Abstract
Background
Transpeople often look for sex reassignment surgery (SRS) to improve their quality of life (QoL). The hormonal therapy has many positive effects before and after SRS. There are no studies about correlation between hormonal status and QoL after SRS.
Aim
To gather information on QoL, quality of sexual life and body image in transpeople at least 2 years after SRS, to compare these results with a control group and to evaluate the relations between the chosen items and hormonal status.
Subjects and methods
Data from 60 transsexuals and from 60 healthy matched controls were collected. Testosterone, estradiol, LH and World Health Organization Quality of Life (WHOQOL-100) self-reported questionnaire were evaluated. Student’s t test was applied to compare transsexuals and controls. Multiple regression model was applied to evaluate WHOQOL’s chosen items and LH.
Results
The QoL and the quality of body image scores in transpeople were not statistically different from the matched control groups’ ones. In the sexual life subscale, transwomen’s scores were similar to biological women’s ones, whereas transmen’s scores were statistically lower than biological men’s ones (P = 0.003). The quality of sexual life scored statistically lower in transmen than in transwomen (P = 0.048). A significant inverse relationship between LH and body image and between LH and quality of sexual life was found.
Conclusions
This study highlights general satisfaction after SRS. In particular, transpeople’s QoL turns out to be similar to Italian matched controls. LH resulted inversely correlated to body image and sexual life scores.
Similar content being viewed by others
Abbreviations
- GD:
-
Gender dysphoria
- SRS:
-
Sex reassignment surgery
- HT:
-
Hormonal treatment
- QoL:
-
Quality of life
- WHOQOL-100:
-
World Health Organization Quality of Life
- LH:
-
Luteinizing hormone
- SD:
-
Standard deviation
References
Oort F (2005) Using structural equation modeling to detect response shifts and true change. Qual Life Res 14(3):587–598
Oort F, Visser M (2005) SM. An application of structural equation modeling to detect response shifts and true changes in quality of life data from cancer patients undergoing invasive surgery. Qual Life Res 14(3):599–609
Cohen-Kettenis PT, Gooren LJ (1999) Transsexualism: a review of ethiology, diagnosis and treatment. J Psychosom Res. 46(4):315–333
Gooren LJ, Giltay EJ, Bunck MC (2008) Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 93(1):19–22
Johansson A, Sundbom E, Hojerback T, Bodlund O (2010) A 5-year follow-up study of Swedish adults with gender identity disorder. Arch Sex Behav 39(6):1429
De Cuypere G, Elaut E, Heylens G, Selvaggi G, T’Sjoen G et al (2006) Long term follow up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery. Sexologies 15:126–133
Ettner R, Monstrey S, Eyler AE (2007) Principles of transgender medicine and surgery. The Hawort Press, New York
Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A et al (2010) Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial. Clin Endocrinol Oxf 72:214–231
Kraemer B, Delsignore A, Schnyder U, Hepp U (2008) Body image and transexualism. Psychopathology 41:96–100
Becker I, Nieder TO, Cerwenka S, Briken P, Kreukels BP et al (2015) Body image in young gender dysphoric adults: a European multi-center study. Arch Sex Behav. doi: 10.1007/s10508-015-0527-z
Bozkurt A, Isikli H, Demir F, Ozmenler KN, Gulcat Z, Karlidere T (2006) Body Image and personality traits of male to female transsexuals and homosexuals. Soc Behav Personal 34:927–937
Fleming MZ, Macgowan BR, Robinson L, Spitz J, Salt P (1982) The body Image of the post-operative female to male transsexual. J Consult Clin Psychol 50:461–462
Van Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S et al (2015) Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case-controlled study (ENIGI). Eur J Endocrinol 172(2):163–171
Fisher AD, Castellini G, Bandini E, Casale H, Fanni E et al (2014) Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med 11(3):709–719
