on the subjective well-being of transgender men – results of the pilot study and discussion about future research
X
Rafał Gerymski
11 Institute of Psychology, Opole University
Summary
This pilot study was aimed at verifying scientific reports on the good functioning of transgender people.
On this basis, it was attempted to compare the subjective well-being of transgender men with heterosexual, homosexual and bisexual cisgender men. This study tried to verify the role of hormone therapy and surgical gender correction (sex reassignment surgery) as potential predictors of the subjective well-being of transgender men. Cisgender heterosexual men showed significantly higher subjective well-being in relation to members of the LGBTQ community (transgender men, homosexual and bisexual cisgender men). Sexual orientation of transgender men did not differentiate their subjective well-being. The roles of the operational gender correction and hormone therapy as potential predictors of the subjective well-being proved to be impossible to verify due to the small number of responses. The above predictors need to be verified again.
Social support, perceived stress, and coping strategies used by transgender people, which are significantly related to the subjective well-being of every human being, may also be worth examining.
Key words:
transgenderism, transsexualism, gender identity, subjective well-being, hormone therapy, sex reassignment surgery
Introduction
Scientific publications provide positive information on the mental functioning of transgender people. Collier has shown that mental disorders occur in them at the same frequency as in the rest of the population [1]. On the other hand, Grossman and D’Augelli reported that
as many as ¼ of the transgender people examined by them attempted suicide and that half of the participants had suicidal thoughts [2]. Research on a much larger sample (N = 435) seem to undermine this data. It shows that only 10% of transgender study participants struggled with psychological problems and suicidal thoughts [3]. In addition, Weyers and colleagues have
shown that transgender women function just as well as biological women [4]. These data may indicate the good functioning of transgender people and encourage reflection on the issue of their subjective well-being.
Subjective well-being is strongly introspective [5]. It is a reflection of personal experiences [6], and the evaluation of these experiences, or the evaluation of life, translates into an assessment of its quality – thus, the evaluation of the quality of mental health [5][6]. As psychological functioning and assessment of human experience serve the description of the individual’s well-being [7] it can be concluded that transgender people (which according to research, enjoy similar mental health as non-transgender people) will show a similar subjective well-being as cisgender people – those who are not transgender, that is, their biological sex is compatible with their gender identity [8,9]. However, Newfield and his team showed that the transgender men they studied were characterized by the lower quality of life compared to the general population [10]. These tests were carried out on the American sample. Also, data on the Dutch sample indicate a worse health-related quality of life of transgender people in relation to the general population [11]. Also Ainsworth and Spiegel indicate that transgender women who did not undergo sex reassignment showed worse quality of life compared to cisgender women. They also pointed the worse quality of life of transgender men in relation to the general population [12]. These data are in line with the health-related quality of life model, according to which the disorder of the social, psychological and physical spheres (which might characterize the incompatibility of biological sex and gender identity) may negatively affect the quality of human life [13][14][15][16].
Exploration of the sphere of the subjective well-being is particularly interesting among a smaller group of transgender people – transgender men. As Imieliński, Lew-Starowicz, Arcelus and colleagues point out, the percentage of transgender women is much larger than transgender men [1][17][18].
The stage or fact of sex reassignment might be a potential predictor of the subjective well-being of transsexual men. Bodlund and Kullgren say that as many as 70% of transgender people after sex reassignment showed a better functioning in the socio-psychological sphere, however transgender women functioned better than transgender men [19]. Abramowitz, Fajkowska-Stanik, Lawrence, Murad and co-workers or Bancroft also point out the
positive correlation between sex reassignment and well-being and life satisfaction. [20][21][22][23][24].
In addition Colizzi and the team claim that hormone therapy had a positive effect on the mental health of transgender people [25]. What’s more, Newfield and colleagues claim the same. They examined transgender men and showed that hormone therapy was an important predictor of the health-related quality of life [10]. These data are also confirmed by Meier and colleagues [26]. Also Berry and colleagues, Wierckx with the team, Costantino and others, as well as Rotondi and assistants point out the important role of gender correction in the lives of transgender men [27][28][29][30]. However, that an operational gender correction, even after some time, may involve health complications [31] and thus negatively shape the subjective well-being of transgender people.
Based on the presented research and the theory of health-related quality of life it can be concluded that transgender men will show a significantly lower subjective well-being in comparison to cisgender men.
H1: Transgender men will have lower subjective well-being in relation to cisgender men.
