1 Introduction
1.1 Eligibility criteria
Category | Criteria |
---|---|
Study population | Transgender people Gender Dysphoria, Transsexualism as well as previous diagnoses according to DSM or ICD, or self-defined as transgender |
LGBT studies only if describing transgender people as separate category All races, ethnicities, and cultural groups | |
Adults | |
Sample size | At least 20 participants |
Study settings | All settings |
No exclusion criteria based on research setting | |
Time period | Published from 1946 to July 2017 |
Publication criteria | Articles in English |
Articles in peer reviewed journal | |
Study design | Observational studies using standardised measure of QoL. Cross-sectional or longitudinal designs |
1.2 Search strategy
1.3 Quality assessment
1.4 Data extraction
1.5 Meta-analysis
1.6 QoL measures used in the review
Measure | Details |
---|---|
1. Short Form 36 Health Survey SF-36 | This tool was developed to measure multiple operational health indicators of QoL [62]. It is a well-validated international measure of health-related QoL consisting of 36-items providing scores for two summary components (Physical and Mental), which encompass 4 subdomains each. The Physical component includes Physical functioning, Role limitations related to Physical problems, Body pain, whilst the Mental component comprises of Perception of General health, Vitality, Social functioning, Role limitations due to Emotional problems, and Mental health. The scores range from a minimum of 0 until a maximum of 100, where higher scores indicate greater functioning and enhanced perception of QoL. The cut-off for the population norm is around 50. The measure was validated in a wide variety of clinical and non-clinical populations, and it displayed an internal consistency value of .88 when used with Transgender populations [63]. |
2. Short Form 36 Health Survey Version 2 SF-36v2 [67] | This measure was developed out of the SF-36. It includes more up-to-date norms and QoL domains. It is a standardised, comprehensive and validated QoL measure assessing two summary scores (Physical and Mental components), which encompass 4 subdomains each. The Physical component includes Physical functioning, Role-physical, Bodily pain, General health, whilst the Mental component comprises of Vitality, Social functioning, Role-emotional, and Mental health. It uses a 5-points Likert-scale ranging from 1 (poor/true) to 5 (excellent/false). Higher scores represent higher perceived QoL levels. This measure has also been used and corroborated in an online sample of transgender men displaying a Cronbach’s alpha for reliability ranging from .93 to .95 [17]. |
3. Short Form 12 Health Survey Version 2 SF-12v2 [72] | This instrument is a subset of the SF-36. It comprises of two summary component scores (Physical and Mental), which encompass 4 subdomains each. The former component includes Physical functioning, Role-physical, Bodily pain, General health, whilst the latter component refers to Vitality, Social functioning, Role-emotional, and Mental health. This measure utilises a 5-points Likert-scale ranging from 1 (poor/true) to 5 (excellent/false). Scores range from 1 to 100, with higher perceived QoL represented by higher scores. This measure was validated and showed a good internal consistency, with Cronbach’s alphas of .89 for the Physical component summary and of .86 for the Mental component summary [72]. This tool was employed by one study reported on within this review [32]. |
