Sleep pattern in transgender men on short-term cross-sex hormone therapy with testosterone

Abstract

It is believed that hormone therapy with testosterone in transgender men may interfere in the sleep quality of these patients, since testosterone may induce worsening of obstructive sleep apnea syndrome (OSAS) in hypogonadal cisgender men receiving testosterone replacement therapy. This study aims to evaluate the association between testosterone therapy and risk of sleep disorders, including OSAS, in transgender men. Eighteen transgender men in a regular and supervised use of testosterone (mean treatment time: 3 ± 1.6 years) were evaluated regarding the risk of sleep disorders through questionnaires already validated in the medical literature. Anthropometric, laboratory and clinical data were collected. According to the Epworth Sleepiness Scale (ESS), 50% of transgender men presented a risk of daytime sleepiness, while 22% and 23% of the participants were at high risk for OSAS according to the Berlin and updated STOP-Bang questionnaires, respectively. No significant association was found between risk of sleep disorders and testosterone type or therapy duration. However, there was a significant and negative correlation between androgen treatment time and ESS score. Regarding the clinical and laboratory profile of the patients, a high risk of sleep disorders was associated with lower levels of HDL cholesterol (HDL-c) and higher blood pressure values. Short-term treatment with testosterone in young transgender men is not associated with an increased risk of sleep disorders and may even improve daytime sleepiness in long-term. Blood pressure and HDL-c should be monitored in transgender men on androgen therapy as, when altered, they may indicate a higher risk of sleep disorders and OSAS.