Early prescription of puberty blockers does not impair sexual function in trans people

As we reported last year in our summary of the WPATH conference in Lisbon, the study by Dr van der Meulen and colleagues on sexual satisfaction and sexual dysfunction in trans adults who received puberty blockers during adolescence has now been published in the Journal of Sexual Medicine.

Using a rigorous approach, the authors examined the long-term effects of this intervention, initiated at the earliest stages of puberty, by comparing it with later initiation and with data from cohorts who began their medical transition in adulthood. By recruiting 70 participants followed for an average of more than 14 years, this study represents one of the longest longitudinal follow-ups in the field of gender-affirming care.

The results show that 52 % of transmasculine people and 40 % of transfeminine people report high sexual satisfaction, figures comparable to those observed in the general cisgender population. Despite some individual differences, the data reveal no significant disparity between groups who initiated hormonal treatment at an early versus a later stage of puberty. These findings contradict prior hypotheses suggesting that the absence of a full endogenous puberty could impair adult sexual function, particularly in terms of desire, arousal, or ability to reach orgasm.

The study also highlights a non-negligible prevalence of sexual dysfunction in both groups: 58 % of transmasculine people and 50 % of transfeminine people reported at least one sexual difficulty associated with distress. Among transmasculine participants, the most frequent difficulty was initiating sexual contact (34 %), while among transfeminine participants it was difficulty reaching orgasm (35 %). These difficulties appear at similar rates to those reported among trans people who began treatment in adulthood, suggesting that pubertal suppression does not exacerbate sexual difficulties.

Beyond the figures, the qualitative testimonies collected lend a human depth to the statistical data. Some participants describe dissatisfaction with the functional or aesthetic outcomes of their genital surgery, a lack of confidence in their body image, or difficulties finding partners who are open to a sexual relationship with a trans person. Others express a persistent sense of difference that hinders spontaneity in their intimate relationships. These accounts highlight the importance of not dissociating the physical, psychological and social dimensions of sexuality when supporting trans people.

In terms of sexual activity, 72 % of trans men report regular sexual activity (more than once per month), compared with 40 % of trans women. While these rates are lower than those observed in the general population for transfeminine people, they broadly align with data reported for other trans populations who began treatment in adulthood. Moreover, the importance attributed to sexuality remains high, particularly among transmasculine people (92 % consider it moderately or very important), exceeding levels reported in the general population.

The authors stress that sexuality cannot be reduced to functional performance alone: sexual satisfaction also depends on factors such as mental health, body image, relational expectations, and the quality of medical and social support received. Indeed, the lower frequency of certain dysfunctions in the group that received early hormonal treatment may be attributable to better mental health and greater body satisfaction resulting from an earlier and more smoothly experienced transition.

In methodological terms, the study stands out for its use of a hybrid questionnaire combining validated instruments with questions developed specifically for this population. The analysis relies primarily on descriptive statistics, given the small size of certain subgroups, particularly transfeminine individuals who initiated treatment early. Despite this limitation, the study provides a solid and clinically useful knowledge base.

Finally, the authors emphasise the need to integrate sexuality into gender-affirming medical care. This involves not only reassuring patients about the effects of hormonal treatments, but also anticipating relational or psychological difficulties that may hinder sexual fulfilment. Targeted interventions, such as psychosexual support, could significantly improve quality of life for those concerned, regardless of the stage at which medical transition began.

This study argues for a nuanced and individualised view of transition pathways. It demonstrates that pubertal suppression, far from systematically impairing sexual function or satisfaction, can coexist with a fulfilling intimate life, provided that care is holistic, sensitive to gender identity, and person-centred. The authors call for further research focused on sexual pleasure, intimacy and the diversity of experiences, in order to broaden understanding of trans sexuality and to inform inclusive, evidence-based clinical approaches.

To read the study in English, click here.