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Klöbl M, Reed MB, Handschuh P, Kaufmann U, Konadu ME, Ritter V, Spurny-Dworak B, Kranz GS, Lanzenberger R, Spies M. Gender Dysphoria and Sexual Euphoria: A Bayesian Perspective on the Influence of Gender-Affirming Hormone Therapy on Sexual Arousal. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1859-1871. [PMID: 38216784 PMCID: PMC11106106 DOI: 10.1007/s10508-023-02778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
Self-reported sexual orientation of transgender individuals occasionally changes over transition. Using functional magnetic resonance imaging, we tested the hypothesis that neural and behavioral patterns of sexual arousal in transgender individuals would shift from the assigned to the experienced gender (e.g., trans women's responses becoming more dissimilar to those of cis men and more similar to those of cis women). To this aim, trans women (N = 12) and trans men (N = 20) as well as cisgender women (N = 24) and cisgender men (N = 14) rated visual stimuli showing male-female, female-female or male-male intercourse for sexual arousal before and after four months of gender-affirming hormone therapy. A Bayesian framework allowed us to incorporate previous behavioral findings. The hypothesized changes could indeed be observed in the behavioral responses with the strongest results for trans men and female-female scenes. Activation of the ventral striatum supported our hypothesis only for female-female scenes in trans women. The respective application or depletion of androgens in trans men and trans women might partly explain this observation. The prominent role of female-female stimuli might be based on the differential responses they elicit in cis women and men or, in theory, the controversial concept of autogynephilia. We show that correlates of sexual arousal in transgender individuals might change in the direction of the experienced gender. Future investigations should elucidate the mechanistic role of sex hormones and the cause of the differential neural and behavioral findings.The study was registered at ClinicalTrials.gov (NCT02715232), March 22, 2016.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Murray Bruce Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Patricia Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Melisande Elisabeth Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Vera Ritter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Benjamin Spurny-Dworak
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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2
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Thurston LT, Skorska MN, Lobaugh NJ, Zucker KJ, Chakravarty MM, Lai MC, Chavez S, VanderLaan DP. White matter microstructure in transmasculine and cisgender adolescents: A multiparametric and multivariate study. PLoS One 2024; 19:e0300139. [PMID: 38470896 DOI: 10.1371/journal.pone.0300139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Adolescence is a sensitive developmental period for neural sex/gender differentiation. The present study used multiparametric mapping to better characterize adolescent white matter (WM) microstructure. WM microstructure was investigated using diffusion tensor indices (fractional anisotropy; mean, radial, and axial diffusivity [AD]) and quantitative T1 relaxometry (T1) in hormone therapy naïve adolescent cisgender girls, cisgender boys, and transgender boys (i.e., assigned female at birth and diagnosed with gender dysphoria). Diffusion indices were first analyzed for group differences using tract-based spatial statistics, which revealed a group difference in AD. Thus, two multiparametric and multivariate analyses assessed AD in conjunction with T1 relaxation time, and with respect to developmental proxy variables (i.e., age, serum estradiol, pubertal development, sexual attraction) thought to be relevant to adolescent brain development. The multivariate analyses showed a shared pattern between AD and T1 such that higher AD was associated with longer T1, and AD and T1 strongly related to all five developmental variables in cisgender boys (10 significant correlations, r range: 0.21-0.73). There were fewer significant correlations between the brain and developmental variables in cisgender girls (three correlations, r range: -0.54-0.54) and transgender boys (two correlations, r range: -0.59-0.77). Specifically, AD related to direction of sexual attraction (i.e., gynephilia, androphilia) in all groups, and T1 related to estradiol inversely in cisgender boys compared with transgender boys. These brain patterns may be indicative of less myelination and tissue density in cisgender boys, which corroborates other reports of protracted WM development in cisgender boys. Further, these findings highlight the importance of considering developmental trajectory when assessing the subtleties of neural structure associated with variations in sex, gender, and sexual attraction.
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Affiliation(s)
- Lindsey T Thurston
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Malvina N Skorska
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nancy J Lobaugh
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth J Zucker
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Ontario, Canada
| | - Meng-Chuan Lai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Sofia Chavez
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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3
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Torgerson C, Ahmadi H, Choupan J, Fan CC, Blosnich JR, Herting MM. Sex, gender diversity, and brain structure in children ages 9 to 11 years old. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.28.551036. [PMID: 37546960 PMCID: PMC10402171 DOI: 10.1101/2023.07.28.551036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
There remains little consensus about the relationship between sex and brain structure, particularly in childhood. Moreover, few pediatric neuroimaging studies have analyzed both sex and gender as variables of interest - many of which included small sample sizes and relied on binary definitions of gender. The current study examined gender diversity with a continuous felt-gender score and categorized sex based on X and Y allele frequency in a large sample of children ages 9-11 years-old (N=7693). Then, a statistical model-building approach was employed to determine whether gender diversity and sex independently or jointly relate to brain morphology, including subcortical volume, cortical thickness, gyrification, and white matter microstructure. The model with sex, but not gender diversity, was the best-fitting model in 75% of gray matter regions and 79% of white matter regions examined. The addition of gender to the sex model explained significantly more variance than sex alone with regard to bilateral cerebellum volume, left precentral cortical thickness, as well as gyrification in the right superior frontal gyrus, right parahippocampal gyrus, and several regions in the left parietal lobe. For mean diffusivity in the left uncinate fasciculus, the model with sex, gender, and their interaction captured the most variance. Nonetheless, the magnitude of variance accounted for by sex was small in all cases and felt-gender score was not a significant predictor on its own for any white or gray matter regions examined. Overall, these findings demonstrate that at ages 9-11 years-old, sex accounts for a small proportion of variance in brain structure, while gender diversity is not directly associated with neurostructural diversity.
