TY - JOUR
T1 - Changes to hypothalamic volume and associated subunits during gender-affirming hormone therapy
AU - Konadu, Melisande E.
AU - Reed, Murray B.
AU - Kaufmann, Ulrike
AU - Handschuh, Patricia A.
AU - Spurny-Dworak, Benjamin
AU - Klöbl, Manfred
AU - Schmidt, Clemens
AU - Godbersen, Godber M.
AU - Briem, Elisa
AU - Seiger, René
AU - Baldinger-Melich, Pia
AU - Kranz, Georg S.
AU - Lanzenberger, Rupert
AU - Spies, Marie
N1 - Publisher Copyright:
© 2023 CMA Impact Inc. or its licensors.
PY - 2023/9/26
Y1 - 2023/9/26
N2 - Background: Among its pleiotropic properties, gender-affirming hormone therapy (GHT) affects regional brain volumes. The hypothal-amus, 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 measure-ments, 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 pcorr < 0.01). In TW, volumes decreased between the first and second MRI in these regions (all pcorr ≤ 0.01), and the change from the first to second MRI in TW differed significantly from that in CM and CW in several subunits (pcorr < 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.
AB - Background: Among its pleiotropic properties, gender-affirming hormone therapy (GHT) affects regional brain volumes. The hypothal-amus, 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 measure-ments, 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 pcorr < 0.01). In TW, volumes decreased between the first and second MRI in these regions (all pcorr ≤ 0.01), and the change from the first to second MRI in TW differed significantly from that in CM and CW in several subunits (pcorr < 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.
UR - http://www.scopus.com/inward/record.url?scp=85172696548&partnerID=8YFLogxK
U2 - 10.1503/jpn.230017
DO - 10.1503/jpn.230017
M3 - Journal article
C2 - 37751919
AN - SCOPUS:85172696548
SN - 1180-4882
VL - 48
SP - E369-E375
JO - Journal of Psychiatry and Neuroscience
JF - Journal of Psychiatry and Neuroscience
IS - 5
ER -