1
|
Mielke MM, Frank RD, Christenson LR, Reid RI, Fields JA, Knyazhanskaya ZE, Kara F, Vemuri P, Rocca WA, Kantarci K. Premenopausal bilateral oophorectomy and brain white matter brain integrity in later-life. Alzheimers Dement 2024; 20:5054-5061. [PMID: 38899634 PMCID: PMC11247692 DOI: 10.1002/alz.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Premenopausal bilateral oophorectomy (PBO) is associated with later-life cognition, but the underlying brain changes remain unclear. We assessed the impact of PBO and PBO age on white matter integrity. METHODS Female participants with regional diffusion tensor imaging (DTI) metrics of fractional anisotropy (FA) and mean diffusivity (MD) were included (22 with PBO < 40 years; 43 with PBO 40-45 years; 39 with PBO 46-49 years; 907 referents without PBO < 50 years). Linear regression models adjusted for age and apolipoprotein E (APOE) genotype. RESULTS Females with PBO < 40 years, compared to referents, had lower FA and higher MD in the anterior corona radiata, genu of the corpus collosum, inferior fronto-occipital fasciculus, superior occipital, and superior temporal white matter. Females who underwent PBO between 45 and 49 also had some changes in white matter integrity. DISCUSSION Females who underwent PBO < 40 years had reduced white matter integrity across multiple regions in later-life. These results are important for females considering PBO for noncancerous conditions. HIGHLIGHTS Females with premenopausal bilateral oophorectomy (PBO) < 40 years had lower FA versus referents. Females with PBO < 40 years had higher MD in many regions versus referents. Adjusting for estrogen replacement therapy use did not attenuate results. Females with PBO 45-49 years also had some white matter changes versus referents.
Collapse
Affiliation(s)
- Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Ryan D. Frank
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Julie A. Fields
- Division of Neurocognitive DisordersDepartment of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | | | - Firat Kara
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | | | - Walter A. Rocca
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Women's Health Research CenterMayo ClinicRochesterMinnesotaUSA
| | - Kejal Kantarci
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
- Women's Health Research CenterMayo ClinicRochesterMinnesotaUSA
| |
Collapse
|
2
|
Lafta MS, Mwinyi J, Affatato O, Rukh G, Dang J, Andersson G, Schiöth HB. Exploring sex differences: insights into gene expression, neuroanatomy, neurochemistry, cognition, and pathology. Front Neurosci 2024; 18:1340108. [PMID: 38449735 PMCID: PMC10915038 DOI: 10.3389/fnins.2024.1340108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Increased knowledge about sex differences is important for development of individualized treatments against many diseases as well as understanding behavioral and pathological differences. This review summarizes sex chromosome effects on gene expression, epigenetics, and hormones in relation to the brain. We explore neuroanatomy, neurochemistry, cognition, and brain pathology aiming to explain the current state of the art. While some domains exhibit strong differences, others reveal subtle differences whose overall significance warrants clarification. We hope that the current review increases awareness and serves as a basis for the planning of future studies that consider both sexes equally regarding similarities and differences.
Collapse
Affiliation(s)
- Muataz S. Lafta
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jessica Mwinyi
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
- Centre for Women’s Mental Health, Uppsala University, Uppsala, Sweden
| | - Oreste Affatato
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
- Centre for Women’s Mental Health, Uppsala University, Uppsala, Sweden
| | - Gull Rukh
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Junhua Dang
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Helgi B. Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Jett S, Malviya N, Schelbaum E, Jang G, Jahan E, Clancy K, Hristov H, Pahlajani S, Niotis K, Loeb-Zeitlin S, Havryliuk Y, Isaacson R, Brinton RD, Mosconi L. Endogenous and Exogenous Estrogen Exposures: How Women's Reproductive Health Can Drive Brain Aging and Inform Alzheimer's Prevention. Front Aging Neurosci 2022; 14:831807. [PMID: 35356299 PMCID: PMC8959926 DOI: 10.3389/fnagi.2022.831807] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 01/14/2023] Open
Abstract
After advanced age, female sex is the major risk factor for late-onset Alzheimer's disease (AD), the most common cause of dementia affecting over 24 million people worldwide. The prevalence of AD is higher in women than in men, with postmenopausal women accounting for over 60% of all those affected. While most research has focused on gender-combined risk, emerging data indicate sex and gender differences in AD pathophysiology, onset, and progression, which may help account for the higher prevalence in women. Notably, AD-related brain changes develop during a 10-20 year prodromal phase originating in midlife, thus proximate with the hormonal transitions of endocrine aging characteristic of the menopause transition in women. Preclinical evidence for neuroprotective effects of gonadal sex steroid hormones, especially 17β-estradiol, strongly argue for associations between female fertility, reproductive history, and AD risk. The level of gonadal hormones to which the female brain is exposed changes considerably across the lifespan, with relevance to AD risk. However, the neurobiological consequences of hormonal fluctuations, as well as that of hormone therapies, are yet to be fully understood. Epidemiological studies have yielded contrasting results of protective, deleterious and null effects of estrogen exposure on dementia risk. In contrast, brain imaging studies provide encouraging evidence for positive associations between greater cumulative lifetime estrogen exposure and lower AD risk in women, whereas estrogen deprivation is associated with negative consequences on brain structure, function, and biochemistry. Herein, we review the existing literature and evaluate the strength of observed associations between female-specific reproductive health factors and AD risk in women, with a focus on the role of endogenous and exogenous estrogen exposures as a key underlying mechanism. Chief among these variables are reproductive lifespan, menopause status, type of menopause (spontaneous vs. induced), number of pregnancies, and exposure to hormonal therapy, including hormonal contraceptives, hormonal therapy for menopause, and anti-estrogen treatment. As aging is the greatest risk factor for AD followed by female sex, understanding sex-specific biological pathways through which reproductive history modulates brain aging is crucial to inform preventative and therapeutic strategies for AD.
Collapse
Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Niharika Malviya
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Grace Jang
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Jahan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Katherine Clancy
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Kellyann Niotis
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Frigerio A, Ballerini L, Valdés Hernández M. Structural, Functional, and Metabolic Brain Differences as a Function of Gender Identity or Sexual Orientation: A Systematic Review of the Human Neuroimaging Literature. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3329-3352. [PMID: 33956296 PMCID: PMC8604863 DOI: 10.1007/s10508-021-02005-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 05/05/2023]
Abstract
This review systematically explored structural, functional, and metabolic features of the cisgender brain compared with the transgender brain before hormonal treatment and the heterosexual brain compared to the homosexual brain from the analysis of the neuroimaging literature up to 2018, and identified and discussed subsequent studies published up to March 2021. Our main aim was to help identifying neuroradiological brain features that have been related to human sexuality to contribute to the understanding of the biological elements involved in gender identity and sexual orientation. We analyzed 39 studies on gender identity and 24 on sexual orientation. Our results suggest that some neuroanatomical, neurophysiological, and neurometabolic features in transgender individuals resemble those of their experienced gender despite the majority resembling those from their natal sex. In homosexual individuals the majority resemble those of their same-sex heterosexual population rather than their opposite-sex heterosexual population. However, it is always difficult to interpret findings with noninvasive neuroimaging. Given the gross nature of these measures, it is possible that more differences too subtle to measure with available tools yet contributing to gender identity and sexual orientation could be found. Conflicting results contributed to the difficulty of identifying specific brain features which consistently differ between cisgender and transgender or between heterosexual and homosexual groups. The small number of studies, the small-to-moderate sample size of each study, and the heterogeneity of the investigations made it impossible to meta-analyze all the data extracted. Further studies are necessary to increase the understanding of the neurological substrates of human sexuality.
Collapse
Affiliation(s)
- Alberto Frigerio
- Division of Health Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Lucia Ballerini
- Division of Health Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | | |
Collapse
|
8
|
Abstract
Gender identity development is complex and involves several key processes. Transgender people experience incongruence between their biological and identified gender. This incongruence can cause significant impairment in overall functioning and lead to gender dysphoria (GD). The pathophysiology of GD is complex and is poorly understood. A PubMed search based on predetermined eligibility criteria was conducted to review neuropsychiatric articles focused on neurological, biological and neuroimaging aspects of gender development, transgender identity and GD. The information obtained from the literature was then used to formulize a GD model. Distinct gray matter volume and brain activation and connectivity differences were found in individuals with GD compared to controls, suggesting a neurobiological basis of GD; which leads to the concept of brain gender. Individuals with GD encounter a recurrent conflict between their brain gender and the societal feedback; which causes recurrent and ongoing cognitive dissonance, finally leading to GD and functional connectivity and activation changes in the transgender brain. GD has neurobiological basis, but it is closely associated with the individuals' interaction with the external world, their self-perception and the feedback received in return. We propose a novel model where the development of GD includes cognitive dissonance, involving anterior cingulate cortex and ventral striatum as the key brain structures. This model can be used to generate testable hypotheses using behavioral and neuroimaging techniques to understand the neuropsychobiology of GD.
