title: High impact of sleeping problems on quality of life in transgender individuals: A cross-sectional multicenter study.
abstract: BACKGROUND
  Studies in the general population suggest that determinants of QoL are often sex-dependent. Sex-dependent analyses of QoL in transgender populations have not been performed so far.
  
  
  OBJECTIVE
  To identify sex-specific and potentially modifiable determinants of QoL in transgender patients.
  
  
  METHODS
  In this cross-sectional multicentre study including 82 transwomen (TW) and 72 transmen (TM) at different treatment stages, we investigated potential determinants for QoL focusing on the impact of mood (BDI, STAI-X), sleep quality (PSQI), chronic pain (GPQ), body image (FBeK) and social support (SSS).
  
  
  METHODS
  Health-related quality of life measured with the Short Form (36) Health Survey (SF-36).
  
  
  RESULTS
  The age-adjusted SF-36 total score and its subscales did not significantly differ between TM and TW. Using a multivariate regression analysis approach, we identified common but also sex-dependent determinants for QoL (Adjusted R2 = 0.228; 0.650 respectively). Accounting for general characteristics such as age, BMI and treatment status, sleep quality according to the PSQI was an independent and strong determinant of QoL in both sexes (β = -0.451, p = 0.003 TM; β = -0.320; p = 0.0029 TW). Chronic pain was a significant independent predictor of QoL in TM (β = -0.298; p = 0.042) but not in TW. In contrast, anxiety (β = -0.451; p< 0.001) being unemployed (β = -0.206; p = 0.020) and insecurity about the own appearance (FBeK) (β = -0.261; p = 0.01) were independent predictors of QoL in TW. The rate of those reporting high sleep disturbances (PSQI ≥5) was high with 79.2% in TW and 81.2% in TM. Accordingly, age-adjusted QoL was also significantly lower in those reporting poor sleep in both sexes.
  
  
  CONCLUSIONS
  Sleep strongly affected QoL in both genders, while other factors, like pain and body image, seem to be gender specific in transgender individuals.
authors.affiliation: Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany.
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Auer
authors.affiliation: Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany.
authors.forename: Anita
authors.initials: A
authors.lastname: Liedl
authors.affiliation: Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Fuss
authors.affiliation: Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Nieder
authors.affiliation: Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Briken
authors.affiliation: Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany.
authors.forename: Günter K
authors.initials: GK
authors.lastname: Stalla
authors.affiliation: Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hildebrandt
authors.affiliation: Clinic of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sarah V
authors.initials: SV
authors.lastname: Biedermann
authors.affiliation: Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sievers
mesh_terms: D000328:Adult; D000367:Age Factors; D001828:Body Image; D015992:Body Mass Index; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000473:pathology; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000473:pathology*; D012944:Social Support; D063106:Transgender Persons / Q000523:psychology*