Fisher AD, Ristori J, Bandini E, Giordano S, Mosconi M et al (2014) Medical treatment in gender dysphoric adolescents endorsed by SIAMS-SIE-SIEDP-ONIG. J Endocrinol Invest 37(7):675–687
Fabris B, Bernardi S, Trombetta C (2015) Cross-sex hormone therapy for gender dysphoria. J Endocrinol Invest 38(3):269–282
Klein C, Gorzalka BB (2009) Sexual functioning in transsexuals following hormone therapy and genital surgery: a review. J Sex Med 6:2922–2923
Slabbekoorn D, van Goozen SHM, Gooren LJG, Cohen-Kettenis PT (2001) Effects of cross-sex hormone treatment on emotionality in transsexuals. Int J Transgenderism. 5(3). http://www.iiav.nl/ezines/web/ijt/97-03/numbers/symposion/ijtvo05no03_02.htm
Costantino A, Cerpolini S, Alvisi S, Morselli PG, Venturoli S, Meriggiola MC (2013) A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. J Sex Marital Ther 00:1–15
Hembre WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM (2009) Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 94:3132–3154
Godano A, Maggi M, Jannini E, Meriggiola MC, Ghigo E, Todarello O, Lenzi A, Manieri C (2009) SIAMS-ONIG. Consensus on hormonal treatment in gender identity disorder. J Endocrinol Invest 32(10):857
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, De Cuypere G et al (2011) Standards of care for the health of transsexual, transgender and gender-nonconforming people, Version 7. Int J Transgenderism 13:165–232. http://www.path.org/documents/IJTSOCV7.pdf
Hines M et al (2004) Androgen and Psychosexual development: core gender identity, sexual orientation and recalled childhood gender role behavior in women and men with congenital adrenal hyperplasia (CAH). J Sex Res 41:1–7
Meyer-Bahlburg HFL, Dolezal C, Baker SW, New MI et al (2008) Sexual orientation in women with classical or not-classical congenital adrenal hyperplasia as a function of degree prenatal androgene excess. Arch Sex Behav 37:85–99
Mathews GA et al (2009) Personality and congenital adrenal hyperplasia: possible effects of prenatal androgen exposure. Horm Behav 55:285–291
Rapkin AJ, Akopians AL (2012) Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. Menopause Int 18(2):52–59
Bouret SG (2013) Organizational actions of metabolic hormones. Front Neuroendocrinol 34(1):18–26
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC
The WHOQOL Group (1994) Development of the WHOQOL rationale and current status. Int J Ment Health 23(3):24–56
The World Health Organization (1998) WHOQOL User Manual. World Health Organization, Geneva
Likert R (1932) A technique for the measurement of attitudes. Arch Psychol 140:44–53
Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M (2011) Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One 6(2):e1688
Asscheman H, Giltay EJ, Megens JA, de Ronde WP, van Trotsenburg MA, Gooren LJ (2011) A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 164(4):635
De Cuypere G, T’Sjoen G, Beerten R, Selvaggi G, De Sutter G et al (2005) Sexual and physical health after sex reassignment surgery. Arch Sex Behav 34(6):679–713
Zimmermann A, Zimmer R, Kovacs L, Einödshofer S, Herschbach P et al (2006) Transsexuals life satisfaction after gender transformation operations. Chirurg 77:432–438
Gooren LJ (2011) Care of Transsexual persons. N Engl J Med 3:31
Bodlund O, Kullgren G (1996) Transsexualism-general outcome and prognostic factors: a 5 year follow up study of ninetten transsexual in the process of changing sex. Arch Sex Behav 25(3):303–316
Smith YL, Van Goozen SH, Kuiper AJ, Cohen-Kettenis PT (2005) Sex reassignment: outcomes and predictors of treatment of adolescent and adult transsexuals. Psychol Med 35:89–99
Smith YL, van Goozen SH, Cohen-Kettenis PT (2001) Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study. J Am Acad Child Adolesc Psychiatry 40:472–481
Hepp U, Kraemer B, Schnyder U, Miller N, Delsignore A (2005) Psychiatric comorbidity in gender identity disorder. J Psychosom Res 58:259–261
Wolfradt U, Neumann K (2001) Depersonalization, self-esteem and body image in male-to-female transsexuals compared to male and female controls. Arch Sex Behav 30:301–310
Fraser L (2009) Depth psychoterapy with transgender people. Sex Rel Ther 24(2):126–142
