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Sexual Orientation, Identity & Libido Shifts

Sexual orientation shifts during HRT are common enough that they should be considered an expected possibility rather than an anomaly — though they do not happen to everyone. Defreyne et al. (2020) and adjacent cohort work document a meaningful minority of trans-feminine people reporting attraction patterns that change after starting HRT, sometimes substantially. Separately: asexuality, aromanticism, and chronic low libido are real identities for some trans-feminine people, not always a dysfunction or symptom — and the clinical question of "is this a problem to treat?" depends on whether the person experiences it as one.

This page covers orientation shifts, the dysfunction-vs-identity distinction for low libido, and ace/aro identity work in a trans-feminine context. For the disclosure layer with partners see Coming Out & Relationships. For chronic libido issues as a clinical complaint see Long-Term Care → Sexual Health Long-Term.

Identity, not symptom

Orientation shift on HRT, ace and aro identity, and stable low libido are framed here as identity material to be navigated, not as side effects to be reversed. The diagnostic axis throughout is internal distress, not deviation from a population mean and not partner or social pressure. A trans-feminine person who is content with her current attraction pattern, libido, or identity is not a candidate for treatment — regardless of how that pattern compares to her pre-HRT baseline or to anyone else's expectation.

Orientation shifts on HRT

What the literature shows

The single best-anchored finding is that a meaningful minority of trans-feminine people report a shift in sexual orientation after starting HRT — not a majority, not a fringe, but a substantial fraction that has been replicated across independent cohorts. The numbers cluster in a wide range, roughly 15–35% of trans-feminine participants reporting some orientation change, depending on how the question is asked and how long after HRT initiation it is asked. Treat any single percentage as approximate; the literature is not crisp.

Source Cohort Finding
Defreyne et al. (2020) ENIGI prospective cohort, three-year follow-up Non-trivial fraction of trans-feminine participants reported an orientation change during follow-up; libido changes ran on a partly independent axis
Auer et al. (2014) German cross-sectional, 115 trans persons on HRT About a third of trans-feminine respondents reported some shift in self-reported orientation post-HRT; modal direction toward men, but all directions present
Holmberg, Arver, Dhejne (2019) Swedish review of sexual function and HRT Orientation discussed as an adjacent variable to sexual desire, function, and dysfunction across HRT cohorts
Bockting WO et al. — sexual-identity literature in trans populations Multi-cohort Orientation as a non-fixed identity variable for a meaningful minority across the trans population
Meier et al. — orientation shifts in trans men Trans-masculine cohort Cross-cohort anchor that orientation shift on cross-sex hormones is a real phenomenon, not a trans-feminine-only artifact
Lawrence — clinical observations Clinical case series Patterns and direction of shift in trans-feminine clinical practice
Bogaert AF — foundational asexuality work General population Cited for ace identity framing, not for the trans-feminine HRT claim specifically
Veale et al. — Canadian cohort observations Canadian community sample Orientation distribution and shift in Canadian trans cohorts

The WPATH Standards of Care v8 acknowledges orientation as a fluid identity variable for some trans people and explicitly rejects orientation-change practices, identifying them as a form of conversion practice when applied to trans populations.

Reported shift patterns

Direction of shift varies and the pattern is not unidirectional. Four directions are reported across cohorts:

  • Toward men. Most commonly reported direction in trans-feminine HRT cohorts. Some people who reported exclusive attraction to women pre-HRT report attraction to men post-HRT — sometimes alongside continuing attraction to women, sometimes as a replacement.
  • Toward women. Less common in the trans-feminine HRT literature than the toward-men direction, but reported. A subset of people who described themselves as attracted to men pre-transition (or who lived as straight in a pre-transition male role) report stabilizing into attraction to women on HRT.
  • Toward all genders. Bisexual, pansexual, or queer outcomes are a reported endpoint for some who had narrower self-reports pre-HRT.
  • Toward none. Reduction in sexual attraction altogether, including new identification with asexuality. The dysfunction-vs-identity distinction below applies — drop in libido is not the same as ace identity, but ace identity can crystallize in the same window.

Two further patterns matter and complicate the simple "shift" framing:

  • Stable → shifted. Some people whose orientation was stable and clearly reported pre-HRT shift after HRT begins.
  • Uncertain → stabilized. Some people whose orientation was uncertain or fluid pre-HRT report it stabilizing after HRT — sometimes onto an unexpected endpoint. Not all change is destabilization; for some it is the first time orientation has felt clear.

