Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Sexual orientation in transgender individuals: results from the longitudinal ENIGI study

Abstract

Transgender people and their next-of-kin may request information on sexual orientation and preferred partners during hormonal affirming process. Although previous research on sexual orientation in transgender people is extensive, this literature may already be outdated and/or the methodology of studies assessing sexual orientation may fall short. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Gender role and preferred partner in sexual fantasies, sexual orientation and gender of current sexual partner were assessed at baseline (initiation of HT) and every follow-up visit. Data from 469 transgender women (TW) and 433 transgender men (TM) were analyzed cross-sectionally and prospectively. At baseline, more than half reported having no partner (35% of TW, 47% of TM). After 12 months, more than half reported having a partner (59% of TW, 56% of TM), with no changes between one and three years of HT. The majority of TM preferred a female partner, TW preferred male and female partners. The sexual identity of their partner matched their sexual orientation in >80%. Sexual orientation did not change over time. We did not observe associations with serum levels of sex steroids or gender-affirming surgery (chest or genital surgery). Sexual orientation did not change during hormonal transition and was not associated with sex steroids or surgery. Also, preferences matched the partner’s sexual identity. We do not assume that changing serum levels of sex steroids is directly associated with changes in partner choice. The number of people with a current partner increased, possibly due to the indirect effects of gender-affirming care.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Flowchart of the study population.
Fig. 2: Percentages for the frequency distributions for people’s selfdescribed sexual orientation (to whom they feel sexually attracted) in transgender women (left) and transgender men (right) at baseline and after the initiation of gender-affirming hormonal therapy, by study visit.
Fig. 3: Percentages for the frequency distributions for sexual identity of the current sexual partner in transgender women (left) and transgender men (right) at baseline and after the initiation of gender-affirming hormonal therapy, by study visit.
Fig. 4: Percentages for the frequency distributions for the preferred partner in sexual fantasies in transgender women (left) and transgender men (right) at baseline and after the initiation of gender-affirming hormonal therapy, by study visit.
Fig. 5: Percentages for the frequency distributions for the gender role in sexual fantasies in transgender women (left) and transgender men (right) at baseline and after the initiation of gender-affirming hormonal therapy, by study visit.

References

  1. 1.

    Auer MK, Fuss J, Höhne N, Stalla GK, Sievers C. Transgender transitioning and change of self-reported sexual orientation. PLoS ONE. 2014;9:e110016.

    Article  Google Scholar 

  2. 2.

    Weyers S, Elaut E, De Sutter P, Gerris J, T’Sjoen G, Heylens G, et al. Long-term assessment of the physical, mental, and sexual health among transsexual women. J Sex Med. 2009;6:752–60.

    Article  Google Scholar 

  3. 3.

    Meier SC, Pardo ST, Labuski C, Babcock J. Measures of clinical health among female-to-male transgender persons as a function of sexual orientation. Arch Sex Behav. 2013;42:463–74.

    Article  Google Scholar 

  4. 4.

    Katz-Wise SL, Reisner SL, Hughto JW, Keo-Meier CL. Differences in sexual orientation diversity and sexual fluidity in attractions among gender minority adults in Massachusetts. J Sex Res. 2016;53:74–84.

    Article  Google Scholar 

  5. 5.

    Bockting W, Benner A, Coleman E. Gay and bisexual identity development among female-to-male transsexuals in North America: emergence of a transgender sexuality. Arch Sex Behav. 2009;38:688–701.

    Article  Google Scholar 

  6. 6.

    Lawrence AA. Sexuality before and after male-to-female sex reassignment surgery. Arch Sex Behav. 2005;34:147–66.

    Article  Google Scholar 

  7. 7.

    Gaither TW, Awad MA, Osterberg EC, Romero A, Bowers ML, Breyer BN. Impact of sexual orientation identity on medical morbidities in male-to-female transgender patients. LGBT Health. 2017;4:11–6.

    Article  Google Scholar 

  8. 8.

    Papadopulos NA, Lellé JD, Zavlin D, Herschbach P, Henrich G, Kovacs L, et al. Psychological pathologies and sexual orientation in transgender women undergoing gender confirming treatment. Ann Plast Surg. 2020;84:312–6.

    CAS  Article  Google Scholar 

  9. 9.

