Instrumentos de avaliação da qualidade de vida em pessoas transgênero em terapia hormonal: uma revisão integrativa

Abstract

INTRODUCTION: The transgender population faces challenges across physical, mental, and social health dimensions, often exacerbated by marginalization contexts and the lack of effective public policies. Assessing their quality of life and health status requires instruments sensitive to their specific characteristics. There is no consolidated diagnosis of quality of life in the transgender population. OBJECTIVES: To analyze the instruments used to assess health and quality of life in transgender populations regarding their intended use, frequency, scope, and psychometric validity. METHOD: An integrative review was conducted in the PubMed database using the combined descriptors: ((indicators of quality of life) OR (quality of life)) AND ((transsexualism) OR (transsexuality) OR (gender dysphoria) OR (transgender persons) OR (transgender people) OR (gender minorities)) AND ((survey) OR (questionnaires)). Studies published between 1996 and 2025 in English, Spanish, and Portuguese were included, focusing on the application or validation of instruments in transgender populations. Qualitative studies without instruments, tangential approaches, and works with insufficient methodological description were excluded. RESULTS: Of the 362 studies identified, 300 were included. Among these, 139 (46.3%) applied structured instruments and 9 (6.5%) performed psychometric evaluation. Within the analyzed studies, 26.3% assessed quality of life, 12% assessed postoperative quality of life, and 8.7% assessed mental health. Instruments for population research (2.7%), healthcare access (2.3%), discrimination and rights (2.3%), and health education (1%) were also identified. The most commonly used instruments were SF-36, SF-12, WHOQOL-BREF, and specific scales such as TCS and GMSR. Only 9 studies reported full psychometric validation procedures. There was a predominance of studies from high-income countries such as the United States, Canada, and the United Kingdom, with a focus on binary transgender adults. There was a scarcity of studies involving travestis, non-binary individuals, and Global South populations. DISCUSSION AND CONCLUSIONS: Despite the growing scientific output on transgender populations, few studies have applied psychometrically robust validated instruments. The predominance of generic scales and the lack of culturally sensitive tools limit their clinical applicability. There is a shortage of validation studies in non-hegemonic contexts and among diverse identity subgroups. This review provides a consolidated overview of the instruments used but also highlights the need to examine to what extent these tools capture the lived experiences of transgender individuals. This methodological gap represents an ethical and epistemic challenge: integrating cultural and identity validity criteria into scientific health assessment. The development of new instruments and the critical adaptation of existing scales are recommended, with active participation of transgender communities, to align psychometric validity with experiential relevance. Palavras-chave: Pessoas transgênero; Qualidade de vida; Instrumentos de avaliação; Saúde pública.