Chapter 6 170 2.2. Participants and measurements All participants were approached and included before the start of GAHT. Participants were eligible to participate in the RESTED study if they were aged between 18 and 50, if they were diagnosed with gender dysphoria and if they had never used gender-affirming hormones before. They were not included if they had a diagnosed sleep disorder (e.g. obstructive sleep apnea, clinical insomnia or parasomnias), or if they used benzodiazepines or barbiturates at time of the study. 2.3. Gender affirming hormone therapy All participants started using GAHT after the baseline measurement of the study, and participants were treated with GAHT according to the WPATH guidelines (Coleman et al., 2022). Transmasculine participants, who were assigned female at birth (AFAB), all started using masculinizing hormones in the form of testosterone. These hormones were either administered via testosterone gel (daily dose of 40.5 mg), testosterone esters (250 mg every 3 weeks) or testosterone undecanoate (1000 mg every 12 weeks). A number of transmasculine participants also used progestins (lynestrenol, 5 mg; levonorgestrel IUD, 52 mg; medroxyprogesterone, 150 mg) or combined hormonal contraceptives, consisting of progestins and estrogens (ethinylestradiol/levonorgestrel, 0.03/0.15 mg; ethinylestradiol/drospirenon 0.02/3 mg) to suppress their menstruation. Transfeminine participants, who were assigned male at birth, started using feminizing hormones, consisting of anti-androgens, either in the form of oral cyproterone acetate (CPA; daily dose of 10 mg) or intramuscular injections of gonadotropin-releasing hormone analogues (GnRH analogues), either shortworking (triptorelin 3.75 mg per 4 weeks, or leuproreline, 3.75 mg per 4 weeks) or long-working (triptorelin 11.25 mg per 12 weeks), combined with estradiol, which was either administered orally (estradiol valerate, 2 mg twice daily) or transdermally through estradiol gel (0.06% 1.5 mg daily) or estradiol patches (100 mcg per 24 hours, twice a week). For the current study, transfeminine participants were excluded if they only started using estrogens (n=1) or anti-androgens (n=1) but not both at the start of GAHT.
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