    De Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8:2276–83.

    Article  Google Scholar 

  10. 10.

    Lawrence AA. Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Arch Sex Behav. 2010;39:514–45.

    Article  Google Scholar 

  11. 11.

    Rachlin K. Factors which influence individual’s decisions when considering female-to-male genital reconstructive surgery. Int J Transgender Health. 1999;3:18–20.

    Google Scholar 

  12. 12.

    Chivers ML, Bailey JM. Sexual orientation of female-to-male transsexuals: a comparison of homosexual and nonhomosexual types. Arch Sex Behav. 2000;29:259–78.

    CAS  Article  Google Scholar 

  13. 13.

    Reisner SL, White JM, Mayer KH, Mimiaga MJ. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS Care. 2014;26:857–64.

    Article  Google Scholar 

  14. 14.

    Kenagy GP, Hsieh CM, Kennedy G. The risk less known: female-to-male transgender persons’ vulnerability to HIV infection. AIDS Care - Psychol Socio-Med Asp AIDS/HIV. 2005;17:195–207.

    CAS  Article  Google Scholar 

  15. 15.

    Nieder TO, Herff M, Cerwenka S, Preuss WF, Cohen-Kettenis PT, De Cuypere G, et al. Age of onset and sexual orientation in transsexual males and females. J Sex Med. 2011;8:783–91.

    Article  Google Scholar 

  16. 16.

    Cerwenka S, Nieder TO, Cohen-Kettenis P, De Cuypere G, Haraldsen IRH, Kreukels BPC, et al. Sexual behavior of gender-dysphoric individuals before gender-confirming interventions: a European multicenter study. J Sex Marital Ther. 2014;40:457–71.

    Article  Google Scholar 

  17. 17.

    Cerwenka S, Nieder TO, Briken P, Cohen-Kettenis PT, De Cuypere G, Haraldsen IRH, et al. Intimate partnerships and sexual health in gender-dysphoric individuals before the start of medical treatment. Int J Sex Health. 2014;26:52–65.

    Article  Google Scholar 

  18. 18.

    Nieder TO, Elaut E, Richards C, Dekker A. Sexual orientation of trans adults is not linked to outcome of transition-related health care, but worth asking. Int Rev Psychiatry. 2016;28:103–11.

    Article  Google Scholar 

  19. 19.

    De Roo C, Tilleman K, T’Sjoen G, De Sutter P. Fertility options in transgender people. Int Rev Psychiatry. 2016;28:112–9.

    Article  Google Scholar 

  20. 20.

    Kreukels BPC, Haraldsen IR, De Cuypere G, Richter-Appelt H, Gijs L, Cohen-Kettenis PT. A European network for the investigation of gender incongruence: the ENIGI initiative. Eur Psychiatry. 2012;27:445–50.

    CAS  Article  Google Scholar 

  21. 21.

    Dekker MJHJ, Wierckx K, Van Caenegem E, Klaver M, Kreukels BP, Elaut E, et al. A European network for the investigation of gender incongruence: endocrine part. J Sex Med. 2016;13:994–9.

    CAS  Article  Google Scholar 

  22. 22.

    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, De Cuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people. Int J Transgender Health. 2012;13:165–232.

    Article  Google Scholar 

  23. 23.

    Kinsey AC, Martin CE, Pomeroy WB. Kinsey Scale. WB Saunders; Philadelphia PA, USA; 1948.

  24. 24.

    Wiepjes CM, Vlot MC, Klaver M, Nota NM, de Blok CJM, de Jongh RT, et al. Bone mineral density increases in trans persons after 1 year of hormonal treatment: a multicenter prospective observational study. J Bone Miner Res. 2017;32:1252–60.

    CAS  Article  Google Scholar 

  25. 25.

    Defreyne J, Kreukels B, T’Sjoen G, Staphorsius A, Den Heijer M, Heylens G, et al. No correlation between serum testosterone levels and state-level anger intensity in transgender people: results from the European Network for the Investigation of Gender Incongruence. Hormones Behav. 2019;110:29–39.

    CAS  Article  Google Scholar 

  26. 26.

    Defreyne J, Elaut E, Kreukels B, Fisher AD, Castellini G, Staphorsius A, et al. Sexual desire changes in transgender individuals upon initiation of hormone treatment: results from the longitudinal European network for the investigation of gender incongruence. J Sex Med. 2020;17:812–25.

