Table 7.
Studies investigating general quality of life in transgender people (n = 22)
| Authors (year) Country |
Number of Trans participants, mean age at assessment | Treatment status | Study design | Comparative groups, follow-up | Outcome measures | Results | Factors associated | Conclusions |
|---|---|---|---|---|---|---|---|---|
| Ainsworth & Spiegel (2010) [68] USA |
247 TW 28 FFS (51 yrs) 28 FFS (51 yrs) 25 GAGS (50 yrs) 47 FFS + GAGS (49 yrs) 147 No surgery (46 yrs) |
28 FFS (CHT 86%) 25 GAGS (CHT 100%) 47 FFS + GAGS (CHT 98%) 147 no surgery (CHT 27%) |
Clinical group Cross-sectional |
CG1 = FFS only CG2 = GAGS only CG3 = FFS + GAGS CG4 = No surgery CG5 = General population (No follow-up) |
SF-36-v2 | CG1 = 50 CG2 = 49.3 CG3 = 49.2 CG4 = 39.5 |
+QoL: Surgical treatments |
TW have lower QoL than Dutch general female population |
| Auer et al. (2017) [55] Germany |
82 TW 72 TM |
TW: CHT 79.3% Pre-GAGS 79.5% TM: CHT 80.6% Pre-CRS 56.9% Pre-GAGS 72.2% |
Multicentre (4 sites) Clinical group Cross-sectional |
(No follow-up) | SF-36 | MCS = 77.66 | +QoL: +Sleep quality -Depressive symptoms -Chronic pain (TM) -Anxiety (TW) +Social support (TW) +Body image (TW) |
QoL levels did not statistically differ between TW and TM. Substantial portion of low QoL in trans is due to poor sleep quality, anxiety in TW and chronic pain in TM |
| Başar et al. (2016) [76] Turkey |
22 TW 72 TM DMS-IV-TR DSM-V 27.73 yrs. TW 26.82 yrs. TM |
CHT: 54.5% TW 20.8% TM; GAGS: 36.4% TW 12.5% TM |
Single centre Clinical group Cross-sectional |
TW vs. TM (No follow- up) |
WHOQOL-BREF-TR | TW = 15.3 TM = 12.7 |
+QoL: Social support -QoL: Discrimination |
Perceived personal discrimination and social support predicted QoL |
| Bouman et al. (2016) [69] UK |
64 TW 40 TM 36.52 yrs |
Assessment 6.7% CHT 78.8% 17.3% Post-GCGS |
Single centre Clinical group Cross-sectional |
140 matched cis control sample (No follow-up) |
SF-36-v2 | MCS = 70.9 | mQoL: Self-esteem Interpersonal issues (too dependent) |
Trans people have lower mQoL compared to the cis group |
| Cardoso da Silva et al. (2016) [56] Brazil |
47 TW 21.23 yrs. |
T1 at entrance to programme 100% T2 at least 1 year post-GAGS 100% |
Single centre Clinical group Prospective longitudinal |
Pre- vs. post-GAGS (T1 = baseline T2 = at least 1 year post-GAGS) |
WHOQOL-100 | T1 = 14.77 T2 = 15.52 |
+QoL: GAGS |
GAGS promotes improvement of psychological aspects of QoL and social relationships, but 1-year post-GAGS TW still report problems with physical health and independence |
| Castellano et al. (2015) [73] Italy |
46 TW 14 TM 32.7 yrs. TW 30.2 yrs. TM |
+ 2 years post-GAGS 100% CHT 100% |
Single centre Clinical group Cross-sectional |
60 matched cis control sample (No follow-up) |
WHOQOL-100 | TW = 67.87 TM = 69.21 |
+QoL: Lower LH |
Trans people reported levels of QoL similar to cis controls |
| Colton Meier et al. (2011) [71] USA |
369 TM 28 yrs |
CHT 66% CRS 41% |
Online Cross-sectional |
CHT vs. No CHT (No follow-up) |
SF-36-v2 | hQoL: CHT = 65.2 No CHT = 53.7 Trans = 61.3 |
+QoL: CHT |
CHT is associated with improved mental health in TM |
| Colton Meier et al. (2013) [42] USA |
581 TM 27 years |
CHT 67% CRS 41% GAGS 4% |
Online Cross-sectional |
AM vs. AW vs. AB Normative data (No follow-up) |
