Gender dysphoria and sexual euphoria - A Bayesian perspective on the influence of gender-affirming hormone therapy on sexual arousal

While the concept of sexual orientation is more clearly defined in cisgender, this is less so in transgender individuals. Both experienced gender and sex hormones have a relation to sexual preferences, arousal in response to erotic stimuli, and thus sexual orientation. In transgender individuals sexual orientation occasionally changes before or during transition, which may involve gender-affirming hormone therapy. Using functional magnetic resonance imaging, we investigated whether the neuronal and behavioral patterns of sexual arousal in transgender individuals moved from the given (before) to their chosen gender after 4.5 months of hormone therapy. To this aim, trans women and men as well as age-matched cisgender controls rated visual stimuli showing heterosexual, lesbian or gay intercourse for subjective sexual arousal. Utilizing a Bayesian framework allowed us to incorporate behavioral findings in cisgender individuals of different sexual orientations. The hypothesized changes in response patterns could indeed be observed in the behavioral responses to the single but not the differentiation between stimulus categories with the strongest results for trans men and lesbian scenes. Activation of the ventral striatum supported our hypothesis only for lesbian scenes in trans women. This prominent role of lesbian stimuli might be explained by their differential responses in cis women and men. We show that correlates of sexual arousal in transgender individuals might change in direction of the chosen gender. Future investigations longer into transition might resolve the discrepancy on behavioral and neuronal levels.

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Incident diabetes risk is not increased in transgender individuals using hormone therapy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab934 ◽

2021 ◽

Author(s):

Daan van Velzen ◽

Chantal Wiepjes ◽

Nienke Nota ◽

Daniel van Raalte ◽

Renée de Mutsert ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

General Population ◽

Hormone Therapy ◽

Trans Men ◽

Data Registry ◽

Central Registry ◽

In Trans ◽

Trans Women

Abstract Background In trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may alter the risk of developing type 2 diabetes in trans women and trans men. We aimed to compare the incidence of type 2 diabetes of adult trans women and trans men during hormone therapy with rates from their birth sex in the general population. Methods Retrospective data from the Amsterdam Cohort of Gender Dysphoria with transgender individuals on hormone therapy between 1972 and 2018 were linked to a nationwide health data registry. Because no central registry of diabetes is available, the occurrence of diabetes was inferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with the same birth sex from the general population. Results Compared to their birth sex in the general population, no difference in the incidence of type 2 diabetes mellitus was observed in trans women (N=2585, 90 cases, SIR 0.94 95%CI 0.76–1.14) or trans men (N=1514, 32 cases, SIR 1.40 95%CI 0.96–1.92). Conclusion Despite studies reporting an increase in insulin resistance in feminizing hormone therapy and a decrease in insulin resistance in masculinizing hormone therapy, the incidence of diabetes in transgender individuals after initiation of hormone therapy was not different compared to the general population.

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Physical and Sociodemographic Features Associated With Quality of Life Among Transgender Women and Men Using Gender-Affirming Hormone Therapy

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.621075 ◽

2021 ◽

Vol 12 ◽

Author(s):

Eliane D. Silva ◽

Tayane M. Fighera ◽

Roberta M. Allgayer ◽

Maria Inês R. Lobato ◽

Poli Mara Spritzer

Keyword(s):

Quality Of Life ◽

Hormone Therapy ◽

Gender Dysphoria ◽

Transgender Women ◽

Breast Development ◽

Body Hair ◽

Trans Men ◽

In Trans ◽

Trans Women

Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the sex assigned at birth and the gender identity, lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy (GAHT) may improve quality of life (QoL).Objectives: We aimed to assess perceived QoL, to compare QoL scores between trans women and men and to identify possible contributing factors related to GAHT in a sample of transgender women and transgender men.Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled and completed the study (60 trans women and 53 trans men).Results: QoL scores did not differ between trans women and trans men. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoL domain scores. In trans men, higher domain scores were found in individuals in a stable relationship, with increased body hair, engaging in physical activity, and being employed.Conclusion: Data from this study suggest that GAHT-related physical characteristics, such as breast development in trans women and increased body hair in trans men, are similar between groups, are associated with higher QoL scores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoL in transgender individuals.

