Influence of sex hormone use on sleep architecture in a transgender cohort 185 we would also recommend further assessing sleep architecture changes using a multi-channel PSG measurement setup including oximetry. Furthermore, as displayed in Table 6.1, numerous participants were using psychotropic medication, most commonly antidepressants or stimulants. There are known effects of psychotropic medication on sleep architecture (Doghramji & Jangro, 2016), but after adjusting for psychotropic medication use, the results remained unchanged in terms of their direction and magnitude. Furthermore, none of the participants reported changing their psychotropic medication between the baseline measurement and three month-follow up. We therefore believe that the impact of psychotropic medication on our findings was small to minimal. Altogether, our results show that sex hormones seem to change sleep architecture, but that the effects of sex hormones are dependent on one’s sex assigned at birth. Although these findings are from a relatively small population, they do provide evidence indicating there is a sex assigned at birth-specific predisposition for sensitivity to the effects of sex hormone fluctuations on sleep. This finding is important for research in transgender people, but it is also of major importance for studies on puberty, pregnancy and menopause. Sleep is an important component of well-being, and decreased sleep quality is associated with poorer physical and mental health (Ramar et al., 2021). If sex hormone exposure, during development or during adulthood, could predispose one to be more sensitive to poor sleep during sex hormone transitions, this is of interest for public health. Future research should focus on studying underlying mechanisms in sleep and sex hormones, mainly on the effects of estradiol and testosterone in sleep-promoting regions of the human brain, as well as on longer-term effects of GAHT on sleep architecture. Furthermore, future research should assess whether the worsening in sleep architecture in transmasculine persons has effects on their well-being, most importantly on risk of depressive disorders.
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