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Affiliation(s)
- Carinna Torgerson
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Hedyeh Ahmadi
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jeiran Choupan
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Chun Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Radiology, School of Medicine, University of California, San Diego
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Megan M. Herting
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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4
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Reed MB, Handschuh PA, Klöbl M, Konadu ME, Kaufmann U, Hahn A, Kranz GS, Spies M, Lanzenberger R. The influence of sex steroid treatment on insular connectivity in gender dysphoria. Psychoneuroendocrinology 2023; 155:106336. [PMID: 37499299 DOI: 10.1016/j.psyneuen.2023.106336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Sex-specific differences in brain connectivity were found in various neuroimaging studies, though little is known about sex steroid effects on insular functioning. Based on well-characterized sex differences in emotion regulation, interoception and higher-level cognition, gender-dysphoric individuals receiving gender-affirming hormone therapy represent an interesting cohort to investigate how sex hormones might influence insular connectivity and related brain functions. METHODS To analyze the potential effect of sex steroids on insular connectivity at rest, 11 transgender women, 14 transgender men, 20 cisgender women, and 11 cisgender men were recruited. All participants underwent two magnetic resonance imaging sessions involving resting-state acquisitions separated by a median time period of 4.5 months and also completed the Bermond-Vorst alexithymia questionnaire at the initial and final examination. Between scans, transgender subjects received gender-affirming hormone therapy. RESULTS A seed based functional connectivity analysis revealed a significant 2-way interaction effect of group-by-time between right insula, cingulum, left middle frontal gyrus and left angular gyrus. Post-hoc tests demonstrated an increase in connectivity for transgender women when compared to cisgender men. Furthermore, spectral dynamic causal modelling showed reduced effective connectivity from the posterior cingulum and left angular gyrus to the left middle frontal gyrus as well as from the right insula to the left middle frontal gyrus. Alexithymia changes were found after gender-affirming hormone therapy for transgender women in both fantasizing and identifying. CONCLUSION These findings suggest a considerable influence of estrogen administration and androgen suppression on brain networks implicated in interoception, own-body perception and higher-level cognition.
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Affiliation(s)
- Murray B Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Patricia A Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Melisande E Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
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5
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Skorska MN, Thurston LT, Biasin JM, Devenyi GA, Zucker KJ, Chakravarty MM, Lai MC, VanderLaan DP. Cortical Structure Differences in Relation to Age, Sexual Attractions, and Gender Dysphoria in Adolescents: An Examination of Mean Diffusivity and T1 Relaxation Time. Brain Sci 2023; 13:963. [PMID: 37371441 PMCID: PMC10296103 DOI: 10.3390/brainsci13060963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Recent research found that the combination of masculine gender identity and gynephilia was associated with cortical T1 relaxation time, which is considered to reflect gray matter density. We hypothesized that mean diffusivity (MD), a diffusion tensor imaging metric that reflects the degree to which water movement is free versus constrained, in combination with T1 relaxation time would provide further insight regarding cortical tissue characteristics. MD and T1 relaxation time were measured in 76 cortical regions in 15 adolescents assigned female at birth who experience gender dysphoria (GD AFAB) and were not receiving hormone therapy, 17 cisgender girls, and 14 cisgender boys (ages 12-17 years). Sexual orientation was represented by the degree of androphilia-gynephilia and the strength of sexual attraction. In multivariate analyses, cortical T1 relaxation time showed a weak but statistically significant positive association with MD across the cortex, suggesting that macromolecule-rich cortical tissue also tends to show water movement that is somewhat more constrained. In further multivariate analyses, in several left frontal, parietal, and temporal regions, the combination of shorter T1 relaxation time and faster MD was associated with older age and greater gynephilia in GD AFAB individuals and cisgender boys and with stronger attractions in cisgender boys only. Thus, for these cortical regions in these groups, older age, gynephilia, and stronger attractions (cisgender boys only) were associated with macromolecule-rich tissue in which water movement was freer-a pattern that some prior research suggests is associated with greater cell density and size. Overall, this study indicates that investigating T1 relaxation time and MD together can further inform how cortical gray matter tissue characteristics relate to age and psychosexuality.
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Affiliation(s)
- Malvina N. Skorska
- Child & Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (M.N.S.)
| | - Lindsey T. Thurston
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Jessica M. Biasin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Gabriel A. Devenyi
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada (M.M.C.)
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada
| | - Kenneth J. Zucker
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - M. Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada (M.M.C.)
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada
- Department of Biological and Biomedical Engineering, McGill University, Montreal, QC H3A 2B4, Canada
| | - Meng-Chuan Lai
- Child & Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (M.N.S.)
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei 100229, Taiwan
| | - Doug P. VanderLaan
- Child & Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (M.N.S.)
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
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6
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The Impact of Gender-affirming Hormone Therapy on Anatomic Structures of the Brain Among Transgender Individuals. J Psychiatr Pract 2022; 28:328-334. [PMID: 35797690 DOI: 10.1097/pra.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the growing numbers of individuals who identify as transgender, this population continues to face worse mental health outcomes compared with the general population. Transgender individuals attempt suicide at a rate that is almost 9 times that of the general population. Few studies have reported on the positive effect of gender-affirming hormone therapy on mental health outcomes in transgender individuals. It is likely that this effect is due in part to the physiological responses that occur as a result of hormone therapy that mitigate incongruencies between one's gender identity and assigned sex. To our knowledge, only limited studies have shown a connection between gender-affirming hormone therapy, its effect on the brain's structure, and long-term effects that this may have on mental health outcomes. The authors propose that, in addition to the physiological responses that occur as a direct result of hormone therapy and the validation that results from receiving gender-affirming medical care, mental health outcomes in transgender individuals may also improve due to the role that hormone therapy plays in altering the brain's structure, possibly shaping the brain to become more like that of the gender with which an individual identifies. In this article, the authors review the current literature on the effects that gender-affirming hormone therapy has on mental health outcomes and anatomic structures of the brain in transgender individuals.
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7
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McManus E, Haroon H, Duncan NW, Elliott R, Muhlert N. The effects of stress across the lifespan on the brain, cognition and mental health: A UK biobank study. Neurobiol Stress 2022; 18:100447. [PMID: 35685679 PMCID: PMC9170771 DOI: 10.1016/j.ynstr.2022.100447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 12/05/2022] Open
Abstract
Repeated overstimulation of the stress response system, caused by exposure to prolonged highly stressful experiences, is thought to affect brain structure, cognitive ability, and mental health. We tested the effects of highly stressful experiences during childhood and adulthood using data from the UK Biobank, a large-scale national health and biomedical study with over 500,000 participants. To do this, we defined four groups with high or low levels of childhood and/or adulthood stress. We then used T1-and diffusion-weighted MRI data to assess the macrostructure of grey matter and microstructure of white matter within limbic brain regions, commonly associated with the stress response. We also compared executive function and working memory between these groups. Our findings suggest that in females, higher levels of Childhood stress were associated with reduced connectivity within the posterior thalamic radiation and cingulum of the hippocampus. In males however, higher levels of Adulthood stress is associated with similar changes in brain microstructure in the posterior thalamic radiation and cingulum of the hippocampus. High stress in Childhood and Adulthood was associated with decreases in executive function and working memory in both males and females. Stress across the lifespan was also positively associated with the number of diagnosed mental health problems, with a stronger effect in females than in males. Finally, our findings also suggest that cognitive and mental health outcomes due to stress may be mediated by the sex specific stress related changes in brain microstructure. Together our findings demonstrate clear links between stress at distinct phases of the lifespan, changes in measures of brain microstructure, impairments in cognitive abilities and negative mental health outcomes.
