Satisfaction with current hormone therapy and goals of additional gender-affirming care in transgender adults

Abstract

Background: Many transgender persons seek hormone therapy to reduce gender dysphoria and improve quality of life, but little is known about patient satisfaction with current gender-affirming hormone therapy.

Aim: To examine patient satisfaction with current gender-affirming hormone therapy and patients' goals of additional hormone therapy.

Methods: Transgender adults in the validated multicenter STRONG cohort (Study of Transition, Outcomes, and Gender) were asked to complete a cross-sectional survey about current and planned hormone therapy and the effects that they experienced or hoped to gain. The proportion of respondents reporting overall satisfaction with hormone therapy were compared with χ2 or Fisher exact test. Cochran-Mantel-Haenszel analysis was used to compare the covariates of interest while controlling for age at the time of survey completion.

Outcomes: Patient satisfaction across hormone therapies, each measured with a 5-point scale, was averaged and dichotomized.

Results: Out of 2136 eligible transgender adults, 696 (33%) completed the survey: 350 transfeminine (TF) and 346 transmasculine (TM) respondents. Most participants (80%) were satisfied or very satisfied with their current hormone therapies. TF participants and older participants were less likely to report being satisfied with their current hormone therapies than TM participants and younger participants, respectively. However, TM and TF categories were not associated with patient satisfaction after controlling for age at the time of survey completion. More TF persons planned to take additional treatment. The most frequent goals for additional hormone therapy for TF persons included breast size growth, feminine body fat distribution, and facial feature softening; for TM persons, goals included diminishing dysphoria, greater muscle mass, and masculine body fat distribution.

Clinical implications: Multidisciplinary care beyond provision of hormone therapy-such as involvement of surgical, dermatologic, reproductive health, mental health, and/or gender expression care-may be important to help achieve unmet gender-affirming care goals.

Strengths and limitations: This study had a modest response rate and included only respondents with private insurance, limiting generalizability.

Conclusion: Understanding patient satisfaction and goals of care will assist shared decision making and counseling in patient-centered gender-affirming therapy.

Keywords: gender-affirming hormone therapy; health services for transgender persons; patient satisfaction; transgender persons.