Changes in psychosocial functioning and social relationships following gender-affirming hormone therapy: a qualitative study of trans people in The Netherlands

Background Gender-affirming hormone therapy (GAHT) may influence psychosocial functioning and interpersonal relationships for trans people, but the causes and everyday consequences of these shifts in the context of healthcare provision are poorly understood. Based on conceptualizations of psychosocial functioning (self-, emotional- and interpersonal functioning), we explored how trans people experience and explain changes after GAHT. We identified how these changes influence social health and have consequences for gender-affirming care information provision.Methods We conducted qualitative semi-structured interviews with 26 participants who were on or had been on GAHT in The Netherlands (12 on feminizing and 14 on masculinizing regimens).Results We generated three overarching themes. Regardless of GAHT type, many participants associated starting GAHT with enhanced perceptions of agency, increased self-esteem, and feelings of authenticity. Participants reported largely unanticipated changes in emotional intensity, identification, and regulation dependent on the GAHT regimen: most often, greater emotionality (feminizing), versus reduced emotionality and mood fluctuations (masculinizing), with the capacity to emotionally regulate improving over time. For many participants these changes had consequences for social networks, with participants seeking out authentic relationships, facilitated by increased self-esteem. While relational conflicts increased, this was attributed to greater honesty, leading to closer relational bonds.Conclusions GAHT is experienced as influencing psychosocial functioning through interconnecting biopsychosocial mechanisms. Clinical acknowledgement and information provision of potential changes in emotional processes and the subsequent implications for social health are urgently needed in gender-affirming care provision.