Development of a quality of life questionnaire for transgender individuals during hormone therapy (iTransQol)

Purpose Quality of life (QoL) is a complex term, including mental, physical and social health, and everyone's individual environment. While transgender individuals still often report lower QoL than other individuals, they can benefit substantially from gender affirming therapy. The aim of this study was to develop a questionnaire to determine QoL in transgender individuals during gender affirming hormone therapy (GAHT). Methods A multi-step questionnaire development process was performed. In phase 1, a list of key issues was established by reviewing relevant literature. In phase 2, n = 38 transgender individuals as well as n = 6 practitioners evaluated the questionnaire (iTransQoL) in terms of relevance, meaning, comprehensibility and redundancy. Psychometric testing of the questionnaire was performed in phase 3 with n = 40 transgender individuals. The external validity of the iTransQoL was tested by comparison with three validated health questionnaires. Results The exploratory factor analysis indicated an underlying four-factor solution. Psychometric testing showed acceptable to good overall reliability (alpha = 0.73-0.83) for the total score and the four subscales as well as good validity indices. Based on the results, a final version of the iTransQoL was established. Conclusion The iTransQoL is a reliable and valid tool to evaluate QoL of transgender individuals during GAHT.