Abstract
BackgroundGender affirming hormone therapy (GAHT), whilst considered the standard of care in clinical guidelines for the treatment of many transgender (trans) people is supported by low quality evidence. In this prospective longitudinal controlled study, we aimed to examine the effect of newly commencing GAHT on gender dysphoria and quality of life (QoL) over a 6 month period.MethodsAdult trans (including those with binary and/or non-binary identities) people newly commencing standard full-doses of masculinising (n = 42; 35 = trans masculine, 7 = non-binary) or feminising (n = 35; 33 = trans feminine, 2 = non-binary) GAHT and cisgender participants (n=53 male, n=50 female) were recruited to participate in this longitudinal prospective study. This analysis of gender dysphoria measured by the Gender Preoccupation and Stability Questionnaire and QoL measured by the RAND Short-Form 36 Health survey at baseline, 3 and 6 months after commencement of GAHT was a prespecified secondary outcome. Dysphoria and QoL over time in those starting GAHT compared to cisgender comparison group matched for their presumed sex at birth is reported as the mean difference (95% confidence interval) adjusted for age.ResultsIn trans people initiating masculinising GAHT, there was a decrease in gender dysphoria with adjusted mean difference -6.80 (-8.68, -4.91), p < 0.001, and a clinically significant improvement in emotional well-being [adjusted mean difference 7.48 (1.32, 13.64), p = 0.018] and social functioning [adjusted mean difference 12.50 (2.84, 22.15), p = 0.011] aspects of QoL over the first 6 months of treatment relative to the cisgender female comparison group. No significant differences were observed in other QoL domains. In trans people initiating feminising GAHT, there was a decrease in gender dysphoria [adjusted mean difference -4.22 (-6.21, -2.24), p < 0.001] but no differences in any aspects of QoL were observed.ConclusionsIn the short-term, our findings support the benefit of initiating masculinising or feminising GAHT for gender dysphoria. Masculinising GAHT improves emotional well-being and social functioning within 6 months of treatment. Multidisciplinary input with speech pathology and surgery to support trans people seeking feminisation is likely needed. Further longitudinal studies controlled for other confounders (such as the presence of social supports) contributing to QoL are needed.
Highlights
Transgender individuals experience a gender identity different from that which they were presumed at birth, and often, but not always, this gender incongruency is associated with significant psychological distress, known as gender dysphoria [1, 2]
Individuals initiating feminising Gender affirming hormone therapy (GAHT) showed no significant changes in quality of life (QoL) over the first 6 months relative to the cisgender male group (Table 2). We demonstrate in this prospective controlled study that in trans people initiating masculinising GAHT, that there is an improvement in gender dysphoria and a clinically significant improvement in emotional well-being and social functioning aspects of QoL over the first 6 months of treatment relative to cisgender female comparison group
We have demonstrated improved emotional well-being and social functioning aspects of QoL in trans people initiating masculinising GAHT over 6 months compared with cisgender females
Summary
Transgender individuals (trans) experience a gender identity (which may be binary or non-binary) different from that which they were presumed at birth, and often, but not always, this gender incongruency is associated with significant psychological distress, known as gender dysphoria [1, 2]. While transgender health research is still in its infancy, research far has indicated that gender-affirming interventions (gender counselling, gender confirmation surgery and hormone therapy), as well as sociocultural factors (external validation of one’s gender, support from family and friends) are associated with improved well-being among transgender individuals [8, 9] Access to such healthcare can be challenging for some, and the largest contributing factor to this, as reported by trans individuals, is an overall lack of medical professionals who are experienced in the field [6, 9, 10]. Gender affirming hormone therapy (GAHT), whilst considered the standard of care in clinical guidelines for the treatment of many transgender (trans) people is supported by low quality evidence In this prospective longitudinal controlled study, we aimed to examine the effect of newly commencing GAHT on gender dysphoria and quality of life (QoL) over a 6 month period
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