Can gender-affirming hormone therapy be associated with enhanced psychological functioning in trans individuals? A Rorschach test study

Abstract

Transgender is an umbrella term that refers to individuals whose gender identity does not align with their birth-assigned sex. Comprehensive psychological assessment is essential to evaluate psychological functioning in this population, such as stress control, cognition, affect, self-perception, and interpersonal perception. However, there is a lack of consensus on the most appropriate assessment procedures. Moreover, commonly used self-report measures may be affected by biases and limitations. This exploratory study aimed to investigate, using the Rorschach test, the psychological functioning of a sample of 28 Italian trans individuals hormone naive compared to a homogeneous group of 29 trans individuals under gender-affirming hormone therapy (GAHT) for at least 3 months. All participants were at least 18 years old, had a diagnosis of gender dysphoria according to DSM-5, were on a waiting list for gender-affirming surgery, and could provide informed consent. Individuals diagnosed with schizophrenia, other psychotic disorders, or moderate to severe intellectual disability were excluded. Hormone-naïve participants tended to show higher levels of coping deficits, impulsivity, and a predilection for escapist fantasies. Conversely, individuals undergoing GAHT showed higher human detail responses, more total human content, better emotional and cognitive resources for coping with daily stressors, and a significant tendency toward activity in interpersonal behaviors. At the same time, their responses suggested a form of cognitive rigidity, which may be associated with a transitional phase of psychological consolidation and defensive stabilization. Both groups showed a general tendency to avoid emotional stimuli, with particularly low affective engagement in the hormone-naïve group. These exploratory findings suggest that the Rorschach test may be a valuable tool for assessing psychological functioning during different phases of gender affirmation.