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Gender Differences in Behavior : Activating Effects of Cross Sex Hormones
Abstract
The relative contribution of organizing and activating effects of sex hormones to the establishment of gender differences in behaviour is still unclear. In a group of 35 female-to-male transsexuals and a group of 15 male-to-female transsexuals a large battery of tests on aggression, sexual motivation and cognitive functioning was administered twice: shortly before and three months after the start of cross-sex hormone treatment. The administration of androgens to females was clearly associated with an increase in aggression proneness, sexual arousability and spatial ability performance. In contrast, it had a deteriorating effect on verbal fluency tasks. The effects of cross-sex hormones were just as pronounced in the male-to-female group upon androgen deprivation: anger and aggression proneness, sexual arousability and spatial ability decreased, whereas verbal fluency improved. This study offers evidence that cross-sex hormones directly and quickly affect gender specific behaviours. If sex-specific organising effects of sex hormones do exist in the human, they do not prevent these effects of androgen administration to females and androgen deprivation of males to become manifest.
... Experiments in healthy young women suggest that performance on tests of creativity (divergent thinking) peaks during the preovulatory phase, when serum estradiol concentrations are highest (17,18). The assumption that estradiol improves creative thinking is supported by observations that verbal fluency benefits from hormone replacement therapy in postmenopausal women (19) and from male-to-female sex reassignment hormone therapy (20), although results are not unequivocal (14,21). The contribution of estradiol to divergent thinking in healthy young men is not known. ...
... We demonstrate that estradiol acutely enhances creative thinking and verbal short-term memory in healthy young men; insulin improves verbal recognition discriminability only in combination with estradiol but, in accordance with previous findings (22), does not acutely benefit other cognitive measures in young men without cognitive impairments. Against the background of previous work on the role of estrogen for cognitive function that largely focused on women as well as, to a lesser extent, elderly men (e.g., (1,7)) and individuals undergoing male-to-female sex reassignment (12,13,20), our findings pinpoint the acute contribution of estrogen to cognitive function in healthy young men and highlight the convergent impact of estradiol and insulin. The 3-day transdermal estrogen treatment in comparison to placebo induced a 3.5-fold increase in circulating estradiol and a decrease in testosterone levels of around 70%; LH and FSH concentrations were likewise decreased. ...
... In contrast, we did not find effects on convergent (arithmetical) thinking that draws on strongly associated representations (30); this pattern indicates that estrogen exerted a specific enhancing effect on creative in contrast to arithmetical thinking. Improvements in verbal fluency have been likewise, albeit not unanimously (21), observed upon estrogen delivery for male-to-female sex reassignment in biological men (20). ...
Background
Systematic investigations into the cognitive impact of estradiol and insulin in male individuals are sparse, and it is unclear whether the two hormones interact to benefit specific cognitive functions in humans. We investigated the acute effect of estradiol and insulin and of their combined administration on divergent (creative) and convergent (arithmetical) thinking as well as short-term and working verbal memory in healthy young men.
Methods
According to a 2×2 design, two groups of men (each n=16) received a 3-day transdermal estradiol (100 µg/24 h) or placebo pre-treatment and on two separate mornings were intranasally administered 160 IU regular human insulin and, respectively, placebo before completing a battery of cognitive tests; we also determined relevant blood parameters.
Results
Estrogen compared to placebo treatment induced a 3.5-fold increase in serum estradiol and suppressed serum testosterone concentrations by 70%. Estrogen in comparison to placebo improved creative performance, i.e., verbal fluency and flexibility, but not arithmetical thinking, as well as verbal short-term memory, but not visuospatial memory. The combination of estrogen and insulin enhanced recognition discriminability at delayed verbal memory recall; insulin alone remained without effect.
Conclusions
Estrogen specifically enhances core aspects of creativity and verbal memory in young male individuals; delayed recognition memory benefits from the combined administration of estradiol and insulin. Our results indicate that insulin’s acute cognitive impact in young men is limited and not robustly potentiated by estradiol. Estradiol per se exerts a beneficial acute effect on creative and verbal performance in healthy young men.
... This advice is based upon their clinical experience and two manuscripts. One manuscript from 1995 assessed prospective differences in anger and aggression in 35 TM and 15 TW over a period of 3 months (Van Goozen et al., 1995), finding an increase in proneness to anger and aggression in both groups. One review article from 2003 mentioned one study observing 'aggression and hypersexuality' as adverse effects of gender-affirming hormonal therapy in TM (Moore et al., 2003). ...
