111 research outputs found

    Health considerations for transgender women and remaining unknowns : a narrative review

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    Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address

    Neuroscience in transgender people : an update

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    Transgender persons identify with a gender different from the one they were assigned at birth. Although describing oneself as transgender is not a new phenomenon, media attention has lately been increasing exponentially, thanks to progressive changes in laws and change in societal attitudes. These changes also allow more people nowadays to (openly) identify as transgender and/or seek gender-affirming treatment. However, simultaneously, not much is presently understood about the underlying neurobiology, and specifically the brain structure and brain function of transgender persons. One major question in neuroimaging and neuroscience has been to determine whether, at the brain level, transgender people resemble more their gender identity, their sex assigned at birth, or have a unique neural profile. Although the evidence is presently inconsistent, it suggests that while the brain structure, at least before hormonal treatment, is more similar to sex assigned at birth, it may shift with hormonal treatment. By contrast, on “sex-stereotypical tasks,” brain function may already be more similar to gender identity in transgender persons, also before receiving gender-affirming hormone treatment. However, studies continue to be limited by small sample sizes and new initiatives are needed to further elucidate the neurobiology of a ‘brain gender’ (sex-dimorphic change according to one’s gender).Transgender-Personen identifizieren sich mit einem anderen Geschlecht als dem bei der Geburt zugewiesenen. Obwohl Menschen, die sich mit einem anderen Geschlecht identifizieren, kein neues Phänomen sind, so ist die mediale Aufmerksamkeit in den letzten Jahren diesbezüglich exponentiell gestiegen. Dies ist auch den gesetzlichen Verbesserungen und einer Veränderung in der gesellschaftlichen Einstellung zu dem Thema zu verdanken. Zur gleichen Zeit aber weiß man noch nicht viel über die Gehirnstruktur und Gehirnfunktion bei transgender Menschen. Eine Hauptfrage in den Neurowissenschaften ist es, ob die Gehirne von Transgender-Personen jenen ähneln des Geschlechtes, dem sie bei der Geburt zugewiesen wurden, des Geschlechtes mit dem sie sich identifizieren, oder ob sie ein unabhängiges neuronales Profil aufzeigen. Obwohl die Befunde derzeit widersprüchlich sind, zeigen sie in die Richtung, dass sich die Gehirnstruktur vor der hormonellen Behandlung nur unwesentlich verändert. Auf der anderen Seite gleicht die neuronale Aktivität bei “geschlechtstypischen Aufgaben” von Transgender-Personen der neuronalen Aktivität ihres identifizierten Geschlechts (auch schon vor der Hormonbehandlung). Trotzdem sind Studien weiterhin limitiert, da sie oft mit kleinen Stichproben auskommen müssen und neue Initiativen zur Bestätigung der ersten Befunde nötig sind

    The Effects of Testosterone on the Brain of Transgender Men

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    Transgender men (TM) experience an incongruence between the female sex assigned when they were born and their self-perceived male identity. Some TM seek for a gender affirming hormone treatment (GAHT) to induce a somatic transition from female to male through continuous administration of testosterone. GAHT seems to be relatively safe. However, testosterone produces structural changes in the brain as detected by quantitative magnetic resonance imaging. Mainly, it induces an increase in cortical volume and thickness and subcortical structural volume probably due to the anabolic effects. Animal models, specifically developed to test the anabolic hypothesis, suggest that testosterone and estradiol, its aromatized metabolite, participate in the control of astrocyte water trafficking, thereby controlling brain volume

    Morphological Differences in Adolescent Female to Male Transsexuals before Cross-Hormone Treatment

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    Early-onset gender identity disorder (EO-GID) describes a strong and persistent development of cross-gender identification. Using structural magnetic resonance imaging (sMRI) and blood samples, we studied 13 female to male patients with EO-GID and compared them to 11 biological female controls. We found that the EO-GID group in comparison to its control group showed several significant differences in regional brain volumes. These include an increase in cerebral gray matter and a decrease in volume of cerebellar white matter in the mid anterior and posterior part of the corpus callosum. Furthermore, we showed statistically significant relationships between hormone levels and regional brain volume. These include relationships between the free thyroid hormone thyroxine (T4) and volumes of the frontal lobe, the temporal lobe and cerebral white matter; between sex-hormone binding globulin (SHGB) and the frontal lobe; as well as between thyroid-stimulating hormone (TSH) and cerebral gray matter. The results of regression analyses indicate that brain volume (outcome variables) decreases with the lower thyroid hormone levels (predictor variables). We propose that abnormal hormonal development of thyroid hormones influences white matter volume in our EO-GID group. Such an abnormal development further might affect both structural and functional properties of the brain

