Abstract
Anger is a state of emotions ranging from irritation to intense rage. Aggression is the externalization of anger through destructive/punitive behavior. The World Professional Association for Transgender Health (WPATH) Standards of Care, Edition 7 (SOC7) guidelines warn about aggression in transgender men (TM) on testosterone treatment. As aggression is often initiated by feelings of anger, we aimed to assess whether anger intensity increases in TM and decreases in transgender women (TW) after initiation of hormone therapy, and to identify predictors for anger intensity in transgender people. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Upon first clinical contact, psychological questionnaires were administered. Anger intensity was prospectively assessed in 898 participants (440 TM, 468 TW) by the STAXI-2 (State-Trait Anger Expression Inventory-2) State Anger (S-Anger) during a three-year follow-up period, starting at the initiation of hormone treatment. Sex steroids were measured at each follow-up visit. Data were analyzed cross-sectional and prospectively.
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