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Affiliation(s)
- Elizabeth McManus
- The University of Manchester, Division of Neuroscience & Experimental Psychology, UK
| | - Hamied Haroon
- The University of Manchester, Division of Neuroscience & Experimental Psychology, UK
| | - Niall W. Duncan
- Taipei Medical University, Graduate Institute of Mind Brain and Consciousness, Taiwan
| | - Rebecca Elliott
- The University of Manchester, Division of Neuroscience & Experimental Psychology, UK
| | - Nils Muhlert
- The University of Manchester, Division of Neuroscience & Experimental Psychology, UK
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8
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Spurny-Dworak B, Handschuh P, Spies M, Kaufmann U, Seiger R, Klöbl M, Konadu ME, Reed MB, Ritter V, Baldinger-Melich P, Bogner W, Kranz GS, Lanzenberger R. Effects of sex hormones on brain GABA and glutamate levels in a cis- and transgender cohort. Psychoneuroendocrinology 2022; 138:105683. [PMID: 35176535 DOI: 10.1016/j.psyneuen.2022.105683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 01/23/2023]
Abstract
Sex hormones affect the GABAergic and glutamatergic neurotransmitter system as demonstrated in animal studies. However, human research has mostly been correlational in nature. Here, we aimed at substantiating causal interpretations of the interaction between sex hormones and neurotransmitter function by using magnetic resonance spectroscopy imaging (MRSI) to study the effect of gender-affirming hormone treatment (GHT) in transgender individuals. Fifteen trans men (TM) with a DSM-5 diagnosis of gender dysphoria, undergoing GHT, and 15 age-matched cisgender women (CW), receiving no therapy, underwent MRSI before and after at least 12 weeks. Additionally, sex differences in neurotransmitter levels were evaluated in an independent sample of 80 cisgender men and 79 cisgender women. Mean GABA+ (combination of GABA and macromolecules) and Glx (combination of glutamate and glutamine) ratios to total creatine (GABA+/tCr, Glx/tCr) were calculated in five predefined regions-of-interest (hippocampus, insula, pallidum, putamen and thalamus). Linear mixed models analysis revealed a significant measurement by gender identity effect (pcorr. = 0.048) for GABA+/tCr ratios in the hippocampus, with the TM cohort showing decreased GABA+/tCr levels after GHT compared to CW. Moreover, analysis of covariance showed a significant sex difference in insula GABA+/tCr ratios (pcorr. = 0.049), indicating elevated GABA levels in cisgender women compared to cisgender men. Our study demonstrates GHT treatment-induced GABA+/tCr reductions in the hippocampus, indicating hormone receptor activation on GABAergic cells and testosterone-induced neuroplastic processes within the hippocampus. Moreover, elevated GABA levels in the female compared to the male insula highlight the importance of including sex as factor in future MRS studies. DATA AVAILABILITY STATEMENT: Due to data protection laws processed data is available from the authors upon reasonable request. Please contact rupert.lanzenberger@meduniwien.ac.at with any questions or requests.
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Affiliation(s)
- B Spurny-Dworak
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - P Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - M Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - U Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - R Seiger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - M Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - M E Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - M B Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - V Ritter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - P Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - W Bogner
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Austria
| | - G S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - R Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
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9
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Zubiaurre-Elorza L, Cerdán S, Uribe C, Pérez-Laso C, Marcos A, Rodríguez del Cerro MC, Fernandez R, Pásaro E, Guillamon A. The Effects of Testosterone on the Brain of Transgender Men. ANDROGENS: CLINICAL RESEARCH AND THERAPEUTICS 2021; 2:252-260. [PMID: 35024694 PMCID: PMC8744429 DOI: 10.1089/andro.2021.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- Leire Zubiaurre-Elorza
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Sebastian Cerdán
- Instituto de Investigaciones Biomédicas Alberto Sols, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Carme Uribe
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Carmen Pérez-Laso
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Alberto Marcos
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | | | - Rosa Fernandez
- Departamento de Psicología, Facultade de Ciencias da Educación, Universidade da Coruña, A Coruña, Spain
| | - Eduardo Pásaro
- Departamento de Psicología, Facultade de Ciencias da Educación, Universidade da Coruña, A Coruña, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
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10
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Beehuspoteea N, Badrakalimuthu VR. Dementia in transgender population: case vignette. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2021. [DOI: 10.1002/pnp.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nirja Beehuspoteea
- Dr Beehuspoteea is ST5 Registrar in Old Age Psychiatry, South London and Maudsley NHS Foundation Trust, Lambeth Hospital, London
| | - Vellingiri Raja Badrakalimuthu
- Dr Badrakalimuthu is Associate Medical Director, Older Adults Division, Surrey & Borders Partnership NHS Foundation Trust, Farnham Road Hospital, Guildford
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11
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Kranz GS, Spies M, Vraka C, Kaufmann U, Klebermass EM, Handschuh PA, Ozenil M, Murgaš M, Pichler V, Rischka L, Nics L, Konadu ME, Ibeschitz H, Traub-Weidinger T, Wadsak W, Hahn A, Hacker M, Lanzenberger R. High-dose testosterone treatment reduces monoamine oxidase A levels in the human brain: A preliminary report. Psychoneuroendocrinology 2021; 133:105381. [PMID: 34416504 DOI: 10.1016/j.psyneuen.2021.105381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/22/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
The sex hormones testosterone and estradiol influence brain structure and function and are implicated in the pathogenesis, prevalence and disease course of major depression. Recent research employing gender-affirming hormone treatment (GHT) of gender dysphoric individuals and utilizing positron emission tomography (PET) indicates increased serotonin transporter binding upon high-dosages of testosterone treatment. Here, we investigated the effects of GHT on levels of monoamine oxidase A (MAO-A), another key target of antidepressant treatment. Participants underwent PET with the radioligand [11C]harmine to assess cerebral MAO-A distribution volumes (VT) before and four months after initiation of GHT. By the time this study was terminated for technical reasons, 18 transgender individuals undergoing GHT (11 transmen, TM and 7 transwomen, TW) and 17 cis-gender subjects had been assessed. Preliminary analysis of available data revealed statistically significant MAO-A VT reductions in TM under testosterone treatment in six of twelve a priori defined regions of interest (middle frontal cortex (-10%), anterior cingulate cortex (-9%), medial cingulate cortex (-10.5%), insula (-8%), amygdala (-9%) and hippocampus (-8.5%, all p<0.05)). MAO-A VT did not change in TW receiving estrogen treatment. Despite the limited sample size, pronounced MAO-A VT reduction could be observed, pointing towards a potential effect of testosterone. Considering MAO-A's central role in regulation of serotonergic neurotransmission, changes to MAO-A VT should be further investigated as a possible mechanism by which testosterone mediates risk for, symptomatology of, and treatment response in affective disorders.
