Sexual satisfaction and dysfunction in transgender adults following puberty suppression treatment during adolescence

Sexual satisfaction and dysfunction in transgender and gender-diverse (TGD) individuals following treatment with puberty suppression (PS) have not yet been studied and remain a topic of clinical and academic concerns.

This study explores the long-term effects of (early) PS treatment on sexual satisfaction and dysfunction in TGD individuals.

This retrospective cohort study included 50 transmasculine and 20 transfeminine individuals treated with PS and gender-affirming hormones (GAH). Fifty-seven percent underwent genital gender-affirming surgery. All gender-related medical treatment (GRMT) was performed at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, between 1998 and 2011. PS treatment was, on average, initiated 14 years prior to study participation. Sexual experiences were assessed using a self-developed questionnaire at least 9 years after GAH and compared between early and late PS treatment groups. Findings were compared with data of a transgender cohort that started GRMT at an adult age.

The primary outcomes included sexual satisfaction and various sexual dysfunctions, defined as the presence of a sexual problem accompanied by distress.

Sexual satisfaction was reported by 52% of transmasculine and 40% of transfeminine individuals, with similar outcomes between early and late PS groups. Among transmasculine individuals, 58% reported at least one sexual dysfunction, most commonly difficulty with initiating sexual contact (34%), with similar frequencies in PS groups. In transfeminine individuals, 50% experienced at least one sexual dysfunction, with difficulty achieving orgasm (35%) being most common, with similar reports across PS groups. The prevalence of sexual dysfunctions was comparable to that of transgender individuals who began GRMT in adulthood.

These findings enable healthcare professionals to provide accurate and personalized information regarding the anticipated effects of early endocrine GRMT.

This is the first study to assess sexual satisfaction and dysfunction in TGD individuals treated with early and late PS. The small sample size precluded inferential statistical analyses.

In this study, the majority of transgender individuals treated with PS did not experience difficulties with desire, arousal, or achieving orgasm in adulthood. Outcomes were similar for early and late PS treatment and comparable to previous findings in those who started GRMT in adulthood. Sexual satisfaction is comparable to the general population. These results may alleviate concerns about long-term effects on sexual satisfaction and dysfunction in TGD individuals who do not undergo (full) endogenous puberty. However, attention for sexual counseling and exploration of factors that influence sexual wellbeing remains essential.