A cross-sectional study of associations between casual partner, friend discrimination, social support and anxiety symptoms among Chinese transgender women

The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth

Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.

The relationship between non-suicidal self-injury and childhood abuse in transgender people: a cross-sectional cohort study

Objective

To explore the relationship between non-suicidal self-injury (NSSI) and childhood abuse in transgender people and the mediating effect of emotional dysregulation traits in the association between childhood abuse and non-suicidal self-injury.

Patients and methods

From May to October 2021, 296 female-to-male (FTM) and 675 male-to-females (MTF), with age of 24.5 ± 6.4 years, were recruited using peer-driven sampling and anonymous questionnaires in Guangdong Province. The Childhood Abuse Questionnaire (CTQ-SF), the Personality Diagnostic Questionnaire (PDQ-4+) emotion regulation ability scale and the DSM-5 Clinical Examination of Stereotypic Disorders were used to measure childhood abuse experiences, emotional dysregulation traits and self-injurious behaviour, respectively.

Results

Childhood abuse scores were positively correlated with both emotional dysregulation traits scores and non-suicidal self-injury (NSSI) behaviours (p < 0.01), and emotional dysregulation traits scores were positively correlated with NSSI behaviours (p < 0.01); emotional dysregulation traits partially mediated the association between childhood abuse and NSSI behaviours, with the mediating effect accounting for 23.23% of the total effect. In addition, among the factors of childhood abuse, emotional dysregulation traits mediated the association between emotional abuse, emotional neglect, sexual abuse, physical abuse, physical neglect and NSSI behaviour significantly, with the mediating effect accounting for 22.48%-32.58% of the total effect.

Conclusion

Transgender NSSI behaviours are associated with childhood abuse and emotional dysregulation traits, and emotional dysregulation traits partially mediates the association between childhood abuse and NSSI behaviours, and screening for emotional dysregulation traits in transgender people and timely interventions are needed to improve the current situation of discrimination against transgender people.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Mental health service utilisation among transgender women sex workers who are at risk of mental health problems in Shenyang, China: An application of minority stress theory

Transgender women sex workers (TGSW), as a highly stigmatised population, are at substantial risk for mental health problems but lack access to mental health care. This study investigated factors of mental health service utilisation (MHSU) behaviour and related behavioural intention among TGSW who were at risk of mental health problems in the past year [subsample 1: scored above the cut-off for probable depression or probable anxiety or had suicidal ideation (N = 126); subsample 2: perceived needs for mental health services (N = 109)]. A cross-sectional survey was conducted among TGSW in Shenyang, China during 2017-2018. Data on minority stress, coping, mental health and MHSU were collected. 10.3% of participants in subsample 1 and 14.7% in subsample 2 had sought help from mental health professionals in the last year. Unwillingness to disclose minority identity and gender non-affirmation were negatively associated with MHSU. Factors for behavioural intention of MHSU included unwillingness to disclose minority identity and social support for both subsamples and adaptive coping for subsample 2. Confidentiality concern, discrimination and cost were the most frequently endorsed barriers to mental health services. Interventions should promote gender affirmation, social support and adaptive coping as well as remove stigma to increase health service access and utilisation among minority populations.

The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study

Background

As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women.

Methods

From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women.

Results

In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000–15,000 yuan (OR:0.16, 95% CI:0.06–0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01–0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06–0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18–0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08–10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91–12.20) were more likely to have psychological distress.

Conclusion

Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13357-9.

Mental health in transgender individuals: a systematic review

Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.

Mental Health Contributors Among Transgender People in a Non-WEIRD Society: Evidence From China

Transgender people face numerous social hurdles and consequently report elevated rates of mental health problems. However, little research has examined whether established mental health findings generalize to experiences of transgender people outside of Western contexts. In an analysis of the 2017 Chinese Transgender Population General Survey ( N = 1,106), we examined how discrimination and environmental support in a school context related to mental health and self-harm among transgender people. We found that more frequent school discrimination was associated with worse mental health and increased self-harm. Further, perceived environmental support was associated with better mental health but was unrelated to self-harm. These relations did not differ based on whether people were “out” about being transgender at school or between men and women. These findings highlight nuance in the experiences of transgender people outside of Western contexts and hold implications for developing effective social interventions.

Perceived social support and its relationship with depression among Bangkok's trans women

Purpose

The purpose of this paper is to evaluate the prevalence of depression and to determine the association between social support and depression among transgender women in Bangkok, Thailand.