When in HRT shifts tend to manifest

The literature places the typical window at roughly months 6 to 18 of HRT, with substantial individual variation. Earlier shifts (within the first three months) are reported but less common; later shifts (year two and beyond) also occur. The peak window roughly tracks the period in which mood, libido, and emotional texture are themselves visibly remodeling — see Sex on HRT for the parallel libido and arousal trajectory.

This is not a claim that month 12 is decisive. Some people experience a clear shift early, others years in, others not at all. The 6–18-month window is the densest reported zone, not a deadline. People who notice no orientation change in the first two years are unlikely but not guaranteed to remain stable indefinitely; people who notice shifts in the first six months sometimes find them re-stabilizing later.

Why shifts happen — partial mechanisms, partial mystery

No single mechanism explains the full pattern. The honest summary is that several plausible mechanisms partially contribute and the literature has not isolated them.

Mechanism What it proposes Where the evidence sits
Estrogen-mediated brain effects Estradiol acts on mood, emotional reactivity, and the affective texture around arousal; the hormonal substrate of attraction itself shifts Mechanically plausible; consistent with reports of orientation feeling differently shaped, not just relabeled. Direct neurobiological evidence is suggestive rather than decisive
Dysphoria-relief unmasking Pre-HRT dysphoria suppressed or distorted attraction; as body and social dysphoria drop, previously-suppressed attractions surface Consistent with self-reports describing surfaced attraction as "always there but inaccessible"; hard to study directly
Social-context change Living as a woman changes who one meets, how social spaces feel, what intimacy looks like, what categories of partner feel available Real but methodologically hard to quantify; cohort effects in different transition environments are consistent with this
Identity reorganization Coming out and transitioning is itself an identity restructuring; orientation labels update as part of that, without underlying attraction necessarily changing Consistent with the "I thought I was X, now I'm Y" pattern below; harder to distinguish from genuine attraction shift

In a given person, more than one of these is likely operating. They are not mutually exclusive, and disentangling them in real time is usually impossible. This page does not promise mechanism — orientation shift is a real trans-feminine experience whether or not its causes are ever cleanly isolated.

Why some people shift and others don't

There is no clear predictor in the literature. Pre-HRT orientation, age at transition, and dysphoria profile have all been examined and none reliably forecasts who will shift and in which direction. A meaningful fraction of trans-feminine people have entirely stable orientation across HRT — same attractions, same labels, no reorganization. This is also a normal outcome. Stable orientation is not evidence of suppressed shift; shift is not evidence of suppressed stability.

The honest framing for any trans-feminine person starting HRT is that orientation shift is a real possibility, not a certainty, and that there is no test that forecasts which side of that distribution they will land on.

Living through an orientation shift

Recognizing the shift early

Markers people commonly notice in real time:

  • Attraction patterns that previously felt clear feel less reliable.
  • A category of person not previously salient becomes salient.
  • The label that previously fit feels incrementally off.
  • Specific desires shift in texture even before the target shifts.
  • Pre-transition partner choices, in retrospect, start to read differently.

These are noticing-cues, not diagnoses. Sitting with the pattern over weeks or months — rather than relabeling on first signal — is usually the more useful posture, because the early HRT window is also the noisiest. Mood, libido, body, and self-perception are all moving simultaneously; an attraction signal in month four can read very differently by month nine.

Communicating it to a partner

If a partner exists, an orientation shift is also a disclosure event. The general principles in Coming Out & Relationships apply: disclosure as early as the trajectory is reasonably clear, with room for the partner's own grief and adjustment, with the recognition that the partner's reaction will not arrive on the same timeline as your processing.

The specific complication for orientation shift is that the partner is being asked to update their sense of the relationship's structure, not just their sense of you. That is qualitatively different from coming out as trans. A partner who absorbed the trans disclosure smoothly may have a much harder time with the orientation update — particularly if the new orientation reframes the relationship as one in which they are no longer the object of your attraction in the way they were before.

Identity-update work

The internal work tends to involve:

  • Re-sorting which attractions are recent, which are surfaced, which are unchanged.
  • Re-labeling if the old label no longer fits — or deciding that no new label fits and moving without one.
  • Re-narrating prior relationships in light of the updated orientation, especially long pre-transition relationships in which one's own attraction may now read differently in retrospect.