Collapse
Affiliation(s)
- Murat Altinay
- Center for Behavioral Health, Cleveland Clinic, 9500 Euclid Avenue/P57, Cleveland, OH, 44195, USA.
| | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic, 9500 Euclid Avenue/P57, Cleveland, OH, 44195, USA
| |
Collapse
|
9
|
Gómez Á, Cerdán S, Pérez-Laso C, Ortega E, Pásaro E, Fernández R, Gómez-Gil E, Mora M, Marcos A, Del Cerro MCR, Guillamon A. Effects of adult male rat feminization treatments on brain morphology and metabolomic profile. Horm Behav 2020; 125:104839. [PMID: 32800765 DOI: 10.1016/j.yhbeh.2020.104839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
Body feminization, as part of gender affirmation process of transgender women, decreases the volume of their cortical and subcortical brain structures. In this work, we implement a rat model of adult male feminization which reproduces the results in the human brain and allows for the longitudinal investigation of the underlying structural and metabolic determinants in the brain of adult male rats undergoing feminization treatments. Structural MRI and Diffusion Tensor Imaging (DTI) were used to non-invasively monitor in vivo cortical brain volume and white matter microstructure over 30 days in adult male rats receiving estradiol (E2), estradiol plus cyproterone acetate (CA), an androgen receptor blocker and antigonadotropic agent (E2 + CA), or vehicle (control). Ex vivo cerebral metabolic profiles were assessed by 1H High Resolution Magic Angle Spinning NMR (1H HRMAS) at the end of the treatments in samples from brain regions dissected after focused microwave fixation (5 kW). We found that; a) Groups receiving E2 and E2 + CA showed a generalized bilateral decrease in cortical volume; b) the E2 + CA and, to a lesser extent, the E2 groups maintained fractional anisotropy values over the experiment while these values decreased in the control group; c) E2 treatment produced increases in the relative concentration of brain metabolites, including glutamate and glutamine and d) the glutamine relative concentration and fractional anisotropy were negatively correlated with total cortical volume. These results reveal, for the first time to our knowledge, that the volumetric decreases observed in trans women under cross-sex hormone treatment can be reproduced in a rat model. Estrogens are more potent drivers of brain changes in male rats than anti-androgen treatment.
Collapse
Affiliation(s)
- Ángel Gómez
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Sebastián Cerdán
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas, 28029 Madrid, Spain
| | - Carmen Pérez-Laso
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - Esperanza Ortega
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Granada, 18016 Granada, Spain
| | - Eduardo Pásaro
- Departamento de Psicología, Universidade da Coruña, 15071 A Coruña, Spain
| | - Rosa Fernández
- Departamento de Psicología, Universidade da Coruña, 15071 A Coruña, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Departamento de Psiquiatría, Hospital Clínic, 08036 Barcelona, Spain
| | - Mireia Mora
- Departamento de Endocrinología, Hospital Clínic, 08036 Barcelona, Spain
| | - Alberto Marcos
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - María Cruz Rodríguez Del Cerro
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Baetens L, Dhondt K. Psychosocial challenges and hormonal treatment in gender diverse children and adolescents. A narrative review. Int J Impot Res 2020; 33:217-227. [PMID: 32366985 DOI: 10.1038/s41443-020-0291-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Gender dysphoria (GD) in children and adolescents is a condition that is characterized by an incongruence between the assigned and experienced gender. Despite the diversity in clinical presentation, literature demonstrates that GD might lead to poor mental health and high rates of co-occurring psychopathology. Due to the overlap of physical aspects as well as psychological needs in these children, a multidisciplinary approach is highly desirable. The aim of this narrative review is to give an overview of recent literature on several topics relevant in this domain. Guidelines on psychological counseling and hormonal treatment are given and challenging topics subject to controversy are explained. Furthermore, attention is drawn to the risks and protective factors in psychological functioning, including the growing evidence of a frequent co-occurrence with Autism Spectrum Disorder. Finally the psycho-sexual development in these children, the impact on fertility and fertility preservation are discussed.
Collapse
Affiliation(s)
- Laura Baetens
- General Psychiatry Department, Sint-Lucas, Bruges, Belgium, Ghent University, Ghent, Belgium
| | - Karlien Dhondt
- Dept Child & Adolescent psychiatry, Center for Gender and Sexuology, Pediatric Gender Clinic, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Ristori J, Cocchetti C, Romani A, Mazzoli F, Vignozzi L, Maggi M, Fisher AD. Brain Sex Differences Related to Gender Identity Development: Genes or Hormones? Int J Mol Sci 2020; 21:ijms21062123. [PMID: 32204531 PMCID: PMC7139786 DOI: 10.3390/ijms21062123] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 12/19/2022] Open
Abstract
The complex process of sexual differentiation is known to be influenced by biological and environmental determinants. The present review has the aim of summarizing the most relevant studies on the biological basis of sexual development, and in particular, it focuses on the impact of sex hormones and genetic background on the development of sexual differentiation and gender identity. The authors conducted a search of published studies on Medline (from January 1948 to December 2019). The evidence suggests that the sexual dimorphic brain could be the anatomical substrate of psychosexual development, on which gonadal hormones may have a shaping role during prenatal and pubertal periods. Additionally, according to several heritability studies, genetic components may have a role, but a promising candidate gene has not been identified. Even though growing evidence underlines the primary role of biological factors on psychosexual development, further studies are necessary to better explain their complex interactions.
Collapse
Affiliation(s)
- Jiska Ristori
- Andrology, Women’s Endocrinology and Gender Incongruence, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy; (J.R.); (C.C.); (A.R.); (F.M.); (L.V.)
| | - Carlotta Cocchetti
- Andrology, Women’s Endocrinology and Gender Incongruence, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy; (J.R.); (C.C.); (A.R.); (F.M.); (L.V.)
| | - Alessia Romani
- Andrology, Women’s Endocrinology and Gender Incongruence, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy; (J.R.); (C.C.); (A.R.); (F.M.); (L.V.)
| | - Francesca Mazzoli
- Andrology, Women’s Endocrinology and Gender Incongruence, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy; (J.R.); (C.C.); (A.R.); (F.M.); (L.V.)
| | - Linda Vignozzi
- Andrology, Women’s Endocrinology and Gender Incongruence, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy; (J.R.); (C.C.); (A.R.); (F.M.); (L.V.)
| | - Mario Maggi
- Endocrinology, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy;
| | - Alessandra Daphne Fisher
- Andrology, Women’s Endocrinology and Gender Incongruence, Careggi University Hospital, Viale Pieraccini 6, 50139 Florence, Italy; (J.R.); (C.C.); (A.R.); (F.M.); (L.V.)
- Correspondence:
| |
Collapse
|
14
|
Perez-Laso C, Cerdan S, Junque C, Gómez Á, Ortega E, Mora M, Avendaño C, Gómez-Gil E, Del Cerro MCR, Guillamon A. Effects of Adult Female Rat Androgenization on Brain Morphology and Metabolomic Profile. Cereb Cortex 2019; 28:2846-2853. [PMID: 29106544 DOI: 10.1093/cercor/bhx163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 11/14/2022] Open
Abstract
Androgenization in adult natal women, as in transsexual men (TM), affects brain cortical thickness and the volume of subcortical structures. In order to understand the mechanism underlying these changes we have developed an adult female rat model of androgenization. Magnetic resonance imaging and spectroscopy were used to monitor brain volume changes, white matter microstructure and ex vivo metabolic profiles over 32 days in androgenized and control subjects. Supraphysiological doses of testosterone prevents aging decrease of fractional anisotropy values, decreased general cortical volume and the relative concentrations of glutamine (Gln) and myo-Inositol (mI). An increase in the N-acetylaspartate (NAA)/mI ratio was detected d. Since mI and Gln are astrocyte markers and osmolytes, we suspect that the anabolic effects of testosterone change astrocyte osmolarity so as to extrude Mi and Gln from these cells in order to maintain osmotic homeostasis. This mechanism could explain the brain changes observed in TM and other individuals receiving androgenic anabolic steroids.