4. WHOQOL-100 [39] | It is a self-administered, self-rated measure to assess QoL developed by the World Health Organization QoL group. It has been developed cross-culturally and it maintains excellent psychometric properties and internal consistency. This tool comprises a total of 100-items; 96 measures 24 specific QoL facets, whilst the remaining 4-items estimate General QoL and Overall QoL. The facets are distributed across 6 domains, such as Physical health, Psychological health, Independence, Social relationships, Environment, and Spirituality/Religion/Personal beliefs. In order to investigate the Sexual QoL the specific Sexual activity facet was measured, whilst to examine Body image-related QoL the body image facet was assessed. Items are rated on a 5-points Likert-scale ranging from 1 (very poor/very dissatisfied/not at all) to 5 (very good/very satisfied/extremely). Higher scores indicate greater reported QoL. The scale’s internal consistency values have been found to range between 0.65 and 0.93 [39]. |
5. WHOQOL-BREF [45] | It is a self-rated measure that has been validated in field studies involving approximately 30 languages [27]. It is an abbreviated version of the WHOQOL-100. This tool has 26-items and uses a 5-points Likert-scale measuring 4 domains (Physical, Psychological, Social relationships, and Environment). In addition, there are two questions regarding General QoL and General health. Higher scores indicate greater QoL. Internal consistency values cross-culturally have been found ranging from .51 to .89 [45]. |
6. WHOQOL-BREF-TR [75] | The WHOQOL-BREF-TR is a 27-items 5-point Likert-scale measuring four domains (Physical, Mental, Social and Environmental) in two categories (Perceived QoL in general and perceived health status). It displays acceptable psychometric properties when used on the Turkish population (Cronbach’s alpha ranging from .53 to .83) [75]. This is the Turkish version of the WHOQOL-BREF and it was used by one study included in this review [76]. |
7. Subjective Quality of Life Analysis SQUALA [77] | It is a self-administered, self-rated, multidimensional QoL measure. It covers 23 QoL domains (e.g. Mental well-being, Perceived health, Physical autonomy, Social relations, Environment) as well as general QoL-related concepts (e.g. justice, freedom, truth, beauty and politics), which identify internal and external reality of everyday life [78]. The measures’ items need to be rated in importance and satisfaction by the person and higher scores indicate better QoL. Cronbach’s alpha was not available. This measure was utilised by one study included within this review [23]. |
8. King’s Health Questionnaire KHQ [79] | This is a validated measure used to assess QoL, and with the aid of specific questions it is often used to estimate levels of incontinence related-QoL. This is a 29-items Likert-scale assessing ten domains (general health, physical limitations, personal limitations, social limitations, role limitations, personal relationships, emotion, symptom severity, sleep/energy and incontinence) and two categories (QoL and Limitation of daily life). The QoL category is measured with 20-items using a 4-points Likert-scale ranging from 1 (not at all) to 4 (a lot), whilst the incontinence category is measured with 9 items ranging from 1 (a little) to 3 (a lot). A change of 5 points is considered to be significant. It has been validated on a sample of urinary incontinent women with Cronbach’s alpha values ranging from .73 to .89 [80]. This tool was employed by one study reported on within this review [81]. |
