Comprehensive Understanding of Transgender Experiences: Cohort Development and the Impact of Gender-Affirming Hormone Therapy on Quality of Life

Abstract

Background: Transgender and gender-diverse (TGD) individuals experience various challenges, including mental health issues and barriers to healthcare access. In addition, TGD individuals also report lower Quality of Life (QoL) levels compared to cisgender individuals. A common intervention shown to have a positive effect on mental well-being and QoL of TGD individuals is gender-affirming hormone therapy (GAHT). However, the short- and long-term effects of GAHT are not fully understood. Therefore, this study aimed to establish a comprehensive database of TGD individuals and to investigate QoL between patients receiving GAHT and controls for both patients assigned male at birth (AMAB) and patients assigned female at birth (AFAB). In addition, QoL between patients AMAB and patients AFAB was investigated. Furthermore, this study aimed to investigate the relationship between sex hormone levels and QoL. Method: This study consists of two parts: 1) the development of a transgender cohort and 2) the original study. A Transgender Cohort at the Centre for Gender Identity (TraCK), Aalborg University Hospital, was established in REDCap, which included self-reported questionnaires and information from medical records. The original study used a cross-sectional study design, and patients were recruited from the TraCK between February 14 and May 6, 2024. To measure QoL the WHOQOL-BREF questionnaire was used. MANOVA and t-tests were performed to investigate QoL between patients receiving GAHT and controls for both patients AMAB and patients AFAB, and QoL between assigned sex at birth groups. Additionally, linear regression analyses were performed to investigate the relationship between QoL and levels of oestradiol and testosterone for patients AMAB and patients AFAB, respectively. Results: 424 patients were included in the TraCK until May 6, 2024, however, only 372 patients completed all questionnaires. In the original study, 360 patients were included (169 AMAB and 191 AFAB). A statistically significant difference in QoL was found between patients receiving GAHT and controls for both patients AMAB (p = 0.005) and patients AFAB (p = 0.021). A statistically significantly higher mean QoL score of the psychological domain (D2) was found for both patients AMAB and patients AFAB (p = 0.003; p = 0.004, respectively). Between patients AMAB and patients AFAB a statistically significant difference in QoL was found for both the GAHT- and control group (p = 0.010; p = 0.042, respectively). However, only a significantly higher mean QoL score of the social domain (D3) was found for patients AFAB compared to patients AMAB in the GAHT group. No significant linear relationship was found between sex hormone levels and QoL. Conclusion: It was possible to establish a comprehensive database of TGD patients. This study found that QoL for patients receiving GAHT was statistically significantly higher than for controls, especially for the psychological domain. Also, a higher QoL was found for patients AFAB compared to patients AMAB, specifically for the social domain. This study highlights the advantages of offering GAHT to TGD individuals and the differences between assigned sex at birth. However, future longitudinal studies are crucial to investigate the short- and long-term effects of GAHT.

A master thesis from Aalborg University

Comprehensive Understanding of Transgender Experiences: Cohort Development and the Impact of Gender-Affirming Hormone Therapy on Quality of Life