Collapse
Affiliation(s)
- Carmen Perez-Laso
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Sebastián Cerdan
- Instituto de Investigaciones Biomédicas Alberto Sols, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Carme Junque
- Departamento de Medicina, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Ángel Gómez
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Esperanza Ortega
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Mireia Mora
- Departamento de Endocrinología, Hospital Clínic, Barcelona, Spain
| | - Carlos Avendaño
- Departamento de Anatomía y Neurociencia, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Departamento de Psiquiatría, Hospital Clìnic, Barcelona, Spain
| | | | - Antonio Guillamon
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| |
Collapse
|
15
|
Schneider MA, Spritzer PM, Minuzzi L, Frey BN, Syan SK, Fighera TM, Schwarz K, Costa ÂB, da Silva DC, Garcia CCG, Fontanari AMV, Real AG, Anes M, Castan JU, Cunegatto FR, Lobato MIR. Effects of Estradiol Therapy on Resting-State Functional Connectivity of Transgender Women After Gender-Affirming Related Gonadectomy. Front Neurosci 2019; 13:817. [PMID: 31440128 PMCID: PMC6692765 DOI: 10.3389/fnins.2019.00817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022] Open
Abstract
An extreme incongruence between sex and gender identity leads individuals with gender dysphoria (GD) to seek cross-sex hormone therapy (CSHT), and gender-affirming surgery (GAS). Although few studies have investigated the effects of CSHT on the brain prior to GAS, no studies in the extant literature have evaluated its impact during hypogonadism in post-GAS individuals. Here, we aimed to evaluate the effects of estradiol on resting-state functional connectivity (rs-FC) of the sensorimotor cortex (SMC) and basal ganglia following surgical hypogonadism. Eighteen post-GAS (male-to-female) participants underwent functional magnetic resonance imaging (fMRI) and neuropsychiatric and hormonal assessment at two time points (t1, hormonal washout; t2, CSHT reintroduction). Based on the literature, the thalamus was selected as a seed, while the SMC and the dorsolateral striatum were targets for seed-based functional connectivity (sbFC). A second sbFC investigation consisted of a whole-brain voxel exploratory analysis again using the thalamus as a seed. A final complementary data-driven approach using multivoxel pattern analysis (MVPA) was conducted to identify a potential seed for further sbFC analyses. An increase in the rs-FC between the left thalamus and the left SCM/putamen followed CSHT. MVPA identified a cluster within the subcallosal cortex (SubCalC) representing the highest variation in peak activation between time points. Setting the SubCalC as a seed, whole-brain analysis showed a decoupling between the SubCalC and the medial frontal cortex during CSHT. These results indicate that CSHT with estradiol post-GAS, modulates rs-FC in regions engaged in cognitive, emotional, and sensorimotor processes.
Collapse
Affiliation(s)
- Maiko A Schneider
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Mood Disorders Program, Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Poli M Spritzer
- Gender Identity Program (PROTIG), Psychiatric 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 Endocrinoloy, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luciano Minuzzi
- Mood Disorders Program, Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Mood Disorders Program, Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Sabrina K Syan
- Mood Disorders Program, Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Peter Boris Centre for Addictions Research, McMaster University, Hamilton, ON, Canada
| | - Tayane M Fighera
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Division of Endocrinoloy, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Karine Schwarz
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ângelo B Costa
- Graduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Dhiordan C da Silva
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil
| | - Cláudia C G Garcia
- Gender Identity Program (PROTIG), Psychiatric 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 (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil
| | - André G Real
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil
| | - Maurício Anes
- Medical Physics and Radiation Protection Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana U Castan
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Psychology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Maria I R Lobato
- Gender Identity Program (PROTIG), Psychiatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program, Universidade Federal do Rio Grand do Sul, Porto Alegre, Brazil.,Psychiatric and Forensic Medical Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
16
|
Kim GW, Kim YH, Park K, Jeong GW. A comparative study of white matter volume between postoperative female-to-male transsexuals and healthy female. Int J Impot Res 2019; 31:432-438. [PMID: 30679768 DOI: 10.1038/s41443-019-0111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/14/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
Cross-sex hormones in female-to-male (FtM) transsexuals play a crucial role in brain plasticity. Morphological study associated with white matter (WM) volume in postoperative FtM transsexuals receiving cross-sex hormones has not been published yet. This study was performed to discriminate the regional WM volume differences between postoperative FtM transsexuals and female controls using voxel-based morphometry (VBM) and further to assess the correlations between regional volume variations and cross-sex hormones. WM volume was assessed in 12 postoperative FtM transsexuals receiving cross-sex hormones with 16 age-matched female controls. WM volume was processed using SPM8 software with diffeomorphic anatomical registration via an exponentiated Lie algebra (DARTEL) algorithm. Serum sex hormones, including estriol, free testosterone (free-T), estradiol, follicle-stimulating hormone, and luteinizing hormone were measured. Postoperative FtM transsexuals showed significantly (p < 0.05) larger WM volumes in the inferior parietal lobule, postcentral gyrus, and middle temporal gyrus compared with female controls. However, there were no brain areas with larger WM volume in female controls compared with FtM transsexuals. WM volumes of the inferior parietal lobule and middle temporal gyrus in FtM transsexuals were positively correlated with the levels of free-T. This study revealed WM volume change and its correlation with free-T level in postoperative FtM transsexuals. These findings will improve our understanding of the morphometric changes in FtM transsexuals under cross-sex hormone therapy.
Collapse
Affiliation(s)
- Gwang-Won Kim
- Advanced Institute of Aging Science, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea
| | - Kwangsung Park
- Advanced Institute of Aging Science, Chonnam National University, Gwangju, 61186, Republic of Korea.,Department of Urology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea
| | - Gwang-Woo Jeong
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea.
| |
Collapse
|
17
|
Nguyen HB, Loughead J, Lipner E, Hantsoo L, Kornfield SL, Epperson CN. What has sex got to do with it? The role of hormones in the transgender brain. Neuropsychopharmacology 2019; 44:22-37. [PMID: 30082887 PMCID: PMC6235900 DOI: 10.1038/s41386-018-0140-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023]
Abstract
Sex differences and hormonal effects in presumed cisgender individuals have been well-studied and support the concept of a mosaic of both male and female "characteristics" in any given brain. Gonadal steroid increases and fluctuations during peri-puberty and across the reproductive lifespan influence the brain structure and function programmed by testosterone and estradiol exposures in utero. While it is becoming increasingly common for transgender and gender non-binary individuals to block their transition to puberty and/or use gender-affirming hormone therapy (GAHT) to obtain their desired gender phenotype, little is known about the impact of these manipulations on brain structure and function. Using sex differences and the effects of reproductive hormones in cisgender individuals as the backdrop, we summarize here the existing nascent neuroimaging and behavioral literature focusing on potential brain and cognitive differences in transgender individuals at baseline and after GAHT. Research in this area has the potential to inform our understanding of the developmental origins of gender identity and sex difference in response to gonadal steroid manipulations, but care is needed in our research questions and methods to not further stigmatize sex and gender minorities.
Collapse
Affiliation(s)
- Hillary B Nguyen
- School of Arts and Sciences, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Philadelphia, PA, USA
| | | | - Emily Lipner
- School of Arts and Sciences, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - C Neill Epperson
- School of Arts and Sciences, Philadelphia, PA, USA.
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Psychiatry, Philadelphia, PA, USA.
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
18
|
Nguyen HB, Chavez AM, Lipner E, Hantsoo L, Kornfield SL, Davies RD, Epperson CN. Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Curr Psychiatry Rep 2018; 20:110. [PMID: 30306351 PMCID: PMC6354936 DOI: 10.1007/s11920-018-0973-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW With increasing numbers of transgender and gender non-binary individuals presenting for care, knowing how to elucidate the mental health and cognitive outcomes of gender-affirming hormone therapy (GAHT) is necessary. This article reviews the present literature covering GAHT effects on mood, behavioral health, and cognition in these individuals and offers research priorities to address knowledge gaps. RECENT FINDINGS Although there are some conflicting data, GAHT overwhelmingly seems to have positive psychological effects in both adolescents and adults. Research tends to support that GAHT reduces symptoms of anxiety and depression, lowers perceived and social distress, and improves quality of life and self-esteem in both male-to-female and female-to-male transgender individuals. Clinically, prescribing GAHT can help with gender dysphoria-related mental distress. Thus, timely hormonal intervention represents a crucial tool for improving behavioral wellness in transgender individuals, though effects on cognitive processes fundamental for daily living are unknown. Future research should prioritize better understanding of how GAHT may affect executive functioning.
Collapse
Affiliation(s)
- Hillary B. Nguyen
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA,Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| | - Alexis M. Chavez
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| | - Emily Lipner
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Liisa Hantsoo
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L. Kornfield
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert D. Davies
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| | - C. Neill Epperson
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, 13001 E 17th Place, MS F546, Aurora, CO 80045, USA
| |
Collapse
|
19
|
Burke SM, Manzouri AH, Dhejne C, Bergström K, Arver S, Feusner JD, Savic-Berglund I. Testosterone Effects on the Brain in Transgender Men. Cereb Cortex 2018; 28:1582-1596. [PMID: 28334217 PMCID: PMC6248653 DOI: 10.1093/cercor/bhx054] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/19/2017] [Accepted: 02/16/2017] [Indexed: 12/22/2022] Open
Abstract
Transgender individuals experience incongruence between their gender identity and birth-assigned sex. The resulting gender dysphoria (GD), which some gender-incongruent individuals experience, is theorized to be a consequence of atypical cerebral sexual differentiation, but support for this assertion is inconsistent. We recently found that GD is associated with disconnected networks involved in self-referential thinking and own body perception. Here, we investigate how these networks in trans men (assigned female at birth with male gender identity) are affected by testosterone. In 22 trans men, we obtained T1-weighted, diffusion-weighted, and resting-state functional magnetic resonance imaging scans before and after testosterone treatment, measuring cortical thickness (Cth), subcortical volumes, fractional anisotropy (FA), and functional connectivity. Nineteen cisgender controls (male and female) were also scanned twice. The medial prefrontal cortex (mPFC) was thicker in trans men than controls pretreatment, and remained unchanged posttreatment. Testosterone treatment resulted in increased Cth in the insular cortex, changes in cortico-cortical thickness covariation between mPFC and occipital cortex, increased FA in the fronto-occipital tract connecting these regions, and increased functional connectivity between mPFC and temporo-parietal junction, compared with controls. Concluding, in trans men testosterone treatment resulted in functional and structural changes in self-referential and own body perception areas.