    Brain network interactions in transgender individuals with gender incongruence

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    Functional brain organization in transgender persons remains unclear. Our aims were to investigate global and regional connectivity differences within functional networks in transwomen and transmen with early-in-life onset gender incongruence; and to test the consistency of two available hypotheses that attempted to explain gender variants: (i) a neurodevelopmental cortical hypothesis that suggests the existence of different brain phenotypes based on structural MRI data and genes polymorphisms of sex hormone receptors; (ii) a functional-based hypothesis in relation to regions involved in the own body perception. T2*-weighted images in a 3-T MRI were obtained from 29 transmen and 17 transwomen as well as 22 cisgender women and 19 cisgender men. Restingstate independent component analysis, seed-to-seed functional network and graph theory analyses were performed. Transmen, transwomen, and cisgender women had decreased connectivity compared with cisgender men in superior parietal regions, as part of the salience (SN) and the executive control (ECN) networks. Transmen also had weaker connectivity compared with cisgender men between intra-SN regions and weaker inter-network connectivity between regions of the SN, the default mode network (DMN), the ECN and the sensorimotor network. Transwomen had lower small-worldness, modularity and clustering coefficient than cisgender men. There were no differences among transmen, transwomen, and ciswomen. Together these results underline the importance of the SN interacting with DMN, ECN, and sensorimotor networks in transmen, involving regions of the entire brain with a frontal predominance. Reduced global connectivity graph-theoretical measures were a characteristic of transwomen. It is proposed that the interaction between networks is a keystone in building a gendered self. Finally, our findings suggest that both proposed hypotheses are complementary in explaining brain differences between gender variants

    Resting-State Functional Connectivity in Youth With Gender Dysphoria

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    Current developmental models of gender identity and gender dysphoria (GD) lack sex-specific profiles of brain function that differentiate between typically-developing and cross-gender identified youth, as postulated by models like the unified theory of the origins of sex differences (Arnold, 2009) and the neurobiological theory of the origins of transsexuality (Swaab & Garcia-Falgueras, 2009). Previously, investigators have used brain imaging modalities such as Resting-State functional Magnetic Resonance Imaging (R-fMRI) to demonstrate differences in resting-state functional connectivity (RSFC) between typically-developing male and female youth, and between typically-developing and GID-diagnosed youth. In the present pilot study, I used R-fMRI to investigate differences in RSFC between typically-developing and cross-gender identified male and female youth subgroups, with the hypothesis that GID-diagnosed subgroups would demonstrate connectivity patterns in between those of typically-developing males and females. Eleven youth diagnosed with gender identity disorder (four males, ages 9 to 20 years; seven females, ages 12 to 20 years) were matched on age and assigned gender with 11 typically-developing youth. All participants completed written informed consent to undergo the IRB-approved research procedures. R-fMRI were collected while the participants were lying down and resting, with their eyes closed. Primary analyses focused on 14 brain regions selected because they showed sex differences most frequently or reliably in previous studies of R-fMRI in typically-developing youth. Statistical analysis used a 2 x 2 mixed effects analysis (assigned female versus assigned male x typically-developing versus GID-diagnosed), with-individual level connectivity maps as the dependent variable. Results showed that significant interaction effects of functional connectivity patterns were associated with 6 of the 14 selected brain regions. GID-diagnosed assigned females exhibited connectivity patterns similar to those of typically-developing males associated with the right medial superior frontal gyrus, right supplementary motor area, left lingual gyrus, right lingual gyrus, left middle frontal gyrus, left medial superior frontal gyrus, left cuneus, right thalamus, left dorsolateral superior frontal gyrus, and left inferior frontal gyrus, triangular part. GID-diagnosed assigned males exhibited functional connectivity patterns similar to those of typically-developing females associated with the right medial superior frontal gyrus and right supplementary motor area; in between those of typically-developing females and males associated with left lingual gyrus, right lingual gyrus, left middle frontal gyrus, left medial superior frontal gyrus, right medial superior frontal gyrus, left dorsolateral superior frontal gyrus, and left inferior frontal gyrus, triangular part; and similar to typically-developing males associated with the right lingual gyrus and left middle frontal gyrus. The right precuneus, hypothesized to show robust findings, did not reveal any effects. In the current study, GID-diagnosed assigned males tended toward demasculinized effects (quantitative interactions showing differences of magnitude), whereas GID-diagnosed assigned females tended toward masculinized effects (qualitative interactions showing differences in direction of correlation). The current findings support the view that brain development associated with gender dysphoria proceeds along separate but overlapping sex-related regions for GID-diagnosed assigned females and males and provide further evidence of greater cross-gender brain differentiation in assigned females at an earlier age than in assigned males (possibly due to earlier onset of puberty in females). These data suggest that any future use of patterns of brain function for diagnosing gender dysphoria may require separate criteria (e.g., different sets of brain regions) for assigned males and assigned females but will require replication on larger samples
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