9. Voice Handicap Inventory VHI [82] | This is a validated measure used to self-assess the QoL related to the relative impact of a person’s voice upon daily activities. It is also used to measure QoL of transgender people concerning the impact and influence of their voices. The VHI is a 30-items 5-points Likert-scale ranging from 0 (never) to 4 (always). The items are regularly divided within three domains; functional (F), emotional (E) and Physical (P). The total score (T) is achieved by summing up E, F and P, and it ranges from 0 (normal voice) to 120 (severely affected voice). Scores below 40 represent either mild or absent disability, values between 40 and 60 reflect moderate disability, whilst scores above 60 represent disability. Internal consistency value was found to be .95 [82] |
9.Transgender Self-Evaluation Questionnaire TSEQ [84] | This is a standardised, subjective measure of voice handicap and vQoL specifically developed for transgender people. It is based on the VHI but adapted to the specific concerns of transgender individuals, such as the impact of masculinity/femininity of voice. It is a 30-items self-reported 5-points Likert-scale ranging from 1 to 5. A total score ranging from 30 to 150 is calculated by adding up the 30 items’ scores and lower scores reflect greater vQoL. The TSEQ was found to have good test-retest reliability (r = .97) [85]. Cronbach’s alpha was not available. |
11. Body Image Quality of Life Inventory BIQLI [86] | This is a 19-items 7-points Likert-scale ranging from −3 (very negative effect) to +3 (very positive effect) that assesses body image-related effects onto 19 different areas of life including sexuality and emotional well-being. Higher scores imply better body image-related QoL. Internal consistency was found to be excellent (α = .95). This tool was used by one study included in this review [35]. |
2 Results
2.1 Study characteristics
2.2 Risk of bias
Source | Sample definition (Inclusion criteria) | Recruitment (Random, complete, consecutive) | Representativeness of Sample (Exclusion criteria and clinical/non-clinical populations) | Response rate (min 70%) | Sample Size (min 300) | Comparison | Use of validated measures | Quality rating |
---|---|---|---|---|---|---|---|---|
1. Auer et al. (2017) [55] | 0 | 1 | 0 | 1 | 1 | 1 | 0 | + |
2. Ainsworth & Spiegel (2010) [68] | 1 | 1 | 1 | 1 | 1 | 1 | 0 | – |
3. Bartolucci et al. (2015) [34] | 0 | 0 | 1 | 0 | 1 | 1 | 0 | + |
4. Başar et al. (2016) [76] | 0 | 0 | 1 | 0 | 1 | 1 | 0 | + |
5. Bouman et al. (2016) [69] UK | 0 | 1 | 0 | 0 | 1 | 0 | 0 | ++ |
6. Cardoso da Silva et al. (2016) [56] | 0 | 0 | 1 | 0 | 1 | 1 | 0 | + |
7. Castellano et al. (2015) [73] | 0 | 1 | 1 | 0 | 1 | 0 | 0 | + |
8. Colton Meier et al. (2011) [71] | 1 | 1 | 0 | 1 | 0 | 1 | 0 | + |
9. Colton Meier et al. (2013) [42] | 1 | 1 | 0 | 1 | 0 | 1 | 0 | + |
10. Davey et al. (2014) [70] | 0 | 1 | 1 | 1 | 1 | 0 | 0 | + |
11. de Vries et al. (2014) [20] | 0 | 0 | 1 | 1 | 1 | 1 | 0 | + |
12. Gomez-Gil et al. (2014) [21] | 0 | 0 | 1 | 0 | 1 | 1 | 0 | + |
13. Gorin-Lazard et al. (2012) [22] | 0 | 0 | 1 | 0 | 1 | 0 | 0 | ++ |
14. Gorin-Lazard et al. (2013) [23] | 0 | 0 | 1 | 1 | 1 | 0 | 0 | + |
15. Hancock et al. (2011) [30] | 0 | 1 | 1 | 1 | 1 | 1 | 0 | – |
16. Hancock et al. (2016) [24] | 1 | 1 | 0 | 1 | 1 | 1 | 0 | – |
17. Hoy-Ellis et al. (2017) [57] USA | 0 | 1 | 1 | 0 | 1 | 1 | 0 | + |
18. Kuhn et al. (2009) [81] | 0 | 0 | 1 | 1 | 1 | 1 | 0 | + |
19. Lindqvist et al. (2017) [64] Sweden | 1 | 0 | 0 | 1 | 1 | 0 | 0 | + |
20. Manieri et al. (2014) [74] | 0 | 0 | 1 | 1 | 1 | 1 | 0 | + |
21. Meister et al. (2017) [31] Germany | 1 | 0 | 1 | 1 | 1 | 1 | 0 | – |
22. Mora et al. (2017) [32] Spain | 1 | 0 | 1 | 1 | 1 | 1 | 0 | – |
23. Motmans et al. (2012) [65] | 0 | 0 | 1 | 1 | 1 | 1 | 0 | + |
24. Newfield et al. (2006) [17] | 1 | 1 | 0 | 1 | 0 | 1 | 0 | + |
25. Parola et al. (2011) [66] | 0 | 1 | 1 | 1 | 1 | 1 | 0 | – |
26. T’Sjoen et al. (2006) [83] | 0 | 0 | 1 | 1 | 1 | 1 | 0 | + |