Collapse
Affiliation(s)
- Sarah M Burke
- Department of Women's and Children's Health, Karolinska Institutet and
University Hospital, SE-171 76 Stockholm, Sweden
| | | | - Cecilia Dhejne
- ANOVA, Center of Expertise in Andrology, Sexual Medicine, and Transgender
Medicine, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Center for Psychiatric Research, Department of Clinical Neuroscience,
Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Karin Bergström
- Department of Women's and Children's Health, Karolinska Institutet and
University Hospital, SE-171 76 Stockholm, Sweden
| | - Stefan Arver
- ANOVA, Center of Expertise in Andrology, Sexual Medicine, and Transgender
Medicine, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Medicine/Huddinge, Karolinska Institutet, SE-141 86
Stockholm, Sweden
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of
California Los Angeles, Los Angeles, CA 90095, USA
| | - Ivanka Savic-Berglund
- Department of Women's and Children's Health, Karolinska Institutet and
University Hospital, SE-171 76 Stockholm, Sweden
| |
Collapse
|
20
|
Manzouri A, Savic I. Cerebral sex dimorphism and sexual orientation. Hum Brain Mapp 2018; 39:1175-1186. [PMID: 29227002 PMCID: PMC6866632 DOI: 10.1002/hbm.23908] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 11/08/2022] Open
Abstract
The neurobiology of sexual orientation is frequently discussed in terms of cerebral sex dimorphism (defining both functional and structural sex differences). Yet, the information about possible cerebral differences between sex-matched homo and heterosexual persons is limited, particularly among women. In this multimodal MRI study, we addressed these issues by investigating possible cerebral differences between homo and heterosexual persons, and by asking whether there is any sex difference in this aspect. Measurements of cortical thickness (Cth), subcortical volumes, and functional and structural resting-state connections among 40 heterosexual males (HeM) and 40 heterosexual females (HeF) were compared with those of 30 homosexual males (HoM) and 30 homosexual females (HoF). Congruent with previous reports, sex differences were detected in heterosexual controls with regard to fractional anisotropy (FA), Cth, and several subcortical volumes. Homosexual groups did not display any sex differences in FA values. Furthermore, their functional connectivity was significantly less pronounced in the mesial prefrontal and precuneus regions. In these two particular regions, HoM also displayed thicker cerebral cortex than other groups, whereas HoF did not differ from HeF. In addition, in HoM the parietal Cth showed "sex-reversed" values, not observed in HoF. Homosexual orientation seems associated with a less pronounced sexual differentiation of white matter tracts and a less pronounced functional connectivity of the self-referential networks compared to heterosexual orientation. Analyses of Cth suggest that male and female homosexuality are not simple analogues of each other and that differences from heterosexual controls are more pronounced in HoM.
Collapse
Affiliation(s)
- Amirhossein Manzouri
- Department of Women's and Children's Health, and Neurology ClinicKarolinska Institutet and HospitalStickholmSE‐171 76Sweden
| | - Ivanka Savic
- Department of Women's and Children's Health, and Neurology ClinicKarolinska Institutet and HospitalStickholmSE‐171 76Sweden
| |
Collapse
|
21
|
Savic I, Engel J. Reprint of "Structural and functional correlates of epileptogenesis--does gender matter?". Neurobiol Dis 2018; 72 Pt B:131-5. [PMID: 25448763 DOI: 10.1016/j.nbd.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/15/2014] [Accepted: 05/22/2014] [Indexed: 11/30/2022] Open
Abstract
In the majority of neuropsychiatric conditions, marked gender-based differences have been found in the epidemiology,clinical manifestations, and therapy of disease. One possible reason is that sex differences in cerebral morphology, structural and functional connections, render men and women differentially vulnerable to various disease processes. The present review addresses this issue with respect to the functional and structural correlates to some forms of epilepsy.
Collapse
|
22
|
Nota NM, Burke SM, den Heijer M, Soleman RS, Lambalk CB, Cohen-Kettenis PT, Veltman DJ, Kreukels BP. Brain sexual differentiation and effects of cross-sex hormone therapy in transpeople: A resting-state functional magnetic resonance study. Neurophysiol Clin 2017; 47:361-370. [DOI: 10.1016/j.neucli.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 02/02/2023] Open
|
23
|
Clemens B, Junger J, Pauly K, Neulen J, Neuschaefer-Rube C, Frölich D, Mingoia G, Derntl B, Habel U. Male-to-female gender dysphoria: Gender-specific differences in resting-state networks. Brain Behav 2017; 7:e00691. [PMID: 28523232 PMCID: PMC5434195 DOI: 10.1002/brb3.691] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/02/2017] [Accepted: 02/23/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Recent research found gender-related differences in resting-state functional connectivity (rs-FC) measured by functional magnetic resonance imaging (fMRI). To the best of our knowledge, there are no studies examining the differences in rs-FC between men, women, and individuals who report a discrepancy between their anatomical sex and their gender identity, i.e. gender dysphoria (GD). METHODS To address this important issue, we present the first fMRI study systematically investigating the differences in typical resting-state networks (RSNs) and hormonal treatment effects in 26 male-to-female GD individuals (MtFs) compared with 19 men and 20 women. RESULTS Differences between male and female control groups were found only in the auditory RSN, whereas differences between both control groups and MtFs were found in the auditory and fronto-parietal RSNs, including both primary sensory areas (e.g. calcarine gyrus) and higher order cognitive areas such as the middle and posterior cingulate and dorsomedial prefrontal cortex. Overall, differences in MtFs compared with men and women were more pronounced before cross-sex hormonal treatment. Interestingly, rs-FC between MtFs and women did not differ significantly after treatment. When comparing hormonally untreated and treated MtFs, we found differences in connectivity of the calcarine gyrus and thalamus in the context of the auditory network, as well as the inferior frontal gyrus in context of the fronto-parietal network. CONCLUSION Our results provide first evidence that MtFs exhibit patterns of rs-FC which are different from both their assigned and their aspired gender, indicating an intermediate position between the two sexes. We suggest that the present study constitutes a starting point for future research designed to clarify whether the brains of individuals with GD are more similar to their assigned or their aspired gender.
Collapse
Affiliation(s)
- Benjamin Clemens
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany
| | - Jessica Junger
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany.,JARA-Translational Brain MedicineJülichGermany
| | - Katharina Pauly
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany.,JARA-Translational Brain MedicineJülichGermany
| | - Josef Neulen
- Department of Gynecological Endocrinology and Reproductive Medicine Medical School RWTH Aachen University Aachen Germany
| | - Christiane Neuschaefer-Rube
- Department of Phoniatrics, Pedaudiology and Communication Disorders Medical School RWTH Aachen University Aachen Germany
| | - Dirk Frölich
- Department of Phoniatrics, Pedaudiology and Communication Disorders Medical School RWTH Aachen University Aachen Germany
| | - Gianluca Mingoia
- JARA-Translational Brain MedicineJülichGermany.,Interdisciplinary Center for Clinical Research (IZKF) RWTH Aachen University Aachen Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy University of Tübingen Tübingen Germany.,Werner Reichardt Center for Integrative Neuroscience (CIN) University of Tübingen Tübingen Germany.,LEAD Graduate School and Research Network Tübingen Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany.,JARA-Translational Brain MedicineJülichGermany
| |
Collapse
|
24
|
Kranz GS, Seiger R, Kaufmann U, Hummer A, Hahn A, Ganger S, Tik M, Windischberger C, Kasper S, Lanzenberger R. Effects of sex hormone treatment on white matter microstructure in individuals with gender dysphoria. Neuroimage 2017; 150:60-67. [DOI: 10.1016/j.neuroimage.2017.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/02/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
|
25
|
Abstract
Neither consensus on best practice nor validated neuropsychological, intelligence, or personality testing batteries exist for assessment and psychological testing on the transgender population. Historically, assessment has been used in a gate-keeping fashion with transgender clients. There are no firm standards of care when considering the content and appropriateness of evaluations conducted presurgically. These evaluations are discussed in the setting of other presurgical evaluations, with a recommendation to move toward a competency to make a medical decisions model. Additional considerations are discussed, such as effects of transition on mood and how to interpret scores in a field where normative data are often gender stratified.