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Affiliation(s)
- Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR , China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Eva-Maria Klebermass
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria; Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Austria
| | - Patricia A Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marius Ozenil
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Matej Murgaš
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Verena Pichler
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria; Department of Pharmaceutical Chemistry, University of Vienna, Austria
| | - Lucas Rischka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Lukas Nics
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Melisande E Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Harald Ibeschitz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
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12
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Baldinger-Melich P, Urquijo Castro MF, Seiger R, Ruef A, Dwyer DB, Kranz GS, Klöbl M, Kambeitz J, Kaufmann U, Windischberger C, Kasper S, Falkai P, Lanzenberger R, Koutsouleris N. Sex Matters: A Multivariate Pattern Analysis of Sex- and Gender-Related Neuroanatomical Differences in Cis- and Transgender Individuals Using Structural Magnetic Resonance Imaging. Cereb Cortex 2021; 30:1345-1356. [PMID: 31368487 PMCID: PMC7132951 DOI: 10.1093/cercor/bhz170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 12/22/2022] Open
Abstract
Univariate analyses of structural neuroimaging data have produced heterogeneous results regarding anatomical sex- and gender-related differences. The current study aimed at delineating and cross-validating brain volumetric surrogates of sex and gender by comparing the structural magnetic resonance imaging data of cis- and transgender subjects using multivariate pattern analysis. Gray matter (GM) tissue maps of 29 transgender men, 23 transgender women, 35 cisgender women, and 34 cisgender men were created using voxel-based morphometry and analyzed using support vector classification. Generalizability of the models was estimated using repeated nested cross-validation. For external validation, significant models were applied to hormone-treated transgender subjects (n = 32) and individuals diagnosed with depression (n = 27). Sex was identified with a balanced accuracy (BAC) of 82.6% (false discovery rate [pFDR] < 0.001) in cisgender, but only with 67.5% (pFDR = 0.04) in transgender participants indicating differences in the neuroanatomical patterns associated with sex in transgender despite the major effect of sex on GM volume irrespective of the self-identification as a woman or man. Gender identity and gender incongruence could not be reliably identified (all pFDR > 0.05). The neuroanatomical signature of sex in cisgender did not interact with depressive features (BAC = 74.7%) but was affected by hormone therapy when applied in transgender women (P < 0.001).
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Affiliation(s)
- Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Maria F Urquijo Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - René Seiger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christian Windischberger
- MR Centre of Excellence, Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
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13
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Sundström-Poromaa I, Comasco E, Sumner R, Luders E. Progesterone - Friend or foe? Front Neuroendocrinol 2020; 59:100856. [PMID: 32730861 DOI: 10.1016/j.yfrne.2020.100856] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/05/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
Estradiol is the "prototypic" sex hormone of women. Yet, women have another sex hormone, which is often disregarded: Progesterone. The goal of this article is to provide a comprehensive review on progesterone, and its metabolite allopregnanolone, emphasizing three key areas: biological properties, main functions, and effects on mood in women. Recent years of intensive research on progesterone and allopregnanolone have paved the way for new treatment of postpartum depression. However, treatment for premenstrual syndrome and premenstrual dysphoric disorder as well as contraception that women can use without risking mental health problems are still needed. As far as progesterone is concerned, we might be dealing with a two-edged sword: while its metabolite allopregnanolone has been proven useful for treatment of PPD, it may trigger negative symptoms in women with PMS and PMDD. Overall, our current knowledge on the beneficial and harmful effects of progesterone is limited and further research is imperative.
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Affiliation(s)
| | - Erika Comasco
- Department of Neuroscience, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Eileen Luders
- School of Psychology, University of Auckland, New Zealand; Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, USA
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14
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Kennedy J, Perchik JD, Porter KK. Systematic Review of Transgender-Related Research in Radiology Over a Decade: There Is Work to Be Done. J Am Coll Radiol 2020; 18:93-102. [PMID: 33007310 DOI: 10.1016/j.jacr.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The ACR has established that diversity and inclusion are central to its mission of excellence in the radiologic professions; therefore, radiologists have a responsibility to serve the imaging needs of the transgender community. To understand radiologists' current knowledge of transgender topics, the authors performed a systematic review of publications from radiology journals. METHODS A lexicon of 14 transgender-related terms was created and expanded through a PubMed keyword search. From the 129 journals from the radiology, nuclear medicine, and medical imaging category of Journal Citation Reports, 106 journals met the inclusion criteria, including English translation and Scopus data for the study period. Using the Scopus advanced search feature, articles with titles, abstracts, Medical Subject Headings terms, or key words including 1 of 14 transgender terms were identified and analyzed. RESULTS Of the more than 200,000 articles published by the 106 journals from January 2008 to July 2019, 29 relevant articles were identified. Only 14 of the 106 journals published any transgender-related topics. The volume of articles has increased over time. The largest proportion of articles was published under the "general radiology" subsection, with the majority of these being editorials (6 of 10). Most of the original research was published under "neuroradiology" (7 of 13). Use of nonpreferred language, such as "transsexual" and "natal sex" was present through 2019. CONCLUSIONS Publication on transgender-related topics was uncommon among radiology journals. It is important to encourage further research and publication on transgender topics, as well as use of respectful, accepted language in radiology journals.
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Affiliation(s)
- Jasper Kennedy
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jordan D Perchik
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristin K Porter
- Chief of MRI, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; President-Elect, American Association for Women in Radiology, Reston, Virginia.
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15
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Flint C, Förster K, Koser SA, Konrad C, Zwitserlood P, Berger K, Hermesdorf M, Kircher T, Nenadic I, Krug A, Baune BT, Dohm K, Redlich R, Opel N, Arolt V, Hahn T, Jiang X, Dannlowski U, Grotegerd D. Biological sex classification with structural MRI data shows increased misclassification in transgender women. Neuropsychopharmacology 2020; 45:1758-1765. [PMID: 32272482 PMCID: PMC7419542 DOI: 10.1038/s41386-020-0666-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 12/14/2022]
Abstract
Transgender individuals (TIs) show brain-structural alterations that differ from their biological sex as well as their perceived gender. To substantiate evidence that the brain structure of TIs differs from male and female, we use a combined multivariate and univariate approach. Gray matter segments resulting from voxel-based morphometry preprocessing of N = 1753 cisgender (CG) healthy participants were used to train (N = 1402) and validate (20% holdout N = 351) a support-vector machine classifying the biological sex. As a second validation, we classified N = 1104 patients with depression. A third validation was performed using the matched CG sample of the transgender women (TW) application sample. Subsequently, the classifier was applied to N = 26 TW. Finally, we compared brain volumes of CG-men, women, and TW-pre/post treatment cross-sex hormone treatment (CHT) in a univariate analysis controlling for sexual orientation, age, and total brain volume. The application of our biological sex classifier to the transgender sample resulted in a significantly lower true positive rate (TPR-male = 56.0%). The TPR did not differ between CG-individuals with (TPR-male = 86.9%) and without depression (TPR-male = 88.5%). The univariate analysis of the transgender application-sample revealed that TW-pre/post treatment show brain-structural differences from CG-women and CG-men in the putamen and insula, as well as the whole-brain analysis. Our results support the hypothesis that brain structure in TW differs from brain structure of their biological sex (male) as well as their perceived gender (female). This finding substantiates evidence that TIs show specific brain-structural alterations leading to a different pattern of brain structure than CG-individuals.
