Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data

Abstract

Introduction As far as we know, no studies to date have investigated the psychobiological correlates of sexual distress (SD) nor the impact of hormonal treatment (HT) on SD in transgender persons. Aim To evaluate the psychobiological correlates of SD and assess the effects of HT on SD in transgender persons without gender-affirming surgery. Methods A consecutive series of 301 transgender persons (160 transwomen and 141 transmen) was considered for the cross-sectional study, and a subset of 72 subjects was studied in a 2-year follow-up. A physical examination was performed. Blood samples were drawn for determination of cortisol levels. Subjects completed psychometric measures. During 2 years of HT, the evaluation of SD was prospectively repeated. Main Outcome Measure Psychobiological correlates of SD in transgender population. Changes in SD during gender affirming hormonal treatment. Clinical Implications Knowing how hormonal treatment influence SD will help care providers when counseling transgender people. Strengths & Limitations To the authors’ knowledge, this is the first study prospectively evaluating the impact of gender affirming hormonal treatment on sexual distress in transgender individuals. The main limitations are represented by the small size of the sample and the use of questionnaires validated only in the cisgender population. Results SD showed a positive correlation with body uneasiness (P < .0001) and with dissatisfaction toward gender-related body parts or shapes (all P < .05). In addition, SD correlated positively with general psychopathology (P < .0001), alexithymia, social anxiety, and humiliation scales (all P < .05). In transmen, SD was positively associated with autism levels (P < .005), as well as with cortisol levels (P < .02). A significant correlation between SD and perceived discrimination was observed in transwomen (P < .05). In transwomen, SD was positively associated with hair density and negatively with breast growth (both P < .05). Finally, in transmen, a negative correlation was found between SD and hair density (P < .05). When the impact of HT on SD was evaluated, a significant reduction of SD was observed across time in both transwomen and transmen (P = .001 and P = .01, respectively). Conclusions The present results support the efficacy of HT in reducing SD in transgender persons.

Caring for gender diverse children and adolescents in Italy: A mixed-method investigation of clinicians’ knowledge and approach to clinical practice

“…This may mean that gender diversity in developmental age receives less attention than it deserves. However, despite the apparently low numbers of referrals and centers compared with other countries, the improved diagnostic accuracy and the intensified resonance and media visibility of transgender lives have led to an increase in Italian studies on this topic (Amodeo et al, 2018; Fisher et al, 2013; Giovanardi et al, 2018, 2019; Lingiardi et al, 2017; Ristori et al, 2020; Scandurra et al, 2018; Vitelli et al, 2017; Vitelli & Riccardi, 2010).…”

Experiences of Life and Intersectionality of Transgender Refugees Living in Italy: A Qualitative Approach

“…In their individuation process, participants conferred a fundamental role to medical-surgical treatments for gender affirmation (e.g., access to hormones and surgery), which represented methods for bringing one’s gender expression closer to one’s gender identity [ 44 , 45 ]. Medical-surgical treatments have long had gender affirming value for many transgender people [ 46 , 47 , 48 , 49 ]. Specifically, hormones and surgery are the medical means by which many transgender people achieve psychophysical wellbeing.…”

“…In achieving psychological wellbeing and quality of life, many transgender and non-binary people find hormone therapies and gender affirming surgery essential. Indeed, through these medical-surgical treatments, many transgender people achieve wellbeing and fulfillment and a more positive identity [ 46 , 47 , 48 , 49 ].…”

What is the most anticipated change induced by treatment using gender‐affirming hormones in individuals with gender incongruence?

“…Recently Psy et al reported that hormone therapy significantly ameliorated sexual distress evaluated by the Female Sexual Distress Scale-Revised in both transgender men and transgender women. 13 Increased body hair density evaluated by the Ferriman-Gallwey Score in transgender men and prominent breast growth evaluated by the Tanner stage in transgender women were involved in decreased sexual distress. However, very few studies showed what effects induced by hormone therapy using gender-affirming hormones mainly contribute to improvement in the quality of life through reduction of gender dysphoria.…”