This work doesn't have to finish before life resumes. Many people carry it in parallel with dating, partnership, and ordinary social life. Treating orientation reorganization as a project that must conclude before any further relational decisions are made is usually neither necessary nor possible.

Returning to dating with a different orientation

Returning to dating after an orientation shift is functionally a second coming-out process, with its own dating-pool changes, disclosure scripts, and community re-orientation. See Dating & Partner Community for the community-ecosystem layer.

Direction of shift What the dating environment looks like
Toward men Trans-feminine-women-attracted-to-men dating environment, with its specific risks and chaser dynamics. Disclosure scripts skew toward early and explicit; safety practices are non-optional.
Toward women Queer-women's spaces, which have their own navigation work for trans women specifically. Inclusion varies sharply by city, scene, and generation.
Toward all genders Bi/pan and queer-mixed spaces, generally lighter category-line work; partner pools more accommodating of further orientation drift.
Toward none Question of which dating spaces — if any — to be visible in. Aro and ace community spaces exist and are reachable, but are not always trans-feminine-coded.

When the partner the shift affects is your spouse

This is the highest-stakes case. The partner is not navigating an abstract identity update; they are facing the possibility that the relationship's structure has changed underneath them. The literature on transition-related breakup applies here, with the additional load that the orientation shift adds a layer of "you are not attracted to me anymore" beyond "you are a different gender than I thought I was partnered with."

Survival of the marriage in this case turns on:

  • Whether the spouse's own orientation accommodates the new pattern.
  • Whether the attraction shift is total or partial — partial shifts (still attracted to the spouse, with a new direction added) are different from total shifts (no longer attracted to the spouse at all).
  • Whether the relationship has been structured on shared sexual orientation as a load-bearing element, or on other elements that survive the shift.
  • Whether both partners are willing to engage with the renegotiation rather than wait for it to settle on its own.

Trans-competent couples therapy — emphasis on couples therapy that knows the trans context, not just any couples therapy — is the standard recommendation in this case. Therapists who treat the orientation shift as itself the problem to be reversed are not trans-competent.

Asexuality and aromanticism

Definitions

  • Asexual (ace). Lacking sexual attraction to others, or experiencing it rarely or under narrow conditions. The spectrum includes gray-asexual and demisexual variants. Ace people may have or not have romantic attraction; may have or not have sex drive; may have or not have sex.
  • Aromantic (aro). Lacking romantic attraction to others, or experiencing it rarely or under narrow conditions. Aromanticism is independent of asexuality; aro people may be sexually attracted to others, and ace people may be romantically attracted to others.
  • The two axes are independent. Ace-aro, ace-alloromantic, allo-aro, and allo-alloromantic are all valid combinations.

The foundational asexuality work (Bogaert) treats ace as a stable orientation in the general population at roughly 1% prevalence; ace community vocabulary has since broadened to include the gray-area and demi variants, which capture people whose attraction patterns are real but rare or context-dependent.

Ace as identity, not symptom

There are trans-feminine ace people whose ace identity precedes HRT, survives HRT, and is not produced by HRT. Ace identity is not a side effect. Treating it as one is one of the more common errors in trans-feminine clinical care: a provider sees a trans-feminine patient on HRT with low or no sexual attraction, and pathologizes that as HRT-induced sexual dysfunction when the person experiences it as an integrated identity that pre-existed HRT entirely.

The diagnostic question is whether the person experiences her state as a problem. A person who is ace and content with being ace is not a candidate for treatment of "low libido."

Aro as identity, not symptom

Same structure. Aro identity can precede transition, survive transition, and be unrelated to HRT. Aromanticism is sometimes harder for clinicians and partners to register than asexuality — there is more cultural narrative for "not interested in sex" than for "not interested in romantic relationships" — but it is a legitimate identity, not a deficit. Aro trans-feminine people face the additional load that the dominant cultural narrative around transition often involves romantic partnership as the destination, which sits uneasily with aro identity without being a problem.

When ace and aro are present pre-HRT and remain post-HRT

The clean case. Pre-HRT identity, post-HRT identity, no shift. HRT may change sex drive, may change body, may change emotional texture, but ace or aro orientation persists. No clinical question to answer, and no relational question beyond the ones any ace or aro person navigates with partners and community.