The information provided on the important role of gender correction in the lives of transgender people allows to formulate the following hypotheses:
H2: Transgender men undergoing hormone therapy will have significantly higher subjective well-being compared to those who have not decided to undergo sex reassignment or hormone therapy.
H3: Transgender men, who completed one of the stages of the sex reassignment, will have significantly higher subjective well-being than those who did not decide to undergo sex reassignment or hormone therapy.
H4: Both hormonal therapy and sex reassignment will be important predictors of the subjective well- being of transgender men.
Aim of this study
This pilot study was aimed to explore the subjective well-being of transgender men and to investigate its relationship with hormonal therapy and sex reassignment. Pilot study was also performed to compare the results of transgender men with cisgender men, including those belonging to the LGBTQ community (Lesbian, Gay, Bisexual, Transsexual, Queer).
Methods
117 men between the ages of 18 and 50 participated in this study (Mage = 23,7; Meage = 22;
SDage = 6,3). Results of transgender men (ntransgender = 34) and non-heteronormative cisgender men (nbisexual = 25;
nhomosexual = 26) were obtained through support groups
and LGBT associations from the Opole Voivodeship.
Data from heterosexual cisgender men (nheterosexual = 32) were obtained among charities and foundations from the Opole Voivodeship, which work was not related to the LGBTQ community. Results of non- heteronormative cisgender men and transgender men were not obtained through those charities and foundations. Data collection was started in 2015 and took place using the „paper-pencil” method. Data was collected after the end of support groups meetings for people from the LGBTQ community. The respondents were informed about the complete anonymity and security of their personal data as well as the possibility of interrupting filling out questionnaires at any time.
Participants completed the SWLS questionnaire in Czapiński’s polish translation [32] of Diener’s life satisfaction measurement tool [33]. This scale contains five questions to which the respondents answer using seven-point Likert scale, where: 1 – I strongly disagree, and 7 – I agree completely. The questionnaire on the
analyzed population shows very good psychometric properties – Cronbach’s α = 0.88, McDonald’s ω = 0.89.
All men completed the author’s questionnaire regarding gender, age and sexual orientation. Ad- ditionally, transgender men were asked to share information about their gender correction stages they are on and / or have gone through. They had the op- portunity to submit their own proposals and select an unlimited number of the proposed: hormone therapy, chest surgery (mastectomy), removal of the uterus (panhisterectomy), penis formation (neophalloplasty or metoidoplasty).
Results
Sexual orientation of transgender men did not differentiate their results of the subjective well-being (H = 0,93; p > 0,05; ε2 = 0,03) – this means that there were no significant differences in the subjective well- being between heterosexual, bisexual and homosexual transgender men.
The Kruskal-Wallis analysis showed statistically significant differences between transsexual men (regardless of orientation) and heterosexual, bisexual and homosexual cisgender men in terms of the subjective well-being (H = 25,6; p < 0,01; ε2 = 0,22) – see tab. 1.
Table 1. Descriptive statistics of the SWLS questionnaire
M Me SD Min Max
Transgender men (regardless of orientation) 14.6 12.5 5.72 5 28
Cisgender heterosexual men 23.7 24 5.72 12 35
Cisgender bisexual men 17.7 18 6.50 7 33
Cisgender homosexual men 17.8 17.5 6.36 7 29
DSCF pairwise comparisons showed that heterosexual men scored higher in the subjective well-being in relation to groups of men belonging to the LGBTQ community – homosexual and bisexual
cisgender men and transgender men (regardless of their orientation). There were no statistically significant differences between transgender men and cisgender bisexual or homosexual men – see tab. 2.
Table 2. Dwass-Steel-Critchlow-Fligner pairwise comparisons
W p
Transgender men (regardless of orientation) Cisgender heterosexual men 6.47 <0.001
Transgender men (regardless of orientation) Cisgender bisexual men –2.46 >0.05
Transgender men (regardless of orientation) Cisgender homosexual men 2.69 >0.05
Cisgender bisexual men Cisgender homosexual men 0.12 >0.05
Cisgender heterosexual men Cisgender bisexual men 4.65 <0.001
Cisgender heterosexual men Cisgender homosexual men 4.57 <0.001
Only 3 respondents answered the question about the gender correction stage. On this basis the rela- tionship between hormone therapy, sex reassignment and the subjective well-being of transsexual men was impossible to verify.