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Change in Visceral Fat and Total Body Fat and the Effect on Cardiometabolic Risk Factors During Transgender Hormone Therapy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab616 ◽

2021 ◽

Author(s):

Maartje Klaver ◽

Daan van Velzen ◽

Christel de Blok ◽

Nienke Nota ◽

Chantal Wiepjes ◽

...

Keyword(s):

Insulin Resistance ◽

Hormone Therapy ◽

Body Fat ◽

Visceral Fat ◽

Cardiometabolic Risk ◽

Trans Men ◽

Total Body Fat ◽

In Trans ◽

Trans Women ◽

Total Body

Abstract Introduction Excess visceral fat increases the risk of type 2 diabetes and cardiovascular disease and is influenced by sex hormones. Our aim was to investigate changes in visceral fat and the ratio of visceral fat to total body fat (VAT/TBF) and their associations with changes in lipids and insulin resistance after 1 year of hormone therapy in trans persons. Methods In 179 trans women and 162 trans men, changes in total body and visceral fat estimated with dual-energy X-ray absorptiometry before and after 1 year of hormone therapy were related to lipids and insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR)] with linear regression analysis. Results In trans women, total body fat increased by 4.0 kg (95% CI 3.4, 4.7), while the amount of visceral fat did not change (−2 grams; 95% CI −15, 11), albeit with a large range from −318 to 281, resulting in a decrease in the VAT/TBF ratio of 17% (95% CI 15, 19). In trans men, total body fat decreased with 2.8 kg (95% CI 2.2, 3.5), while the amount of visceral fat did not change (3 g; 95% CI −10, 16; range −372, 311), increasing the VAT/TBF ratio by 14% (95% CI 10, 17). In both groups, VAT/TBF was not associated with changes in blood lipids or HOMA-IR. Conclusions Hormone therapy in trans women and trans men resulted in changes in VAT/TBF, mainly due to changes in total body fat and were unrelated to changes in cardiometabolic risk factors, which suggests that any unfavorable cardiometabolic effects of hormone therapy are not mediated by changes in visceral fat or VAT/TBF.

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Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

Acta Endocrinologica ◽

10.1530/eje-13-0493 ◽

2013 ◽

Vol 169 (4) ◽

pp. 471-478 ◽

Cited By ~ 141

Author(s):

K Wierckx ◽

E Elaut ◽

E Declercq ◽

G Heylens ◽

G De Cuypere ◽

...

Keyword(s):

Myocardial Infarction ◽

Type 2 Diabetes ◽

Adverse Events ◽

Hormone Therapy ◽

Sex Hormone ◽

Men And Women ◽

Trans Men ◽

In Trans ◽

Trans Women

ObjectiveThis study evaluated the short- and long-term cardiovascular- and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons.Subjects and methodsA specialist center cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) with an age- and gender-matched control population (1–3 matching). The participants were on cross-sex hormone therapy for an average of 7.4 years. We assessed physical health and possible treatment-related adverse events using questionnaires.ResultsFive percent of trans women experienced venous thrombosis and/or pulmonary embolism during hormone therapy. Five of these adverse events occurred during the first year of treatment, while another three occurred during sex reassignment surgery. Trans women experienced more myocardial infarctions than the control women (P=0.001), but a similar proportion compared with control men. The prevalence of cerebrovascular disease (CVD) was higher in trans women than in the control men (P=0.03). The rates of myocardial infarction and CVD in trans men were similar to the control male and female subjects. The prevalence of type 2 diabetes was higher in both trans men and women than in their respective controls, whereas the rates of cancer were similar compared with the control men and women.ConclusionMorbidity rate during cross-sex hormone therapy was relatively low, especially in trans men. We observed a higher prevalence of venous thrombosis, myocardial infarction, CVD, and type 2 diabetes in trans women than in the control population. Morbidity rates in trans men and controls were similar, with the exception of the increased prevalence of type 2 diabetes.

