TY - JOUR
T1 - Influence of sex hormone use on sleep architecture in a transgender cohort
AU - Morssinkhof, Margot W. L.
AU - van der Werf, Ysbrand D.
AU - van den Heuvel, Odile A.
AU - van den Ende, Daan A.
AU - van der Tuuk, Karin
AU - den Heijer, Martin
AU - Broekman, Birit F. P.
N1 - Funding Information: First and foremost, we would like to thank all the RESTED study participants for their participation and efforts, without which this study would not have been possible. Furthermore, we would like to thank all the interns and students who assisted in the data collection of the RESTED study: Rens Voskuijlen, Lotte van der Kolk, Claartje Binnerts, Jip Andriesse, Danique Hofs, Laura Varkevisser, Maureen González, Annefleur Zwager, Sigrid Theunis, Berend Slootman, Nina Pot and Isabel Löwensteijn. Lastly, we would like to thank the clinical staff of the Amsterdam UMC and University Medical Centre Groningen for their collaboration and efforts to help the study succeed. Funding Information: Financial disclosures: This work was supported by the NWO, Netherlands [Veni grant, grant number 91619085, 2018] supplied to BB. The NWO had no involvement in the study design, data collection, analysis or interpretation of the data, or writing of the report. All other authors have no financial conflicts of interest to declare. Nonfinancial disclosures: none to declare. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - 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.
AB - 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.
KW - estradiol
KW - sleep EEG
KW - testosterone
KW - transgender
UR - http://www.scopus.com/inward/record.url?scp=85176508660&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/sleep/zsad249
DO - https://doi.org/10.1093/sleep/zsad249
M3 - Article
C2 - 37715990
SN - 0161-8105
VL - 46
JO - SLEEP
JF - SLEEP
IS - 11
M1 - zsad249
ER -