27. van de Grift et al. (2016) [35] | 0 | 0 | 1 | 1 | 1 | 1 | 0 | + |
28. Wierckx et al. (2011) [43] | 0 | 1 | 1 | 1 | 1 | 1 | 0 | – |
29. Yang et al. (2016) [54] | 0 | 1 | 0 | 1 | 1 | 1 | 0 | + |
3 Results of the literature review
3.1 Voice-related QoL
Authors (year) Country | Number of Trans participants, mean age at assessment | Treatment status | Study design | Comparative groups, follow-up | Outcome measures | Results | Factors associated | Conclusions |
---|---|---|---|---|---|---|---|---|
Hancock et al. (2011) [30] USA | 20 TW 48.8 yrs | Post-VFT 100% Post-GAGS 45% | Single centre Clinical group Cross-sectional | CG1 Speakers: 5 cis women (46.8 yrs) 5 cis men (40.8 yrs); CG2 Listeners: 12 cis men (18.8 yrs) 13 cis women (19.65 yrs) (No follow-up) | TSEQ | Self-ratings: Femininity = 529 Likability = 552 Listener ratings: Femininity = 493 Likability = 533 | None studied | For TW vQoL moderately correlated with how others perceive their voice. vQoL correlated more strongly with speaker’s perception of voice compared with others’ perceptions |
Hancock (2016) [24] USA | 81 TW 43 yrs | VFT 46% | Clinical and non-clinical group Cross-sectional | Online vs. paper Completed VHI vs. completed VHI + TSEQ (No follow-up) | VHI TSEQ | General: VHI = 37.5 TSEQ = 76.5 VHI + TSEQ: VHI = 37.6 TSEQ = 76.5 | -vQoL: Increased age Femininity of voice | TW reported a wide range of vQoL; some individuals are severely affected by their voices whilst others are not. |
Meister et al. (2017) [31] Germany | T0 21 TW 42.1 yrs. T1 18 TW 46 yrs | T0 = Pre-VFT 100% T1 = Post-VFT 100% | Single centre Clinical group Prospective longitudinal with cross-sectional data regarding VHI | T0 vs T1 German control group | VHI | VHImean = 32.29 | None studied | Despite the elevation of vocal pitch, elevated VHI scores indicate transwomen feel handicapped in everyday life because of their voice |
T’Sjoen et al. (2006) [83] Belgium | 28 TW 20 TM 33 yrs. TW 49 yrs. TM | GAGS 100% CHT 100% | Single centre Clinical group Cross-sectional | TW vs. TM (No follow-up) | VHI | TM: Total = 4(0–10) (F = 1, E = 0, P = 3, Phone = 0) TW: Total = 12 (6–31) (F = 1, E = 2, P = 6, Phone = 2) | TM + vQoL: Lower DHT Higher LH | Better vQoL for both TW and TM above the cut-off for disability, meaning that they do experience voice-related disability |
3.2 Sex-related QoL
Authors (year) Country | Number of Trans participants, mean age at assessment | Treatment status | Study design | Comparative groups, follow-up | Outcome measures | Results | Factors associated | Conclusions |
---|---|---|---|---|---|---|---|---|
Bartolucci et al. (2015) [34] Spain | 67 TW 36 TM DSM-IV-TR 31.46 yrs. TW 28.69 yrs. TM | Pre-GAGS 100% CHT 40% (TW 46% TM 28%) Post-CRS 30% (TW 35% TM 19%) | Single centre Clinical group Cross-sectional | Normative data (No follow-up) | WHOQOL-100 | sQoL TW: Poor/very poor 48% Good 23% Very good 20% TM: Poor/very poor 54% Good 27% Very good 28% | + sQoL: CHT Having a partner Less negative feelings | Pre-GAGS about half of trans sample perceived sexual QoL as either poor or very poor compared to the control group |
Castellano et al. (2015) [73] Italy | 46 TW 14 TM 32.7 yrs. TW 30.2 yrs. TM | + 2 years post-GAGS 100% CHT 100% | Single centre Clinical group Cross-sectional | 60 matched cis control sample (No follow-up) | WHOQOL-100 | sQoL TW = 65.85 TM = 54.21 | +QoL: Lower LH | Trans people reported levels of QoL similar to cis controls |
Kuhn et al. (2009) [81] Switzerland | 52 TW 3 TM 51 yrs. Trans | CHT 100% GAGS 100% | Single centre Clinical group Cross-sectional | 20 healthy female medical staff, not matched (No follow-up) | KHQ | KHQ = 27.31 | None studied | 15-years post-GAGS QoL is lower for trans people in domains of General health, Role, Physical and Personal limitation than the cis control group |