    CAS  Article  Google Scholar 

  27. 27.

    Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.

    Google Scholar 

  28. 28.

    Fein LA, Salgado CJ, Sputova K, Estes CM, Medina CA. Sexual preferences and partnerships of transgender persons mid- or post-transition. J Homosex. 2018;65:659–71.

    Article  Google Scholar 

  29. 29.

    Rowniak S, Chesla C. Coming out for a third time: transmen, sexual orientation, and identity. Arch Sex Behav. 2013;42:449–61.

    Article  Google Scholar 

  30. 30.

    Katz-Wise SL, Hyde JS. Sexual fluidity and related attitudes and beliefs among young adults with a same-gender orientation. Arch Sex Behav. 2015;44:1459–70.

    Article  Google Scholar 

  31. 31.

    Fundamental Rights Agency. Being trans in the EU—comparative analysis of the EU LGBT survey data. Luxembourg: Fundamental Rights Agency; 2014.

  32. 32.

    Statbel. Population by place of residence, nationality (Belgian/non-Belgian), marital status, age and gender. Statbel (Directorate-general Statistics - Statistics Belgium); Brussels, Belgium; 2020.

  33. 33.

    Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, et al. Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-year follow-up data. J Clin Endocrinol Metab. 2016;101:4260–9.

    CAS  Article  Google Scholar 

  34. 34.

    Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, et al. Cross‐sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med. 2014;11:709–19.

    CAS  Article  Google Scholar 

  35. 35.

    van de Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, De Cuypere G, Richter-Appelt H, et al. Effects of medical interventions on gender dysphoria and body image: a follow-up study. Psychosom Med. 2017;79:815.

    Article  Google Scholar 

  36. 36.

    Heylens G, Verroken C, De Cock S, T’Sjoen G, De Cuypere G. Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. J Sex Med. 2014;11:119–26.

    Article  Google Scholar 

  37. 37.

    Fisher AD, Bandini E, Casale H, Ferruccio N, Meriggiola MC, Gualerzi A, et al. Sociodemographic and clinical features of gender identity disorder: an Italian multicentric evaluation. J Sex Med. 2013;10:408–19.

    Article  Google Scholar 

  38. 38.

    Kuper LE, Nussbaum R, Mustanski B. Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. J Sex Res. 2012;56:249–63.

    Google Scholar 

  39. 39.

    Baker WB. The meaning of sexual and gender identities in transgender men. Montclair State University; 2017.

  40. 40.

    Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G, Monstrey S, et al. Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med. 2014;11:107–18.

    Article  Google Scholar 

  41. 41.

    Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, et al. Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender persons. J Acquired Immune Defic Syndr. 2009;52:417–21.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the people who contributed to the ENIGI study: Sarah Collet, Meltem Kiyar, Thomas Schreiner, Timo Nieder, Inga Becker, Yona Greenman, Chantal Wiepjes, Maartje Klaver, Christel De Blok, Nienke Nota, Carlotta Cocchetti, Koen Dreijerink, Daan Van Velzen, Dennis Van Dijk, Margot Morssinkhof, Elfi Conemans, Brand Coumou, and Iris de Nie. We also thank all endocrinology residents who made a valuable contribution to the ENIGI study: Greet Roef, Mirra Boer, Marijn Carpentier, Liesbeth Van Huffel, Sara Vandewalle, Loes Moernaut, Sabine Vermeersch, Gertjan Vereecke, Xavier-Philippe Aers, Charlotte Verroken, Emmanuelle Versele, Eva Van Caenegem, Katrien Wierckx, and Bram Vantomme for their outpatient care; Charlotte Bultynck, Charlotte Pas, Anne-Sophie De Maertelaere, and Kessewa Abosi-Appeadu for their help with the dataset; our study nurse Kaatje Toye for handling the extensive administration to the study, and all participants in the ENIGI study protocol.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J. Defreyne.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Defreyne, J., Elaut, E., Den Heijer, M. et al. Sexual orientation in transgender individuals: results from the longitudinal ENIGI study. Int J Impot Res (2021). https://doi.org/10.1038/s41443-020-00402-7

Download citation

Search

Quick links