Sexual desire in trans persons: associations with sex reassignment treatment

J Sex Med. 2014 Jan;11(1):107-18. doi: 10.1111/jsm.12365. Epub 2013 Oct 24.


Introduction: Sex steroids and genital surgery are known to affect sexual desire, but little research has focused on the effects of cross-sex hormone therapy and sex reassignment surgery on sexual desire in trans persons.

Aim: This study aims to explore associations between sex reassignment therapy (SRT) and sexual desire in a large cohort of trans persons.

Methods: A cross-sectional single specialized center study including 214 trans women (male-to-female trans persons) and 138 trans men (female-to-male trans persons).

Main outcome measures: Questionnaires assessing demographics, medical history, frequency of sexual desire, hypoactive sexual desire disorder (HSDD), and treatment satisfaction.

Results: In retrospect, 62.4% of trans women reported a decrease in sexual desire after SRT. Seventy-three percent of trans women never or rarely experienced spontaneous and responsive sexual desire. A third reported associated personal or relational distress resulting in a prevalence of HSDD of 22%. Respondents who had undergone vaginoplasty experienced more spontaneous sexual desire compared with those who planned this surgery but had not yet undergone it (P = 0.03). In retrospect, the majority of trans men (71.0%) reported an increase in sexual desire after SRT. Thirty percent of trans men never or rarely felt sexual desire; 39.7% from time to time, and 30.6% often or always. Five percent of trans men met the criteria for HSDD. Trans men who were less satisfied with the phalloplasty had a higher prevalence of HSDD (P = 0.02). Trans persons who were more satisfied with the hormonal therapy had a lower prevalence of HSDD (P = 0.02).

Conclusion: HSDD was more prevalent in trans women compared with trans men. The majority of trans women reported a decrease in sexual desire after SRT, whereas the opposite was observed in trans men. Our results show a significant sexual impact of surgical interventions and both hormonal and surgical treatment satisfaction on the sexual desire in trans persons.

Keywords: Cross-Sex Hormone Therapy; Gender Identity Disorder; Sexual Desire; Sexual Functioning; Transsexual.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Gonadal Steroid Hormones / administration & dosage
  • Gonadal Steroid Hormones / adverse effects
  • Humans
  • Libido / drug effects
  • Libido / physiology*
  • Male
  • Middle Aged
  • Personal Satisfaction
  • Prevalence
  • Sex Reassignment Procedures*
  • Sexual Behavior / drug effects
  • Sexual Dysfunctions, Psychological / chemically induced
  • Sexual Dysfunctions, Psychological / epidemiology*
  • Surveys and Questionnaires
  • Transgender Persons / psychology*
  • Vagina / surgery


  • Gonadal Steroid Hormones