When they emerge during HRT

Less clean. A person who was allosexual pre-HRT comes to identify as ace during HRT. Three plausible interpretations:

  • HRT-induced libido drop, not identity. Sexual desire dropped but attraction patterns are otherwise intact; given altered hormones or addressed underlying causes, attraction would return.
  • Ace identity surfaced by dysphoria relief. Pre-HRT attraction was performed under dysphoria load; post-HRT the underlying ace state became visible.
  • Genuine post-HRT identity emergence. New ace identity that did not pre-exist HRT, valid as identity regardless of mechanism.

The three are often hard to distinguish in real time. The dysfunction-vs-identity diagnostic below is the practical tool for sorting which framing fits.

Distinguishing from HRT-induced libido drop

Libido and attraction are related but distinct. HRT routinely lowers libido in trans-feminine people — this is well-documented and expected; see Sex on HRT. Lowered libido is not identical to lacking attraction. Some people on HRT report:

  • Lower frequency of sexual desire but the same pattern of attraction.
  • Lower intensity of sexual desire but ongoing romantic attraction.
  • Both lower libido and altered attraction structure.

A drop in how often you want sex is libido. A change in whether and to whom you experience sexual attraction is orientation. Ace identity is the latter, not the former. The two often co-occur on HRT, which is why the distinction needs to be made deliberately.

Low libido — dysfunction vs identity

When low libido is a complaint

The person experiences low libido as a problem. She wants it changed. She misses the libido she had pre-HRT or wants a libido she never had. This is a clinical complaint, and it is treatable — see Sexual Health Long-Term for the medical workup. Low estradiol, high SHBG with low free testosterone, thyroid issues, antidepressant side effects, sleep, and depression are all on the differential.

When it's a stable preference

The person experiences low libido as fine. The body is calmer. Sexual intrusiveness is gone. The state is preferred, not endured. This is not a dysfunction, regardless of whether it is statistically average. The diagnostic axis for sexual dysfunction is the person's own distress, not deviation from a population mean.

The "is this a problem?" diagnostic

The right marker is internal distress, not external pressure. The diagnostic questions:

  • Does she experience her libido state as a problem?
  • Would she want it changed if external pressures (partner expectation, social expectation, internalized scripts about what trans-feminine sexuality should look like) were removed?
  • Is the distress about the libido itself, or about its consequences in a specific relationship?

If the distress is internal and persistent, it's a complaint to investigate. If the distress is downstream of partner or social pressure, the clinical question is different — the libido state may be fine; what needs work may be the relationship or the script. This distinction is load-bearing for everything that follows: it determines whether the next step is a medical workup, a relationship conversation, or neither.

What the partner thinks vs what you think

A partner's distress about your low libido is real and matters in the relationship. It does not, however, make your low libido a dysfunction in you. The category error to avoid: pathologizing the trans-feminine person's sexual state because the partner wants it different. The relationship has a problem; the trans-feminine person may not.

This matters in clinical settings where a partner attends the appointment and frames the issue as "she has low libido" — the question to ask the trans-feminine patient privately is whether she experiences it that way. The answers are sometimes very different, and the treatment plan that follows from each is different.

When to investigate medically

Investigation is indicated when:

  • The person experiences her libido state as a complaint.
  • A previously-stable libido has changed in a way that distresses her.
  • There are co-occurring symptoms (mood, sleep, energy, cognitive) suggesting endocrine or systemic cause.
  • A medication change (SSRI, antiandrogen dose, estradiol formulation) is temporally linked to the change.

Investigation is not indicated when the person is content with the state and the only stakeholder is a partner. See Sexual Health Long-Term for the workup.

Sexual identity reconfiguration

"I thought I was X, now I might be Y"

The recognition pattern. Common variants in trans-feminine accounts: "I thought I was a straight man, now I'm a lesbian"; "I thought I was a gay man, now I'm a straight woman"; "I thought I was bi, now I think I'm mostly attracted to women"; "I thought I had a clear orientation, now I think I'm queer or fluid."

None of these statements are about being wrong before. They are about the fact that orientation labels were doing different work pre-transition and post-transition — describing different bodies, different social positions, and sometimes different underlying attraction structures.

The internal-vs-external timing mismatch

Felt orientation often shifts before the label updates. People describe months of mismatched experience — attractions reorganizing while the identity-label catches up. The reverse also happens: the label updates quickly while felt experience continues to be mixed. Neither is wrong; the label and the felt experience are different layers of the identity, and they update on different timescales.

