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Arshed A, Madanes S, Pottinger S, Ackerman MG, Deutch AB. Menstrual management in transgender and gender diverse individuals: psychiatric and psychosocial considerations. Front Psychiatry 2024; 15:1422333. [PMID: 39534608 PMCID: PMC11554503 DOI: 10.3389/fpsyt.2024.1422333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/09/2024] [Indexed: 11/16/2024] Open
Abstract
Transgender and gender-diverse (TGD) menstruators are individuals assigned female at birth (AFAB)*, who retain the capacity to menstruate and have a gender identity that differs from their natal sex. Reports indicate up to 1.6 million individuals in the US identify as TGD. Until recently, the mainstream menstrual discourse has failed to capture the experience of transmenstruators. However, a better understanding of the menstrual experiences of TGD-AFAB will allow for more individualized patient-centered care. In this review, we provide the relevant data necessary to inform the psychiatric management of menstruation in TGD-AFAB individuals, including experiences of menstruation, preferences for menstrual management, and the impact on mental health. Our review indicates that menstrual care in TGD patients must be tailored to the individual; clinicians should remain open-minded to the unique experience of transmenstruators; gender-affirming menstrual care is necessary to reduce psychological burden. It should not be assumed that TGD-AFAB menstruators are utilizing appropriate contraceptive methods and should receive contraceptive and fertility preservation counseling. We highlight the importance of having these conversations early in the reproductive arch, even before puberty onset. Keeping in mind the gender minority stress model, in the upcoming sections, we discuss the limited body of literature on mood disorders in TGD-AFAB individuals who menstruate, undergo menstrual suppression, or continue to ovulate. The psychological impact of hormonal therapies is also reviewed.
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Affiliation(s)
- Arslaan Arshed
- Department of Psychiatry, New York University, New York, NY, United States
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Maniaci G, Collura G, La Cascia C, Piccoli T, Bongiorno E, Barresi I, Marrale M, Gagliardo C, Giammanco A, Blandino V, Sartorio C, Radellini S, Ferraro L, Toia F, Zabbia G, Bivona G, Midiri M, Ciaccio M, La Barbera D, Cordova A, Quattrone D. Beyond the Gender Binarism: Neural Correlates of Trans Men in a Functional Connectivity-Resting-State fMRI Pilot Study. J Clin Med 2024; 13:5856. [PMID: 39407916 PMCID: PMC11477323 DOI: 10.3390/jcm13195856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/20/2024] Open
Abstract
Introduction: Several studies have investigated the specific neural correlates of trans people, highlighting mixed results. This study aimed to compare the presence of specific functional connectivity and differences in cognitive profile and hormone levels in trans men diagnosed with gender dysphoria (GD), and a homogeneous group of cisgender men and cisgender women. Methods: A total of 42 participants (19 trans men, 11 cisgender men, and 12 cisgender women) underwent a resting state fMRI and were measured for blood levels of testosterone, estradiol, and progesterone. A neuropsychological battery evaluated executive functions, attention, visual-perceptual ability, verbal fluency, manual preference, and general intelligence. Results: Trans men showed weaker functional connectivity in the precentral gyrus, subcallosal cortex, paracingulate gyrus, temporal pole, and cingulate gyrus than cisgender men (p < 0.01). Trans men performed worse than cisgender men in verbal and visuospatial working memory but similarly to cisgender women (p < 0.05). In trans men, functional connectivity of the precentral gyrus correlated positively with testosterone (r = 0.459, p = 0.064) and negatively with estradiol (r = -0.654, p = 0.004) and progesterone blood levels (r = -0.475, p = 0.054). The cluster involving the subcallosal cortex showed a positive correlation with testosterone (r = 0.718, p = 0.001), and a negative correlation with estradiol (r = -0.602, p = 0.011). The functional connectivity from a cluster involving the paracingulate gyrus showed a positive correlation with testosterone (r = 0.592, p = 0.012). Conclusions: This study highlights the importance of overpassing the binary model by underlining the presence of neural pathways that could represent the peculiarity of the neural profile of people with GD.
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Affiliation(s)
- Giuseppe Maniaci
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Giorgio Collura
- Department of Physics and Chemistry, University of Palermo, 90127 Palermo, Italy; (G.C.); (M.M.)
- National Institute of Nuclear Physics, Section of Catania, 95125 Catania, Italy
| | - Caterina La Cascia
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Tommaso Piccoli
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (T.P.); (V.B.)
| | - Eleonora Bongiorno
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Ilaria Barresi
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Maurizio Marrale
- Department of Physics and Chemistry, University of Palermo, 90127 Palermo, Italy; (G.C.); (M.M.)
- National Institute of Nuclear Physics, Section of Catania, 95125 Catania, Italy
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.G.); (M.M.)
| | - Alessandra Giammanco
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
- Department of Medical Sciences and Public Health, University of Cagliari, 09040 Cagliari, Italy
| | - Valeria Blandino
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (T.P.); (V.B.)
| | - Crocettarachele Sartorio
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Stefano Radellini
- Section of Endocrinology, Department of Health Promotion, Maternal-Infantile, Internal and Specialist Medicine of Excellence “G. d’Alessandro” (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Laura Ferraro
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (F.T.); (G.Z.); (A.C.)
| | - Giovanni Zabbia
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (F.T.); (G.Z.); (A.C.)
| | - Giulia Bivona
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127 Palermo, Italy; (G.B.); (M.C.)
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.G.); (M.M.)
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127 Palermo, Italy; (G.B.); (M.C.)
| | - Daniele La Barbera
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (F.T.); (G.Z.); (A.C.)
| | - Diego Quattrone
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (C.L.C.); (E.B.); (I.B.); (A.G.); (C.S.); (L.F.); (D.L.B.); (D.Q.)
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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