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

Summary & key facts

This systematic review looked at 46 studies on how gender-affirming hormone therapy relates to social and emotional functioning in transgender people. Across different study types, most studies found reductions in depressive symptoms and general psychological distress after starting hormone therapy. Results were mixed for quality of life. Some studies showed different emotional changes for masculinizing versus feminizing therapies, and there were hints of better social interactions. However, study sizes were often small and methods varied, so it is hard to draw firm causal conclusions.

Key facts:

• The review included 46 journal articles: 6 qualitative, 21 cross-sectional and 19 prospective cohort studies.
• Studies in the review were consistent in reporting reductions in depressive symptoms and psychological distress after people began gender-affirming hormone therapy.
• Evidence for changes in overall quality of life was inconsistent; some studies suggested improvement, but others did not show clear change.
• Some studies reported different affective changes by treatment type: there were signs that masculinizing versus feminizing hormone therapy produced different patterns of emotional change.
• Several studies suggested greater anger expression in people on masculinizing hormone therapy, but they did not find an increase in anger intensity.
• The six qualitative studies together included 171 transgender participants (individual study sizes ranged from 10 to 67).
• Risk of bias and study quality were highly variable, with many studies having small samples and limited control for possible confounding factors, which limits strong causal claims.
• Adjustment for potential confounders was uneven; for example, 12 studies (30%) reported adjusting for body image in their analyses.

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

Conditions & symptoms

Anxiety Depression Anxiety or worry Feeling disconnected from others Sadness or low mood