Appraisal of Sexual Life Among Midlife and Older Transgender People in The Netherlands Receiving Long-Term Gender-Affirming Medical Care.

Sexual well-being is a neglected topic in the aging population, particularly in midlife and older transgender adults. Cultural and generational perceptions of sexuality, aging, and gender-affirming medical care (GAMC) can influence how people appraise their sexual life. This mixed-methods study explored the appraisal of sexual life and its association with body image among midlife and older (56-84 y) transgender women (N = 64) and men (N = 36) receiving ≥10 y GAMC, using questionnaires. Associations between satisfaction with sexual life and body image were assessed using linear-regression analyses. Open-ended questions were analyzed with template analysis to extract subthemes underlying positive, neutral, and negative appraisal of sexual life. Women and men expressed varying degrees of importance and satisfaction with sexual life, and better genital body image was associated with higher satisfaction with sexual life in transgender women (95%CI -0.54 to -0.10) but not in transgender men. Initiating and seeking sexual contacts was among the most frequently reported difficulties for women and men. This may be related to negative sexual self-concept, a recurrent subtheme underlying negative sexual life appraisal that emerged throughout the analyses. Further research is needed to understand how biopsychosocial stressors and resilience resources, such as partner support, shape sexual well-being in midlife and older transgender individuals.