Design/methodology/approach

A cross-sectional study was conducted among 280 transgender women in Bangkok, Thailand between March 2019 and May 2019 using the snowball sampling method. Data were collected through a self-administered questionnaire. The questionnaire included demographic questions and measures of social support (MSPSS) and depression (CES-D). Multivariable logistic regression analysis was employed to explore the association between social support and depression.

Findings

The prevalence of depression among transgender women was 58.2%. Multivariable logistic regression analysis indicated that depression was significantly associated with perceived low social support (OR: 9.55, 95%CI: 2.10–43.39) and moderate social support (OR: 2.03, 95%CI: 1.19–3.46) after being adjusted for religion, sufficient income and alcohol drinking.

Originality/value

Transgender women were prone to experience a higher prevalence of depression than the general population. Social support would reduce the risk of depression among transgender women. Therefore, social support service systems for transgender women should be embedded into organizations concerned.

The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals

BACKGROUND

According to the minority stress theory, the minority stressors of gender-related discrimination, rejection, and victimization will increase depression in the transgender and gender non-conforming (TGNC) population. However, few studies focused on these relations in the context of mainland China, and the positive perspective of their resilience still remained unstudied.

METHODS

This cross-sectional study recruited 361 TGNC individuals through the online community of TGNC people. The participants were involved in this study by measuring their experiences of gender-related discrimination, rejection, victimization, resilience, and depression. The SPSS and PROCESS were used to assess the relations of the studied variables.

RESULTS

High rates of gender-related discrimination, rejection, and victimization were reported by TGNC participants in this study (80.1%, 98.9%, and 77.0% accordingly). The participants who had experienced gender-related discrimination and victimization showed a significantly higher level of depression than those who never experience such unfair treatments. Besides, gender-related discrimination and resilience significantly contributed to the variance of the depression (R² adjusted=0.344, F=21.674, p<0.01), and their resilience was found to play a moderating role between discrimination and depression.

LIMITATIONS

A longitudinal study may need to examine the causal effects, and the limitations of the online data should be noted.

CONCLUSIONS

The Chinese TGNC people are living in a relatively unfavorable environment with experiencing high rates of gender-related unfair treatments, which can be detrimental to their mental health status. However, their resilience can be a buffer for them in facing adversity. Intervention and educational programs might be developed accordingly.

Counselling and psychotherapy service use in Chinese sexual minority populations: a nationwide survey

BACKGROUND

This study investigated the prevalence and factors associated with counselling and psychotherapy service use among Chinese sexual minority populations.

METHODS

A nationwide cross-sectional study was performed using snowball sampling method, which led to the inclusion of 18,193 participants. Participants' sociodemographic background, clinical, and psychological data were gathered. Multivariate logistic regression analysis was performed to explore any associated factors.

RESULTS

There were 2007 participants who had used counselling and psychotherapy service out of the total population. Among those who had used psychotherapy services, 80.2% participants perceived discrimination, 1.1% reported that they had been refused treatment by a counsellor and/or psychotherapist, 1.6% had experienced verbal harassment, and 8.4% reported that their counsellor and/or psychotherapist lacked knowledge and experience in treating sexual minorities. In addition, regression analyses indicated that those who were divorced/widowed, had religious beliefs, and those who had experienced discrimination, verbal harassment, and rejection for treatment by health professionals all had an increased likelihood of utilising counselling and psychotherapy service.

CONCLUSIONS

Service providers and policy makers in China should improve the quality and availability of counselling and psychotherapy services to address the mental health needs of sexual minority populations.

Prevalence and associated factors of sexualized drug use in sex work among transgender women sex workers in China

Sexualized drug use (SDU) is associated with a higher risk of HIV transmission. There is a dearth of study investigating the association between sex work characteristics and SDU in sex work among transgender women sex workers. To address these gaps, we conducted a secondary analysis of a cross-sectional study among 220 transgender women sex workers in Shenyang, China. The prevalence of SDU in sex work was 20.9% in the past month. After adjustment for age, HIV status, education, monthly income and duration of stay in Shenyang, performing sex work mainly in hotel rooms, charging higher per episode of commercial sex, depressive symptoms and anxiety symptoms were associated with higher likelihood of SDU in sex work. Future SDU prevention programmes SDU targeting transgender women sex workers should focus on those who charged higher and performed sex work in hotel rooms, and integrate mental health promotion as an essential component.

The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study

BACKGROUND

Gender-affirming hormone therapy and surgery are important medically necessary approaches to transgender care. However, few related data exist in China.

AIM

To understand the desire and access of transgender cares in the Chinese transgender men and women population.

