"Gender congruence and acceptance before and after cross-sex hormonal therapy" G. Senofonte, F. Cargnelutti, A. Petrozzi, S. Colangelo, F. Pallotti, D. Paoli, M. Mosconi, F. Lombardo

Introduction - Gender dysphoria (GD) is a non congruity between an individual’s assigned gender and the perceived gender identity. This incongruence often produces significant distress and/or social functioning problems. Aim – To evaluate gender congruence in FtM and MtF patients using a validated psychometric scale. Materials and Methods - We recruited 62 patients (33 FtM and 29 MtF; mean age 27.3 ± 6.7 and 28 ± 6.2 years, respectively) who referred to the outpatient clinic of Endocrinology and Andrology of the Department of Experimental Medicine for Gender Dysphoria, “Sapienza” University of Rome, sent by the mental health specialists. Each patient underwent clinical evaluation, blood hormone testing and completed the Transgender Congruence Scale (TGCS). This questionnaire is composed of 12 items, exploring Transgender Congruence (TC), Appearance Congruence (AC) and Gender Identity Acceptance (GIA) (score 1-5). The evaluation was carried out before the beginning of cross-sex hormone therapy (T0) and after 6 months of therapy (T6). Results – Baseline evaluation – We detected higher TC scores in FtM patients compared to MtF (2.65 ± 0.62 vs 2.17 ± 0.73, respectively; p = 0.001), and comparable AC and GIA scores in both groups (AC: 1.94 ± 0.88 vs 1.69 ± 0.85, p = 0.087; GIA: 4.02 ± 0.26 vs 3.96 ± 0.26, p = 0.409); blood testosterone and estradiol values were within normal cis-gender ranges for all patients. FtM post therapy evaluation – At T6 we detected a significant increase of both TC and AC scores (TC: 2.65 ± 0.62 vs 3.61 ± 0.21, T0 vs T6 respectively, p = 0.001; AC: 1.94 ± 0.88 vs 3.30 ± 0.16, T0 vs T6 respectively, p = 0.001). Hormone testing revealed a significant increase of testosterone levels within eugonadal male range (1.35 ± 0.83 vs 13.36 ± 4.52, T0 vs T6 respectively, p = 0.001). MtF post therapy evaluation – Similarly, we detected a significant increase of both TC and AC scores at T6 (TC: 2.17 ± 0.73 vs 3.27 ± 0.57, T0 vs T6, p = 0.005; AC: 1.69 ± 0.85 vs 3.06 ± 0.79, T0 vs T6, p = 0.011). Blood hormone analysis revealed a significant decrease of testosterone levels (19.39 ± 10.76 vs 2.70 ± 4.51, T0 vs T6, p = 0.004) without variation of estradiol levels (24.52 ± 7.61 vs 31.23 ± 14.01, T0 vs T6, p = 0.424). It is noteworthy that TC scores at T6 in MtF were significantly lower than in FtM (p = 0.048). Correlations - No significant correlations were detected between sex hormones levels and TGCS scores in both groups. Conclusions – Both FtM and MtF individuals show high acceptance of their new gender identity even before treatment due to their rejection of their birth-assigned gender. Six months of cross-sex hormone therapy determined an outstanding improvement of selfreported congruence and appearance scores in both groups, although to a milder extent on MtF. This reflects the fact that androgen therapy induces marked physical changes in FtM (menses cessation, hair growth, etc.) and with shorter latency than anti-androgens and estradiol in MtF. Longer follow-up is required to determine long term maintenance of physical and psychological effects of therapy.