Manieri et al. (2014) [74] Italy | 56 TW 27 TM 32.7 yrs. TW 30.2 yrs. TM | T0 = initiation of CHT 100% T1 = 3 months post-CHT 100% T2 = 6 months post-CHT 100% T3 = 9 months post-CHT 100% T4 = 1 year post-CHT 100% | Single centre Clinical group Prospective longitudinal | Pre- vs. during CHT | WHOQOL-100 | T4 TW: sQoL = 50.25 TM: sQoL = 62.05 | None studied | TW reported significant improvement in sexual and general QoL 1 year post-CHT |
3.3 Body image-related QoL
Authors (year) Country | Number of Trans participants, mean age at assessment | Treatment status | Study design | Comparative groups, follow-up | Outcome measures | Results | Factors associated | Conclusions |
---|---|---|---|---|---|---|---|---|
Castellano et al. (2015) [73] Italy | 46 TW 14 TM 32.7 yrs. TW 30.2 yrs. TM | + 2 years post-GAGS 100% CHT 100% | Single centre Clinical group Cross-sectional | 60 matched cis control sample (No follow-up) | WHOQOL-100 | BodyQoL TW = 64.64 TM = 67.91 | +QoL: Lower LH | Trans people reported levels of QoL similar to cis controls |
Manieri et al. (2014) [74] Italy | 56 TW 27 TM 32.7 yrs. TW 30.2 yrs. TM | T0 = initiation of CHT 100% T1 = 3 months post-CHT 100% T2 = 6 months post-CHT 100% T3 = 9 months post-CHT 100% T4 = 1 year post-CHT 100% | Single centre Clinical group Prospective longitudinal | Pre- vs. during CHT | WHOQOL-100 | T4 TW: BI = 21.85 TM: BI = 68.75 | None studied | TW reported significant improvement in sexual and general QoL 1 year post-CHT |
van de Grift et al. (2016) [34] The Netherlands | 26 TM 26.1 yrs | T0: CHT 100% T1: CRS 100% CHT 100% | Single centre Clinical group Prospective longitudinal | Pre- vs. post-CRS (T0 = baseline T1 = 6 months after CRS) | BIQLI | Pre-CRS = 0.32 Post-CRS = 0.38 | +QoL: Body satisfaction Feelings of “passing” in social situations | Body satisfaction and “passing” in social situations are associated with higher QoL and self-esteem in TM |
3.4 General (non-condition specific) QoL
Authors (year) Country | Number of Trans participants, mean age at assessment | Treatment status | Study design | Comparative groups, follow-up | Outcome measures | Results | Factors associated | Conclusions |
---|---|---|---|---|---|---|---|---|
Ainsworth & Spiegel (2010) [68] USA | 247 TW 28 FFS (51 yrs) 28 FFS (51 yrs) 25 GAGS (50 yrs) 47 FFS + GAGS (49 yrs) 147 No surgery (46 yrs) | 28 FFS (CHT 86%) 25 GAGS (CHT 100%) 47 FFS + GAGS (CHT 98%) 147 no surgery (CHT 27%) | Clinical group Cross-sectional | CG1 = FFS only CG2 = GAGS only CG3 = FFS + GAGS CG4 = No surgery CG5 = General population (No follow-up) | SF-36-v2 | CG1 = 50 CG2 = 49.3 CG3 = 49.2 CG4 = 39.5 | +QoL: Surgical treatments | TW have lower QoL than Dutch general female population |
Auer et al. (2017) [55] Germany | 82 TW 72 TM | TW: CHT 79.3% Pre-GAGS 79.5% TM: CHT 80.6% Pre-CRS 56.9% Pre-GAGS 72.2% | Multicentre (4 sites) Clinical group Cross-sectional | (No follow-up) | SF-36 | MCS = 77.66 | +QoL: +Sleep quality -Depressive symptoms -Chronic pain (TM) -Anxiety (TW) +Social support (TW) +Body image (TW) | QoL levels did not statistically differ between TW and TM. Substantial portion of low QoL in trans is due to poor sleep quality, anxiety in TW and chronic pain in TM |
Başar et al. (2016) [76] Turkey | 22 TW 72 TM DMS-IV-TR DSM-V 27.73 yrs. TW 26.82 yrs. TM | CHT: 54.5% TW 20.8% TM; GAGS: 36.4% TW 12.5% TM | Single centre Clinical group Cross-sectional | TW vs. TM (No follow- up) | WHOQOL-BREF-TR | TW = 15.3 TM = 12.7 | +QoL: Social support -QoL: Discrimination | Perceived personal discrimination and social support predicted QoL |
