An analysis of medical records from a large German endocrine clinic suggests more transgender men are seeking gender-affirming treatment, with nearly all individuals reporting an improvement in their overall situation after initiating hormone therapy, according to findings published in Clinical Endocrinology.
“So far, there are few data about chronological correlation of medical and legal aspects of gender reassignment,” Gesine Meyer, of the division of endocrinology at Goethe University Hospital in Frankfurt, Germany, and colleagues wrote in the study background. “The heterogenity of legislations and the sociocultural differences between countries make it difficult to compare the available data.”
In a retrospective study, Meyer and colleagues analyzed data from 350 individuals who presented in an endocrine outpatient clinic in Germany for gender dysphoria who initiated and continued gender-affirming HT between January 2009 and March 2017, with follow-up of at least 10 to 14 months. Within the cohort, 121 adults were transgender women and 229 were transgender men; median age at first presentation, 22 years.
During 8 years of follow-up, researchers observed that nearly twice as many transgender men as transgender women visited the outpatient clinic; however, by 2013, researchers noted a “remarkable increase” in the ratio.
“Since previous studies predominantly show a distinct preponderance of transwomen, more recent analyses indicate an adjustment of gender-ratio over time,” the researchers wrote. “Our study is, to our knowledge, the first showing a reverse ratio.”
Gender-affirming HT was initiated by a medical professional for most individuals; however, the proportion of self-initiated HT was higher among transgender women vs. transgender men (5.2% vs. 0.45%; P < .001). Most individuals (95%) contacted a trained mental health professional before presenting in the endocrine clinic. The mean latency between onset of psychotherapy and receipt of gender-affirming HT was 9 months, with no between-sex differences. About 70% of adults began a social gender role transition before presenting to the clinic, according to researchers.
Almost all individuals (98.7%) reported an improvement of their overall situation after initiating gender-affirming HT. Among transgender men, the use of antidepressant therapy declined during the 10 to 14 months after initiating HT; however, researchers did not observe this trend among transgender women.
Researchers observed that use of illegal substances was rare in the cohort (4.6%), although about one-third reported smoking.
“The overall very high level of individuals who appraised gender-affirming HT as an improvement of their overall situation as well as the absence of misdetermination in our cohort point out that individuals diagnosed with gender dysphoria benefit from a procedure according to the established standards of care and best-practice guideline,” the researchers wrote. “The declining use of illegal substances, the diminishing proportion of self-medication with gender-affirming hormones as well as the remarkable reduction of antidepressant comedication observed at least in transmen could be interpreted as possible signs for a decline of psychosocial burden in individuals diagnosed with gender dysphoria over the last years.”
The researchers also noted a latency between application for legal gender reassignment in Germany and a court decision, with a median process time of 9 months, and differing requirements across countries within the European Union. In Germany, for example, the decision for gender reassignment is up to the jurisdiction of the responsible district court, and two mutually independent and fee-based expert opinions are required.
“The justifying reasons for the comparably complex and expensive procedure are incomprehensible, especially taking into account the high grade of satisfaction with gender reassignment, the marginal share of misdeterminations as well as the abated occupational and financial capacities of persons concerned, which we have validated with this study,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.