Background

Transgender men are assigned female sex at birth, but identify as men. The anabolic and androgenic sex hormone testosterone has been positively associated with aggression. Therefore, transgender men are warned of increasing aggression when initiating testosterone therapy.

Aim

To explore the literature regarding the effects of testosterone therapy on aggression-related constructs in transgender men.

Methods

Following PRISMA-guidelines, PsycINFO, MEDLINE®, EMBASE, and PubMed® were searched in November 2019. Risk of bias was analyzed using the Newcastle-Ottawa-Scale, and result-synthesis was grouped by aggression-outcome.

Results

Seven prospective cohort studies investigating aggression-dimensions pre- and post-testosterone therapy, reporting on data from 664 transgender men, were eligible. The studies had moderate to high risk of bias due to non-randomization, lack of appropriate control groups, and reliance on self-report. The behavioral tendency to react aggressively increased in three studies out of four (at three months follow-up), whereas only one study out of five found angry emotions to increase (at seven months follow-up). In contrast, one out of three studies reported a decrease in hostility after initiation of testosterone therapy. The remaining studies found no change in aggressive behavior, anger or hostility during hormone therapy.

Discussion and conclusion

Four out of seven studies reported an increase in aggression-related constructs, while one study reported a decrease. In all studies reporting changes, the follow-up period was less than 12 months, indicating that gender-affirming testosterone therapy could have a short-term impact on aggression-related constructs. However, the available studies carried a risk of bias, which indicates a need for further research.

中文翻译：

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睾酮疗法对跨性别男性攻击性相关结构的影响：系统评价

背景

跨性别男性在出生时被指定为女性，但被认定为男性。合成代谢和雄激素性激素睾酮与攻击性呈正相关。因此，跨性别男性在开始睾丸激素治疗时会被警告要增加攻击性。

目的

探索有关睾酮治疗对跨性别男性攻击相关结构影响的文献。

方法

遵循 PRISMA 指南，PsycINFO、MEDLINE ®、EMBASE 和 PubMed ®于 2019 年 11 月进行了搜索。使用纽卡斯尔-渥太华量表分析了偏倚风险，并按攻击性-结果对结果合成进行了分组。

结果

七项前瞻性队列研究调查了睾酮治疗前后的攻击性维度，报告了 664 名跨性别男性的数据，符合条件。由于非随机化、缺乏合适的对照组以及依赖自我报告，这些研究具有中度至高度的偏倚风险。在四项研究中的三项研究中（在三个月的随访中），积极反应的行为倾向增加，而五分之一的研究中只有一项发现愤怒情绪增加（在七个月的随访中）。相比之下，三分之一的研究报告了在开始睾酮治疗后敌意减少。其余的研究发现激素治疗期间攻击性行为、愤怒或敌意没有变化。

讨论与结论

七项研究中有四项报告攻击性相关结构增加，而一项研究报告减少。在所有报告变化的研究中，随访期都少于 12 个月，这表明性别肯定睾酮疗法可能对攻击相关的结构产生短期影响。然而，现有研究存在偏倚风险，这表明需要进一步研究。