Sex hormones, insomnia, and sleep quality: subjective sleep in the first year of hormone use 145 Linear mixed models show that in the trans men, reported ISI scores decrease after 3 and 9 months of GAHT compared to baseline in both the unadjusted model (by -0.96 (95% CI: -1.64; -0.29) and -0.91 (95% CI: -1.82; -0.40) points, respectively) as well as in the adjusted model (by -1.11 (95% CI -1.82; -0.40) and -0.97 (95% CI: -1.81; -0.13) points, respectively) but they show no significant changes after 12 months of GAHT compared to baseline. The trans women report a decrease in ISI scores at 3 months after GAHT of 0.87 (95% CI: -1.70; -0.04) points in the unadjusted model, although this is no longer significant in the adjusted model (-0.54, 95% CI: -1.43; 0.35). Neither model shows indications of significant changes in reported ISI scores after 6- , 9- or 12 months. Table 5.3 displays the ISI scores at start of GAHT and after 3, 6, 9, and 12 months of GAHT, and Figure 5.2 displays the course of ISI scores over the 12 months of GAHT in both groups. Figure 5.2. Estimated mean Insomnia Severity Index (ISI) scores and 95% confidence intervals per participant group and measurement timepoint. Asterisks indicate significant changes (p<0.05) within the group after 12 months of GAHT. 3.3. Sleep quality PSQI scores indicate that at baseline, 57% of trans men and 48.7% of trans women report poor sleep quality (PSQI>5) at the start of GAHT. After 12 months of GAHT, 63.3% of the trans men report poor sleep, and the PSQI score in this group is slightly increased in the adjusted model by 0.78 points
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