The Influence of Gender-Affirming Hormone Therapy, With or Without Pubertal Suppression, on Sexual Function in...

Gender-affirming medical therapy (GAMT), including pubertal suppression with gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormone therapy (GAHT), is a key component of care for many transgender and gender diverse (TGD) individuals. Although hormonal impacts on physical changes are well documented, effects of GAHT compared with GnRHa + GAHT on sexual function and desire remain underexplored.

The present study assessed sexual function and desire in TGD adults using the validated Changes in Sexual Functioning Questionnaire 14. Participants were recruited from 2 clinical sites and grouped by GAMT type: GAHT alone or GnRHa + GAHT.

A total of 58 participants (24 assigned female at birth, 34 assigned male at birth; mean age 22 years, range 18-25) were enrolled and their responses were analyzed. Survey questions were grouped into 5 domains of sexual functioning and scored as outlined by the instrument's developers. Overall, there were no significant differences in sexual function between individuals who received GAHT alone and those who also received pubertal suppression with GnRHa. However, assigned male at birth participants exhibited significantly higher rates of decreased sexual function compared with assigned female at birth individuals across most domains, including desire (P = .021), arousal (P = .040), and orgasm (P < .001).

Our pilot study suggests that pubertal suppression with GnRHa was not associated with sexual function compared with GAHT alone. Further research with larger, diverse samples and longitudinal design is warranted to better understand the long-term effects of GAMT on sexual health. This study highlights the need for inclusive sexual health assessments and improved tools tailored to TGD populations.