Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition

Nguyen, Hillary Brenda; Chavez, Alexis; Lipner, Emily; Hantsoo, Liisa; Kornfield, Sara L.; Davies, Robert D. M.; Epperson, C. Neill

doi:10.1007/s11920-018-0973-0

Cited by 110 publications

(85 citation statements)

References 60 publications

(111 reference statements)

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“…A previous meta-analysis demonstrated that cognitive reserve was positively associated with cognitive performance among PLWH, with a large effect size (Cohen's d = 0.9) (39). Besides, we found that female was associated with higher odds of HAND, which is consistent with original reports in other populations (40)(41)(42). Sex difference may exist in prevalence, incidence, and cognitive decline trajectories and in certain type of cognitive impairment (such as non-amnesia MCI) (43).…”

Section: Had Mnd and Ani Prevalencesupporting

confidence: 91%

“…Surprisingly, no original studies reported the prevalence of HAND in transgender participants, which is highly under-representative in the minority group. However, hormone therapy, the commonly used treatment in transgender group, is associated with poor executive functioning (41,44). Future studies are thus needed to verify the HAND prevalence and the effects of hormone therapy on cognition in transgender living with HIV.…”

Section: Had Mnd and Ani Prevalencementioning

confidence: 99%

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The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

Wei

Hou

et al. 2020

Front. Neurol.

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Background: The HIV associated mortality is decreasing in most countries due to the widespread use of antiretroviral therapy. However, HIV-associated neurocognitive disorder (HAND) remains a problematic issue that lowers the quality of life and increases the public health burden among people living with HIV. The prevalence of HAND varies across studies and selected samples. Therefore, we aimed to quantitatively summarize the pooled prevalence of Frascati-criteria-based HAND and to explore the potential demographic, clinical, and immunological factors.Methods: A comprehensive literature search in PubMed/Medline, Web of Science, Embase, and PsycINFO was performed. A random-effects meta-analysis was conducted using the event rate (ER) for the estimation of the incidence of HAND. Subgroup meta-analyses were used to evaluate between-group differences in categorical variables. Meta-regression with the unrestricted maximum likelihood (ML) method was used to evaluate associations of continuous variables.Results: Eighteen studies whose sample sizes ranged from 206 to 1555 were included in the final analyses. The estimated prevalence of HAND, ANI, MND and HAD were 44.9% (95% CI 37.4–52.7%), 26.2% (95% CI 20.7–32.7%), 8.5% (95% CI 5.6–12.7%), 2.1% (95% CI 1.2–3.7%), respectively. Factors associated with HAND were percent female, current CD4 count, education level and country development level (all ps < 0.05).Conclusion: Longitudinal cohort and multimodal neuroimaging studies are needed to verify the clinical prognosis and the underlying neurocognitive mechanism of HAND. In addition, it is urgently necessary to establish a standardized HAND diagnostic process.

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Section: Had Mnd and Ani Prevalencesupporting

confidence: 91%

Section: Had Mnd and Ani Prevalencementioning

confidence: 99%

The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

Wei

Hou

et al. 2020

Front. Neurol.

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“…in regions associated with emotional learning [24,19]. However, longitudinal studies are scarce and a recent large study did not find any differences between TW pre and post CHT [20,10]. Next to univariate analyses, multivariate approaches offer new insights into the similarities and differences between cisgender and transgender individuals [25,26].…”

Section: Introductionmentioning

confidence: 99%

Biological sex classification with structural MRI data shows increased misclassification in transgender women

Flint

Förster

Koser

et al. 2020

Neuropsychopharmacol.

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Transgender individuals show brain structural alterations that differ from their biological sex as well as their perceived gender. To substantiate evidence that the brain structure of transgender individuals differs from male and female, we use a combined multivariate and univariate approach. Gray matter segments resulting from voxel-based morphometry preprocessing of N = 1753 cisgender (CG) healthy participants were used to train (N = 1402) and validate (20 % hold-out N = 351) a support vector machine classifying the biological sex. As a second validation, we classified N = 1104 patients with depression. A third validation was performed using the matched CG sample of the transgender women (TW) application sample. Subsequently, the classifier was applied to N = 25 TW. Finally, we compared brain volumes of CG-men, women and TW pre/post treatment (CHT) in a univariate analysis controlling for sexual orientation, age and total brain volume. The application of our biological sex classifier to the transgender sample resulted in a significantly lower true positive rate (TPR-male = 56.0 %). The TPR did not differ between CG-individuals with (TPR-male = 86.9 %) and without depression (TPR-male = 88.5 %). The univariate analysis of the transgender application sample revealed that TW pre/post treatment show brain structural differences from CG-women and CG-men in the putamen and insula, as well as the whole-brain analysis. Our results support the hypothesis that brain structure in TW differs from brain structure of their biological sex (male) as well as their perceived gender (female). This finding substantiates evidence that transgender individuals show specific brain structural alterations leading to a different pattern of brain structure than CG individuals.

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“…The finding that transmales, who were significantly more likely to have taken steps toward gender affirmation, presented with better mental health may provide further evidence supporting the effectiveness of gender-affirming treatments in ameliorating distress and improving quality of life. 69,70 Further gender disparities were observed among indices of eating-and weight-related pathology. More specifically, similar to the gender differences observed in cisgender samples that largely indicate that females are disproportionately affected by eating disorders, 71 transfemales in the current sample reported significantly greater eating-and weight-related concerns when compared with transmales.…”

Section: Discussionmentioning

confidence: 99%

A Descriptive Study of Transgender Active Duty Service Members in the U.S. Military

et al. 2020

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Department of Defense policy prohibits, with limited exceptions, transgender individuals from serving in their affirmed gender in the U.S. Military, citing potential impact on unit cohesion and military readiness. To date, however, little is known about the sociodemographic profile and health of transgender military personnel. Methods: U.S. Military personnel who self-identified as transgender completed anonymous online measures of demographics and military service. Participants also completed measures of health, mood, eating pathology, and risk behaviors. Results: One hundred ninety-five service members (mean age: 28.9-7.2 years, 48.7% transmale, 70.3% non-Hispanic White, 7.83-5.9 years in service) completed the survey. The majority of respondents first identified as transgender before military accession. Most had disclosed their gender identity to their command and providers, and had undertaken steps toward gender affirmation. The sample as a whole reported above average physical health, with mood symptoms within normal ranges and few reported risk behaviors. Analyses of covariance indicated that transmales reported significantly better mental health and psychosocial functioning compared with transfemales. Conclusion: In light of current policy that precludes, with limited exceptions, transgender individuals from serving in the U.S. Military in their affirmed gender, the current study provides an initial sociodemographic profile of this understudied population and indicates that transgender service members report above average physical health and few risk behaviors. Preliminary analyses indicated that transfemales in the military may be at higher risk for mental health concerns, compared with transmales. Additional research is needed to elucidate risk and protective factors among transgender service members.

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Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition

Cited by 110 publications

References 60 publications

The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

Biological sex classification with structural MRI data shows increased misclassification in transgender women

A Descriptive Study of Transgender Active Duty Service Members in the U.S. Military

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