Chapter 5 150 electroencephalogram (EEG) measurements in another study(Friess et al., 1997). Future research comparing CPA use with, for example, the use of GnRH analogs in a large sample could provide more clarity on the effects of various anti-androgens and SOL duration. Our findings also showed that trans women who experienced hot flashes reported more severe insomnia symptoms than trans women who did not experience hot flashes after 6 and 9 months of GAHT use. This is in concordance with studies in cisgender women going through the menopausal transition, which also show that women who experience hot flashes are more likely to report insomnia (Baker et al., 2015; M. M. Ohayon, 2006). Hot flashes seem to be associated with low estrogen levels (Whiteman et al., 2003), and supplementing estrogen offers symptom relief in postmenopausal women (Nelson, 2004). A similar pattern is also found in persons with prostate cancer who undergo androgen deprivation therapy, for whom hot flashes are a common complaint (Dosani et al., 2017). In this group, the use of CPA or estrogen supplementation was suggested to reduce the frequency of hot flashes (Freedland et al., 2009; Frisk, 2010). Clinicians working with trans women who report hot flashes could consider monitoring the levels of estrogen to ensure that the estradiol levels are not undersupplied, and they could consider switching the form of antiandrogens to see whether that offers symptom relief from the hot flashes to improve sleep quality. Although this study in transgender persons on GAHT offers the opportunity to study prospectively the influences of sex hormones on sleep, there are also several limitations. Firstly, many transgender persons describe starting the use of GAHT as a big life event. GAHT comes with physical and mental changes and, for many, it reduces experienced gender dysphoria or depression (Fisher et al., 2016) and improves quality of life (van Leerdam et al., 2021). Alleviation of gender dysphoria and depression after GAHT could also affect changes in sleep. Previous research found that transgender people assigned female at birth reported that they experienced sleep disturbances due to the presence of their breasts, which increased gender dysphoria at night (Harry-Hernandez et al., 2020). We conducted a post-hoc interaction analysis to see whether trans men who had undergone mastectomy surgery reported more or less insomnia symptoms than trans men who had not and found no differences between the two groups (full
RkJQdWJsaXNoZXIy MTk4NDMw