Bartolucci C, Gomez GE, Salamero M, Esteva I, Guillamon A et al (2015) Sexual quality of life in gender- dysphoric adults before genital sex reassignment surgery. J Sex Med 12(1):180–188
Schroder M, Carroll RA (1999) New women: sexological outcomes of male-to-female gender reassignment surgery. J Sex Educ Ther 24:146–147
Ross MW, Need JA (1989) Effects of adequacy of gender reassignment surgery on psychological adjustment: a follow-up of fourteen male-to-female patients. Arch Sex Behav 18:145–153
Bettocchi C, Ralph DJ, Pryor JP (2005) Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int 95:120–124
Leriche A, Timisit MO, Morel-Journel N, Bouillot A, Dembele D, Ruffion A (2008) Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism. BJU Int 101:1297–1303
Wierckx K, Van Caenegem E, Elaut E, Dedecker D, Van De Peer F et al (2011) Quality of life and sexual health after sex reassignment surgery in transsexual men. J Sex Med 8(12):3379–3388
Bentler PM (1976) A typology of transsexualism: gender identity theory and data. Arch Sex Behav 5:567–584
Lief HI, Hubschman L (1993) Orgasm in the postoperative transsexual. Arch Sex Behav 22:145–155
Gomez-Gill E, Zubiaurre-Elorza L, Esteva E, Guillamon A, Godas T et al (2012) Hormon-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology 37:662–667
Gomez-Gill E, Canizzarez-Torres A, De La Torre F, Halperin I, Salamero M (2009) Androgen treatment effects on memory in female to male transsexuals. Psychoneuroendocrinology 34:110–111
Slabbekoorn D, van Goozen SH, Megens J, Cohen Kettenis PT, Gooren LJ (1999) Activating effects of cross sex hormonon cognitive functioning: a study of short term and long-term hormone effects in transsexuals. Psychoneuroendocrinology 24:423–447
Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G et al (2014) Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med 11(1):107–118
Gorin-Lazard A, Baumstarck K, Boyer L, Maquigneau A, Gebleux S et al (2012) Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. J Sex Med 9(2):531–534
Gorin-Lazard A, Baumstarck K, Boyer L, Maquigneau A, Penochet JC et al (2013) Hormonal therapy is associated with better self-esteem, mood, and quality of life in transsexuals. J Nerv Ment Dis 201(11):996–1000
Van Kesteren P, Lips P, Gooren LJ, Asscheman H, Megens J (1998) Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones. Clin Endocrinol (Oxf). 48:347–354
Wierckx K, Elaut E, Van Caenegem E, Van De Peer F, Dedecker D et al (2011) Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration. Eur J Endocrinol 165(2):331
Hines M (2010) Sex-related variation in human behavior and the brain. Trends Cogn Sci. 14(10):448
Zhou JN, Hofman MA, Gooren LJ, Swaab DF (1995) A sex difference in the human brain and its relation to transsexuality. Nature. 2:378 (6552)
Feingold A, Mazzella R (1998) Gender differences in body image are increasing. Psychol Sci 19:190–195
Esnaola I, Rodriguez A (2010) GA. Body dissatisfaction and perceived sociocultural pressures: gender and age differences. Salud Ment 33:21–29
Hulley S, Grady D, Bush T, Furberg C, Herrington D et al (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin replacement Study (HERS) Research Group. JAMA 280(7):605
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This research did not receive any specific grant from any funding agency in the public, commercial or not-for profit sector.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this study, involving human participants, were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
Informed consent
An informed consent was obtained from all participants/controls. To maintain privacy, all data were coded. All transsexuals’ data were collected as part of the clinical and psychological routine procedures.
Rights and permissions
About this article
Cite this article
Castellano, E., Crespi, C., Dell’Aquila, C. et al. Quality of life and hormones after sex reassignment surgery. J Endocrinol Invest 38, 1373–1381 (2015). https://doi.org/10.1007/s40618-015-0398-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40618-015-0398-0