ORIGINAL RESEARCH—INTERSEX AND GENDER IDENTITY DISORDERS Sexual Desire in Trans Persons: Associations with Sex Reassignment Treatment Katrien Wierckx, MD,* Els Elaut, MrSc, † Birgit Van Hoorde, MrSc, † Gunter Heylens, MD, † Griet De Cuypere, MD, PhD, † Stan Monstrey, MD, PhD, ‡ Steven Weyers, MD, PhD, § Piet Hoebeke, MD, PhD, ¶ and Guy T’Sjoen, MD, PhD* † *Department of Endocrinology, Ghent University Hospital, Ghent, Belgium; † Center for Sexology and Gender Problems, Ghent University Hospital, Ghent, Belgium; ‡ Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium; § Department of Gynaecology, Ghent University Hospital, Ghent, Belgium; ¶ Department of Urology, Ghent University Hospital, Ghent, Belgium DOI: 10.1111/jsm.12365 ABSTRACT Introduction. Sex steroids and genital surgery are known to affect sexual desire, but little research has focused on the effects of cross-sex hormone therapy and sex reassignment surgery on sexual desire in trans persons. Aim. This study aims to explore associations between sex reassignment therapy (SRT) and sexual desire in a large cohort of trans persons. Methods. A cross-sectional single specialized center study including 214 trans women (male-to-female trans persons) and 138 trans men (female-to-male trans persons). Main Outcome Measures. Questionnaires assessing demographics, medical history, frequency of sexual desire, hypoactive sexual desire disorder (HSDD), and treatment satisfaction. Results. In retrospect, 62.4% of trans women reported a decrease in sexual desire after SRT. Seventy-three percent of trans women never or rarely experienced spontaneous and responsive sexual desire. A third reported associated personal or relational distress resulting in a prevalence of HSDD of 22%. Respondents who had undergone vaginoplasty experienced more spontaneous sexual desire compared with those who planned this surgery but had not yet undergone it (P = 0.03). In retrospect, the majority of trans men (71.0%) reported an increase in sexual desire after SRT. Thirty percent of trans men never or rarely felt sexual desire; 39.7% from time to time, and 30.6% often or always. Five percent of trans men met the criteria for HSDD. Trans men who were less satisfied with the phalloplasty had a higher prevalence of HSDD (P = 0.02). Trans persons who were more satisfied with the hormonal therapy had a lower prevalence of HSDD (P = 0.02). Conclusion. HSDD was more prevalent in trans women compared with trans men. The majority of trans women reported a decrease in sexual desire after SRT, whereas the opposite was observed in trans men. Our results show a significant sexual impact of surgical interventions and both hormonal and surgical treatment satisfaction on the sexual desire in trans persons. Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G, Monstrey S, Weyers S, Hoebeke P, and T’Sjoen G. Sexual desire in trans persons: Associations with sex reassignment treatment. J Sex Med 2014;11:107–118. Key Words. Gender Identity Disorder; Transsexual; Sexual Desire; Sexual Functioning; Cross-Sex Hormone Therapy 107 © 2013 International Society for Sexual Medicine J Sex Med 2014;11:107–118