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Physical and Sociodemographic Features Associated With Quality of Life in Transgender Individuals Using Gender-Affirming Hormone Therapy

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1616 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A794-A795

Author(s):

Eliane Dias Da Silva ◽

Tayane Muniz Fighera ◽

Roberta Martins Costa Moreira Allgayer ◽

Maria Inês Rodrigues Lobato ◽

Poli Mara Spritzer

Keyword(s):

Quality Of Life ◽

Hormone Therapy ◽

Gender Dysphoria ◽

Transgender Women ◽

Genital Surgery ◽

Trans Men ◽

Significant Difference ◽

In Trans ◽

Trans Women

Abstract Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the gender assigned at birth and the identity gender and lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy(GAHT) may improve quality of life (QoL). Objectives: Here, we aimed to assess perceived QoL and possible contributing factors in a sample of transgender women and transgender men using GAHT. Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled in the study (60 trans women and 53 trans men). Results: There was no significant difference in QoLbetween the groups. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoLdomain scores. In trans men, higher domain scores were found in individuals with a stable relationship, increased body hair, physical activity practice, and being employed. Conclusion: Data from this study suggest that GAHT-related physical characteristics are associated with higher QoLscores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoLin transgender individuals.

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Who are gynandromorphophilic men? Characterizing men with sexual interest in transgender women

Psychological Medicine ◽

10.1017/s0033291715002317 ◽

2015 ◽

Vol 46 (4) ◽

pp. 819-827 ◽

Cited By ~ 14

Author(s):

K. J. Hsu ◽

A. M. Rosenthal ◽

D. I. Miller ◽

J. M. Bailey

Keyword(s):

Sexual Orientation ◽

Sexual Arousal ◽

Sexual Attraction ◽

Sexual Interest ◽

Transgender Women ◽

Heterosexual Men ◽

Homosexual Men ◽

Male And Female ◽

Erotic Stimuli ◽

Subjective Sexual Arousal

BackgroundGynandromorphophilia (GAMP) is sexual interest in gynandromorphs (GAMs; colloquially, shemales). GAMs possess a combination of male and female physical characteristics. Thus, GAMP presents a challenge to conventional understandings of sexual orientation as sexual attraction to the male v. female form. Speculation about GAMP men has included the ideas that they are homosexual, heterosexual, or especially, bisexual.MethodWe compared genital and subjective sexual arousal patterns of GAMP men with those of heterosexual and homosexual men. We also compared these groups on their self-ratings of sexual orientation and sexual interests.ResultsGAMP men had arousal patterns similar to those of heterosexual men and different from those of homosexual men. However, compared to heterosexual men, GAMP men were relatively more aroused by GAM erotic stimuli than by female erotic stimuli. GAMP men also scored higher than both heterosexual and homosexual men on a measure of autogynephilia.ConclusionsResults provide clear evidence that GAMP men are not homosexual. They also indicate that GAMP men are especially likely to eroticize the idea of being a woman.

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Gender-specific genital and subjective sexual arousal to prepotent sexual stimuli in androphilic men and gynephilic women

The Canadian Journal of Human Sexuality ◽

10.3138/cjhs.2021-0004 ◽

2021 ◽

pp. e20210004

Author(s):

Nina Micanovic ◽

Amanda D. Timmers ◽

Meredith L. Chivers

Keyword(s):

