The present study examines the quality of life (QoL) of transgender and gender-diverse individuals receiving versus not receiving gender-affirming hormone therapy (GAHT) in those assigned male at birth (AMAB) and assigned female at birth (AFAB). It also explores the relationship between QoL and concentrations of oestradiol and testosterone.

This cross-sectional study used the WHOQOL-BREF questionnaire to assess QoL. Participants were categorised into four groups based on assigned sex at birth (AMAB or AFAB) and GAHT status, with non-GAHT participants serving as controls. MANOVA and t-tests were used to compare QoL between groups, and linear regression analyses examined associations between QoL and oestradiol/testosterone concentrations in AMAB and AFAB participants.

The study included 360 participants: 169 AMAB (143 receiving GAHT and 26 controls) and 191 AFAB (141 receiving GAHT and 50 controls). GAHT recipients had significantly higher QoL than controls in both AMAB (p < 0.01) and AFAB (p = 0.02) groups, particularly in the psychological health domain (D2). AFAB participants reported higher overall QoL than AMAB in both GAHT (p = 0.01) and control (p = 0.04) groups, with significance in the social relationship domain among GAHT participants. No significant relationship was found between oestradiol concentrations and QoL for participants AMAB. However, a significant relationship between testosterone concentrations and QoL was observed only in the social relationship domain (D3) for participant AFAB.

This study highlights the benefits of GAHT for QoL and differences in QoL between individuals AMAB and AFAB.