Sexual desire in transgender and gender diverse individuals: a systematic review and meta-analysis

Introduction: Sexual health, including sexual desire in its two dimensions (solitary and dyadic), is a crucial component of overall well-being. In transgender and gender diverse (TGD) individuals, sexual desire may be further modulated by gender-affirming therapies (GATs). However, empirical appraisal of sexual desire across different domains in TGD individuals remains limited. Objectives: To compare sexual desire between TGD individuals and the general population, and to examine the associations between sexual desire, age, and GAT. Methods: A preregistered systematic review and meta-analysis, retrieving literature from three databases (PubMed, Scopus, and EMBASE). Six studies reporting population means by the Sexual Desire Inventory were finally included (TGD individuals, n = 1940). First, population means were derived within TGD individuals either assigned male (AMAB) or female (AFAB) at birth. Comparisons with reference means from the general population (n = 79.423) were made through Cohen's d. Associations with age, exposure to GAT, and duration of GAT were evaluated through meta-regression analyses. Results: AMAB (n = 1105) and AFAB (n = 835) TGD individuals reported significantly lower levels of sexual desire compared to the general population (solitary: Cohen's d = -0.53 to -0.57; dyadic: d = -0.76 to -1.27; total: d = -0.35 to -0.53; all P < .001). Solitary sexual desire was not significantly associated with age (β = 0.178, P = .587) or GAT (β = 10.168, P = .303). In contrast, dyadic sexual desire and total sexual desire were positively associated with exposure to GAT (dyadic: β = 30.201, P < .001; total: β = 42.823, P < .001). Older TGD individuals reported lower dyadic sexual desire (β = -0.404, P = .033) and were less likely to report increases in dyadic or total sexual desire following GAT (interaction terms, dyadic: β = -0.601, P = .014; total: β = -0.946, P < .001). No significant difference was found in sexual desire between AMAB and AFAB TGD individuals (solitary: β = -0.068, P = .962; dyadic: β = -3.186, P = .360; total: β = -5.505, P = .402). Conclusion: TGD individuals exhibit reduced sexual desire compared to the general population, particularly dyadic sexual desire. Dyadic sexual desire was also the domain most influenced by GAT. Current results suggest that older age may impede reaching the full benefits associated with GAT. These findings highlight the importance of addressing relational aspects of sexuality and age-specific needs in transgender health care.