Evidence for the health benefits of medical transition in treating gender dysphoria and its various comorbidities is abundant. Dozens of studies have found that transitioning is associated with reductions in gender dysphoria, depression, anxiety, and suicidality, along with improvements in body image, body satisfaction, sexual functioning, and general functioning. Another recent meta-analysis confirmed that gender-confirming surgery is associated with an improved quality of life (Passos, Teixeira, & Almeida-Santos, 2019).
And contrary to the practically cliché misrepresentations of Dhejne et al. (2011) which wrongly assert that transitioning causes trans people to become more distressed and suicidal over a period of decades following surgery, a recent study has found that as more time passes since beginning transition, trans people tend to experience a greater degree of improvement in body satisfaction, with an indirect effect on reduction of sexual distress as well (Staples et al., 2019).
As with previous studies, those who wanted hormone therapy or gender-confirming surgery but had not received this showed lower body satisfaction than those who sought this and had received it. However, time was a factor as well: Greater time since initiating any kind of medical transition was found to have a significant association with satisfaction with one’s body, and body satisfaction was in turn significantly associated with less sexual distress, although time since starting transition did not show a significant association with sexual distress directly. The authors observe that these findings should inform how healthcare providers manage trans people’s expectations of the results of transitioning:
During preintervention consultation with patients, it may be important for providers to discuss the potential wait time for body satisfaction to improve. Indeed, research suggests that while expectations related to emotional and social changes post-GAS [gender affirming surgery] are often met when patients are evaluated approximately one to 10 years later, expectations at the physical and sexual level are not (De Cuypere et al., 2005). The reality is that body satisfaction may improve over time after transition begins, and such improvements may occur over the course of transition. Gathering informed consent may need to include discussion of these expectations both acutely following an intervention and over time.
These results support what many trans people have learned firsthand over the course of their transitions: that physical changes do take time to develop on cross-sex hormone therapy, but the extent of these changes can be increasingly dramatic over the years, sometimes unexpectedly so. Over the years, these bodily changes increasingly reflect our image of ourselves as we wish we were, in a way that is deeply affirming, fulfilling – and measurable. ■