METHODS

A cross-sectional self-selecting survey targeting the Chinese transgender population was conducted in 2017 using a snowball sampling method. Participants completed an online questionnaire anonymously. Gender identity was verified by specifically designed questions. Data analysis of this study was performed in 2019.

OUTCOMES

The main outcome was the status of receiving transgender medical care, including the desire vs actual state of receiving gender-affirming hormone treatment and gender-affirmation surgery, methods of accessing hormonal therapy and surgery, and risky behaviors associated with obtaining treatments.

RESULTS

Of the total 2060 valid questionnaires, there were 1,304 transgender individuals (626 transgender men and 678 transgender women), with a median age of 22 (interquartile range, 19-26) years. Among them, 1,036 (79.4%) expressed desires for hormonal therapy, but of 1,036, 741 (71.5%) considered it difficult to obtain medications from doctors. Of 1,036 individuals, 275 (26.5%) and 172 (16.6%) had thoughts or behaviors of self-injury, respectively, when lacking access to hormone therapy. Of 1,036 individuals, 602 (58.1%) had used hormones. Of those 602 hormone users, 407 (67.6%) had ever obtained medications from informal drug dealers, and 372 (61.8%) of them did not perform regular monitoring. 868 of 1,303 (66.6%) participants had received or wanted to undergo gender-affirming surgeries, but 710 of 868 (81.8%) considered the surgery resources not adequate or very scarce.

CLINICAL IMPLICATIONS

The transgender medical resources in China are scarce, and many transgender individuals have engaged in high-risk activities to access care.

STRENGTHS & LIMITATIONS

This is the first study to focus on the current status of gender-affirming hormone therapy and surgery in the Chinese transgender population, providing valuable and real-world data for understanding the need for transgender health care in China. But, the online questionnaire could not provide the prevalence and other epidemiologic information about transgender individuals in China, and the survey did not address specific medication regimens, dosages, sex hormone levels, and specific hormone therapy-related or surgery-related adverse events.

CONCLUSION

Significant improvement in access to gender-affirming medical and surgery care is needed in China. Liu Y, Xin Y, Qi J, et al. The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study. J Sex Med 2020;17:2291-2298.

Meanings attributed by a group of adult men to the experience of having type 2 diabetes mellitus

Background: Trans people may find themselves in a situation of social discrimination, reflected in their health and in the lack of scientific research. The minority stress theory points out the importance of social support for the stress of sexual or gender minorities. This study aims to explore social support and its dimensions in this population. Method: 81 people participate, of which 36 are trans and 45 non-trans (cisgender), as a control group. The Mos Social Support Survey is applied to measure perceived social support and a questionnaire with sociodemographic variables. Results: The results show that there are no differences in the perceived social support between both groups. However, sociodemographic variables such as having a partner, age, and employment situation show change for the trans population in some dimensions. Conclusion: These findings promote future lines of research that expand the knowledge of these variables in this group.

Mapping out a spectrum of the Chinese public's discrimination toward the LGBT community: results from a national survey

Background

China has the world’s largest lesbian, gay, bisexual, and transgender (LGBT) population. This study assessed the discrimination experienced by LGBT individuals in China in a comprehensive way, covering discrimination perpetrated by family, media, medical services, religious communities, schools, social services, and in the workplace.

Methods

The current study involved a national survey of 31 provinces and autonomous regions. Discrimination was measured both in terms of heterosexual participants’ attitudes towards LGBT individuals, and LGBT participants’ self-perceived discrimination. Pearson correlation analysis was performed to examine the difference between heterosexual participants’ attitudes towards LGBT individuals and LGBT participants’ self-perceived discrimination. Linear regression was used to investigate the association between gross domestic product per capita and discrimination.

Results

Among 29,125 participants, 2066 (7.1%) identified as lesbian, 9491 (32.6%) as gay, 3441 (11.8%) as bisexual, 3195 (11.0%) as transgender, and 10,932 (37.5%) as heterosexual. Heterosexual people were generally friendly towards the LGBT community with a mean score of 21.9 (SD = 2.7, total scale score = 100) and the grand averaged score of self-perceived discrimination by LGBT participants was 49.9 (SD = 2.5). Self-perceived discrimination from family and social services is particularly severe. We created a series of provincial level choropleth maps showing heterosexual participants’ acceptance towards the LGBT community, and self-perceived discrimination reported by members of the LGBT community. We found that a higher level of economic development in provinces was associated with a decrease in discrimination, and we identified that every 100 thousand RMB increase in per capita GDP lead to a 6.4% decrease in discriminatory events perpetrated by heterosexuals.