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Affiliation(s)
- Claas Flint
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany ,grid.5949.10000 0001 2172 9288Department of Computer Science, University of Münster, Einsteinstraße 62, 48149 Münster, Germany
| | - Katharina Förster
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Sophie A. Koser
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Carsten Konrad
- grid.440210.30000 0004 0560 2107Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, 27356 Rotenburg, Germany
| | - Pienie Zwitserlood
- grid.5949.10000 0001 2172 9288Department of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Klaus Berger
- grid.5949.10000 0001 2172 9288Department of Epidemiology and Social Medicine, University of Münster, Albert Schweitzer-Campus 1, D3, 48149 Münster, Germany
| | - Marco Hermesdorf
- grid.5949.10000 0001 2172 9288Department of Epidemiology and Social Medicine, University of Münster, Albert Schweitzer-Campus 1, D3, 48149 Münster, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Igor Nenadic
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Axel Krug
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Bernhard T. Baune
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany ,grid.1008.90000 0001 2179 088XDepartment of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XThe Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC Australia
| | - Katharina Dohm
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Ronny Redlich
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Nils Opel
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Volker Arolt
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Tim Hahn
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
| | - Xiaoyi Jiang
- grid.5949.10000 0001 2172 9288Department of Computer Science, University of Münster, Einsteinstraße 62, 48149 Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149, Münster, Germany.
| | - Dominik Grotegerd
- grid.5949.10000 0001 2172 9288Department of Psychiatry, University of Münster, Albert Schweitzer-Campus 1, A9, 48149 Münster, Germany
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16
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Scharaga EA, Chang A, Kulas JF. What happens when we forget our own narrative: Transgender dementia case study. Clin Neuropsychol 2020; 35:1485-1497. [PMID: 32449495 DOI: 10.1080/13854046.2020.1766575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Neuropsychological evaluations in a geriatric population have an assortment of challenges due to increased risk in the population for chronic/acute medical conditions, varied psychiatric disorders, and chronic negative lifestyle behaviors, all which impact one's cognitive functioning. One relatively new challenge is conducting cognitive evaluations within an elderly transgender population. There is a considerable lack of specific normative data in neuropsychological evaluations for transgender individuals due to the prevalence of binary gender categorization in current scoring protocols. However, a reasonable question is whether gender is such a significant normative factor, as the field of neuropsychology once thought? METHOD The current article reports on these issues in the context of a case of an 85-year-old transgender female who was referred to an outpatient neuropsychology service due to cognitive and functional declines. RESULTS Her performance on the neuropsychological evaluation indicated significant decline across many of the cognitive domains measured. When using binary male and female normative data, scores did not statistically differ across the majority of the domains. CONCLUSIONS Overall, it was difficult to determine nuanced gender differences due to the patient's marked cognitive impairment. Potentially, differences may be more obvious in a less impaired individual.
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Affiliation(s)
- Elyssa A Scharaga
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA.,Center for Neuropsychological Services, Northwell Health, Glen Oaks, NY, USA
| | - Annie Chang
- Yale School of Medicine, New Haven, CT, USA.,Veterans Affairs Connecticut Healthcare System, Newington, CT, USA
| | - Joseph F Kulas
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
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17
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Kranz GS, Zhang BBB, Handschuh P, Ritter V, Lanzenberger R. Gender-affirming hormone treatment - A unique approach to study the effects of sex hormones on brain structure and function. Cortex 2020; 129:68-79. [PMID: 32438011 DOI: 10.1016/j.cortex.2020.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 12/22/2022]
Abstract
Investigating the effects of the gender-affirming hormone treatment of transgender people using neuroimaging provides a unique opportunity to study the impact of high dosages of sex hormones on human brain structure and function. This line of research is of relevance from a basic neuroscientific as well as from a psychiatric viewpoint. Prevalence rates, etiopathology, and disease course of many psychiatric disorders exhibit sex differences which are linked to differences in sex hormone levels. Here, we review recent neuroimaging studies from others and our group that investigate the effects of gender-affirming hormone treatment in a longitudinal design utilizing structural and functional magnetic resonance imaging and positron emission tomography. Studies point to a general anabolic and anticatabolic effect of testosterone on grey and white matter structure, whereas estradiol and antiandrogen treatment seems to have partly opposite effects. Moreover, preliminary research indicates that gender-affirming hormone treatment influences serotonergic neurotransmission, a finding that is especially interesting for psychiatry. A clear picture of a hormonal influence on brain activity has yet to emerge. In conclusion, the available evidence reviewed here clearly indicates that sex hormone applications influence brain structure and function in the adult human brain.
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Affiliation(s)
- Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China.
| | - Bella B B Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Patricia Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Vera Ritter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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18
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Gryglewski G, Seiger R, Baldinger-Melich P, Unterholzner J, Spurny B, Vanicek T, Hahn A, Kasper S, Frey R, Lanzenberger R. Changes in White Matter Microstructure After Electroconvulsive Therapy for Treatment-Resistant Depression. Int J Neuropsychopharmacol 2020; 23:20-25. [PMID: 31740958 PMCID: PMC7064047 DOI: 10.1093/ijnp/pyz059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/11/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Treatment-resistant depression is among the most debilitating conditions in psychiatry. Recent studies have associated alterations in white matter microstructure measured with magnetic resonance imaging with poor antidepressant response. Therefore, the extent to which electroconvulsive therapy, the most effective therapeutic option for treatment-resistant depression, affects white matter microstructure warrants investigation. METHODS A total 13 patients suffering from severe unipolar treatment-resistant depression underwent magnetic resonance imaging with a diffusion tensor imaging sequence before and after undergoing a series of right unilateral electroconvulsive therapy. Diffusivity metrics were compared voxel-wise using tract-based spatial statistics and repeated-measures ANOVA. RESULTS A total 12 patients responded to electroconvulsive therapy and 9 were classified as remitters. An increase in axial diffusivity was observed in the posterior limb of the internal capsule of the right hemisphere (PFWE ≤ .05). The increase in this area was higher in the right compared with the left hemisphere (P < .05). No correlation of this effect with treatment response could be found. CONCLUSIONS The strong lateralization of effects to the hemisphere of electrical stimulation suggests an effect of electroconvulsive therapy on diffusivity metrics which is dependent of electrode placement. Investigation in controlled studies is necessary to reveal to what extent the effects of electroconvulsive therapy on white matter microstructure are related to clinical outcomes and electrode placement.
