Chapter 3 76 Feminizing hormones for TF participants consisted of oral estradiol (estradiol valerate, 2 mg twice daily) or transdermal estradiol (estradiol patches, 100 µg per 24 hours, twice a week; estradiol spray, 4.59 mg daily; estradiol gel 0.06%, 1.5 mg daily) combined with an anti-androgen, either cyproterone acetate (daily dose of 10mg) or GnRH-analogs, (triptorelin, 3.75 mg per 4 weeks; triptorelin, 11.25 mg per 12 weeks). Several TF participants only used estradiol or anti-androgens. Sensitivity analyses were conducted to compare results between TF participants using both and TF participants using only estradiol or only anti-androgens (i.e. “incomplete GAHT”), of which results are reported in Supplementary Table S3.1. 2.4. Variables Demographic and clinical variables Participants’ age (range 16 to 68, interquartile range from 21 to 29), sex assigned at birth, previous hormone use, and current medication were recorded at outpatient clinic visits by participants’ healthcare providers. Gender identity was inquired in a questionnaire in the study survey (in the ENIGI study) or obtained from medical files based on reported gender identity at the time of starting GAHT (in the RESTED study). To assess psychiatric comorbidities, the Mini-International Neuropsychiatric Interview (MINI+; Sheehan et al., 1998) was conducted shortly after clinical entry in all participants from the Amsterdam UMC, but not in participants from the UMCG. If participants had their clinic intake under the age of 18, the MINI+ interview was not conducted, since an age-appropriate instrument was used to assess psychiatric conditions. Demographic characteristics were not added to the main analyses, but analyses incorporating age, study, cycle regulation use, testosterone form and estrogen form are reported in Supplementary Table S3.2. Depressive symptoms Both studies used a digital survey program to send out invitation links to the questionnaires, which were sent to participants in the weeks or months before the start of GAHT (in the RESTED study) or at the start of GAHT (in the ENIGI study) and after 3 and 12 months of GAHT. Surveys were only saved in the research environment and were not accessible to participants’ healthcare providers to ensure maximum anonymity for study participants.
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