Sociodemographic and gender affirmation factors associated with gender euphoria: a cohort study

Gender euphoria encompasses positive feelings associated with gender expression, identity, and affirmation, and is important for wellbeing. However, little is known about how gender euphoria is experienced by different subgroups within trans communities. Such knowledge could contribute to a more holistic understanding of trans health and promote more accurate and inclusive care. This study aimed to explore differences in gender euphoria by sociodemographic and gender affirmation factors.

In this cohort study in Australia, participants aged 16 years or older who were enrolled in a longitudinal trans-led project (TRANSform), with a gender other than that presumed for them at birth, were invited to complete surveys between 22nd November 2022 and 12th April 2023. Participants completed the Gender Euphoria Scale (GES) comprising three subscales: social-affirmation, self-affirmation, and community connection, and reported on frequency and strength of gender euphoria. Demographics were collected through the TRANSform study including rurality and socioeconomic deciles. Responses were subsequently categorised into those who had accessed hormones or surgery and those who were contemplating or desiring hormones or surgery. Mann-Whitney U and Kruskal-Wallis H tests were used to compare differences between groups.

Participants (N = 732) were aged 16-79 years and were women (36·9%), men (36·9%), non-binary and gender diverse (25·8%) or had a culturally specific gender identity (0·4%). Non-binary participants reported higher community connection euphoria but lower self-affirmation euphoria than women and men. Gen X participants (born 1965-1980) reported higher social affirmation euphoria than millennial participants (born 1981-1996). Participants who had accessed gender affirming hormones had higher self-affirmation euphoria than those who had not, as did those who had undergone gender affirming surgery compared to those who had not. Gender euphoria did not significantly differ by birth continent, rurality, or socioeconomic indices.

Results highlight the diversity of gender euphoric experiences within trans communities and can be used to inform individualised supports across gender affirming care, mental health, and community settings.

This study was funded by Australian Rotary Health, ASC is supported by a NHMRC Investigator Grant #2008956, SZ is supported by a Fellowship from the Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne.