Hormone therapy might reduce sexual distress in transgender people who have not had gender-affirming surgery, according to a recent study in the Journal of Sexual Medicine.
Until now, there was little research investigating sexual distress in transgender patients who had not had surgery.
The study had a cross-sectional component and a prospective component.
The cross-sectional component involved 301 transgender people (160 transwomen with an average age of 32 and 141 transmen with an average age of 28). None of the participants had undergone gender-affirming surgery.
Among the transwomen, 34% were on hormone therapy at the time of the study, and 66% had never had hormone therapy. For the transmen, the rates were 9% and 91%, respectively.
A variety of measures and assessments were completed, including a physical exam and questionnaires related to sexual distress, sexual function, body uneasiness, general psychopathology, depression symptoms, alexithymia, autism, social anxiety, perceived humiliation, and discrimination.
The researchers found that sexual distress was positively correlated with body uneasiness and dissatisfaction with gender-related body parts and shapes. They pointed out that transgender people frequently struggle with body image, especially if they are seeking gender-affirmation treatment. “Indeed, body image can be considered as a bridging core element between sexual wellbeing and [gender dysphoria],” they wrote.
Certain aspects of the body, such as height in transmen and face shape in transwomen, “may serve as stressful reminders” of body traits that might not be modifiable with hormone therapy, the authors added.
Sexual distress was also positively correlated with general psychopathology, alexithymia, social anxiety, and humiliation scales.
In transwomen, the researchers found a significant correlation between sexual distress and perceived discrimination. Discrimination could affect sexuality through accompanying depression and anxiety, they suggested.
In transmen, sexual distress was positively associated with autism and cortisol levels. On the latter finding, the authors explained that transmen may be unable to fully take part in a male sexual role, leading to stress.
The study also included a prospective phase involving a subset of 72 participants (36 transwomen and 36 transmen) who were on hormone therapy. Evaluations were conducted periodically over the next 24 months.
As time progressed, both groups had decreases in sexual distress. For transmen, improvements were significant at all follow-up points, but for transwomen, improvements started to become significant after the three-month point.
“The positive role of [hormone therapy] on sexuality should be taken into account by health care providers when caring for transgender people,” the authors concluded.
Resources
The Journal of Sexual Medicine
Ristori, Jiska, Psy, et al.
“Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data”
(Full-text. Published online: November 14, 2019)
https://www.jsm.jsexmed.org/article/S1743-6095(19)31464-X/fulltext