Years of Hormone Therapy As a Predictor of Life Satisfaction Among Trans People

Background and Purpose: Hormone therapy is commonly understood as a key element improving trans people’s lives, but most studies of hormone therapy among trans people have focused on distress rather than well-being. Meanwhile, those that have evaluated quality of life only covered participants’ first few years on hormone therapy.

This study aimed to demonstrate the connection between hormone therapy and life satisfaction over the long term using a national probability sample of trans people in the United States. The first research question was whether current use of hormone therapy predicts life satisfaction. The second was, among those using hormone therapy, whether the years since beginning hormone therapy predict life satisfaction, and whether this is moderated by gender.

Methods: This study used secondary data from TransPop, a survey conducted from 2016–2018 with a probability sample of trans people in the United States. Participants were asked their current age, the age at which they began hormone therapy, and whether they were currently on hormone therapy. Respondents with up to 20 years of hormone therapy (N=96) were used for analysis for the second research question.

The five-item Satisfaction With Life Scale was used as the dependent variable for analysis. After bivariate analysis among key variables, multiple linear regression models were constructed using age, gender, race, social support, and gender-affirming surgical procedures as additional covariates.

Results: For the first question, simply using hormone therapy had a small positive and statistically significant correlation with life satisfaction in bivariate analysis (Spearman ρ), but its regression coefficient was not significant when included in a linear regression model alongside key covariates (R² = 0.31, p < 0.001).

In the second model, the coefficient of years on hormone therapy was small and did not predict life satisfaction absent an interaction term. However, adding interaction with gender showed a stark difference: men had a moderate correlation between years of hormone therapy and life satisfaction (b = 0.11, p = 0.024), while none was found for women and nonbinary people. This model also had strong explanatory power (R² = 0.37, p < 0.001). Social support and having a gender-affirming procedure were both significant predictors of life satisfaction in these models.

Conclusions and Implications: This study shows that sustained hormone therapy is associated with significantly higher life satisfaction among trans men, even when controlling for other factors and gender-affirming procedures. Only nine nonbinary respondents reported current hormone use, so conclusions from the second model are limited for them.

Women, however, do not appear to have any positive correlation between years of hormone therapy and life satisfaction when controlling for other predictors. This is not to say that hormone therapy is not helpful: trans women themselves speak to its benefits, and it works hand-in-hand with gender-affirming procedures that this study shows to be highly predictive of life satisfaction. However, these results highlight the need to explore the specific needs of women in gender-affirming practice, including the intersectional effects of transmisogyny and the asymmetrical effects of hormones on facial hair and vocal range.