Chronotype changes after sex hormone use: a prospective cohort study in transgender users of gender-affirming hormones

Background Chronotype, an individual’s preferred sleep-wake timing, is influenced by sex and age. Men report a later chronotype than women and age is associated with earlier chronotype. The sex-related changes in chronotype coincide with puberty and menopause. However, the effects of sex hormones on human chronotype remain unclear. Aim To examine the impact of 3 months of gender-affirming hormone therapy (GAHT) on chronotype in transgender persons. Methods This study used data from 93 participants from the prospective RESTED cohort, including 49 transmasculine (TM) participants starting testosterone and 44 transfeminine (TF) participants starting estrogens and antiandrogens. Midpoint of sleep and sleep duration were measured using the ultra-short Munich ChronoType Questionnaire (µMCTQ). Results After 3 months of GAHT, TM participants’ midpoint of sleep increased by 24 minutes (95%CI: 3 to 45), whereas TF participants’ midpoint of sleep decreased by 21 minutes (95%CI: −38 to −4). Total sleep duration did not change significantly in either group. Conclusion This study provides the first prospective assessment of sex hormone use and chronotype in transgender persons, showing that GAHT can change chronotype in line with cisgender sex differences. These findings provide a basis for future studies on biological mechanisms and clinical consequences of chronotype changes.