Collapse
|
26
|
Seitz J, Lyall AE, Kanayama G, Makris N, Hudson JI, Kubicki M, Pope HG, Kaufman MJ. White matter abnormalities in long-term anabolic-androgenic steroid users: A pilot study. Psychiatry Res 2017; 260:1-5. [PMID: 27988413 PMCID: PMC5272808 DOI: 10.1016/j.pscychresns.2016.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/14/2016] [Accepted: 12/01/2016] [Indexed: 12/21/2022]
Abstract
Recent studies of long-term anabolic-androgenic steroid (AAS) users reported amygdala structural and functional connectivity abnormalities. We assessed white matter microstructure in the inferior-fronto-occipital fasciculus (IFOF), a major associative bundle of the amygdala network. Diffusion weighted images acquired from 9 male long-term AAS users and 8 matched controls aged 36-51 years old were processed using a standardized pipeline (Tract-Based Spatial Statistics). Group differences were examined using linear regression with adjustment for age and current testosterone level. Compared to nonusers, AAS users exhibited significantly higher fractional anisotropy (FA) in the IFOF. Users showed markedly greater FA than nonusers on the left IFOF but only a modest, nonsignificant difference on the right IFOF. Moreover, FA was positively associated with lifetime cumulative AAS dose. Our results suggest that long-term AAS use alters IFOF white matter organization and integrity, which in turn might affect amygdala-related processes such as reward system function. Accordingly, further studies are needed to replicate findings in larger subject groups to determine the functional significance of the FA abnormality.
Collapse
Affiliation(s)
- Johanna Seitz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda E Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikos Makris
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry, Neurology and Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James I Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry, Neurology and Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc J Kaufman
- McLean Imaging Center, McLean Hospital, Department of Psychiatry, Harvard Medical School, 115 Mill St., Belmont 02478, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
27
|
Savic I, Frisen L, Manzouri A, Nordenstrom A, Lindén Hirschberg A. Role of testosterone and Y chromosome genes for the masculinization of the human brain. Hum Brain Mapp 2017; 38:1801-1814. [PMID: 28070912 DOI: 10.1002/hbm.23483] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/18/2016] [Accepted: 11/21/2016] [Indexed: 01/18/2023] Open
Abstract
Women with complete androgen insensitivity syndrome (CAIS) have a male (46,XY) karyotype but no functional androgen receptors. Their condition, therefore, offers a unique model for studying testosterone effects on cerebral sex dimorphism. We present MRI data from 16 women with CAIS and 32 male (46,XY) and 32 female (46,XX) controls. METHODS FreeSurfer software was employed to measure cortical thickness and subcortical structural volumes. Axonal connections, indexed by fractional anisotropy, (FA) were measured with diffusion tensor imaging, and functional connectivity with resting state fMRI. RESULTS Compared to men, CAIS women displayed a "female" pattern by having thicker parietal and occipital cortices, lower FA values in the right corticospinal, superior and inferior longitudinal tracts, and corpus callosum. Their functional connectivity from the amygdala to the medial prefrontal cortex, was stronger and amygdala-connections to the motor cortex weaker than in control men. CAIS and control women also showed stronger posterior cingulate and precuneus connections in the default mode network. Thickness of the motor cortex, the caudate volume, and the FA in the callosal body followed, however, a "male" pattern. CONCLUSION Altogether, these data suggest that testosterone modulates the microstructure of somatosensory and visual cortices and their axonal connections to the frontal cortex. Testosterone also influenced functional connections from the amygdala, whereas the motor cortex could, in agreement with our previous reports, be moderated by processes linked to X-chromosome gene dosage. These data raise the question about other genetic factors masculinizing the human brain than the SRY gene and testosterone. Hum Brain Mapp 38:1801-1814, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, SE-113 30, Sweden.,Department of Neurology, Stockholm, SE-113 30, Sweden
| | - Louise Frisen
- Dept of Clinical Neuroscience, Stockholm, SE-113 30, Sweden.,Child and Adolescent Psychiatry Research Center, Stockholm, SE-113 30, Sweden
| | - Amirhossein Manzouri
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, SE-113 30, Sweden
| | - Anna Nordenstrom
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, SE-113 30, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, SE-113 30, Sweden.,Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
28
|
Seiger R, Hahn A, Hummer A, Kranz GS, Ganger S, Woletz M, Kraus C, Sladky R, Kautzky A, Kasper S, Windischberger C, Lanzenberger R. Subcortical gray matter changes in transgender subjects after long-term cross-sex hormone administration. Psychoneuroendocrinology 2016; 74:371-379. [PMID: 27744092 DOI: 10.1016/j.psyneuen.2016.09.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 08/29/2016] [Accepted: 09/21/2016] [Indexed: 02/08/2023]
Abstract
Sex-steroid hormones are primarily involved in sexual differentiation and development and are thought to underlie processes related to cognition and emotion. However, divergent results have been reported concerning the effects of hormone administration on brain structure including side effects like brain atrophy and dementia. Cross-sex hormone therapy in transgender subjects offers a unique model for studying the effects of sex hormones on the living human brain. In this study, 25 Female-to-Male (FtM) and 14 Male-to-Female (MtF) subjects underwent MRI examinations at baseline and after a period of at least 4-months of continuous cross-sex hormone administration. While MtFs received estradiol and anti-androgens, FtM subjects underwent high-dose testosterone treatment. The longitudinal processing stream of the FreeSurfer software suite was used for the automated assessment and delineation of brain volumes to assess the structural changes over the treatment period of cross-sex hormone administration. Most prominent results were found for MtFs receiving estradiol and anti-androgens in the form of significant decreases in the hippocampal region. Further analysis revealed that these decreases were reflected by increases in the ventricles. Additionally, changes in progesterone levels correlated with changes in gray matter structures in MtF subjects. In line with prior studies, our results indicate hormonal influences on subcortical structures related to memory and emotional processing. Additionally, this study adds valuable knowledge that progesterone may play an important role in this process.
Collapse
Affiliation(s)
- Rene Seiger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Allan Hummer
- MR Centre of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Ganger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Woletz
- MR Centre of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Kraus
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Ronald Sladky
- MR Centre of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Windischberger
- MR Centre of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria.
| |
Collapse
|
29
|
Mueller SC, Wierckx K, Jackson K, T'Sjoen G. Circulating androgens correlate with resting-state MRI in transgender men. Psychoneuroendocrinology 2016; 73:91-98. [PMID: 27479654 DOI: 10.1016/j.psyneuen.2016.07.212] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 12/29/2022]
Abstract
Despite mounting evidence regarding the underlying neurobiology in transgender persons, information regarding resting-state activity, particularly after hormonal treatment, is lacking. The present study examined differences between transgender persons on long-term cross-sex hormone therapy and comparisons on two measures of local functional connectivity, intensity of spontaneous resting-state activity (low frequency fluctuations, LFF) and local synchronization of specific brain areas (regional homogeneity, ReHo). Nineteen transgender women (TW, male-to-female), 19 transgender men (TM, female-to-male), 21 non-transgender men (NTM) and 20 non-transgender women (NTW) underwent a resting-state MRI scan. The results showed differences between transgender persons and non-transgender comparisons on both LFF and ReHo measures in the frontal cortex, medial temporal lobe, and cerebellum. More interestingly, circulating androgens correlated for TM in the cerebellum and regions of the frontal cortex, an effect that was associated with treatment duration in the cerebellum. By comparison, no associations were found for TW with estrogens. These data provide first evidence for a potential masculinization of local functional connectivity in hormonally-treated transgender men.
Collapse
Affiliation(s)
- Sven C Mueller
- Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium.
| | - Katrien Wierckx
- Department of Endocrinology & Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | | | - Guy T'Sjoen
- Department of Endocrinology & Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
30
|
Burke SM, Kreukels BP, Cohen-Kettenis PT, Veltman DJ, Klink DT, Bakker J. Male-typical visuospatial functioning in gynephilic girls with gender dysphoria - organizational and activational effects of testosterone. J Psychiatry Neurosci 2016; 41:395-404. [PMID: 27070350 PMCID: PMC5082510 DOI: 10.1503/jpn.150147] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sex differences in performance and regional brain activity during mental rotation have been reported repeatedly and reflect organizational and activational effects of sex hormones. We investigated whether adolescent girls with gender dysphoria (GD), before and after 10 months of testosterone treatment, showed male-typical brain activity during a mental rotation task (MRT). METHODS Girls with GD underwent fMRI while performing the MRT twice: when receiving medication to suppress their endogenous sex hormones before onset of testosterone treatment, and 10 months later during testosterone treatment. Two age-matched control groups participated twice as well. RESULTS We included 21 girls with GD, 20 male controls and 21 female controls in our study. In the absence of any group differences in performance, control girls showed significantly increased activation in frontal brain areas compared with control boys (pFWE = 0.012). Girls with GD before testosterone treatment differed significantly in frontal brain activation from the control girls (pFWE = 0.034), suggesting a masculinization of brain structures associated with visuospatial cognitive functions. After 10 months of testosterone treatment, girls with GD, similar to the control boys, showed increases in brain activation in areas implicated in mental rotation. LIMITATIONS Since all girls with GD identified as gynephilic, their resemblance in spatial cognition with the control boys, who were also gynephilic, may have been related to their shared sexual orientation rather than their shared gender identity. We did not account for menstrual cycle phase or contraceptive use in our analyses. CONCLUSION Our findings suggest atypical sexual differentiation of the brain in natal girls with GD and provide new evidence for organizational and activational effects of testosterone on visuospatial cognitive functioning.