The practical implication is that any single point-in-time self-report is a snapshot of an ongoing process. People who answer "what's your orientation now" in month six and again in month eighteen often give different answers, and the later answer is not necessarily more correct than the earlier one — it's a later snapshot.

Coming out about orientation while also being trans

Multi-stage coming out. A trans-feminine person who has already come out as trans may then come out as a lesbian, or as bi, or as queer, or as ace. Each stage has its own audience and its own response. People who absorbed the trans disclosure smoothly do not always absorb the orientation disclosure smoothly, especially if the new orientation contradicts a narrative they had built ("she came out as trans and is dating a man — at least that part makes sense to me").

This is a common landing point for family-of-origin friction even where trans disclosure went well, and it is one of the predictable second waves of family work. See Coming Out & Relationships for the disclosure framework — it applies recursively to orientation as well as to gender.

When orientation labels feel wrong altogether

Some trans-feminine people land on queer-as-default, fluid, or label-resistant. Reasons reported:

  • The standard labels were designed around cisgender configurations and don't translate cleanly to trans-feminine bodies and social positions.
  • Attraction patterns are too variable across time to anchor a single label.
  • Political or community framing — queer as a gesture toward refusing the taxonomy.
  • The labels that fit best are too granular for everyday social use.

Label-resistance is itself a kind of identity, not an absence of identity. Treating "I don't have a label" as evasion or confusion is the wrong reading, and clinicians or partners who push for a category answer are usually generating their own friction rather than surfacing real ambivalence.

Partner-side identity questions

A cis-straight man whose partner comes out as a trans woman attracted to women

What happens to his straight identity? Possible landing points:

  • He renegotiates as a man partnered with a woman in a configuration where he is not the object of her attraction in the way he was before — the relationship may continue without sexual intimacy or may end.
  • He stays partnered but the relationship category changes — companionate, co-parenting, structurally non-sexual.
  • He ends the relationship but his straight identity stays intact.

His straight identity was built around partnership with a person he understood as a woman attracted to him. That assumption has changed on two axes simultaneously, and neither axis is inside his control.

A cis-lesbian whose partner now is attracted to men

The mirror case with its own texture. If the trans-feminine partner is now attracted to men, the lesbian partner faces both the loss of her partner's sexual attention and a community-level question about the relationship's identity. Some couples in this position survive as non-sexual partnerships; some end; some renegotiate into open structures where the trans-feminine partner can pursue attraction to men while the relationship continues. The lesbian partner's own orientation is not in question; the relationship's configuration is.

Bi/pan/queer partners — usually less reconfiguration

Partners whose own orientation already accommodates multiple genders absorb the trans-feminine partner's orientation shift with less identity load. Their relationship may still need renegotiation, but their identity generally does not. This is one of the durable findings in the partner literature: pre-existing flexibility in the partner's own orientation is one of the strongest predictors of relationship survival through transition and through orientation shift.

Renegotiation rather than rupture

The pattern visible across cohorts is that many of these relationships can renegotiate rather than rupture, but renegotiation is active work. It typically requires:

  • Both people engaging with the change rather than waiting for it to settle.
  • A trans-competent couples therapist or comparable third-party container.
  • Honesty about whether the relationship's foundation was sexual, romantic, companionate, logistical, or some mix — and which parts survive the shift.
  • Time. The arc resembles the parental-acceptance arc: meaningful change measured in months and years, not weeks.

Some relationships should end; some can continue in altered form; very few continue unchanged. The framing "renegotiation, not rupture" is meant as a real third option, not a sentimental gesture — it requires the same deliberate work as either of the other outcomes.

Specific intersections

Ace + trans

Trans-feminine ace people are visible in trans community spaces but sometimes feel poorly served by both communities — trans community narratives that center sexual reclamation post-transition can feel alien; ace community spaces that don't center trans experience can feel incomplete. The intersection has its own slowly-growing literature and community vocabulary, and ace-trans-specific peer spaces exist online and in larger cities.

Aro + trans

Aro trans-feminine people face the additional load that the dominant cultural narrative around transition often involves romantic partnership as the destination — the "and then she met someone and they lived happily ever after" narrative arc. Aro identity sits uneasily with that narrative without being a problem. Aro-trans peer spaces are smaller than ace-trans spaces and harder to find, but exist.

