A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people

Summary & key facts

This review looked at 46 studies about how gender-affirming hormone therapy relates to mental and social functioning in transgender people. Studies consistently reported fewer depressive symptoms and less psychological distress after starting hormone therapy. Results for quality of life were mixed. Some evidence suggested different emotional changes for masculinizing versus feminizing hormones, and a few studies reported more anger expression (but not greater anger intensity) with masculinizing therapy. Overall, study quality and sample sizes varied a lot, and many studies did not control for other important factors, so strong cause-and-effect conclusions are not possible.

Key facts:

• The review included 46 journal articles: 6 qualitative studies, 21 cross-sectional studies and 19 prospective cohort studies.
• Studies consistently found reductions in depressive symptoms and in general psychological distress after people started gender-affirming hormone therapy.
• Evidence for changes in quality of life was inconsistent; some studies showed improvement while others did not.
• There was some evidence that affective (emotional) changes differed between masculinizing and feminizing hormone therapies.
• Several studies suggested greater anger expression among people on masculinizing (testosterone) therapy, but they did not find increases in anger intensity.
• The six qualitative studies involved a total of 171 transgender participants, with individual study samples ranging from 10 to 67 people; most qualitative work focused on feminizing therapy.
• Risk of bias varied widely across studies. Small samples and limited adjustment for key confounders reduced the ability to draw clear causal conclusions.
• Only 12 studies (30%) adjusted for body image and 9 studies (23%) adjusted for gender-affirming surgeries; many other possible confounders (for example, social support, substance use, prior mental health treatment) were rarely controlled fo

Abstract

This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.

Topics

Eating Disorders and Behaviors Gender Roles and Identity Studies LGBTQ Health, Identity, and Policy

Categories

Psychology Social Psychology Social Sciences

Tags

Anger Breast cancer Cancer Clinical psychology Confounding Hormone therapy Internal medicine Medicine Psychoanalysis Psychology Psychosocial Psychotherapist Transgender