Collapse
Affiliation(s)
- Sarah M. Burke
- Correspondence to: S.M. Burke, Karolinska Institute, Department of Women’s and Children’s Health, Karolinska Hospital, Stockholm, Sweden;
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
The current review gives an overview of brain studies in transgender people. First, we describe studies into the aetiology of feelings of gender incongruence, primarily addressing the sexual differentiation hypothesis: does the brain of transgender individuals resemble that of their natal sex, or that of their experienced gender? Findings from neuroimaging studies focusing on brain structure suggest that the brain phenotypes of trans women (MtF) and trans men (FtM) differ in various ways from control men and women with feminine, masculine, demasculinized and defeminized features. The brain phenotypes of people with feelings of gender incongruence may help us to figure out whether sex differentiation of the brain is atypical in these individuals, and shed light on gender identity development. Task-related imaging studies may show whether brain activation and task performance in transgender people is sex-atypical. Second, we review studies that evaluate the effects of cross-sex hormone treatment on the brain. This type of research provides knowledge on how changes in sex hormone levels may affect brain structure and function.
Collapse
Affiliation(s)
- Baudewijntje P C Kreukels
- a VU University Medical Centre, Department of Medical Psychology, Centre of Expertise on Gender Dysphoria, EMGO Institute for Health and Care Research , Amsterdam , the Netherlands
| | - Antonio Guillamon
- b Universidad Nacional de Educacion a Distancia (UNED) , Departamento de Psicobiologia , Madrid , Spain
| |
Collapse
|
32
|
Guillamon A, Junque C, Gómez-Gil E. A Review of the Status of Brain Structure Research in Transsexualism. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1615-48. [PMID: 27255307 PMCID: PMC4987404 DOI: 10.1007/s10508-016-0768-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2015] [Accepted: 04/29/2016] [Indexed: 05/22/2023]
Abstract
The present review focuses on the brain structure of male-to-female (MtF) and female-to-male (FtM) homosexual transsexuals before and after cross-sex hormone treatment as shown by in vivo neuroimaging techniques. Cortical thickness and diffusion tensor imaging studies suggest that the brain of MtFs presents complex mixtures of masculine, feminine, and demasculinized regions, while FtMs show feminine, masculine, and defeminized regions. Consequently, the specific brain phenotypes proposed for MtFs and FtMs differ from those of both heterosexual males and females. These phenotypes have theoretical implications for brain intersexuality, asymmetry, and body perception in transsexuals as well as for Blanchard's hypothesis on sexual orientation in homosexual MtFs. Falling within the aegis of the neurohormonal theory of sex differences, we hypothesize that cortical differences between homosexual MtFs and FtMs and male and female controls are due to differently timed cortical thinning in different regions for each group. Cross-sex hormone studies have reported marked effects of the treatment on MtF and FtM brains. Their results are used to discuss the early postmortem histological studies of the MtF brain.
Collapse
Affiliation(s)
- Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, c/Juand del Rosal, 10, 28040, Madrid, Spain.
- Academia de Psicología de España, Madrid, Spain.
| | - Carme Junque
- Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | - Esther Gómez-Gil
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Unidad de Identidad de Género, Hospital Clinic, Barcelona, Spain
| |
Collapse
|
33
|
Abstract
OBJECTIVE To review current literature that supports a biologic basis of gender identity. METHODS A traditional literature review. RESULTS Evidence that there is a biologic basis for gender identity primarily involves (1) data on gender identity in patients with disorders of sex development (DSDs, also known as differences of sex development) along with (2) neuroanatomical differences associated with gender identity. CONCLUSIONS Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis of gender identity.
Collapse
Affiliation(s)
- Aruna Saraswat
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine
| | | | - Joshua D Safer
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine
| |
Collapse
|
34
|
Bos PA, Hofman D, Hermans EJ, Montoya ER, Baron-Cohen S, van Honk J. Testosterone reduces functional connectivity during the 'Reading the Mind in the Eyes' Test. Psychoneuroendocrinology 2016; 68:194-201. [PMID: 26994483 PMCID: PMC6345363 DOI: 10.1016/j.psyneuen.2016.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
Abstract
Women on average outperform men in cognitive-empathic abilities, such as the capacity to infer motives from the bodily cues of others, which is vital for effective social interaction. The steroid hormone testosterone is thought to play a role in this sexual dimorphism. Strikingly, a previous study shows that a single administration of testosterone in women impairs performance on the 'Reading the Mind in Eyes' Test (RMET), a task in which emotions have to be inferred from the eye-region of a face. This effect was mediated by the 2D:4D ratio, the ratio between the length of the index and ring finger, a proxy for fetal testosterone. Research in typical individuals, in individuals with autism spectrum conditions (ASC), and in individuals with brain lesions has established that performance on the RMET depends on the left inferior frontal gyrus (IFG). Using functional magnetic resonance imaging (fMRI), we found that a single administration of testosterone in 16 young women significantly altered connectivity of the left IFG with the anterior cingulate cortex (ACC) and the supplementary motor area (SMA) during RMET performance, independent of 2D:4D ratio. This IFG-ACC-SMA network underlies the integration and selection of sensory information, and for action preparation during cognitive empathic behavior. Our findings thus reveal a neural mechanism by which testosterone can impair emotion-recognition ability, and may link to the symptomatology of ASC, in which the same neural network is implicated.
Collapse
Affiliation(s)
- Peter A. Bos
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands,Department of Psychiatry, University of Cape Town, Cape Town, South Africa,Corresponding author at: Department of Experimental Psychology, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands. (P.A. Bos)
| | - Dennis Hofman
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Erno J. Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands,Department for Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Estrella R. Montoya
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Jack van Honk
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands,Department of Psychiatry, University of Cape Town, Cape Town, South Africa,Department of Psychiatry and Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| |
Collapse
|
35
|
Abstract
Transgender individuals experience unique challenges with regards to discrimination and access to health care. Further, their unique health-care needs and challenges lead to greater rates of morbidity. This article seeks to review the unique biology of transgender patients and the effects of cross-sex hormone therapy on ophthalmic and non-ophthalmic pathology. Attention is given to topics in neuro-ophthalmology, oculoplastics, and retinal disease.
Collapse
Affiliation(s)
- Matthew W Hollar
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Matthew M Zhang
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Louise A Mawn
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Neurological Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| |
Collapse
|
36
|
Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W, Reisner S, Sevelius J, Ettner R. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes 2016; 23:188-97. [PMID: 26835800 PMCID: PMC4809047 DOI: 10.1097/med.0000000000000232] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. RECENT FINDINGS Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. SUMMARY Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
Collapse
Affiliation(s)
- Walter Bockting
- aDivision of Gender, Sexuality, and Health New York State Psychiatric Institute/Columbia Psychiatry and the School of Nursing, Columbia University Medical Center, New York bProgram in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota cSchool of Medicine, University of California, San Francisco, California dDepartment of Psychobiology, National Distance Education University, Madrid, Spain eThe Williams Institute, University of California, Los Angeles School of Law, Los Angeles, California fDivision of Psychiatry, University of Texas Medical Branch, Galveston, Texas gFenway Institute, Fenway Health hDepartment of Epidemiology, Harvard T.H. Chan School of Public Health iDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts jSchool of Medicine, University of California, San Fransisco, California kPrivate Practice, Evanston, Illinois
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Schwarz K, Fontanari AMV, Mueller A, Soll B, da Silva DC, Salvador J, Zucker KJ, Schneider MA, Lobato MIR. Neural Correlates of Psychosis and Gender Dysphoria in an Adult Male. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:761-765. [PMID: 26597648 DOI: 10.1007/s10508-015-0660-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 06/05/2023]
Abstract
Gender dysphoria (GD) (DSM-5) or transsexualism (ICD-10) refers to the marked incongruity between the experience of one's gender and the sex at birth. In this case report, we describe the use of LSD as a triggering factor of confusion in the gender identity of a 39-year-old male patient, with symptoms of psychosis and 25 years of substance abuse, who sought psychiatric care with the desire to undergo sex reassignment surgery. The symptoms of GD/psychosis were resolved by two therapeutic measures: withdrawal of psychoactive substances and use of a low-dose antipsychotic. We discuss the hypothesis that the superior parietal cortical area may be an important locus for body image and that symptoms of GD may be related to variations underlying this brain region. Finally, this case report shows that some presentations of GD can be created by life experience in individuals who have underlying mental or, synonymously, neurophysiological abnormalities.
