This thesis identifies barriers and opportunities in addressing sexuality in medical research and healthcare practice in transgender people. The diverse topics explored in this thesis reflect the biopsychosocial nature of sexuality in all people, including transgender people, and points out diverse directions for future research. Cisgender and heteronormative assumptions often shape sexual healthcare interactions, impacting transgender people’s comfort in asking questions and openness in sharing experiences relevant to their sexual well-being. In both clinical practice and research in transgender people, sexuality is often defined narrowly, with insufficient attention paid to individual differences and preferences as well as a lack of attention for positive sexual experiences. Both healthcare practitioners and researchers need to reflect on their assumptions and broaden their approaches to the diverse ways of experiencing sexual well-being. Using and further developing inclusive questionnaires such as the Amsterdam Sexual Pleasure Index can facilitate researchers in broadening sex-positive approaches in research. Clinical studies into questions related to effects of GAMC on sexual well-being are also necessary. This, in turn, may require researchers to zoom in on subgroups of transgender people based on ways they enjoy being sexually active. In this thesis, we explored the role of androgens in transgender women after vaginoplasty and found that supplementation of testosterone to female physiological levels is possible and safe on the short term. All clinical outcome measures related to mood, energy and sexual function changed in the desired direction and general neovaginal perfusion as well as feeling of arousal in response to sexual stimulation seemed to increase, calling for further research to assess clinical benefit. Ultimately, our findings highlight and contribute to more inclusive, tailored and sex-positive care and research approaches to addressing sexuality in healthcare for transgender people.
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