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Affiliation(s)
- Gregor Gryglewski
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - René Seiger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Jakob Unterholzner
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Benjamin Spurny
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Vanicek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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19
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Schneider MA, Spritzer PM, Suh JS, Minuzzi L, Frey BN, Schwarz K, Costa AB, da Silva DC, Garcia CCG, Fontanari AMV, Anes M, Castan JU, Cunegatto FR, Picon FA, Luders E, Lobato MIR. The Link between Estradiol and Neuroplasticity in Transgender Women after Gender-Affirming Surgery: A Bimodal Hypothesis. Neuroendocrinology 2020; 110:489-500. [PMID: 31461715 DOI: 10.1159/000502977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
For transgender individuals, gender-affirming surgery (GAS) and cross-sex hormone therapy (CSHT) are part of the gender transition process. Scientific evidence supporting the maintenance of CSHT after GAS-related gonadectomy is accumulating. However, few data are available on the impact of CSHT on the brain structure following hypogonadism. Thus, we aimed to investigate links between estradiol and brain cortical thickness (CTh) and cognition in 18 post-gonadectomy transgender women using a longitudinal design. For this purpose, the participants underwent a voluntary period of CSHT washout of at least 30 days, followed by estradiol re-institution for 60 days. High-resolution T1-weighted brain images, hormonal measures, working and verbal memory were collected at 2 time points: on the last day of the washout (t1) and on the last day of the 2-month CSHT period (t2). Between these 2 time points, CTh increased within the left precentral gyrus and right precuneus but decreased within the right lateral occipital cortex. However, these findings did not survive corrections of multiple comparisons. Nevertheless, there was a significant negative correlation between changes in estradiol levels and changes in CTh. This effect was evident in the left superior frontal gyrus, the left middle temporal gyrus, the right precuneus, the right superior temporal gyrus, and the right pars opercularis. Although there was an improvement in verbal memory following hypogonadism correction, we did not observe a significant relationship between changes in memory scores and CTh. Altogether, these findings suggest that there is a link between estradiol and CTh.
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Affiliation(s)
- Maiko A Schneider
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada,
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada,
| | - Poli M Spritzer
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jee Su Suh
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Karine Schwarz
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Angelo B Costa
- Graduate Program in Psychology, Pontifícia Universidade do Rio Grande do Sul, Porto Alegre, Brazil
| | - Dhiordan C da Silva
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil
| | - Claudia C G Garcia
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil
| | - Anna M V Fontanari
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil
| | - Mauricio Anes
- Medical Physics and Radiation Protection Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana U Castan
- Psychology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Felipe A Picon
- ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eileen Luders
- School of Psychology, University of Auckland, Auckland, New Zealand
- Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Maria I R Lobato
- Gender Identity Program, Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Psychiatry and Forensic Medical Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Kranz GS, Kaufmann U, Lanzenberger R. Probing the Impact of Gender-Affirming Hormone Treatment on Odor Perception. Chem Senses 2019; 45:37-44. [PMID: 31638640 DOI: 10.1093/chemse/bjz069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Evidence suggests that women outperform men in core aspects of odor perception, and sex hormones may play a significant role in moderating this effect. The gender-affirming treatment (GAT) of transgender persons constitutes a powerful natural experiment to study the psychological and behavioral effects of high dosages of cross-sex hormone applications. Therefore, our aim was to investigate the effects of GAT on odor perception in a sample of 131 participants including female and male controls, as well as transmen and transwomen over their first 4 months of gender transition. The Sniffin’ Sticks test battery was used to measure odor detection, discrimination, and identification at baseline, as well as 1 and 4 months after the start of GAT. Plasma levels of estradiol, testosterone, and sex hormone-binding globulin were analyzed for each assessment point. Results revealed no significant change of olfactory performance in the two transgender groups compared with female and male controls. There was no significant difference between groups at baseline or any other time point. Neither biological sex, nor gender identity had an influence on odor perception. Moreover, there was no significant correlation between sex hormones and odor perception and between GAT-induced changes in sex hormones and changes in odor perception. Our results indicate that the effects of sex hormones on olfactory performance are subtle, if present at all. However, our results do not preclude hormonal effects on odors not included in the Sniffin’ Sticks test battery, such as body odors or odors associated with sex.
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Affiliation(s)
- Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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Iwamoto SJ, Defreyne J, Rothman MS, Van Schuylenbergh J, Van de Bruaene L, Motmans J, T’Sjoen G. Health considerations for transgender women and remaining unknowns: a narrative review. Ther Adv Endocrinol Metab 2019; 10:2042018819871166. [PMID: 31516689 PMCID: PMC6719479 DOI: 10.1177/2042018819871166] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Sean J. Iwamoto
- University of Colorado School of Medicine, Division of Endocrinology, Metabolism and Diabetes, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Center for Research on Culture and Gender, Ghent University, Ghent, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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22
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Wilde EA, Provenzale JM, Taylor BA, Boss M, Zuccolotto A, Hachey R, Pathak S, Tate DF, Abildskov TJ, Schneider W. Assessment of quantitative magnetic resonance imaging metrics in the brain through the use of a novel phantom. Brain Inj 2018; 32:1266-1276. [PMID: 30169993 DOI: 10.1080/02699052.2018.1494855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Multisite and longitudinal neuroimaging studies are important in uncovering trajectories of recovery and neurodegeneration following traumatic brain injury (TBI) and concussion through the use of diffusion tensor imaging (DTI) and other imaging modalities. This study assessed differences in anisotropic diffusion measurement across four scanners using a human and a novel phantom developed in conjunction with the Chronic Effects of Neurotrauma Consortium. METHOD Human scans provided measurement within biological tissue, and the novel physical phantom provided measures of anisotropic intra-tubular diffusion to serve as a model for intra-axonal water diffusion. Intra- and inter-scanner measurement variances were compared, and the impact on effect size was calculated. RESULTS Intra-scanner test-retest reliability estimates for fractional anisotropy (FA) demonstrated relative stability over testing intervals. The human tissue and phantom showed similar FA ranges, high linearity and large within-device effect sizes. However, inter-scanner measures of FA indicated substantial differences, some of which exceeded typical DTI effect sizes in mild TBI. CONCLUSION The diffusion phantom may be used to better elucidate inter-scanner variability in DTI-based measurement and provides an opportunity to better calibrate results obtained from scanners used in multisite and longitudinal studies. Novel solutions are being evaluated to understand and potentially overcome these differences.
