Melisande E Konadu, Murray B Reed, Ulrike Kaufmann, Patricia A Handschuh, Benjamin Spurny-Dworak, Manfred Klöbl, Clemens Schmidt, Godber, M Godbersen, Elisa Briem, René Seiger, Pia Baldinger-Melich, Georg S Kranz, Rupert Lanzenberger, Marie Spies
{"title":"性别确认激素治疗过程中下丘脑体积和相关亚基的变化。","authors":"Melisande E Konadu, Murray B Reed, Ulrike Kaufmann, Patricia A Handschuh, Benjamin Spurny-Dworak, Manfred Klöbl, Clemens Schmidt, Godber, M Godbersen, Elisa Briem, René Seiger, Pia Baldinger-Melich, Georg S Kranz, Rupert Lanzenberger, Marie Spies","doi":"10.1503/jpn.230017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <i>p</i> <sub>corr</sub> < 0.01). In TW, volumes decreased between the first and second MRI in these regions (all <i>p</i> <sub>corr</sub> ≤ 0.01), and the change from the first to second MRI in TW differed significantly from that in CM and CW in several subunits (<i>p</i> <sub>corr</sub> < 0.05).</p><p><strong>Limitations: </strong>We did not address the influence of transition-related psychological and behavioural changes.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50073,"journal":{"name":"Journal of Psychiatry & Neuroscience","volume":"48 5","pages":"E369-E375"},"PeriodicalIF":4.1000,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/10/be/48-5-E369.PMC10521920.pdf","citationCount":"0","resultStr":"{\"title\":\"Changes to hypothalamic volume and associated subunits during gender-affirming hormone therapy.\",\"authors\":\"Melisande E Konadu, Murray B Reed, Ulrike Kaufmann, Patricia A Handschuh, Benjamin Spurny-Dworak, Manfred Klöbl, Clemens Schmidt, Godber, M Godbersen, Elisa Briem, René Seiger, Pia Baldinger-Melich, Georg S Kranz, Rupert Lanzenberger, Marie Spies\",\"doi\":\"10.1503/jpn.230017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <i>p</i> <sub>corr</sub> < 0.01). In TW, volumes decreased between the first and second MRI in these regions (all <i>p</i> <sub>corr</sub> ≤ 0.01), and the change from the first to second MRI in TW differed significantly from that in CM and CW in several subunits (<i>p</i> <sub>corr</sub> < 0.05).</p><p><strong>Limitations: </strong>We did not address the influence of transition-related psychological and behavioural changes.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":50073,\"journal\":{\"name\":\"Journal of Psychiatry & Neuroscience\",\"volume\":\"48 5\",\"pages\":\"E369-E375\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2023-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/10/be/48-5-E369.PMC10521920.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Psychiatry & Neuroscience\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1503/jpn.230017\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/9/1 0:00:00\",\"PubModel\":\"Print\",\"JCR\":\"Q2\",\"JCRName\":\"NEUROSCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Psychiatry & Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1503/jpn.230017","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/1 0:00:00","PubModel":"Print","JCR":"Q2","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
Changes to hypothalamic volume and associated subunits during gender-affirming hormone therapy.
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 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.
期刊介绍：
The Journal of Psychiatry & Neuroscience publishes papers at the intersection of psychiatry and neuroscience that advance our understanding of the neural mechanisms involved in the etiology and treatment of psychiatric disorders. This includes studies on patients with psychiatric disorders, healthy humans, and experimental animals as well as studies in vitro. Original research articles, including clinical trials with a mechanistic component, and review papers will be considered.
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