Bouman et al. (2016) [69] UK | 64 TW 40 TM 36.52 yrs | Assessment 6.7% CHT 78.8% 17.3% Post-GCGS | Single centre Clinical group Cross-sectional | 140 matched cis control sample (No follow-up) | SF-36-v2 | MCS = 70.9 | mQoL: Self-esteem Interpersonal issues (too dependent) | Trans people have lower mQoL compared to the cis group |
Cardoso da Silva et al. (2016) [56] Brazil | 47 TW 21.23 yrs. | T1 at entrance to programme 100% T2 at least 1 year post-GAGS 100% | Single centre Clinical group Prospective longitudinal | Pre- vs. post-GAGS (T1 = baseline T2 = at least 1 year post-GAGS) | WHOQOL-100 | T1 = 14.77 T2 = 15.52 | +QoL: GAGS | GAGS promotes improvement of psychological aspects of QoL and social relationships, but 1-year post-GAGS TW still report problems with physical health and independence |
Castellano et al. (2015) [73] Italy | 46 TW 14 TM 32.7 yrs. TW 30.2 yrs. TM | + 2 years post-GAGS 100% CHT 100% | Single centre Clinical group Cross-sectional | 60 matched cis control sample (No follow-up) | WHOQOL-100 | TW = 67.87 TM = 69.21 | +QoL: Lower LH | Trans people reported levels of QoL similar to cis controls |
Colton Meier et al. (2011) [71] USA | 369 TM 28 yrs | CHT 66% CRS 41% | Online Cross-sectional | CHT vs. No CHT (No follow-up) | SF-36-v2 | hQoL: CHT = 65.2 No CHT = 53.7 Trans = 61.3 | +QoL: CHT | CHT is associated with improved mental health in TM |
Colton Meier et al. (2013) [42] USA | 581 TM 27 years | CHT 67% CRS 41% GAGS 4% | Online Cross-sectional | AM vs. AW vs. AB Normative data (No follow-up) | SF-36-v2 | AM = 58.85 AW = 64.77 AB = 60.81 | + QoL: - Depression - Anxiety - Stress + Social Support | TM displayed higher QoL levels than the norm |
Davey et al. (2014) [70] UK | 63 TW 40 TM 56.9 yrs. TW 28.05 yrs. TM | TW: Post-GAGS 17.5% CHT currently 79.4% TM: Post-GAGS 15% CHT currently 0% | Single centre Clinical group Cross-sectional | Matched cis control sample No follow-up | SF-36-v2 | MCS = 69.31 | + MCS, VT, SF QoL: Social support | Trans clinical sample reported lower QoL than matched cis sample |
de Vries et al. (2014) [20] The Netherlands | 22 TW 33 TM TW: T0 = 13.6 yrs. T1 = 16.5 yrs. T2 = 21 yrs. TM: T0 = 13.7 yrs. T1 = 16.8 yrs. T2 = 20.5 yrs | T0 = pre-puberty suppression T1 = post CHT T2 = 1 year post-GAGS | Single centre Clinical group Prospective longitudinal with cross-sectional data regarding QoL | T0 vs. T1 vs. T2 Participants vs. nonparticipants (T0 = pre-puberty suppression T1 = when CHT introduced T2 = 1 year post-GAGS) | WHOQOL-BREF | T2 pQoL = 14.66 | +pQoL: Post-surgical well-being | Well-being in trans same or enhanced compared to same-age general population young adults |
Gomez-Gil et al. (2014) [21] Spain | 119 TW 74 TM ICD-10 31.2 yrs. Trans | CHT 62.2% No CHT 37.8% | Single centre Clinical group Cross-sectional | 101 cis people (No follow-up) | WHOQOL-BREF | pQoL = 56.09 | +QoL: CHT Family support Working/studying | Trans reported lower perceived QoL compared to the cis sample. Additionally, TM reported higher social QoL than TW |
Gorin-Lazard et al. (2012) [22] France | 31 TW 30 TM 39.4 yrs. TW 29.9 yrs. TM | No CHT: TW 19.4% TM 36.7% CHT: TW 80.6% TM 63.3% | Multicentre (3 sites) Clinical group Cross-sectional | French age- and sex-matched control Normative data (No follow-up) | SF-36-v2 | MCS = 47.92 | + mQoL: CHT - mQoL: Depression | Positive effect of CHT on QoL. Trans QoL did not differ from cis matched controls except for RP |
Gorin-Lazard et al. (2013) [23] France | 36TW 31 TM 35.1 yrs. Trans | No CHT: TW 38.9% TM 61.1% CHT: TW 59.2% TM 40.8% | Multicentre (3 sites) Clinical group Cross-sectional | TW vs. TM CHT vs. No CHT (No follow-up) | SQUALA | TW = 12.1 TM = 11.34 Total = 11.72 | + pQoL: CHT | CHT predicted positive self-esteem, less severe depression, and greater psychological dimensions of QoL |
