Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium.
J Sex Med. 2018 May;15(5):768-776. doi: 10.1016/j.jsxm.2018.03.079.
Although research on the relation between testosterone and aggression in humans is inconclusive, guidelines (including the World Professional Association for Transgender Health Standards of Care, edition 7) have warned for an increase in aggression in transgender men taking testosterone treatment.
To investigate the association between levels of testosterone and aggression in treatment-seeking transgender people and explore the role of mental health psychopathology (anxiety and depressive symptoms) and social support in aggression in this population.
Every transgender person invited for assessment at a national transgender health clinic in the United Kingdom during a 3-year period (2012-2015) completed self-report measures for interpersonal problems, including levels of aggression (Inventory of Interpersonal Problems [IIP-32]), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), social support (Multidimensional Scale of Perceived Social Support), and experiences of transphobia before and 1 year after the initiation of gender-affirming hormonal therapy. Correlations between prospective scores for the IIP-32 factor "too aggressive" and prospective levels of sex steroids, prospective psychological (HADS), and baseline psychosocial measurements were tested.
Prospective scores for the factor "too aggressive" were not correlated to prospective serum testosterone levels.
Results of 140 people (56 transgender men, 84 transgender women) were analyzed. A prospective increase in scores for the factor "too aggressive" of the IIP-32 in transgender men 1 year after being treated with testosterone treatment or a decrease of the IIP-32 aggression scores in transgender women 1 year after gender-affirming hormonal therapy was not found. However, a positive correlation was found between increasing HADS anxiety scores and increasing scores for the IIP-32 "too aggressive" score in the entire study population and a positive correlation with lower support from friends in transgender women.
Hormone-prescribing physicians can be reassured that the long-term administration of testosterone in transgender men does not increase aggressive behavior.
This is the 1st prospective study to assess the effect of gender-affirming hormonal care on aggression. Limitations included the use of different laboratories, the use of a patient-reported outcome measure, and the lack of aggression subtypes.
Testosterone therapy was not associated with an increase in levels of aggression in transgender men or a decrease in aggressive behavior in transgender women on antiandrogen and estrogen therapy, but other psychological and/or social factors, such as anxiety levels, appear to contribute to self-reported aggression in transgender people. Defreyne J, T'Sjoen G, Bouman WP, et al. Prospective Evaluation of Self-Reported Aggression in Transgender Persons. J Sex Med 2018;15:768-776.
尽管关于睾酮与人类攻击性之间的关系的研究尚无定论，但指南（包括世界专业变性人协会第 7 版的护理标准）已警告接受睾酮治疗的变性男性的攻击性会增加。
调查寻求治疗的跨性别者的睾酮水平与攻击性之间的关系，并探讨精神健康病理学（焦虑和抑郁症状）和社会支持在该人群中的攻击性中的作用。
在英国的一个全国性跨性别健康诊所，在 3 年期间（2012-2015 年），每位受邀接受评估的跨性别者都完成了人际关系问题的自我报告措施，包括攻击性水平（人际关系问题清单 [IIP-32]）、焦虑和抑郁症状（医院焦虑和抑郁量表 [HADS]）、社会支持（多维感知社会支持量表），以及在开始性别肯定激素治疗之前和之后 1 年的跨性别恐惧症经历。测试了 IIP-32 因子“过于激进”的前瞻性分数与前瞻性血清睾丸激素水平、前瞻性心理（HADS）和基线心理社会测量之间的相关性。
未发现接受睾酮治疗的跨性别男性 1 年后 IIP-32 因子“过于激进”的前瞻性评分或接受性别肯定激素治疗的跨性别女性 1 年后 IIP-32 攻击性评分降低与前瞻性血清睾丸激素水平相关。然而，在整个研究人群中，发现 HADS 焦虑评分增加与 IIP-32“过于激进”评分增加之间存在正相关，而在跨性别女性中，发现与朋友的支持减少之间存在正相关。
可以向开具激素处方的医生保证，长期给予睾酮不会增加男性变性者的攻击行为。
这是第一项评估性别肯定激素治疗对攻击性影响的前瞻性研究。限制包括使用不同的实验室、使用患者报告的结果测量以及缺乏攻击行为亚型。
睾酮治疗与接受抗雄激素和雌激素治疗的变性男性的攻击性水平升高或变性女性的攻击性行为降低无关，但其他心理和/或社会因素，如焦虑水平，似乎与跨性别者自我报告的攻击性有关。
