General discussion 277 4. Recommendations for research and clinical practice To provide a broader context to the findings in this thesis, the following section will address the role of sex and sex hormones in research and clinical practice. It will focus on four specific themes: firstly, it will focus on direct recommendations for future research on sex hormones, depression and sleep, secondly, on the role of sex hormones in the lifespan, thirdly, on the role of sex and gender in research, and fourthly, on how to account for sex hormones in clinical practice. 4.1. Research on sex hormones, depression and sleep Psychosocial reasons for OC and GAHT use This thesis has mainly focused on the assumed biological effects of exogenous sex hormones, but OCs and GAHT are often used for psychosocial reasons. OCs are commonly used to prevent pregnancy and regulate menstruation, and GAHT is used to reduce gender dysphoria and better align physical presentation with their gender identity. Since both can have effects on psychosocial well-being, as also discussed in section 3.3, future studies should also focus on the interwoven role of the biological and psychosocial changes during use of OCs and GAHT. Daily mood fluctuations Recent studies on sex hormones and mood show that sex hormones can also have a strong effect on short-term or daily mood fluctuations: changes in mood after sex hormone interventions can occur within one week (Eisenlohr-Moul et al., 2023). Clinical interviews or depression questionnaires to measure mood in these settings will most likely not be able to capture these short-onset changes in mood. Recent work also found changes in mood stability, affect lability, and mood swings after sex hormone interventions (Eisenlohr-Moul et al., 2023), which are also not included in standardized depression measures. It is likely that these emotional changes are also relevant in the context of OCs and GAHT: studies show that OCs can reduce mood variability (Hamstra et al., 2017; Jarva & Oinonen, 2007), which is sometimes called “emotional
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