SF-36-v2 | AM = 58.85 AW = 64.77 AB = 60.81 |
+ QoL: - Depression - Anxiety - Stress + Social Support |
TM displayed higher QoL levels than the norm |
| Davey et al. (2014) [70] UK |
63 TW 40 TM 56.9 yrs. TW 28.05 yrs. TM |
TW: Post-GAGS 17.5% CHT currently 79.4% TM: Post-GAGS 15% CHT currently 0% |
Single centre Clinical group Cross-sectional |
Matched cis control sample No follow-up |
SF-36-v2 | MCS = 69.31 | + MCS, VT, SF QoL: Social support |
Trans clinical sample reported lower QoL than matched cis sample |
| de Vries et al. (2014) [20] The Netherlands |
22 TW 33 TM TW: T0 = 13.6 yrs. T1 = 16.5 yrs. T2 = 21 yrs. TM: T0 = 13.7 yrs. T1 = 16.8 yrs. T2 = 20.5 yrs |
T0 = pre-puberty suppression T1 = post CHT T2 = 1 year post-GAGS |
Single centre Clinical group Prospective longitudinal with cross-sectional data regarding QoL |
T0 vs. T1 vs. T2 Participants vs. nonparticipants (T0 = pre-puberty suppression T1 = when CHT introduced T2 = 1 year post-GAGS) |
WHOQOL-BREF | T2 pQoL = 14.66 |
+pQoL: Post-surgical well-being |
Well-being in trans same or enhanced compared to same-age general population young adults |
| Gomez-Gil et al. (2014) [21] Spain |
119 TW 74 TM ICD-10 31.2 yrs. Trans |
CHT 62.2% No CHT 37.8% |
Single centre Clinical group Cross-sectional |
101 cis people (No follow-up) |
WHOQOL-BREF | pQoL = 56.09 | +QoL: CHT Family support Working/studying |
Trans reported lower perceived QoL compared to the cis sample. Additionally, TM reported higher social QoL than TW |
| Gorin-Lazard et al. (2012) [22] France |
31 TW 30 TM 39.4 yrs. TW 29.9 yrs. TM |
No CHT: TW 19.4% TM 36.7% CHT: TW 80.6% TM 63.3% |
Multicentre (3 sites) Clinical group Cross-sectional |
French age- and sex-matched control Normative data (No follow-up) |
SF-36-v2 | MCS = 47.92 | + mQoL: CHT - mQoL: Depression |
Positive effect of CHT on QoL. Trans QoL did not differ from cis matched controls except for RP |
| Gorin-Lazard et al. (2013) [23] France |
36TW 31 TM 35.1 yrs. Trans |
No CHT: TW 38.9% TM 61.1% CHT: TW 59.2% TM 40.8% |
Multicentre (3 sites) Clinical group Cross-sectional |
TW vs. TM CHT vs. No CHT (No follow-up) |
SQUALA | TW = 12.1 TM = 11.34 Total = 11.72 |
+ pQoL: CHT |
CHT predicted positive self-esteem, less severe depression, and greater psychological dimensions of QoL |
| Hoy-Ellis et al. (2017) [57] USA |
84 TW 51 TM 48 Other 46.88 yrs. TW 27.48 yrs. TM 25.64 yrs. Other |
None reported | Online and/or paper Non-clinical group Cross-sectional |
Military service vs No military service (No follow-up) |
WHOQOL-BREF | pQoL = 64.12 | -pQoL: Identity stigma +pQoL: Prior military service |
Those with prior military service had lower depressive symptomatology and higher pQoL |
| Lindqvist et al. (2017) [64] Sweden |
T0 = 146 TW T1 = 108 TW T2 = 64 TW T3 = 43 TW 36 yrs |
T0 = pre-GAGS + CHT 100% T1 = 1 yr. post-GAGS 100% T2 = 3 yrs. post-GAGS 100% T3 = 5 yrs. post-GAGS |
Single centre Clinical group Prospective longitudinal |
T0 vs T1 vs T2 vs T3 Swedish normative data |
SF-36 | MCS: T0 = 73.8 T1 = 74.1 T2 = 71 T3 = 67.6 |
None studied | TW (both pre and post-GAGS) reported lower QoL than general population; GAGS improves QoL 1 year post-GAGS but it tends to gradually diminish over time |
| Manieri et al. (2014) [74] Italy |
