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Is gender affirming hormonal therapy linked to aggression in transgender people?

Defreyne, J1; T'Sjoen, G1; Bouman, WP2; Brewin, N2; Arcelus, J2

1: Ghent University Hospital, Belgium; 2: The Nottingham Centre for Transgender Health, Nottingham, UK

Objectives Published guidelines, including the World Professional Association for Transgender Health (WPATH) Standards of Care ed. 7, warn of possible increase in aggression among transgender men (TM) when starting on testosterone treatment. However, previous research on the relationship between endogenous and/or exogenous testosterone is often inconclusive and the effects of testosterone therapy in TM and anti-testosterone therapy in transgender women (TW) on aggression have never been assessed. The aim of this study is to evaluate differences in self-reported aggression among transgender people pre and post hormonal treatment.  

Material and Methods Every transgender person attending an assessment at a large national transgender health clinic in the UK between 2012 and 2015 was invited to complete a questionnaire pack before and one year after the initiation of gender affirming hormonal therapy. The questionnaire pack included socio-demographic information and self-report measures for interpersonal problems, including levels of aggression (IIP-32), symptoms of anxiety and depression (HADS) and social support (MSPSS). In order to evaluate the effect of gender affirming hormonal therapy on aggression, scores for the IIP-32 factor ‘too aggressive’ were prospectively analyzed.

Results 140 people (56 TM, 84 TW) completed the IIP-32 questionnaire at baseline and after one year. No prospective increase in the scores for the factor ‘too aggressive’ in our population was found. A correlation between prospective serum testosterone levels and scores for the factor ‘too aggressive’ could not be identified in TM (ρ = 0.117, P = 0.412) or TW (ρ = 0.214, P = 0.098). However, a robust positive correlation was found between increasing HADS anxiety scores and increasing scores for the factor ‘too aggressive’ in both TM (ρ = 0.539, P < 0.001) and TW (ρ = 0.359, P = 0.001) and lower support from friends in TW (ρ = 0.215, P = 0.044).

Conclusion Testosterone and anti-androgen therapy was not associated with an increase (in TM) or decrease (TW) in self-reported aggression over time. Other psychological and/or social factors, such as anxiety levels and social support appear to be correlated with higher self-reported aggression in transgender people.


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