Hoy-Ellis et al. (2017) [57] USA | 84 TW 51 TM 48 Other 46.88 yrs. TW 27.48 yrs. TM 25.64 yrs. Other | None reported | Online and/or paper Non-clinical group Cross-sectional | Military service vs No military service (No follow-up) | WHOQOL-BREF | pQoL = 64.12 | -pQoL: Identity stigma +pQoL: Prior military service | Those with prior military service had lower depressive symptomatology and higher pQoL |
Lindqvist et al. (2017) [64] Sweden | T0 = 146 TW T1 = 108 TW T2 = 64 TW T3 = 43 TW 36 yrs | T0 = pre-GAGS + CHT 100% T1 = 1 yr. post-GAGS 100% T2 = 3 yrs. post-GAGS 100% T3 = 5 yrs. post-GAGS | Single centre Clinical group Prospective longitudinal | T0 vs T1 vs T2 vs T3 Swedish normative data | SF-36 | MCS: T0 = 73.8 T1 = 74.1 T2 = 71 T3 = 67.6 | None studied | TW (both pre and post-GAGS) reported lower QoL than general population; GAGS improves QoL 1 year post-GAGS but it tends to gradually diminish over time |
Manieri et al. (2014) [74] Italy | 56 TW 27 TM 32.7 yrs. TW 30.2 yrs. TM | T0 = initiation of CHT 100% T1 = 3 months post CHT 100% T2 = 6 months post-CHT 100% T3 = 9 months post-CHT 100% T4 = 1 year post-CHT 100% | Single centre Clinical group Prospective longitudinal | Pre- vs. during CHT | WHOQOL-100 | T4 TW: QoL = 63.25 TM: QoL = 72.2 | None studied | TW reported significant improvement in sexual and general QoL 1 year post-CHT |
Mora et al. (2017) [32] Spain | T0 = 30 TW T1 = 18 TW 30 yrs | Pre-FFS 100% | Single centre Clinical group Prospective longitudinal with cross-sectional data regarding SF12v2 | None (No follow-up) | SF-12v2 | MCS = 48.63 | None studied | Trans women suffer poor QoL |
Motmans et al. (2011) [65] Belgium | 63 TW 58 TM 42.26 yrs. TW 37.03 yrs. TM | TW: CHT 94.6% FFS 18.7% GAGS 64% TM: CHT 96.7% GAGS 67.8% | Clinical group Cross-sectional | Normative data (No follow-up) | SF-36 | MCS = 72.04 | +QoL: Being Employed Being in a Relationship Young age, Higher Education Higher household income | TM reported reduced mQoL than Dutch male sample. Older, low educated, unemployed, with a low household income and single trans people had significantly lower QoL |
Newfield et al. (2006) [17] USA | 376 TM 32.6 yrs | CHT 64% CRS 37% GAGS 11% | Opportunity sampling Cross-sectional | Normative data (No follow-up) | SF-36-v2 | MCS = 39.51 | + QoL: Testosterone Usage CRS | TM reported significantly lower mental health-related QoL than US general population |
Parola et al. (2010) [66] France | 38 Trans 32–65 yrs. range | +2 years CHT and GAGS 100% | Single centre Clinical group Cross-sectional | TW vs. TM; Extraversion vs. Introversion; Neuroticism vs. Emotional stability (No follow-up) | SF-36 | TW: Better Social QoL = 11/15 people Better Quality of family relationships = 4/15 people TM: Better Social QoL = 10/15 people Better Quality of family relationships = 6/15 people Extroverted = 54.28 Introverted = 52.02 High neuroticism = 53.16 Low neuroticism = 50.77 | +QoL: CHT | TM reported better social and professional QoL, and friendly lifestyles than TW |
Wierckx et al. (2011) [43] Belgium | 49 TM 37 yrs | Post-GAGS 100% CHT 100% | Single centre Clinical group Cross-sectional | Dutch normative data (No follow-up) | SF-36 | MCS = 75.8 | QoL: Post-operative sexual functioning | TM have good QoL post-GAGS compared to general Dutch population but still lower than the normative data |
Yang et al. (2016) [54] China | 209 TW 26.7 yrs | FFS 34.93% CHT 17.70% | Non-clinical group Cross-sectional | None (No follow-up) | SF-36 | MCS = 68.28 | mQoL: Hope Resilience PhQoL: -Lower age | Chinese TW reported high levels of physical QoL but low levels of mental QoL |