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Affiliation(s)
- Elisabeth A Wilde
- a Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,b Department of Neurology, University of Utah , Salt Lake City , UT , USA.,c Departments of Physical Medicine and Rehabilitation, Neurology, and Radiology, Baylor College of Medicine , Houston , TX , USA
| | - James M Provenzale
- d Department of Radiology, Duke University Medical Center , Durham , NC , USA
| | - Brian A Taylor
- e Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University , Richmond , VA , USA
| | - Michael Boss
- f Department of Physics, University of Colorado Boulder , Boulder , CO , USA.,g National Institute of Standard and Technology , Boulder , CO , USA
| | - Anthony Zuccolotto
- h Phantom Metrics Division of Psychology Software Tools Inc , Pittsburgh, Pennsylvania, USA
| | - Rebecca Hachey
- i Learning Research and Development Center, University of Pittsburgh , Pittsburgh , PA , USA
| | - Sudhir Pathak
- i Learning Research and Development Center, University of Pittsburgh , Pittsburgh , PA , USA
| | - David F Tate
- j Missouri Institute of Mental Health, University of Missouri-St. Louis , St. Louis , MO , USA
| | - Tracy J Abildskov
- b Department of Neurology, University of Utah , Salt Lake City , UT , USA.,k Department of Psychology, Brigham Young University , Provo , UT , USA
| | - Walter Schneider
- h Phantom Metrics Division of Psychology Software Tools Inc , Pittsburgh, Pennsylvania, USA.,i Learning Research and Development Center, University of Pittsburgh , Pittsburgh , PA , USA.,l Departments of Psychology and Engineering, University of Pittsburgh Medical Center , Pittsburgh , PA , USA.,m Departments of Neurosurgery and Radiology, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
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23
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Çeri V, Aykutlu HC, Görker I, Akça ÖF, Tarakçıoğlu MC, Aksoy UM, Kaya H, Sertdemir M, İnce E, Kadak MT, Yalçın GY, Guliyev C, Bilgiç A, Çiftçi E, Tekin K, Tuna ZO, Oğuzdoğan B, Duman NS, Semerci B, Üneri ÖŞ, Karabekiroglu K, Mutluer T, Nebioglu M, Başgül ŞS, Naharcı Mİ, Maden Ö, Hocaoğlu Ç, Durmaz O, Usta H, Boşgelmez Ş, Puşuroğlu M, Eser HY, Kaçar M, Çakır M, Karatepe HT, Işık Ü, Kara H, Yeloğlu ÇH, Yazıcı E, Gündüz A, Karataş KS, Yavlal F, Uzun N, Yazici AB, Bodur Ş, Aslan EA, Batmaz S, Çelik F, Açıkel SB, Topal Z, Altunsoy N, Tulacı ÖD, Demirel ÖF, Çıtak S, Çak HT, Artık AB, Özçetin A, Özdemir I, Çelik FGH, Kültür SEÇ, Çipil A, Ay R, Arman AR, Yazıcı KU, Yuce AE, Yazıcı İP, Kurt E, Kaçar AŞ, Erbil N, Poyraz CA, Altın GE, Şahin B, Kılıç Ö, Turan Ş, Aydın M, Kuru E, Bozkurt A, Güleç H, İnan MY, Şevik AE, Baykal S, Karaer Y, Yanartaş O, Aksu H, Ergün S, Görmez A, Yıldız M, Bag S, Özkanoğlu FK, Caliskan M, Yaşar AB, Konuk E, Altın M, Bulut S, Bulut GÇ, Tulacı RG, Küpeli NY, Enver N, Tasci İ, Kani AS, Bahçeci B, Oğuz G, Şenyuva G, Ünal GT, Yektaş Ç, Örüm MH, Göka E, Gıca Ş, Şahmelikoğlu Ö, Dinç GŞ, Erşan S, Erşan E, Ceylan MF, Hesapçıoğlu ST, Solmaz M, Balcioglu YH, Cetin M, Tosun M, Yurteri N, Ulusoy S, Karadere ME, Kivrak Y, Görmez V. Symposium Oral Presentations. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1464274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Veysi Çeri
- Marmara University Pendik Research and Training Hospital, Child and Adolescent Psychiatry Clinic, Istanbul, Turkey
| | - Hasan Cem Aykutlu
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, Edirne, Turkey
| | - Işık Görker
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, Edirne, Turkey
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Health Sciences University Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Umut Mert Aksoy
- Health Sciences University Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Heysem Kaya
- Department of Computer Engineering, Çorlu Faculty of Engineering, Namık Kemal University, Çorlu, Tekirdağ, Turkey
| | - Merve Sertdemir
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Ezgi İnce
- Department of Psychiatry, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Muhammed Tayyib Kadak
- Department of Child and Adolescent Psychiatry, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | | | | | - Ayhan Bilgiç
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Elvan Çiftçi
- Department of Psychiatry, Erenkoy Research and Training Hospital, Istanbul, Turkey
| | | | | | | | | | - Bengi Semerci
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Özden Şükran Üneri
- Department of Child and Adolescent Psychiatry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | | | - Tuba Mutluer
- Koç University Hospital, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Melike Nebioglu
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | | | - Mehmet İlkin Naharcı
- Division of Geriatrics, Department of Internal Medicine, Health Sciences University, Ankara, Turkey
| | - Özgür Maden
- SBÜ Sultan Abdülhamid Han Education and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Çiçek Hocaoğlu
- Department of Psychiatry, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Onur Durmaz
- Erenköy Mental Health and Neurology Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Haluk Usta
- Erenköy Mental Health and Neurology Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Şükriye Boşgelmez
- Kocaeli Derince Research and Training Hospital, Psychiatry Clinic, Kocaeli, Turkey
| | | | - Hale Yapıcı Eser
- KOÇ University School of Medicine, Istanbul, Turkey
- KOÇ University Research Center FOR Translational Medicine (Kuttam), Istanbul, Turkey
- Koç University School of Medicine Department of Psychiatry, Istanbul, Turkey
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Murat Kaçar
- Department of Child and Adolescent Psychiatry, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Mahmut Çakır
- Child Psychiatry Clinic, Health Sciences University, Amasya Research and Training Hospital, Amasya, Turkey
| | - Hasan Turan Karatepe
- Department of Psychiatry, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ümit Işık
- Department of Child and Adolescent Psychiatry, Yozgat State Hospital, Yozgat, Turkey
| | - Halil Kara
- Department of Child and Adolescent Psychiatry, Aksaray University Research and Training Hospital, Aksaray, Turkey
| | | | - Esra Yazıcı
- Department of Psychiatry, Sakarya University School of Medicine, Sakarya, Turkey
| | - Anıl Gündüz
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Kader Semra Karataş
- Recep Tayyip Erdogan University School of Medicine Psychiatry Department, Rize, Turkey
| | - Figen Yavlal
- Department of Neurology, School of Medicine, Bahcesehir University, Istanbul, Turkey
- Department of Neurology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Necati Uzun
