Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data

Jiska Ristori, Carlotta Cocchetti, Giovanni Castellini, Marina Pierdominici, Agnese Cipriani, Diletta Testi, Gioele Gavazzi, Francesca Mazzoli, Maddalena Mosconi, Maria Cristina Meriggiola, Emanuele Cassioli, Linda Vignozzi, Valdo Ricca, Mario Maggi, Alessandra D. Fisher

Research output: Contribution to journalArticlepeer-review


Introduction: As far as we know, no studies to date have investigated the psychobiological correlates of sexual distress (SD) nor the impact of hormonal treatment (HT) on SD in transgender persons. Aim: To evaluate the psychobiological correlates of SD and assess the effects of HT on SD in transgender persons without gender-affirming surgery. Methods: A consecutive series of 301 transgender persons (160 transwomen and 141 transmen) was considered for the cross-sectional study, and a subset of 72 subjects was studied in a 2-year follow-up. A physical examination was performed. Blood samples were drawn for determination of cortisol levels. Subjects completed psychometric measures. During 2 years of HT, the evaluation of SD was prospectively repeated. Main Outcome Measure: Psychobiological correlates of SD in transgender population. Changes in SD during gender affirming hormonal treatment. Clinical Implications: Knowing how hormonal treatment influence SD will help care providers when counseling transgender people. Strengths & Limitations: To the authors’ knowledge, this is the first study prospectively evaluating the impact of gender affirming hormonal treatment on sexual distress in transgender individuals. The main limitations are represented by the small size of the sample and the use of questionnaires validated only in the cisgender population. Results: SD showed a positive correlation with body uneasiness (P <.0001) and with dissatisfaction toward gender-related body parts or shapes (all P <.05). In addition, SD correlated positively with general psychopathology (P <.0001), alexithymia, social anxiety, and humiliation scales (all P <.05). In transmen, SD was positively associated with autism levels (P <.005), as well as with cortisol levels (P <.02). A significant correlation between SD and perceived discrimination was observed in transwomen (P <.05). In transwomen, SD was positively associated with hair density and negatively with breast growth (both P <.05). Finally, in transmen, a negative correlation was found between SD and hair density (P <.05). When the impact of HT on SD was evaluated, a significant reduction of SD was observed across time in both transwomen and transmen (P =.001 and P =.01, respectively). Conclusions: The present results support the efficacy of HT in reducing SD in transgender persons. Ristori J, Cocchetti C, Castellini G, et al. Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data. J Sex Med 2020;17:142–151.

Original languageEnglish
Pages (from-to)142-151
Number of pages10
JournalJournal of Sexual Medicine
Issue number1
Early online dateNov 14 2019
Publication statusPublished - Jan 2020


  • Hormonal Treatment
  • Sexual Distress
  • Transgender Health

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology
  • Urology


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