Discussion
The pilot study showed that transgender men (regardless of their orientation), bisexual and homosexual cisgender men score lower on the SWLS questionnaire in comparison to heterosexual cisgender men. Research by King and colleagues on a sample of 2179 people shows that homosexual men inflict wound to themselves more often than heterosexual men. In addition, drug use and consultations with specialists on mental health were more frequent in the group of men from the LGBTQ community [34]. On the basis of their research, Dhejne and his team report that 343 transgender participants surveyed after sex reassignment showed greater suicidal tendencies in relation to the general population [35]. This may be due to the lack or poor care of patients who have made a gender correction.
This information seems to contradict those presented in the theoretical introduction. This shows that there are many variables that modify the subjective well- being of people from the LGBTQ community and the importance of further exploration of the sphere of the subjective well-being of transgender people, which could allow for the creation of better strategies for increasing the subjective well-being and mental health of transgender men and women.
Men who were members of the LGBTQ community exhibited a significantly lower subjective well-being compared to heterosexual cisgender men. The low strength of the effect suggests however, that further exploration of mediators and predictors of the subjective well-being of transgender men should be made. One of the potential variables may be the feeling of being discriminated on the background of gender identity – transphobia [36]. Although foreign research reports that discrimination has less and less influence on their mental functioning with age [37], it is worth checking this relationship in the case of transgender men living in Poland. As Russell and colleagues report, reducing the feeling of being discriminated can significantly affect the overall health of LGBTQ community members [38].
Another important variable would be perceived and received social support related to the occurrence
of depression among transgender people [39]. Erich and colleagues showed that support and good relations with loved ones affects the life satisfaction of transgender people [40]. This is also confirmed by Meier and the team, which research shows that transgender men being in the relationship were less likely to suffer from depression in relation to single transgender men [41]. An analysis of the relationship between the types and sources of support and the subjective well-being of transgender men should be made. Based on this study, we do not know if the participants have any support networks. This is an important variable because, according to Helgeson, a man with a large support network in a situation of strong stress functions just like a man who does not experience that kind of stress. [42]. It is likely that the participants may have had a support network, however, it was too small or not effective so could not compensate for the effects of the strong distress present in their lives. This distress, which probably is the incompatibility of gender identity with biological sex, can have a negative impact on human well-being [43], however, its effects can be eliminated thanks to the use of coping strategies, which shape the individual’s quality of life [44] and are important in the impact of discrimination on the well-being of transgender people [37].
Based on the feedback provided in the questionnaire, it can be concluded that some transgender men perceived the study as biased. The respondents mentioned that the presented study was transphobic because it did not focus on things that were important for transgender people and aimed at getting intimate information and presenting their community in a negative light. Perhaps this is the reason why the relationship between the sex reassignment and the subjective well-being was not verifiable, as the respondents did not want to provide such personal information. The proper study should reformulate the question regarding the gender correction stage or conduct in-depth interviews with the men under examination. It may help with gaining the trust of the respondents [45].
Thanks to the in-depth interview it is much easier to get honest answers from the participants of the study [45]. This is a very important issue because, as demonstrated in the introduction to this paper, sex reassignment and hormone therapy are important predictors of the subjective well-being of transgender people [14][15][16][17][18][19][20]. In addition,
obtaining information on important spheres of life of transgender people would allow to conduct scientific research that would be in accordance with the position and needs of transgender people.
Conclusions
1. The subjective well-being of transgender men and other LGBTQ community members deserves a more thorough examination. It is worth to make an accurate exploration of this sphere with the help of a tool such as the Kwestionariusz Poczucia Jakości Życia KPJŻ (subjective well-being questionnaire) by Straś-Romanowska, Oleszkowicz and Frąckowiak [46]. This questionnaire examines the areas of the subjective well-being such as the psychophysical, psychosocial, subjective and metaphysical spheres. Better understanding of the dimensions
of the biological and social subjective well-being of transgender men (i.e. those that may be the most important in assessing the lives of transgender people) may bring interesting results in the future research on the functioning of transgender men and LGBTQ community members.
2. It is worth verifying potential mediators and moderators of the subjective well-being of transgender people. Those might be perceived and received social support [47,48], perceived stress [43] or coping strategies their use [47].
3. Further researchers considering the hormonal the- rapy and sex reassignment as potential predictors and mediators of the subjective well-being, should try to obtain information on this subject in the form of e.g. in-depth interviews. This will allow them to build contact and sense of safety with the respon- dents, which can translate into honest answers.
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