JMIR Publications

ABSTRACT

Background:

Gender dysphoria is associated with impaired functioning, reduced quality of life, psychiatric symptoms, and increased healthcare needs. Although gender-affirming care is increasingly provided, long-term outcomes remain insufficiently studied, particularly in prospective designs integrating self-reported, clinical, registry-based, and qualitative data.

Objective:

The GLOW study aims to investigate long-term psychosocial, functional, and medical outcomes among adults referred for gender dysphoria assessment within Swedish National Highly Specialized Care. The primary aim is to examine longitudinal changes in functional disability. Secondary aims are to assess quality of life, gender congruence, psychiatric symptoms, substance use, self-concept clarity, personality functioning, healthcare utilization, work-related outcomes, mortality, and lived experiences of gender-affirming healthcare.

Methods:

GLOW is a prospective longitudinal mixed-methods cohort study conducted at National Highly Specialized Care clinics for gender dysphoria in Region Skåne and Region Östergötland, Sweden. Approximately 500 adults referred for gender dysphoria assessment between 2026 and 2028 will be included. Self-report data will be collected at baseline, end of clinical assessment, and at 24 and 60 months. The primary outcome is functional disability measured with the World Health Organization Disability Assessment Schedule 2.0. Secondary outcomes include health-related quality of life, gender congruence, depressive and anxiety symptoms, substance use, self-concept and identity, personality functioning, interoceptive awareness, and autism spectrum traits. Medical record and national registry data will be used to assess diagnoses, medication use, healthcare utilization, work capacity, sociodemographic outcomes, and mortality. Semi-structured interviews will be conducted with 25–40 participants.

Results:

The study will generate longitudinal evidence on trajectories of functioning, mental health, quality of life, gender congruence, healthcare use, work-related outcomes, and lived experiences among adults undergoing gender dysphoria assessment and gender-affirming care.

Conclusions:

GLOW will provide comprehensive evidence on long-term outcomes of gender-affirming care in a Swedish specialized healthcare context and may inform clinical practice, healthcare planning, and future research. Clinical Trial: The GLOW study is a prospective longitudinal mixed-methods cohort study conducted at the National Highly Specialized Care Clinic for Gender Dysphoria in Region Skåne, and Linköpring, Sweden. Ethical approval was granted by the Swedish Ethical Review Authority (Dnr: 2024-07577-02, 2025-06297-02). The study will be conducted in accordance with the Declaration of Helsinki and applicable Swedish regulations on research ethics, data protection, and processing of personal data. The study is preregistryed at ClinicaTtrials.gov: NCT07480590). Findings will be disseminated via journals, policy briefs, and through patient advocacy organizations.