56 TW 27 TM 32.7 yrs. TW 30.2 yrs. TM |
T0 = initiation of CHT 100% T1 = 3 months post CHT 100% T2 = 6 months post-CHT 100% T3 = 9 months post-CHT 100% T4 = 1 year post-CHT 100% |
Single centre Clinical group Prospective longitudinal |
Pre- vs. during CHT | WHOQOL-100 | T4 TW: QoL = 63.25 TM: QoL = 72.2 |
None studied | TW reported significant improvement in sexual and general QoL 1 year post-CHT |
| Mora et al. (2017) [32] Spain |
T0 = 30 TW T1 = 18 TW 30 yrs |
Pre-FFS 100% | Single centre Clinical group Prospective longitudinal with cross-sectional data regarding SF12v2 |
None (No follow-up) |
SF-12v2 | MCS = 48.63 | None studied | Trans women suffer poor QoL |
| Motmans et al. (2011) [65] Belgium |
63 TW 58 TM 42.26 yrs. TW 37.03 yrs. TM |
TW: CHT 94.6% FFS 18.7% GAGS 64% TM: CHT 96.7% GAGS 67.8% |
Clinical group Cross-sectional |
Normative data (No follow-up) |
SF-36 | MCS = 72.04 | +QoL: Being Employed Being in a Relationship Young age, Higher Education Higher household income |
TM reported reduced mQoL than Dutch male sample. Older, low educated, unemployed, with a low household income and single trans people had significantly lower QoL |
| Newfield et al. (2006) [17] USA |
376 TM 32.6 yrs |
CHT 64% CRS 37% GAGS 11% |
Opportunity sampling Cross-sectional |
Normative data (No follow-up) |
SF-36-v2 | MCS = 39.51 | + QoL: Testosterone Usage CRS |
TM reported significantly lower mental health-related QoL than US general population |
| Parola et al. (2010) [66] France |
38 Trans 32–65 yrs. range |
+2 years CHT and GAGS 100% | Single centre Clinical group Cross-sectional |
TW vs. TM; Extraversion vs. Introversion; Neuroticism vs. Emotional stability (No follow-up) |
SF-36 | TW: Better Social QoL = 11/15 people Better Quality of family relationships = 4/15 people TM: Better Social QoL = 10/15 people Better Quality of family relationships = 6/15 people Extroverted = 54.28 Introverted = 52.02 High neuroticism = 53.16 Low neuroticism = 50.77 |
+QoL: CHT |
TM reported better social and professional QoL, and friendly lifestyles than TW |
| Wierckx et al. (2011) [43] Belgium |
49 TM 37 yrs |
Post-GAGS 100% CHT 100% |
Single centre Clinical group Cross-sectional |
Dutch normative data (No follow-up) |
SF-36 | MCS = 75.8 | QoL: Post-operative sexual functioning |
TM have good QoL post-GAGS compared to general Dutch population but still lower than the normative data |
| Yang et al. (2016) [54] China |
209 TW 26.7 yrs |
FFS 34.93% CHT 17.70% |
Non-clinical group Cross-sectional |
None (No follow-up) |
SF-36 | MCS = 68.28 | mQoL: Hope Resilience PhQoL: -Lower age |
Chinese TW reported high levels of physical QoL but low levels of mental QoL |
AB Attracted to Both, AM Attracted to Men, AW Attracted to Women, BI Body Image, CG Control Group, CHT Cross-sex Hormonal Treatment, Cis Cisgender, CRS Chest Reconstructive Surgery, FFS Face Feminisation Surgery, GAGS Gender Confirming Genital Surgery, hQoL Health-related QoL, LH Luteinizing Hormone, MCS Mental Component Score, mQoL Mental health-related QoL, pQoL Psychological QoL, p-hQoL Psychological Health-related QoL, RP Role-Physical, SF Social Functioning, sQoL Sexual QoL, SR Social Relationships, TM Transgender men, TW Transgender women, VT Vitality