levels of sex steroids in TM and TW. Lower baseline levels of gender dysphoria (Utrecht Gender Dysphoria Scale) correlated to a higher prospective increase in SDI scores in TM after 12 months of HT (ρ=-0.355, P<0.001).
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