Abstract
Background
There are known sex disparities in temperature perception with lower thermal detection thresholds found in people assigned female at birth compared to people assigned male at birth. However, underlying mechanisms of these differences and the influences of sex hormones are not yet sufficiently understood.
Methods
To assess the effects of sex hormones on temperature perception, we measured in a prospective observational cohort study temperature detection and pain thresholds with quantitative sensory testing and subjective temperature sensation in transgender patients undergoing gender-affirming hormone therapy (GAHT). We included 12 trans women (male-to-female transgender) and 17 trans men (female-to-male transgender) before and 3 and 6 months after start of GAHT. As a control group, we measured 13 cis women and 10 cis men without hormone treatment at the same timepoints.
Results
Here we show that temperature detection thresholds in persons assigned female at birth at baseline are lower than in persons assigned male at birth. Accordingly, in trans women, temperature detection thresholds decrease with GAHT. Pain detection thresholds do not differ between sexes assigned at birth and do not change with time.
Conclusions
We demonstrate that in trans women undergoing GAHT with estradiol and cyproterone acetate sensitivity to temperature changes increases, consistent with the greater temperature sensitivity observed in cis women compared to cis men. Future studies need to assess at which neurobiological processing stages the relevant changes occur and what molecular mechanisms play a role.
Trial registration
NCT04838249.
Plain english summary
Previous investigations showed that cis women can detect smaller temperature differences on their skin than cis men. However, it is not yet known if hormones play a role in these variations, or if, e.g., only different genes are responsible. To learn more about the influences of hormones on temperature perception, we tested how persons with different sex hormone levels can sense temperature. We measured 12 trans women (male-to-female transgender) and 17 trans men (female-to-male transgender) before and after 3 and 6 months of their hormone therapy. In trans women, temperature perception improved. These results help to better understand sex differences and hormone levels in temperature perception.
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Data availability
The source data for Figs. 1 and 2 is in Supplementary Dataset 1. Other datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.
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Acknowledgements
We thank all participants for their participation in the study. We thank Jens Przybilla and Paul Czechowski for statistical advice. We thank Natalia Schischkarjow, Björn Drechsler-Kryst, Lotte Oldenburg and Antonia Stengler for helping to conduct the study. Pauline Zimmermann and Franziska Labinski received a 6-month scholarship from the German Diabetes Society (Deutsche Diabetes Gesellschaft e.V.) during their medical studies. The study was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany´s Excellence Strategy—EXC-3105/1— 533765739 (to M.S.) and a research grant from Besins Healthcare (to H.S.). The funders had no role in the study design, data collection, data analysis, interpretation of results, or the writing of the manuscript. Coverage of the publication fee was supported by the Open Access Publishing Fund of Leipzig University.
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P.Z.: data analysis, conduction of the study, writing, reviewing and editing of the manuscript; M.K.: conduction of the study, reviewing and editing of the manuscript; T.B.: conduction of the study, reviewing and editing of the manuscript; L.M.: conduction of the study, reviewing and editing of the manuscript; F.L.: conduction of the study, reviewing and editing of the manuscript; F.E.: reviewing and editing of the manuscript; M.B.: funding acquisition, resources, reviewing and editing of the manuscript; M.S.: funding acquisition, resources, reviewing and editing of the manuscript; S.H.: conceptualization, conduction of the study, reviewing and editing of the manuscript; H.S.: conceptualization, funding acquisition, data analysis, conduction of the study, project administration, writing, reviewing and editing of the manuscript. All authors read and approved the final manuscript.
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H.S. received financial support for this study from Besins Healthcare. The funder had no role in the study design, data collection, data analysis, interpretation of results, or the writing of the manuscript. M.B. received honoraria as a consultant and speaker from Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Lilly, Novo Nordisk, Novartis, and Sanofi. All other authors have no competing interests.
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Zimmermann, P., Kaar, M., Bokeloh, T. et al. Changes in temperature perception in transgender persons undergoing gender-affirming hormone therapy. Commun Med (2026). https://doi.org/10.1038/s43856-026-01420-0
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DOI: https://doi.org/10.1038/s43856-026-01420-0