- Department of Child and Adolescent Psychiatry, Elazığ Psychiatry Hospital, Elazığ, Turkey
| | - Ahmet Bulent Yazici
- Department of Psychiatry, Sakarya University School of Medicine, Sakarya, Turkey
| | - Şahin Bodur
- Health Sciences University, Gulhane Research and Training Hospital, Child and Adolescent Psychiatry Clinic, Ankara, Turkey
| | - Esma Akpınar Aslan
- Department of Psychiatry, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Sedat Batmaz
- Department of Psychiatry, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Feyza Çelik
- Department of Psychiatry, Dumlupınar University School of Medicine, Evliya Çelebi Research and Training Hospital, Kütahya, Turkey
| | - Sadettin Burak Açıkel
- Dr. Sami Ulus Research and Training Hospital, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | | | | | | | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Serhat Çıtak
- Department of Psychiatry, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Halime Tuna Çak
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdül Baki Artık
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Adnan Özçetin
- Department of Psychiatry, Duzce University School of Medicine, Duzce, Turkey
| | - Ilker Özdemir
- Giresun University Prof. Dr. A. İlhan Özdemir Research and Training Hospital, Giresun, Turkey
| | | | | | - Arif Çipil
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Rukiye Ay
- Malatya Research and Training Hospital, Malatya, Turkey
| | - Ayşe Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University School of Medicine, Istanbul
| | - Kemal Utku Yazıcı
- Department of Child and Adolescent Psychiatry, Firat University School of Medicine, Elazig, Turkey
| | | | - İpek Perçinel Yazıcı
- Department of Child and Adolescent Psychiatry, Firat University School of Medicine, Elazig, Turkey
| | - Emel Kurt
- Psychiatry Clinic, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Anıl Şafak Kaçar
- Koc University, Research Center for Translational Medicine, Istanbul, Turkey
| | - Nurhan Erbil
- Department of Biophysics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | | | - Berkan Şahin
- Iğdır State Hospital, Child and Adolescent Psychiatry Clinic, Iğdır, Turkey
| | - Özge Kılıç
- Department of Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Şenol Turan
- Department of Psychiatry, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Memduha Aydın
- Department of Psychiatry, Selçuk University School of Medicine, Konya, Turkey
| | - Erkan Kuru
- Özel Boylam Psychiatry Hospital, Ankara, Turkey
| | - Abdullah Bozkurt
- Department of Child and Adolescent Psychiatry, Konya Research and Training Hospital, Konya, Turkey
| | - Hüseyin Güleç
- Erenköy Mental Health and Neurology Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | | | - Ali Emre Şevik
- Department of Psychiatry, Çanakkale 18 Mart University School of Medicine, Çanakkale, Türkiye
| | - Saliha Baykal
- Department of Child and Adolescent Psychiatry, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Yusuf Karaer
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Omer Yanartaş
- Department of Psychiatry, Marmara Medical School, Istanbul, Turkiye
| | - Hatice Aksu
- Department of Child and Adolescent Psychiatry, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Serhat Ergün
- Department of Psychiatry, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Aynur Görmez
- Department of Child and Adolescent Psychiatry, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Mesut Yıldız
- Department of Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sevda Bag
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | | | - Mecit Caliskan
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Alişan Burak Yaşar
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
- Behavioral Sciences Institute, Istanbul, Turkey
| | - Emre Konuk
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
- Behavioral Sciences Institute, Istanbul, Turkey
| | - Murat Altın
- Istinye University Hospital, Psychiatry Clinic, Istanbul, Turkey
| | - Serkut Bulut
- Psychiatry Clinic, Health Sciences University Sakarya Research and Training Hospital, Sakarya, Turkey
| | | | - Rıza Gökçer Tulacı
- Uşak University School of Medicine Research and Training Hospital, Uşak, Turkey
| | - Neşe Yorguner Küpeli
- Department of Psychiatry, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - İlker Tasci
- Health Sciences University, Gulhane School of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Ayşe Sakallı Kani
- Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Bülent Bahçeci
- Department of Psychiatry, Recep Tayyip Erdogan University, Rize, Turkey
| | | | | | - Gülşen Teksin Ünal
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Çiğdem Yektaş
- Duzce University School of Medicine, Department of Child and Adolescent Psychiatry, Duzce, Turkey
| | - Mehmet Hamdi Örüm
- Department of Psychiatry, Adiyaman University School of Medicine, Adiyaman, Turkey
| | - Erol Göka
- SBÜ Ankara Numune Eğitim ve Araştırma Hastanesi
| | - Şakir Gıca
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Özge Şahmelikoğlu
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Gülser Şenses Dinç
- Department of Child and Adolescent Psychiatry, Ankara Children’s Hematology Oncology Research and Training Hospital, Ankara Turkey
| | - Serpil Erşan
- Cumhuriyet University Advanced Technology Research and Application Center, Sivas, Turkey
| | - Erdal Erşan
- Sivas Numune Hospital, Community Mental Health Center, Sivas, Turkey
| | - Mehmet Fatih Ceylan
- Department of Child and Adolescent Psychiatry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Selma Tural Hesapçıoğlu
- Department of Child and Adolescent Psychiatry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mustafa Solmaz
- Health Sciences University Bagcilar Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
- Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Forensic Psychiatry Unit, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Health Sciences University Bagcilar Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
- Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Forensic Psychiatry Unit, Istanbul, Turkey
| | | | - Musa Tosun
- Istanbul University Cerrahpaşa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Nihal Yurteri
- Duzce University School of Medicine, Department of Child and Adolescent Psychiatry, Duzce, Turkey
| | - Sevinc Ulusoy
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry and Neurology, Istanbul, Turkey
| | | | - Yüksel Kivrak
- Department of Psychiatry, Kafkas University School of Medicine, Kars, Turkey
| | - Vahdet Görmez
- Bezmialem Vakif University, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
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