Chapter 9 260 associated with some beneficial effects on depressive symptoms, but we find adverse changes in sleep after masculinizing GAHT, including slightly poorer sleep, shorter SWS, shorter REM sleep latency, longer REM sleep and a later chronotype. Vice versa, in those starting feminizing GAHT we find an increase in low mood, but also a reported shorter SOL, earlier chronotype and no changes in sleep architecture. Altogether, the meta-synthesis of our studies do not support the hypothesis that changes in sleep after use of exogenous sex hormones are associated with an increased risk of depressive symptoms. 1.4. Overall summary Taken together, the findings in this thesis show that sex hormones impact both depressive symptoms and sleep, especially sleep architecture and sleep timing. Findings on depression indicate that both OCs and GAHT can have modest effects on depressive symptoms. OC could increase the risk of depressive symptoms, although effects differ between individuals. Effects of GAHT are dependent on the form, since masculinizing GAHT is associated with a temporary decrease in lethargy and feminizing GAHT is associated with an increase in low mood. Findings in the studies on sleep indicate that sex hormones seem to affect sleep architecture and timing more than subjective sleep quality. In the study using NESDA data, we find OC use could modestly increase insomnia symptoms, but we could not replicate these findings in the Cimbi cohort data. GAHT is not associated with clinically significant changes in sleep quality or insomnia, but masculinizing GAHT can affect sleep architecture, reducing SWS duration and REM latency and increasing REM sleep duration, and masculinizing GAHT is associated with a later chronotype and feminizing GAHT with an earlier chronotype. Finally, we find no evidence for the hypothesis that adverse changes in sleep in those using exogenous sex hormones, including OCs or GAHT, are associated with a higher risk of depression or more severe depressive symptoms.
RkJQdWJsaXNoZXIy MTk4NDMw