The quality and satisfaction of romantic relationships in transgender people: A systematic review of the literature

Figures & data

Table 1. Eligibility criteria.

Category	Criteria
Study Population	Included: Transgender individuals Current or ex-partners of transgender individuals All races, ethnicities, and cultural groups Excluded: LGBT studies that do not describe transgender individuals as a separate category
Phenomena of Interest	Included: Articles examining romantic relationship quality and satisfaction Excluded: Articles focusing solely on sexual health or partner violence Articles examining relationships with any other family members
Setting / Context	All nations
Time period	Articles published from January 1966 to January 2020
Publication criteria	Included: Articles in print / peer reviewed literature Excluded: Articles in gray literature or non-peer-reviewed journals
Study design	Included: Qualitative and quantitative studies Excluded: Discussion papers Reviews or meta-analysis

Figure 1. Study selection process.

Table 2. Quantitative studies exploring relationship experiences for transgender individuals and their partners.

Authors	Country (Year)	Aims	Population / Sample	Methods / Tools	Main Finding(s)	MQ¹
Kins et al.	Belgium (2008)	To compare the level relationship satisfaction between CW partnered with TM and CW partnered with CM.	N = 18 9 CW in a stable relationship with TM (who had undergone SRS, relationships had started at various stages of the transition) and 9 CW partnered with CM. Relationship duration ranged from 1 – over 10 years. Age range: 24 -40 Average age: 31.78	Self-constructed questionnaire Maudsley Marital Questionnaire (MMQ) Bem Sex Role Inventory (BSRI)	No significant difference in relationship satisfaction between CW partnered with TM and CW partnered with CM. No association between length of relationship, number of children, stage of relationship (i.e. dating, cohabitating, married) with relationship satisfaction for both CW partnered with TM and CW partnered with CM.	*
Meier et al.	USA (2013)	To assess relationship stability through transition and explore associations between mental health symptomology, social support and relationship stability.	N = 593 TM, various stages of transition. No requirement for relationship status or experience. Age range: 18 – 71 Average age: 27	Demographics Relationship status question (MSPSS) (DASS)	Half of relationships are maintained through transition. For the relationships that were formed pre transition and were no longer, 54% ended due to transition. The length of time since transition (measured by length of time on testosterone) was significantly longer for those whose relationships ended than for those who maintained a relationship. Participants in good quality and stable relationships report fewer symptoms of depression and anxiety and have better support to buffer against mental health symptomology.	**
Gamarel et al.	USA (2014)	To examine how transgender-related discrimination and relationship stigma are associated with relationship quality and mental health for TW and their CM partners.	N = 382 (191 couples) TW partnered with CM for at least 3 months. Average length of relationship = 37.9 months. Average age: 37.12 years Age range: Not reported	Demographics Dyadic Adjustment Scale (DAS) – adapted by authors Relationship stigma	Level of perceived discrimination for TW and CM was inversely correlated with relationship quality (higher discrimination – lower relationship quality) Age of CM partner was associated with relationship quality for TW and CM. Financial hardship was associated with relationship quality for TW and CM.	***
Riggs et al.	Australia (2015)	To explore relationship experiences and satisfaction in past relationship and assess the impact of satisfaction in past relationships on current or future relationships.	N = 160 119 trans participants, 41 gender diverse participants Average age: 39.8 years Age range: Not reported	Demographic questionnaire Open-ended questions – developed by research team	Gender differences reported - TW were more likely than TM or gender diverse people to experience challenges in their romantic relationships. Lower satisfaction in past relationships was negatively correlated with lower satisfaction in current and future relationships for both TW and TM.	*
Gamarel et al.	USA (2019)	To explore level of relationship commitment and associated factors of interpersonal stigma and psychological distress for TG individuals and their partners.	N = 382 (191 couples) TW partnered with CM for at least 3 months. Average length of relationship = 37.9 months. Average age: 37.12 years Age range: Not reported	Adapted Commitment subscale of the Triangular Theory of Love Scale	No significant difference in level of relationship commitment between TW and CM partner. For TW in relationships, relationship commitment is associated with interpersonal stigma, depressive and anxious symptoms. Level of relationship commitment buffers the relationship between interpersonal stigma and mental health symptoms for TW No significant associations were found for partners between interpersonal stigma, psychological distress and relationship commitment.	***
Platt	USA (2020)	To identify factors that predict relationship commitment among partners of transgender individuals.	N = 137 CW partners of self-identified transgender individuals (TM, TW & GD - all stages of transition). Average length of relationship = 5.14 years. Average age: 35 years Age range: Not reported	Demographic questionnaire Investment Model Scale (IMS) Brief Resilience Scale (BRS) Gender Role Beliefs Scale – Short version (GRBS-S) Attitudes Toward Divorce Scale	Personal resilience and years in the relationship prior to transition were associated with relationship commitment. Personal resilience was positively correlated with relationship commitment i.e. those who reported higher personal resilience also reported higher relationship commitment. Years in the relationship prior to transition was negatively correlated with relationship commitment i.e. those who had been together longer before transition reported lower levels of relationship commitment. Personal resilience and years in relationship before transition were associated with relationship satisfaction. Relationship satisfaction mediated the association between personal resilience and years in relationship before transition with relationship commitment.	**

¹ MQ: Methodological Quality (Instrument adapted from CASP Checklist, 2013).

* Poor;

** Fair;

*** Good.

TG: Transgender; TW: Trans women; TM: Trans men; GD: Gender diverse individual; CW: Cis women; CM: Cis men.

Table 3. Qualitative studies exploring relationship experiences for transgender individuals and their partners.

