Inflammation as a Potential Mechanism Contributing to Sexual Functioning Following Initiation of Gender-Affirming Hormone Therapy

Purpose of Review Many transgender and gender non-conforming (TGNC) people seek gender-affirming hormone therapy (GAHT). While GAHT is generally safe and increases well-being, it is essential to accurately understand potential unintended effects and risk factors to better inform and manage treatment. This narrative review covers recent literature documenting changes in sexual function following the initiation of GAHT and explores inflammation as a potential mediator of these changes. Recent Findings Generally, the initiation of GAHT is correlated with increased sexual desire in transgender men and decreased sexual desire in transgender women, with time-limited effects that return to levels approaching baseline after about a year; there are also changes in inflammation markers that parallel this timeline. Findings on other aspects of sexual function (e.g., orgasm, pain, and sexual quality of life) are more limited. As there is evidence from cisgender populations that inflammation acts as a mechanism by which hormones influence sexual function, we propose applying this model to TGNC people taking GAHT. Summary Sexual function may change in TGNC patients receiving GAHT, and those changes may be influenced by inflammation. However, these changes often return to baseline as TGNC patients’ bodies adjust to a new hormonal equilibrium.