Longitudinal outcomes of gender affirming hormone therapy on gender incongruence and psychosocial wellbeing : a mixed methods study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, Aotearoa, New Zealand
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2023
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Massey University
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Abstract
Access to Gender Affirming Hormone Therapy (GAHT) has increased internationally and in Aotearoa, New Zealand, in recent years. While majority of research supports the positive impact of GAHT on gender congruence and wellbeing, there is a dearth of longitudinal data specifically within Aotearoa. To address this gap, I conducted a mixed methods study to explore the longitudinal outcomes of GAHT on gender congruence and psychosocial wellbeing.
In study one, 35 participants aged between 18 and 59 years (m = 27.5) completed the Patient Health Questionnaire (PHQ-SADS) measuring somatic, depressive, and anxious symptomology, the Personal Wellbeing Index (PWI), the Transgender Congruence Scale (TCS), and a Visual Analogue Scale tracking their personalised goals (GTF). Survey scores were collected at baseline (prior to starting GAHT) and at a six month and 12 month follow up of GAHT commencement. Both binary and non-binary trans identities were included in this study. In total, 22 participants received oestrogen-based gender affirming hormone therapy (E-GAHT) and 13 participants received testosterone-based gender affirming hormone therapy (T-GAHT). Differences between survey responses over time were measured using repeated measures ANOVA.
Quantitative findings revealed that scores on the TCS and GTF significantly increased over time, suggesting participants experienced enhanced gender congruence and progress towards their individual GAHT goals after one year of treatment. Responses from the PHQ-SADS did not significantly change over time suggesting that these symptomologies remained stable following GAHT. Similarly, responses from the PWI showed no significant change over time. Of note, participants mean baseline scores on the PHQ-SADS were within the minimal and mild ranges resulting in a floor effect for detecting any reduction in symptomology.
Study two comprised of semi structured interviews with 10 participants from study one aged between 21 and 45 years (m=30). Qualitative analysis was performed using Reflexive Thematic Analysis. From this study, five participants were taking T-GAHT and five E-GAHT, six participants identified with a binary trans identity, and four identified with a non-binary or agender trans identity.
Qualitative analysis yielded five overarching themes. The first theme highlighted the lengthy and thoughtful decision-making process of participants preceding the initiation of GAHT, reflecting participants' extensive contemplation and understanding of their gender identity and desire to seek GAHT. Themes two, three, and four explored the outcomes of GAHT on the physical body, sense of self, and social interactions. Changes in these three areas were mostly positive and well received, while discussions also acknowledged aspects that GAHT did not affect, such as certain physical changes and certain societal attitudes and reactions towards trans individuals. The fifth theme centred on the importance of support throughout the GAHT journey, encompassing interpersonal relationships, community support, and comprehensive healthcare services.
Overall, the research indicated that GAHT did not significantly impact participants' mental health, physical health, or subjective wellbeing after one year. GAHT positively influenced feelings of gender incongruence and the achievement of specific goals. Participants' decisions to pursue GAHT were well considered, and they expressed satisfaction with the outcomes. Additionally, robust social support and access to comprehensive services were deemed essential alongside GAHT.
These findings highlight many favourable longitudinal outcomes of GAHT across physical, emotional, and social areas with findings from the qualitative analysis providing further context for the quantitative findings. These findings also underscore the necessity for improved access to GAHT within primary healthcare settings, increased availability of additional gender-affirming services beyond the scope of GAHT, and the need for ongoing advocacy and support for trans people from wider society.
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Gender transition, Hormone therapy, Transgender people, Medical care, Gender-affirming care, New Zealand