Collapse
Affiliation(s)
- Karine Schwarz
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Anna Martha Vaitses Fontanari
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andressa Mueller
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bianca Soll
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Dhiordan Cardoso da Silva
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jaqueline Salvador
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kenneth J Zucker
- Gender Identity Clinic, Child, Youth, and Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Maiko Abel Schneider
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Inês Rodrigues Lobato
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
38
|
Hahn A, Kranz GS, Sladky R, Kaufmann U, Ganger S, Hummer A, Seiger R, Spies M, Vanicek T, Winkler D, Kasper S, Windischberger C, Swaab DF, Lanzenberger R. Testosterone affects language areas of the adult human brain. Hum Brain Mapp 2016; 37:1738-48. [PMID: 26876303 PMCID: PMC4949561 DOI: 10.1002/hbm.23133] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/17/2015] [Accepted: 01/25/2016] [Indexed: 12/19/2022] Open
Abstract
Although the sex steroid hormone testosterone is integrally involved in the development of language processing, ethical considerations mostly limit investigations to single hormone administrations. To circumvent this issue we assessed the influence of continuous high-dose hormone application in adult female-to-male transsexuals. Subjects underwent magnetic resonance imaging before and after 4 weeks of testosterone treatment, with each scan including structural, diffusion weighted and functional imaging. Voxel-based morphometry analysis showed decreased gray matter volume with increasing levels of bioavailable testosterone exclusively in Broca's and Wernicke's areas. Particularly, this may link known sex differences in language performance to the influence of testosterone on relevant brain regions. Using probabilistic tractography, we further observed that longitudinal changes in testosterone negatively predicted changes in mean diffusivity of the corresponding structural connection passing through the extreme capsule. Considering a related increase in myelin staining in rodents, this potentially reflects a strengthening of the fiber tract particularly involved in language comprehension. Finally, functional images at resting-state were evaluated, showing increased functional connectivity between the two brain regions with increasing testosterone levels. These findings suggest testosterone-dependent neuroplastic adaptations in adulthood within language-specific brain regions and connections. Importantly, deteriorations in gray matter volume seem to be compensated by enhancement of corresponding structural and functional connectivity. Hum Brain Mapp 37:1738-1748, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- 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
| | - Ronald Sladky
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Sebastian Ganger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Allan Hummer
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Rene Seiger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Thomas Vanicek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Dick F Swaab
- Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| |
Collapse
|
39
|
Auer MK, Hellweg R, Briken P, Stalla GK, T'Sjoen G, Fuss J. Serum brain-derived neurotrophic factor (BDNF) is not regulated by testosterone in transmen. Biol Sex Differ 2016; 7:1. [PMID: 26753091 PMCID: PMC4705590 DOI: 10.1186/s13293-015-0055-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Abstract
Brain morphology significantly differs between the sexes. It has been shown before that some of these differences are attributable to the sex-specific hormonal milieu. Brain-derived neurotrophic factor (BDNF) is involved in myriads of neuroplastic processes and shows a sexual dimorphism. Transsexual persons may serve as a model to study sex steroid-mediated effects on brain plasticity. We have recently demonstrated that serum levels of BDNF are reduced in transwomen following 12 months of cross-sex hormone treatment. We now wanted to look at the effects of testosterone treatment on BDNF in transmen. In contrast to our initial hypothesis, BDNF levels did not significantly change, despite dramatic changes in the sex-hormonal milieu. Our data indicate that testosterone does not seem to play a major role in the regulation of BDNF in females.
Collapse
Affiliation(s)
- Matthias K Auer
- Endocrinology, Diabetology and Internal Medicine, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Rainer Hellweg
- Department of Psychiatry, University of Medicine of Berlin, Campus Charité Mitte, Bonhoefferweg 3, 10117 Berlin, Germany
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martininstr. 52, 20246 Hamburg, Germany
| | - Günter K Stalla
- Endocrinology, Diabetology and Internal Medicine, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Johannes Fuss
- Institute for Sex Research and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martininstr. 52, 20246 Hamburg, Germany
| |
Collapse
|
40
|
Cerebral gray matter volume variation in female-to-male transsexuals: a voxel-based morphometric study. Neuroreport 2015; 26:1119-25. [PMID: 26559725 DOI: 10.1097/wnr.0000000000000481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several studies seem to support the hypothesis that brain anatomy is associated with transsexualism. However, these studies were still limited because few neuroanatomical findings have been obtained from female-to-male (FtM) transsexuals. This study compared the cerebral regional volumes of gray matter (GM) between FtM transsexuals and female controls using a voxel-based morphometry. Twelve FtM transsexuals who had undergone sex-reassignment surgery and 15 female controls participated in this study. Both groups were age matched and right-handed, with no history of neurological illness. Fifteen female controls were recruited to determine whether GM volumes in FtM transsexuals more closely resembled individuals who shared their biological sex. MRI data were processed using SPM 8 with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL). FtM transsexuals showed significantly larger volumes of the thalamus, hypothalamus, midbrain, gyrus rectus, head of caudate nucleus, precentral gyrus, and subcallosal area compared with the female controls. However, the female controls showed a significantly larger volume in the superior temporal gyrus including Heschl's gyrus and Rolandic operculum. These findings confirm that the volume difference in brain substructures in FtM transsexuals is likely to be associated with transsexualism and that transsexualism is probably associated with distinct cerebral structures, determining gender identity.
Collapse
|
41
|
Smith ES, Junger J, Derntl B, Habel U. The transsexual brain – A review of findings on the neural basis of transsexualism. Neurosci Biobehav Rev 2015; 59:251-66. [DOI: 10.1016/j.neubiorev.2015.09.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 12/30/2022]
|
42
|
Kim TH, Kim GW, Kim SK, Jeong GW. Brain activation-based sexual orientation in female-to-male transsexuals. Int J Impot Res 2015; 28:31-8. [PMID: 26581912 DOI: 10.1038/ijir.2015.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/18/2015] [Accepted: 09/22/2015] [Indexed: 12/17/2022]
Abstract
This study was performed to identify the sexual orientation in association with brain activation pattern in response to visual erotic stimuli in female-to-male (FtM) transsexuals by using functional magnetic resonance imaging (fMRI). Eleven FtM transsexuals who have had sex-reassignment surgery to alter their natal bodies with the gender-identity disorder were participated. Brain activation for sexual orientation was induced by visual stimuli with female and male erotic nude pictures compared with emotionally-neutral pictures. During viewing the erotic female pictures, the brain areas dominantly activated consist of the superior frontal gyrus, supplementary motor area, anterior/median cingulate gyri and hypothalamus, whereas during viewing male pictures, the brain areas with predominant activities were the middle frontal gyrus, precentral gyrus, middle temporal gyrus, fusiform gyrus, angular gyrus, precuneus, superior/middle occipital gyri, cerebellar cortex and vermis. These findings demonstrate that the brain activation patterns induced by viewing male or female erotic pictures show some correlation to the sexual orientation opposite to the genetic sex in FtM transsexuals. This study would be helpful to understand the neural mechanism associated with visual sexual arousal in patients with gender disorder.
Collapse
Affiliation(s)
- T-H Kim
- Research Institute of Medical Imaging, Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - G-W Kim
- Research Institute of Medical Imaging, Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S-K Kim
- Department of Plastic and Reconstructive Surgery, Dong-A University Hospital, Busan, Republic of Korea
| | - G-W Jeong
- Research Institute of Medical Imaging, Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea.,Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
43
|
Gooren LJ, Kreukels B, Lapauw B, Giltay EJ. (Patho)physiology of cross-sex hormone administration to transsexual people: the potential impact of male-female genetic differences. Andrologia 2014; 47:5-19. [PMID: 25495275 DOI: 10.1111/and.12389] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 12/11/2022] Open
Abstract
There is a limited body of knowledge of desired and undesired effects of cross-sex hormones in transsexual people. Little attention has been given to the fact that chromosomal configurations, 46,XY in male-to-female transsexuals subjects (MtoF) and 46,XX in female-to-male transsexual subjects (FtoM), obviously, remain unchanged. These differences in their genomes cause sex differences in the functions of cells. This study reviews sex differences in metabolism/cardiovascular pathology, immune mechanisms, bone (patho)physiology and brain functions and examines whether they are, maybe partially, determined by genetic mechanisms rather than by (cross-sex) hormones. There do not appear to be major genetic impacts on the changes in bone physiology. Also immune functions are rather unaffected and the evidence for an increase of autoimmune disease in MtoF is preliminary. Brain functions of transsexuals may have differed from controls before cross-sex hormones; they do undergo shifts upon cross-sex hormone treatment, but there is no evidence for changes in sex-specific brain disease. The prevalence of cardiovascular disease is higher in MtoF receiving oestrogens than in FtoM receiving androgens. While type of oestrogen and route of administration might be significant, it is reasonable to speculate that nonhormonal/genetic factors play a role.