Bi/pan + trans

The numerically larger intersection. A meaningful fraction of trans-feminine people identify as bi, pan, or queer post-HRT; bi/pan partner pools are also more accommodating of orientation shifts in their partners. The community navigation tends to be lighter than for orientations with stricter categorical lines, though it has its own texture (bi-erasure dynamics, pan-vs-bi label politics, the question of whether bi partner pools are actually as flexible in practice as in identity).

Queer-women community navigation post-shift

Trans-feminine people newly identifying as attracted to women face the specific dynamics of queer-women's spaces — including the ongoing contestation over trans-woman inclusion in lesbian-identified spaces. This varies sharply by city, scene, and generation. Some spaces are uniformly welcoming, some are uniformly hostile, most are mixed. The navigation is its own learning curve and one of the harder community-orientation tasks for trans-feminine people shifting toward women.

Queer-men community navigation post-shift

Trans-feminine people attracted to men navigate distinct spaces depending on whether they identify as straight women, as queer women attracted to men, or as something else. The dynamics differ from the queer-women case and have their own chaser-pattern and safety considerations — see Dating & Partner Community for the chaser typology and safety baseline.

When orientation shift causes distress

Internalized stigma about the new orientation

Some trans-feminine people who shift orientation on HRT find that the new orientation triggers internalized stigma they did not have to confront before. A person raised with strong anti-gay-male messaging who realizes on HRT that she is attracted to women may feel relief; a person raised similarly who realizes she is attracted to men may face old internalized material reactivating. Same person, same household of origin, different internalized load depending on the direction of shift. See Internalized Transphobia for the broader framework.

Religious and cultural context

Religious or cultural background that shaped the pre-transition orientation self-understanding does not always update at the same speed as the orientation does. People whose family or faith community had quietly accepted the trans disclosure may push back harder on the orientation disclosure if the new orientation contradicts the community's frame. This is a predictable second wave of family work, not a sign that the first round failed. The denomination and bridging-resource scaffolding in Coming Out & Relationships applies recursively.

When to bring it to a therapist

Indications:

  • Orientation shift is present, the new orientation is causing distress that does not lift over weeks.
  • Internalized stigma about the new orientation is interfering with functioning or with the ability to act on attraction.
  • A spouse or long-term partner relationship is in active renegotiation and the couple wants a third-party container.
  • The orientation question is tangled with the trans question in a way that solo processing isn't resolving.

Trans-competent affirming therapy is the relevant kind. Therapists who treat orientation shift on HRT as itself the problem to be reversed are not trans-competent. The WPATH Standards of Care v8 explicitly rejects orientation-change practices and identifies them as a form of conversion practice when applied to trans people; this rejection covers both attempts to change pre-HRT orientation and attempts to reverse post-HRT orientation shift.

What we don't know

Mechanism of orientation shift

The honest answer: mixed evidence for hormonal, social, and identity-related mechanisms; no clean isolation of any one. The neurobiological literature on hormone effects on attraction is suggestive rather than decisive. The social-context contribution is real but hard to quantify. The identity-reorganization contribution is real but methodologically hard to study. People who want a clean mechanistic story will not find one in the current literature.

Stability of post-HRT orientation

Longitudinal data is partial. Most cohort follow-ups extend two to five years, with diminishing returns past that. Whether orientations that shift in the first 6–18 months of HRT are stable at year ten and beyond is not well-characterized. Clinical observation suggests substantial stability once the early HRT window has closed, but this is not established at the level of the early-window literature.

Why some shift and others don't

No reliable predictor in the literature. Pre-HRT orientation, age, dysphoria profile, and relationship structure have all been examined; none reliably forecasts shift, direction, or magnitude. The honest framing for any trans-feminine person starting HRT remains: orientation shift is a real possibility, not a certainty, and there is no test that forecasts which side of that distribution she will land on.

Sources

Primary cohort and review literature

Secondary and cross-cohort references

  • Bogaert AF — foundational asexuality work (general-population prevalence and framing of ace identity).
  • Lawrence AA — clinical observations on orientation patterns in trans women.
  • Veale JF et al. — Canadian cohort observations on orientation distribution and shift in trans populations.
  • Meier SC et al. — orientation shifts in trans men, used here as a cross-cohort anchor that orientation change on cross-sex hormones is not a trans-feminine-only artifact.