Sexual Arousal ◽

Specific Pattern ◽

Sexual Response ◽

Sex Characteristics ◽

Complex Nature ◽

Specific Response ◽

Response Patterns ◽

Sexual Stimuli ◽

Subjective Sexual Arousal ◽

Gender Specific

Marked differences have been found in men’s and women’s sexual response patterns, contingent upon their sexual orientation; androphilic (attracted to men) and gynephilic (attracted to women) men demonstrate greatest genital and self-reported arousal to their preferred stimulus type (a “gender-specific” response), whereas androphilic women do not, and findings for gynephilic women have been mixed. While there have been many investigations into gynephilic men’s and androphilic women’s (i.e., heterosexual men/women) sexual response, there has been less investigation into the specificity of sexual response of androphilic men and gynephilic women. Given the complex nature of sexual stimuli that are used in sexual response research, it is often unclear to what extent contextual cues (e.g., cues other than the sexual actor’s primary and secondary sex characteristics, such as physical attractiveness, sexual activity, etc.) influence participants’ sexual response patterns. As such, the current study examined genital, discrete self-reported, and continuous self-reported responses of androphilic men ( n = 22) and gynephilic women ( n = 10) to prepotent sexual features (stimuli thought to elicit automatic sexual arousal: erect penises and exposed vulvas), non-prepotent sexual features (flaccid penises and pubic triangles) and neutral stimuli (clothed men and women). Both samples exhibited a gender-specific pattern of genital, self-reported, and continuous self-reported sexual arousal. Similarly, all measures of sexual arousal were generally found to be greatest to “prepotent” sexual cues. Implications for understanding gender specificity of sexual response are discussed.

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Lactation Induction in a Transgender Woman Wanting to Breastfeed: Case Report

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa976 ◽

2021 ◽

Author(s):

Rachel Wamboldt ◽

Shirley Shuster ◽

Bikrampal S Sidhu

Keyword(s):

Hormone Therapy ◽

Medical Literature ◽

Breast Size ◽

Health And Wellness ◽

Milk Supply ◽

Daily Dose ◽

In Trans ◽

Trans Women ◽

Potential Methods ◽

Endocrinology Clinic

Abstract Context Breastfeeding is known to have many health and wellness benefits to the mother and infant; however, breastfeeding in trans women has been greatly under-researched. Objective To review potential methods of lactation induction in trans women wishing to breastfeed and to review the embryological basis for breastfeeding in trans women. Design This article summarizes a case of successful lactation in a trans woman, in which milk production was achieved in just over 1 month. Setting This patient was followed in an outpatient endocrinology clinic. Participant A single trans woman was followed in our endocrinology clinic for a period of 9 months while she took hormone therapy to help with lactation. Interventions Readily available lactation induction protocols for nonpuerpural mothers were reviewed and used to guide hormone therapy selection. Daily dose of progesterone was increased from 100 mg to 200 mg daily. The galactogogue domperidone was started at 10 mg 3 times daily and titrated up to effect. She was encouraged to use an electric pump and to increase her frequency of pumping. Main Outcome Measure Lactation induction Results At one month, she had noticed a significant increase in her breast size and fullness. Her milk supply had increased rapidly, and she was producing up to 3 to 5 ounces of milk per day with manual expression alone. Conclusions We report the second case in the medical literature to demonstrate successful breastfeeding in a trans woman through use of hormonal augmentation.

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Ready or Not: Exploring Sexual Arousal with Women who Report Sexual Arousal Difficulties

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.9831 ◽

2018 ◽

Author(s):

Erin Zadorozny

Keyword(s):

Blood Flow ◽

Sexual Arousal ◽

Self Report ◽

Doppler Imaging ◽

Erotic Stimuli ◽

Heterosexual Women ◽

Subjective Sexual Arousal ◽

First Time ◽

Subjective Arousal ◽

Report Measure

The purpose of this study is to examine possible differences in genital and subjective components of sexual arousal between women with and without sexual arousal/desire difficulties (SADD). Previous research has focused on physiological differences with women who have SADD, in particular, genital response to erotic stimuli. The pattern of results in the literature indicates that women with SADD exhibit similar genital responses to controls (Meston, Rellini, & McCall, 2010), yet women with SADD typically report a decrease in intensity of genital sensation in sexual situations (Laan, van Driel, & van Lunsen, 2008; Giraldi, Rellini, Pfaus, & Laan, 2013), calling into question the method of measurement employed to assess genitalresponse. In the current study, genital and subjective arousal, along with genital-subjective agreement (i.e., sexual concordance), will be investigated to determine if there is a difference between women with SADD and controls. Participants will include 30 self-identified heterosexual women who will complete a validated self-report measure of sexual function and a session in which they rate their subjective sexual arousal while their genital blood flow is measured in response to various films. Laser Doppler Imaging will be used to measure genital blood flow for the first time in this population. This study could lead to a better understanding of sexual arousal in women with SADD, which will assist with diagnosis, as well as identify areas to focus on when trying to develop treatments for sexual dysfunction.

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