title: Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes.
abstract: OBJECTIVE
  To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self-reported psychosocial outcomes.
  
  
  METHODS
  We searched electronic databases, bibliography of included studies and expert files. All study designs were included with no language restrictions. Reviewers working independently and in pairs selected studies using predetermined inclusion and exclusion criteria, extracted outcome and quality data. We used a random-effects meta-analysis to pool proportions and estimate the 95% confidence intervals (CIs). We estimated the proportion of between-study heterogeneity not attributable to chance using the I(2) statistic.
  
  
  RESULTS
  We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%).
  
  
  CONCLUSIONS
  Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.
authors.affiliation: Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN 55905, USA. Murad.Mohammad@mayo.edu
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elamin
authors.forename: Magaly Zumaeta
authors.initials: MZ
authors.lastname: Garcia
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mullan
authors.forename: Ayman
authors.initials: A
authors.lastname: Murad
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D005260:Female; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011788:Quality of Life; D019968:Sexual and Gender Disorders / Q000188:drug therapy* / Q000523:psychology
chemical_list: D006728:Hormones