"Several studies demonstrate a decrease in sexual desire after initiation of estrogen and antiandrogen medications. Prevalence of low sexual desire ranged from 32% to 73%, but the percentage of those experiencing distress from low sexual desire or hypoactive sexual desire disorder (HSDD) was 22% in a study of 214 trans women after medical and surgical affirmation. This distress associated with low sexual desire is a key marker for HSDD, a diagnosis often paired with depression."