Authors	Country (Year)	Aims	Population / Sample	Methods	Themes	Main Finding(s)	MQ
Hines	UK (2006)	To explore how TG individuals negotiate their relationships through transition with partners and children.	N = 3 2 TW, 1 TM at various stages of transition. All are in relationships and live with their partners. Ages: 30, 40, 70	Narrative – semi-structured interviews / case studies	Emotional honesty	Participants focused on the importance of emotional honesty in the relationship process in order to negotiate challenges and maintain high satisfaction within the relationship during transition.	*
Pfeffer	USA (2008)	To explore the impact of gender transition on body image and the relationship for the cisgender partner.	N = 5 5 CW, lesbian partners of TM. Partners are at various stages of transition and relationship length ranges from one year to 11 years. Age range: 20-50	In-depth semi-structured interviews	No themes reported	Partner’s body image is impacted during their TG partner’s transition through internalization of external society and cultural norms and messages. This generally results in a negative body image which in turn has an impact on sexual intimacy and the overall quality of the romantic relationship.	*
Joslin-Roher and Wheeler	USA (2009)	To examine the experiences of lesbian, bisexual, and queer identified partners of TM through the transition process.	N = 9 LGB identified partners of trans men, 5 CW, 1 TW, 3 identify as female / femme. 7 participants currently in relationship with TM, 2 participants no longer with TM. Length of relationships ranged 6 months to 4 years. Age range: 22 – 36	Semi-structured interviews	Impact of transition on identity Community Caretaking Peer support The relationship itself Mental health	The LGB partner experience is complex and includes both challenges and rewards. Major theme reported was the impact of transition on the quality and satisfaction of the relationship. This included different aspects within the relationship including emotional and physical caretaking, sexuality, coming out, and sexual partnership.	**
Alegria	USA (2010)	To describe the relational dynamics that help sustain relationships for TW and their CW partners following disclosure.	N = 34 17 TW and their CW partners. TW were in various different stages of transition. Relationship duration ranged from 3 to 44 years. Age range: 30-69	Interviews and surveys	Challenges faced by couples: Sexual identity Relationship uncertainty Transition-related decision making Public presentation. Activities for maintaining relationship: Communication Self-talk Networks Positivity Impression management Social activism	TG individuals and their partners reported challenges within their relationships due to sexual identity and relationship uncertainty, transition-related decision making and public presentation. Participants reported activities that help to maintain relationships include communication, self-talk, networks, positivity, impression management and social activism. Challenges negatively impacted relationship satisfaction but maintenance factors help to buffer against this impact, and thus improve satisfaction.	**
Iantaffi and Bockting	USA (2011)	To explore the influence of heteronormativity, the related concept of sexual legitimacy, and gender as a binary construct on relationships for TG individuals.	N = 131 131 transgender participants Part of larger quantitative study – only qualitative findings look at relationship quality. No additional information provided for the 131 sample for the interviews	Online interview –bulletin boards and chat room formats	Four major themes emerged: Fearful of rejection Discomfort about disclosure and body Binary construct Society expectations	Findings suggest the quality and satisfaction of relationships for TG individuals’ relationships is influenced by heteronormative discourses within society. The discourse effect sexual intimacy which in turns impacts on the individual’s satisfaction within the relationship.	*
Theron and Collier	South Africa (2013)	To explore the relationship between cisgender female partners and trans persons.	N = 8 CW, all partnered with TM. 7 participants were currently in a relationship with TG individual, one participant’s relationship had ended. Partners were at varying stages of transition. Age range: 25-55	Semi-structured interviews	Three major themes identified: Sense of self for partners- sexual orientation and identity Co-transitioning process for partners Family and community acceptance of the trans-cis relationship	Relationship experiences of female partners of trans masculine individuals are diverse. Partners reported no change in their sexual orientation, experiencing their own transitioning experience and varied responses when disclosing to their own social circle. All of these impacted on their own overall experiences and their satisfaction with the relationship.	**
Platt and Bolland	USA (2017)	To examine the nature of partner relationships for people who identify as trans*.	N = 38 21 TW, 17 TM, various stages of transition. Not all participants were in a relationship. Age range: 18 - 70	Semi-structured interviews using ‘The Trans* Intimate Partner Experience Interview’	Gender binary system Disclosure Intimacy Communication, compromise, work on the relationship Live an authentic life	The relationship experience for TG individuals can be complex and filled with both joys and challenges. Social support, intimacy within the relationship and the binary system have a major impact on relationship quality and satisfaction. The disclosure process can be complex within long-term relationship. Communication and openness can be helpful with the challenges faced due to the disclosure process and overall satisfaction within the relationship.	**
Platt and Bolland	USA (2018)	To explore the unique elements of the experiences of those who partner with TG individuals.	N =21 13 CW, 2 CM, 4 TG, 2 gender fluid partnered with a TG individual. Partners were either TW (n = 8), TM (n = 9) or gender fluid (n = 4) and various stages of transition. Relationships had started at varying points of the transition. Age range: 20 – 61	Semi-structured interviews	Intimacy Sexual orientation labels Safety concerns Isolation Gender spectrum	Partners experience considerable change in their lives and relationships as their TG partner transitions. Challenges are faced, in particular through changes in intimacy, potential changes to personal identity labels, safety concerns and feelings of isolation as the partner. However, facing these challenges brings positives with partners experiencing a new appreciation of the gender spectrum and developing their own identity. All of which impacts on the partner perception of the quality and satisfaction of their relationship.	**

* MQ: Methodological Quality (Instrument adapted from CASP Checklist, 2013 and COREQ-32, 2007).

* Poor;

** Fair;

*** Good.

TG: Transgender; TW: Trans women; TM: Trans men; CW: Cis women; CM: Cis men.