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Konadu ME, Reed MB, Kaufmann U, Handschuh PA, Spurny-Dworak B, Klöbl M, Schmidt C, Godber, Godbersen M, Briem E, Seiger R, Baldinger-Melich P, Kranz GS, Lanzenberger R, Spies M. Changes to hypothalamic volume and associated subunits during gender-affirming hormone therapy. J Psychiatry Neurosci 2023; 48:E369-E375. [PMID: 37751919 PMCID: PMC10521920 DOI: 10.1503/jpn.230017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Among its pleiotropic properties, gender-affirming hormone therapy (GHT) affects regional brain volumes. The hypothalamus, which regulates neuroendocrine function and associated emotional and cognitive processes, is an intuitive target for probing GHT effects. We sought to assess changes to hypothalamus and hypothalamic subunit volumes after GHT, thereby honouring the region's anatomical and functional heterogeneity. METHODS Individuals with gender dysphoria and cisgender controls underwent 2 MRI measurements, with a median interval of 145 days (interquartile range [IQR] 128.25-169.75 d, mean 164.94 d) between the first and second MRI. Transgender women (TW) and transgender men (TM) underwent the first MRI before GHT and the second MRI after approximately 4.5 months of GHT, which comprised estrogen and anti-androgen therapy in TW or testosterone therapy in TM. Hypothalamic volumes were segmented using FreeSurfer, and effects of GHT were tested using repeated-measures analysis of covariance. RESULTS The final sample included 106 participants: 38 TM, 15 TW, 32 cisgender women (CW) and 21 cisgender men (CM). Our analyses revealed group × time interaction effects for total, left and right hypothalamus volume, and for several subunits (left and right inferior tubular, left superior tubular, right anterior inferior, right anterior superior, all p corr < 0.01). In TW, volumes decreased between the first and second MRI in these regions (all p corr ≤ 0.01), and the change from the first to second MRI in TW differed significantly from that in CM and CW in several subunits (p corr < 0.05). LIMITATIONS We did not address the influence of transition-related psychological and behavioural changes. CONCLUSION Our results suggest a subunit-specific effect of GHT on hypothalamus volumes in TW. This finding is in accordance with previous reports of positive and negative effects of androgens and estrogens, respectively, on cerebral volumes.
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Affiliation(s)
- Melisande E Konadu
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Murray B Reed
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Ulrike Kaufmann
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Patricia A Handschuh
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Benjamin Spurny-Dworak
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Manfred Klöbl
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Clemens Schmidt
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Godber
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - M Godbersen
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Elisa Briem
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - René Seiger
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Pia Baldinger-Melich
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Georg S Kranz
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Rupert Lanzenberger
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
| | - Marie Spies
- From the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Kranz, Lanzenberger, Spies); the Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria (Konadu, Reed, Handschuh, Spurny-Dworak, Klöbl, Schmidt, Godbersen, Briem, Seiger, Baldinger-Melich, Lanzenberger, Spies); the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria (Kaufmann); the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (Kranz)
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