Chapter 7 200 gender-affirming sex hormone use on sleep and mood. RESTED participants were recruited at the gender clinics of the Amsterdam University Medical Centers (Amsterdam UMC) and the University Medical Centre Groningen (UMCG). In the RESTED study, adults were eligible for participation if they were aged between 18 and 50, diagnosed with gender dysphoria and/or gender incongruence, and planning to start the use of gender-affirming hormone therapy (GAHT). The exclusion criteria for the RESTED study included: having a pre-existent sleep disorder, use of sleep medication (benzodiazepines, barbiturates, and opiates), or previous use of gender-affirming hormones. Individuals interested in participating in the study received oral and written information about the study protocol, after which informed consent was obtained. The RESTED study was classified as a ‘non-WMO’ study by the Medical Ethical Committee of the Amsterdam UMC (location VUmc) and the local committee at the UMCG, meaning that the Medical Research Involving Human Subjects Act (WHO) did not apply to the data collection of this study (study id. 2019.353). 2.2. Data collection The study data was collected at the Amsterdam UMC and UMCG between December 2019 and January 2023. A total of 99 participants was included in the RESTED study, of whom 51 TM participants, who were assigned female at birth and started masculinizing GAHT, and 48 TF participants, who were assigned male at birth and started feminizing GAHT. Participants provided measurements before starting GAHT, after 3 months of GAHT, and after 12 months of GAHT. The study measures at every timepoint included questionnaires on depressive symptoms, using the IDS-SR (Rush et al., 1996), stress, using the Perceived Stress Scale (Cohen et al., 1983), sleep quality, using the Pittsburgh Sleep Quality index (Buysse et al., 1989), and insomnia, using the Insomnia Severity Index (Bastien et al., 2001), as well as seven nights of ambulatory sleep EEG measurements, using an ambulatory singleelectrode EEG sleep measurement device (Smartsleep, Philips, the Netherlands). The results of these aforementioned assessments are not reported on here. Chronotype was studied using the ultra-short Munich ChronoType Questionnaire (µMCTQ) (Ghotbi et al., 2020).
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