Collapse
Affiliation(s)
- L J Gooren
- Emeritus VU Medical Center, Amsterdam, The Netherlands; Androconsult, Chiang Mai, Thailand
| | | | | | | |
Collapse
|
44
|
Pangelinan MM, Leonard G, Perron M, Pike GB, Richer L, Veillette S, Pausova Z, Paus T. Puberty and testosterone shape the corticospinal tract during male adolescence. Brain Struct Funct 2014; 221:1083-94. [PMID: 25503450 DOI: 10.1007/s00429-014-0956-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022]
Abstract
Some of the known sex differences in white matter emerge during adolescence. Here, we replicate and extend our previous findings of sex differences in the structure of the corticospinal tract (Perrin et al. 2009; Hervé et al. 2009). In a large normative sample of adolescents, we observed age × sex interactions in the signal intensity of T1-weighted (T1W) images (n = 941) and in magnetization transfer ratio (MTR; n = 761); both features were inversely associated with age in males but not in females. Moreover, we hypothesized that the age-related differences in CST structure exhibited by males would be mediated by differences in puberty stage and levels of bioavailable testosterone. We confirmed this prediction using mediation analysis with bootstrapping. These findings suggest that sex differences in the CST structure observed during male adolescence may be due to multiple processes associated with puberty, including (but not limited to) the rising levels of testosterone.
Collapse
Affiliation(s)
- Melissa M Pangelinan
- Rotman Research Institute, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | - Gabriel Leonard
- Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Michel Perron
- ECOBES, Céjep de Jonquière, 2505 Rue Saint Hubert, Jonquière, QC, G7X 3W1, Canada
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, 555 Boulevard de l'Université, Chicoutimi, QC, G7H 2B1, Canada
| | - G Bruce Pike
- Faculty of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Louis Richer
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, 555 Boulevard de l'Université, Chicoutimi, QC, G7H 2B1, Canada
| | - Suzanne Veillette
- ECOBES, Céjep de Jonquière, 2505 Rue Saint Hubert, Jonquière, QC, G7X 3W1, Canada
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, 555 Boulevard de l'Université, Chicoutimi, QC, G7H 2B1, Canada
| | - Zdenka Pausova
- The Hospital of Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Tomáš Paus
- Rotman Research Institute, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada.
- Departments of Psychology and Psychiatry, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada.
| |
Collapse
|
45
|
Junger J, Habel U, Bröhr S, Neulen J, Neuschaefer-Rube C, Birkholz P, Kohler C, Schneider F, Derntl B, Pauly K. More than just two sexes: the neural correlates of voice gender perception in gender dysphoria. PLoS One 2014; 9:e111672. [PMID: 25375171 PMCID: PMC4222943 DOI: 10.1371/journal.pone.0111672] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/03/2014] [Indexed: 01/28/2023] Open
Abstract
Gender dysphoria (also known as “transsexualism”) is characterized as a discrepancy between anatomical sex and gender identity. Research points towards neurobiological influences. Due to the sexually dimorphic characteristics of the human voice, voice gender perception provides a biologically relevant function, e.g. in the context of mating selection. There is evidence for a better recognition of voices of the opposite sex and a differentiation of the sexes in its underlying functional cerebral correlates, namely the prefrontal and middle temporal areas. This fMRI study investigated the neural correlates of voice gender perception in 32 male-to-female gender dysphoric individuals (MtFs) compared to 20 non-gender dysphoric men and 19 non-gender dysphoric women. Participants indicated the sex of 240 voice stimuli modified in semitone steps in the direction to the other gender. Compared to men and women, MtFs showed differences in a neural network including the medial prefrontal gyrus, the insula, and the precuneus when responding to male vs. female voices. With increased voice morphing men recruited more prefrontal areas compared to women and MtFs, while MtFs revealed a pattern more similar to women. On a behavioral and neuronal level, our results support the feeling of MtFs reporting they cannot identify with their assigned sex.
Collapse
Affiliation(s)
- Jessica Junger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
- * E-mail:
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| | - Sabine Bröhr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Josef Neulen
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - Christiane Neuschaefer-Rube
- Department of Phoniatrics, Pedaudiology and Communication Disorders, Medical School, RWTH Aachen University, Aachen, Germany
| | - Peter Birkholz
- Department of Phoniatrics, Pedaudiology and Communication Disorders, Medical School, RWTH Aachen University, Aachen, Germany
| | - Christian Kohler
- Department of Psychiatry, Neuropsychiatry Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| | - Birgit Derntl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| | - Katharina Pauly
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| |
Collapse
|
46
|
Stanyon R, Bigoni F. Sexual selection and the evolution of behavior, morphology, neuroanatomy and genes in humans and other primates. Neurosci Biobehav Rev 2014; 46P4:579-590. [PMID: 25445181 DOI: 10.1016/j.neubiorev.2014.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 09/20/2014] [Accepted: 10/01/2014] [Indexed: 12/22/2022]
Abstract
Explaining human evolution means developing hypotheses about the occurrence of sex differences in the brain. Neuroanatomy is significantly influenced by sexual selection, involving the cognitive domain through competition for mates and mate choice. Male neuroanatomy emphasizes subcortical brain areas and visual-spatial skills whereas that of females emphasizes the neocortex and social cognitive areas. In primate species with high degrees of male competition, areas of the brain dealing with aggression are emphasized. Females have higher mirror neuron activity scores than males. Hundreds of genes differ in expression profiles between males and females. Sexually selected differences in gene expression can produce neuroanatomical sex differences. A feedback system links genes, gene expression, hormones, morphology, social structure and behavior. Sex differences, often through female choice, can be rapidly modulated by socialization. Human evolution is a dramatic case of how a trend toward pair bonding and monogamy lowered male competition and increased female choice as a necessary step in releasing the cognitive potential of our species.
Collapse
Affiliation(s)
- Roscoe Stanyon
- Department of Biology, University of Florence, Anthropology laboratories, via del Proconsolo 12, 50122 Florence, Italy.
| | - Francesca Bigoni
- Department of Biology, University of Florence, Anthropology laboratories, via del Proconsolo 12, 50122 Florence, Italy
| |
Collapse
|
47
|
Hjelmervik H, Hausmann M, Osnes B, Westerhausen R, Specht K. Resting states are resting traits--an FMRI study of sex differences and menstrual cycle effects in resting state cognitive control networks. PLoS One 2014; 9:e103492. [PMID: 25057823 PMCID: PMC4110030 DOI: 10.1371/journal.pone.0103492] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/03/2014] [Indexed: 01/05/2023] Open
Abstract
To what degree resting state fMRI is stable or susceptible to internal mind states of the individual is currently an issue of debate. To address this issue, the present study focuses on sex differences and investigates whether resting state fMRI is stable in men and women or changes within relative short-term periods (i.e., across the menstrual cycle). Due to the fact that we recently reported menstrual cycle effects on cognitive control based on data collected during the same sessions, the current study is particularly interested in fronto-parietal resting state networks. Resting state fMRI was measured in sixteen women during three different cycle phases (menstrual, follicular, and luteal). Fifteen men underwent three sessions in corresponding time intervals. We used independent component analysis to identify four fronto-parietal networks. The results showed sex differences in two of these networks with women exhibiting higher functional connectivity in general, including the prefrontal cortex. Menstrual cycle effects on resting states were non-existent. It is concluded that sex differences in resting state fMRI might reflect sexual dimorphisms in the brain rather than transitory activating effects of sex hormones on the functional connectivity in the resting brain.
Collapse
Affiliation(s)
- Helene Hjelmervik
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- * E-mail:
| | - Markus Hausmann
- Department of Psychology, Durham University, Durham, United Kingdom
| | - Berge Osnes
- Bjørgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - René Westerhausen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Medical Engineering, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
48
|
Structural and functional correlates of epileptogenesis - does gender matter? Neurobiol Dis 2014; 70:69-73. [PMID: 24943053 DOI: 10.1016/j.nbd.2014.05.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/15/2014] [Accepted: 05/22/2014] [Indexed: 01/10/2023] Open
Abstract
In the majority of neuropsychiatric conditions, marked gender-based differences have been found in the epidemiology, clinical manifestations, and therapy of disease. One possible reason is that sex differences in cerebral morphology, structural and functional connections, render men and women differentially vulnerable to various disease processes. The present review addresses this issue with respect to the functional and structural correlates to some forms of epilepsy.
Collapse
|
49
|
Zubiaurre-Elorza L, Junque C, Gómez-Gil E, Guillamon A. Effects of Cross-Sex Hormone Treatment on Cortical Thickness in Transsexual Individuals. J Sex Med 2014; 11:1248-61. [DOI: 10.1111/jsm.12491] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
50
|
Savic I. Sex differences in human epilepsy. Exp Neurol 2014; 259:38-43. [PMID: 24747359 DOI: 10.1016/j.expneurol.2014.04.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 01/07/2023]
Abstract
In the majority of neuropsychiatric conditions, marked gender-based differences have been found in the epidemiology, clinical manifestations, and therapy of disease. Emerging data suggest that gender differences exist also in the epidemiology, and pathophysiology of epilepsy. The present review summarizes the current information regarding gender and epilepsy. These differences are regarded from the perspective of innate sex differences in cerebral morphology, structural and functional connections, and assuming that these differences may render men and women differently vulnerable to epileptogenicity.
Collapse
Affiliation(s)
- Ivanka Savic
- Karolinska Institute, Department of Women's, Children's Health, Neurology Clinic Karolinska Hospital, Q2:07, SE-171 76 Stockholm, Sweden.
| |
Collapse
|