Influence of sex hormone use on sleep architecture in a transgender cohort

Author:

Morssinkhof Margot W L1234ORCID,van der Werf Ysbrand D56,van den Heuvel Odile A156,van den Ende Daan A7,van der Tuuk Karin8,den Heijer Martin24ORCID,Broekman Birit F P139

Affiliation:

1. Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam , The Netherlands

2. Department of Endocrinology and Metabolism, Amsterdam UMC, Location Vrije Universiteit Amsterdam , The Netherlands

3. Department of Psychiatry and Medical Psychology, OLVG , Amsterdam , The Netherlands

4. Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam , The Netherlands

5. Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands

6. Amsterdam Neuroscience, Compulsivity Impulsivity and Attention , Amsterdam , The Netherlands

7. Remote Patient Monitoring & Chronic Care, Philips , Eindhoven , The Netherlands

8. Department of Obstetrics and Gynecology, University Medical Centre Groningen , Groningen , The Netherlands

9. Amsterdam Public Health, Mental Health Program , Amsterdam , The Netherlands

Abstract

Abstract Study Objectives Sex differences in sleep architecture are well-documented, with females experiencing longer total sleep time, more slow wave sleep (SWS), and shorter Rapid Eye Movement (REM) sleep duration than males. Although studies imply that sex hormones could affect sleep, research on exogenous sex hormones on sleep architecture is still inconclusive. This study examined sleep architecture changes in transgender individuals after 3 months of gender-affirming hormone therapy (GAHT). Methods We assessed sleep architecture in 73 transgender individuals: 38 transmasculine participants who started using testosterone and 35 transfeminine participants who started using estrogens and antiandrogens. Sleep architecture was measured before GAHT and after 3 months of GAHT for 7 nights using an ambulatory single-electrode sleep EEG device. Changes in sleep architecture were analyzed using linear mixed models, and non-normally distributed outcomes were log-transformed and reported as percentages. Results In transmasculine participants, SWS decreased by 7 minutes (95% CI: −12; −3) and 1.7% (95% CI: −3%; −0.5%), REM sleep latency decreased by 39% (95% CI: −52%; −22%) and REM sleep duration increased by 17 minutes (95% CI: 7; 26) after 3 months of GAHT. In transfeminine participants, sleep architecture showed no significant changes after 3 months of GAHT. Conclusions Sleep architecture changes after 3 months of masculinizing GAHT in line with sleep in cisgender males, while it shows no changes after feminizing GAHT. The sex-specific nature of these changes raises new questions about sex hormones and sleep. Future research should focus on studying possible underlying neural mechanisms and clinical consequences of these changes.

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Neurology (clinical)

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