Discuss the role that hormones play in sexual drive for male-to-female transgender patients
Discuss the role that hormones play in sexual drive for male-to-female transgender patients
Hormone therapy for transgender women aims to feminize patients by altering fat distribution, inducing the formation of breasts, and decreasing male pattern hair growth and distribution. Estrogens are the mainstay hormone therapy for trans female patients. Their mechanism of action is through a negative feedback loop. In transgender women, exogenous estrogen helps to feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features (Nguyen et al., 2019). The exogenous therapy suppresses gonadotropin secretion of the breast from the pituitary gland, resulting in decreased androgen production. However, estrogen alone is usually not enough to attain desirable suppression of androgens, and adjunctive anti-androgenic therapy is often necessary.
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Hormone therapy with estrogen causes the growth of breasts, increased body fat, delayed growth of body and facial hair, reduced testicular size, and erectile function. Testosterone plays a major role in sexual arousal in both hypogonadal and eugonadal birth-assigned men (Defreyne et al., 2020). However, the initiation of hormonal therapy in transgender women affects their sexual drive by causing a decrease in sexual desire. This is likely connected to testosterone suppression, but it eventually increases to greater levels than before hormonal therapy. During testosterone withdrawal, transgender women experience a decrease in the level of sexual desire.
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It is worth noting that while hormonal therapy decreases sexual desire and sexual arousal in transgender women, it does the opposite in transgender men. Consequently, transgender men on hormonal therapy (testosterone) usually have increased sexual desire and arousal. Defreyne et al. (2020) established that gender-affirming hormonal therapy only triggers short-term changes in sexual desire in transgender persons. The study observed that over an extended period, the net increase in dyadic sexual desire in transgender women on estrogen and sexual desire scores compared to the baseline in transgender men on testosterone therapy.
References
Defreyne, J., Elaut, E., Kreukels, B., Fisher, A. D., Castellini, G., Staphorsius, A., … & T’Sjoen, G. (2020). Sexual desire changes in transgender individuals upon initiation of hormone treatment: results from the longitudinal European network for the investigation of gender incongruence. The Journal of Sexual Medicine, 17(4), 812-825. https://doi.org/10.1016/j.jsxm.2019.12.020
Nguyen, H. B., Loughead, J., Lipner, E., Hantsoo, L., Kornfield, S. L., & Epperson, C. N. (2019). What has sex got to do with it? The role of hormones in the transgender brain. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 44(1), 22–37. https://doi.org/10.1038/s41386-018-0140-7
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