Priorities for efficacy trials of gender-affirming hormone therapy with estrogen: collaborative design and results of a community survey.

The most frequently rated 'extremely important' or 'very important' overall treatment goals were improved satisfaction with life, appearing more feminine, appearing less masculine, improved mental health, and being seen as your true gender by others.

• Improved satisfaction with life was rated extremely or very important by 81% of respondents
• Appearing more feminine was rated extremely or very important by 80% of respondents
• Appearing less masculine was rated extremely or very important by 77% of respondents
• Improved mental health was rated extremely or very important by 76% of respondents
• Being seen as your true gender by others was rated extremely or very important by 75% of respondents

The three body characteristics most frequently rated 'highest priority' or 'high priority' for change were facial hair, breast shape or size, and body shape.

• Facial hair was rated highest or high priority by 85% of respondents
• Breast shape or size was rated highest or high priority by 84% of respondents
• Body shape was rated highest or high priority by 80% of respondents

The highest-rated research priority among survey respondents was comparing feminization outcomes with different routes of estrogen administration.

• This finding emerged from a 60-item survey that included a section on future research priorities
• The survey was distributed primarily through social networks designed for gender-expansive individuals seeking treatment with estrogen
• A total of 1270 individuals completed the survey

The survey was developed collaboratively with a community advisory board and covered a broad range of topics relevant to gender-affirming hormone therapy with estrogen.

• The survey consisted of 60 items
• Topics covered included demographics, transition history, goals and priorities for treatment, indicators of treatment success, sexual function goals, and future research priorities
• The survey was cross-sectional in design and distributed during the summer of 2021
• Development was based on broad clinical experience and consultation with a community advisory board

A total of 1270 individuals completed the survey, which was distributed primarily through social networks designed for gender-expansive individuals seeking treatment with estrogen.

• Distribution occurred primarily through social networks designed for gender-expansive individuals seeking treatment with estrogen
• The survey was administered in summer 2021
• The study design was cross-sectional

Treatment guidelines for gender-affirming hormone therapy with estrogen recommend specific dosing regimens based on limited data, underscoring the need for well-controlled efficacy trials.

• Current guidelines recommend specific dosing regimens but are based on limited data
• Well-controlled efficacy trials are described as essential to tailoring treatment to patient goals as the guidelines recommend
• The study was designed as a foundational step toward designing community-centered effectiveness trials for gender-diverse individuals seeking GAHT-E