Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
Psychoneuroendocrinology. 2023 Oct;156:106319. doi: 10.1016/j.psyneuen.2023.106319. Epub 2023 Jun 8.
Transgender/non-binary (TNB) youth are at increased risk for anxiety, depression, and suicidality compared to cisgender youth. Gender affirming hormone therapy (GAHT, i.e., testosterone or estrogen) is a standard of care option for TNB youth, and we have recently shown that GAHT (testosterone) in transgender youth assigned a female sex at birth is associated with reductions in internalizing symptomatology. The current analysis explores: 1) whether these benefits are observed in both TNB youth assigned female at birth (TNB) and TNB youth assigned male at birth (TNB) and 2) the extent to which body image dissatisfaction and alteration in neural circuitry relate to internalizing symptoms.
The current study is an expansion of a previous publication from our lab that explored the association between gender-affirming testosterone and internalizing symptomatology. While participants in our previous study consisted of 42 TNB youth, participants in the current study included adolescent TNB receiving GAHT (n = 21; GAHT+) and not receiving GAHT (n = 29; GAHT-) as well as adolescent GAHT+ TNB (n = 15) and GAHT- TNB (n = 17). Participants reported symptoms of trait and social anxiety, depression, suicidality in the past year, and body image dissatisfaction. Brain activation was measured during a face processing task designed to elicit amygdala activation during functional MRI.
GAHT+ TNB had significantly lower rates of social anxiety, depression, and suicidality compared to GAHT- TNB. While there were no significant relationships between estrogen and depression and anxiety symptoms, longer duration of estrogen was related to less suicidality. Both testosterone and estrogen administration were related to significantly lower rates of body image dissatisfaction compared to GAHT- youth. No significant differences emerged for BOLD response in the left or right amygdala during the face processing task, however, there was a significant main effect of GAHT on functional connectivity between the right amygdala and the ventromedial prefrontal cortex, such that GAHT+ youth had stronger co-activation between the two regions during the task. Body image dissatisfaction, greater functional connectivity, their interaction effect, and age predicted depression symptomatology and body image dissatisfaction additionally predicted suicidality in the past year.
The current study suggests that GAHT is associated with fewer short-term internalizing symptoms in TNB than in TNB, although internalizing symptoms among TNB may diminish with longer durations of estrogen treatment. Controlling for age and sex assigned at birth, our findings indicate that less body image dissatisfaction and greater functional connectivity between the amygdala and ventromedial prefrontal cortex were both predictors of fewer levels of internalizing symptoms following GAHT.
与顺性别青年相比，跨性别/非二元性别（TNB）青年患焦虑症、抑郁症和自杀意念的风险更高。性别肯定激素治疗（GAHT，即睾酮或雌激素）是 TNB 青年的标准治疗选择，我们最近表明，出生时被分配女性性别的跨性别青年接受 GAHT（睾酮）与内化症状减少有关。目前的分析探讨了：1）这些益处是否在出生时被分配女性的 TNB 青年（TNB）和出生时被分配男性的 TNB 青年（TNB）中均观察到，以及 2）身体意象不满和神经回路改变与内化症状的关系程度。
目前的研究是对我们实验室之前一项研究的扩展，该研究探讨了性别肯定的睾酮与内化症状之间的关联。虽然我们之前研究中的参与者包括 42 名 TNB 青年，但当前研究中的参与者包括接受 GAHT（n=21；GAHT+）和未接受 GAHT（n=29；GAHT-）的青春期 TNB 以及接受 GAHT+ TNB（n=15）和 GAHT- TNB（n=17）。参与者报告了特质和社交焦虑、抑郁、过去一年的自杀意念以及身体意象不满。在功能磁共振成像期间，通过面部处理任务测量大脑激活，该任务旨在引发杏仁核激活。
GAHT+ TNB 的社交焦虑、抑郁和自杀意念发生率明显低于 GAHT- TNB。虽然雌激素与抑郁和焦虑症状之间没有显著关系，但雌激素持续时间较长与自杀意念减少有关。与 GAHT-青年相比，睾酮和雌激素的给药均与身体意象不满率显著降低有关。然而，在左或右杏仁核的 BOLD 反应中没有出现显著差异，但是 GAHT 对右杏仁核和腹内侧前额叶皮质之间的功能连接有显著的主要影响，即 GAHT+ 青年在任务期间两个区域之间的共激活更强。身体意象不满、更强的功能连接、它们的交互作用以及年龄预测了抑郁症状，身体意象不满此外还预测了过去一年的自杀意念。
目前的研究表明，与 TNB 相比，GAHT 与 TNB 的短期内化症状较少相关，尽管 TNB 的内化症状可能随着雌激素治疗时间的延长而减少。控制出生时的年龄和性别分配，我们的发现表明，较少的身体意象不满和杏仁核与腹内侧前额叶皮质之间更强的功能连接都是 GAHT 后内化症状水平降低的预测因素。
