Implications of Gender-Affirming Hormone Therapy for Psychosocial Functioning and Social Relationships of Transgender People

Project Information

AFFIRMRelationships

Grant agreement ID: 101042028

DOI

10.3030/101042028

EC signature date 19 August 2022

Start date 1 January 2023

End date 31 December 2027

Funded under

• European Research Council (ERC)

Total cost

€ 1 500 000,00

EU contribution

€ 1 500 000,00

Coordinated by

STICHTING AMSTERDAM UMC
Netherlands

Periodic Reporting for period 1 - AFFIRMRelationships (Implications of Gender-Affirming Hormone Therapy for Psychosocial Functioning and Social Relationships of Transgender People)

Reporting period: 2023-01-01 to 2025-06-30

Summary of the context and overall objectives of the project

Using a combination of cutting-edge approaches, AFFIRM Relationships is investigating how sex hormones, for example, estrogen and testosterone, affect relationships and social health. As defined by the grantee, social health refers to “adequate quantity and quality of relationships in a particular context to meet an individual’s need for meaningful human connection,” and is a critically important but under-studied domain within healthcare.
But what connects sex hormones with social health? The AFFIRM Relationships project will test how certain psychological and social factors may play a role in this pathway. Indeed, how people feel within themselves, for example, their emotional well-being and self-esteem; the feelings of control people have over their reactions and behaviors; and how people experience interpersonal interactions with others, such as in developing trust and closeness, are all things that may be influenced by sex hormones and which may also have an effect on relationships and social health.
A group of people for whom this research has particular relevance both clinically and practically are transgender people, that is, people whose gender identity and/or gender expression does not align with the sex they were assigned at birth. Gender-affirming hormone therapy is, for many transgender people, an essential part of their transition journey. This is because hormones can lead to physical changes, for example, hair growth and hair loss alongside body fat redistribution and changes in skin texture, which can help transgender people to live and be recognized by others as the gender they are. These changes may be accompanied by other psychological and social changes, such as higher self-esteem and increased comfort interacting with others. It is also the case that relationships with friends, romantic partners, and family may be particularly important during gender transition and hormone therapy, because this is a time when the need for support from others is high. Thus far, it is not well known how taking sex hormones may affect transgender people's psychological and social well-being. This information is very relevant to know when considering how to navigate, and what to expect from, gender transition.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

A primary goal of the AFFIRM Relationships project was to engage the transgender community in the research at various stages, including during the design of the research studies, when interpreting results, and when working out what these results mean for clinical care and the community. This involved setting up a consultancy group of transgender people and their loved ones, such as romantic partners or family members, to brainstorm research priorities and gather and implement feedback on study design and material selection. This practice has informed our research and provides ongoing insights that are fundamental to the continued success of the project. Related to this, we also conducted 26 in-depth interviews with transgender people on the topics of psychological and social well-being over the course of gender-affirming hormone therapy. These interviews provided important insights on the role that hormones may play in the daily lives of transgender people, such as changes in mood and social life, and whether transmen, transwomen, and nonbinary people experience potential changes differently. Findings from these interviews have helped us further develop the next steps in our research.
In addition to collecting new data from participants, we aim to maximize current knowledge available in existing data repositories. For example, we analyzed available data from several sources, including the World Health Organization and the Transgender EU Health Map, to group European countries based on quality of and access to gender-affirming medical care. This type of data provides insight on the role that structural and societal factors play in the well-being of transgender people, alongside gaining better understanding of how hormone therapy is provided across culturals and contexts within which transgender people are living and accessing care across Europe.
Coming up, we will be running a new study to understand the effects of sex hormones on social health during gender transition over a 2-year time span. We will be recruiting 300 transgender people starting different types of gender-affirming care: People starting gender-affirming hormone therapy, including both masculinizing and feminizing hormone therapy; people undergoing a mastectomy, which is a masculinizing top surgery to remove breast tissue; and people starting voice training to achieve a more feminine-sounding voice. Participants will be filling out surveys related to their psychological health, such as their mood and self-esteem, and social well-being, including satisfaction with close relationships and support from others, at the start of gender-affirming care, and then again at 3, 6, 12, and 24 months after starting their treatment. This project will allow us to disentangle the biological, medical, and social aspects of gender-affirming care that may influence well-being for transgender people.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The AFFIRM Relationships project has the potential to provide state-of-the-art clinically and socially relevant evidence on the effects of gender-affirming hormone therapy on social health in transgender people. Going one step further, findings can help to elucidate how such changes in social health may be explained by biological, individual, and external societal factors. This information is especially valuable for transgender people undergoing gender-affirming care, their loved ones, as well as medical doctors and clinicians involved in their care. The transgender community will benefit from such insights given the lack of current scientific knowledge on the broader psychological and social changes that can occur over the course of transition; these insights may help people know what to expect from medical and hormonal transition. Because a focus of the project is also on the social aspects of transition, including changes in transgender people’s social networks and the role that supportive others can play in the well-being of transgender people, this project will also provide important findings for loved ones of transgender people who want to be supportive but may lack key knowledge and insights about how to best go about providing support. Finally, results of this work will be valuable to doctors and clinicians to inform their patients of expected and possible psychological and social changes during gender-affirming hormone therapy.

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