(143) Effects of Gender Affirming Hormone Therapy on Sexual Function for Transmasculine Populations

Abstract Introduction Gender affirming hormonal therapy (GAHT) is a safe and accessible method of care for transgender and gender-diverse people. While existing research focuses on improvements in body image and overall quality of life, the effects of GAHT on sexual health are less studied. Components of sexual health such as desire and satisfaction are complex and multifaceted. In this review, we discuss the existing research about the effects of GAHT on sexual dysfunction, desire, and arousal in gender-diverse and transgender people. Objective To synthesize findings on changes to sexual function for transgender men before and after starting GAHT based on duration of treatment to inform a future research study. Methods A narrative review was conducted using studies from years 2014 to 2024. Databases PubMed and ClinicalKey were searched. Study formats included meta-analyses, cross-sectional studies, and prospective cohort studies. Studies that primarily focused on transgender women and gender-affirming surgery were excluded. Twenty-eight studies were included in this review. Many studies utilized validated measures to assess sexual dysfunction, such as the Female and Male Sexual Function Index (FSFI, MSFI), Changes in Sexual Functioning Questionnaire (CSFQ), and PROMIS SexFS. Outcomes included self-reported sexual desire, arousal, orgasmic function, sexual distress, and dysfunction. Results Baseline prevalence of sexual dysfunction before initiating GAHT ranged from 32-53%, with the most commonly reported issues being inability to achieve orgasm and difficulty initiating sex. Across multiple studies, GAHT was associated with increased sexual desire and arousal, initially and sustained over multiple years of continued use, particularly in transgender men following testosterone initiation. Satisfaction with GAHT in transgender men was negatively correlated with prevalence of hypoactive sexual desire disorder (HSDD). There appears to be conflicting data about pain with sex; no significant changes in pain or orgasmic function were found in one systematic review of transgender men on GAHT, while another reported a 21% lower prevalence of chronic pelvic pain among testosterone users. Duration of GAHT largely showed unchanged outcomes, except for one study describing higher sexual desire with shorter duration of testosterone use in transgender men. This could be describing an initial increase which plateaus over time. For long-term GAHT, increased masturbation frequency, stable sexual satisfaction, and higher sexual esteem were noted by patients. Conclusions GAHT is associated with significant short and long-term improvements in sexual desire, arousal, and distress. However, sexual dysfunction can persist in subsets of patients in specific outcome fields, such as pain, highlighting the need for more longitudinal studies that focus on sexual wellbeing in this domain with GAHT. After performing this review, this research team is conducting a study to address the relative lack of research on pain with sex for transgender men on GAHT to add to the body of literature on this subject. Disclosure No.