Conclusions

Chinese LGBT groups consistently experience discrimination in various aspects of their daily lives. The prevalence of this discrimination is associated with the economic development of the province in which it occurs. In order to reduce discrimination, it is important for future studies to discover the underlying reasons for discrimination against LGBT individuals in China.

Ansiedade em minorias sexuais e de gênero: uma revisão integrativa

RESUMO Objetivo Evidenciar os fatores predisponentes relativos à ansiedade em minorias sexuais e de gênero na literatura. Métodos Trata-se de uma revisão integrativa. A busca dos artigos foi realizada em três bases de dados eletrônicas: PubMed/Medline, Scopus e ISI Web of Knowledge . Foram utilizados os descritores “ anxiety ”, “ LGBT people ”, “ gay ”, “ bisexual ”, “ lesbian ” e “ transgender ”, com textos completos, publicados no período de 2013 a 2018, no idioma inglês, e foi usado o operador boleano AND . Resultados Foram encontrados 712 artigos. Cinquenta e oito (58) artigos foram selecionados para serem lidos na íntegra e 13 atenderam aos critérios de inclusão desta revisão. As evidências mostram que a população LGBT apresenta maior risco para transtornos mentais, entre eles a ansiedade, quando comparada aos heterossexuais. O aparecimento dos sinais e sintomas de ansiedade estão relacionados com a vergonha e o comportamento evitativo dessa população devido à forte discriminação e à ausência de apoio social e familiar, o que ocasiona altos níveis de angústia. Apenas dois artigos estudaram menores de 18 anos. Conclusões Os profissionais da saúde devem estar abertos, acolhedores e atentos à saúde mental desse público, visando contribuir com a promoção da saúde, apoio social, familiar e a redução da discriminação.

Family acceptance, peer support, and HIV serostatus disclosure of MSM-PLWHA in Medan, Indonesia

OBJECTIVE

This study was conducted to determine the correlation between family acceptance and HIV serostatus disclosure, and the correlation between peer support and HIV serostatus disclosure.

METHODS

This was a quantitative study with a cross-sectional design involving 176 MSM-PLWHA (Men who have sex with men-people living with HIV and AIDS). Instruments used in this study is Brief Scale of HIV disclosure, perceived acceptance scale, and peer group caring interaction scale.

RESULTS

The analysis showed a significant correlation between peer support and HIV serostatus disclosure (p-value 0.011), but there was no significant correlation between family acceptance and HIV serostatus disclosure (p-value 0.979).

CONCLUSION

Peer support affects HIV serostatus disclosure in MSM-PLWHA. Peer group interventions need to be improved. Providing systematic peer group support for MSM-PLWHA and integrating intervention with peer support might need to be done for the next care plan for MSM-PLWHA in Medan, Indonesia.

High impact of sleeping problems on quality of life in transgender individuals: A cross-sectional multicenter study

INTRODUCTION

Studies in the general population suggest that determinants of QoL are often sex-dependent. Sex-dependent analyses of QoL in transgender populations have not been performed so far.

AIM

To identify sex-specific and potentially modifiable determinants of QoL in transgender patients.

METHODS

In this cross-sectional multicentre study including 82 transwomen (TW) and 72 transmen (TM) at different treatment stages, we investigated potential determinants for QoL focusing on the impact of mood (BDI, STAI-X), sleep quality (PSQI), chronic pain (GPQ), body image (FBeK) and social support (SSS).

MAIN OUTCOME MEASURE

Health-related quality of life measured with the Short Form (36) Health Survey (SF-36).

RESULTS

The age-adjusted SF-36 total score and its subscales did not significantly differ between TM and TW. Using a multivariate regression analysis approach, we identified common but also sex-dependent determinants for QoL (Adjusted R2 = 0.228; 0.650 respectively). Accounting for general characteristics such as age, BMI and treatment status, sleep quality according to the PSQI was an independent and strong determinant of QoL in both sexes (β = -0.451, p = 0.003 TM; β = -0.320; p = 0.0029 TW). Chronic pain was a significant independent predictor of QoL in TM (β = -0.298; p = 0.042) but not in TW. In contrast, anxiety (β = -0.451; p< 0.001) being unemployed (β = -0.206; p = 0.020) and insecurity about the own appearance (FBeK) (β = -0.261; p = 0.01) were independent predictors of QoL in TW. The rate of those reporting high sleep disturbances (PSQI ≥5) was high with 79.2% in TW and 81.2% in TM. Accordingly, age-adjusted QoL was also significantly lower in those reporting poor sleep in both sexes.

CONCLUSIONS

Sleep strongly affected QoL in both genders, while other factors, like pain and body image, seem to be gender specific in transgender individuals.