... Research on the relationship between testosterone administration and anger in transgender people is based on small study samples. One older study that included 35 TM reported a prospective increase in anger proneness three months after the initiation of gender affirming hormonal therapy (Van Goozen et al., 1995). A more recent study with 52 TM also reported an increase in the number of TM reporting higher anger expression 7 months after the initiation of testosterone treatment (Motta et al., 2018). ...
... It remains unclarified whether anger experience and expression are related to gender (Kopper and Epperson, 1991;Thomas, 1993). Regarding the relationship between anger and testosterone therapy in TM, only two manuscripts have been published: Van Goozen et al. first observed an increase in anger 3 months after the initiation of gender affirming hormone treatment (Van Goozen et al., 1995). However, they did not test for correlations with serum testosterone levels. ...
AIM: Anger is a state of emotions ranging from irritation to intense rage. Aggression is the externalization of anger through destructive/punitive behaviour. The World Professional Association for Transgender Health (WPATH) Standards of Care, Edition 7 (SOC7) guidelines warn about aggression in transgender men (TM) on testosterone treatment. We aimed to assess whether aggression and anger intensity increase in TM and decrease in transgender women (TW) after initiation of gender affirming hormone therapy and to identify predictors for anger intensity in transgender people, including levels of sex steroids as well as psychological measurements. METHODS: Prospective changes in aggression were measured at baseline and after one year of gender affirming hormones in 155 transgender persons (64 TM, 91 TW), using the Inventory of Interpersonal Problems (IIP-32) factor ‘too aggressive’. State-level anger intensity was prospectively assessed in 898 participants (440 TM, 468 TW) by the STAXI-2 (State-Trait Anger Expression Inventory-2) State Anger (S-Anger) questionnaire during a three-year follow-up period, starting at the initiation of hormone treatment (testosterone in TM, oestrogens plus anti-androgens in TW). At baseline, psychological questionnaires were administered. Data were analysed cross-sectionally and prospectively. RESULTS: No prospective changes were reported in ‘too aggressive’ scores (after one year of hormone therapy) and S-Anger scores (over 3, 12 and 36 months of hormone therapy) in TM and TW. ‘Too aggressive’ scores were positively correlated to increasing anxiety scores in the entire study population and with lower support from friends in TW. At three, twelve and thirty-six months of gender affirming hormone therapy, anger intensity was not correlated to serum testosterone levels, although there was a correlation with various psychological measures after three and twelve months. TM experiencing menstrual spotting after three months had higher S-Anger scores compared to those without (median 26.5 [18.0 - 29.8] versus 15.0 [15.0 - 17.0], P=0.020). Changes in STAXI-2 S-Anger scores were not correlated to changes in serum testosterone levels after three, twelve and thirty-six months in TM or TW. CONCLUSIONS: Aggression and state-level anger intensity are associated with psychological and/or psychiatric vulnerability or the persistence of menses in TM, but not with exogenous testosterone therapy in TM or serum testosterone levels in both TM and TW.
... This advice is based upon their clinical experience and two manuscripts. One manuscript from 1995 assessed prospective differences in anger and aggression in 35 TM and 15 TW over a period of 3 months (Van Goozen et al., 1995), finding an increase in proneness to anger and aggression in both groups. One review article from 2003 mentioned one study observing 'aggression and hypersexuality' as adverse effects of gender-affirming hormonal therapy in TM (Moore et al., 2003). ...
... Research on the relationship between testosterone administration and anger in transgender people is based on small study samples. One older study that included 35 TM reported a prospective increase in anger proneness three months after the initiation of gender affirming hormonal therapy (Van Goozen et al., 1995). A more recent study with 52 TM also reported an increase in the number of TM reporting higher anger expression 7 months after the initiation of testosterone treatment (Motta et al., 2018). ...
... It remains unclarified whether anger experience and expression are related to gender (Kopper and Epperson, 1991;Thomas, 1993). Regarding the relationship between anger and testosterone therapy in TM, only two manuscripts have been published: Van Goozen et al. first observed an increase in anger 3 months after the initiation of gender affirming hormone treatment (Van Goozen et al., 1995). However, they did not test for correlations with serum testosterone levels. ...
... This advice is based upon their clinical experience and two manuscripts. One manuscript from 1995 assessed prospective differences in anger and aggression in 35 TM and 15 TW over a period of 3 months (Van Goozen et al., 1995), finding an increase in proneness to anger and aggression in both groups. One review article from 2003 mentioned one study observing 'aggression and hypersexuality' as adverse effects of gender-affirming hormonal therapy in TM (Moore et al., 2003). ...
... Research on the relationship between testosterone administration and anger in transgender people is based on small study samples. One older study that included 35 TM reported a prospective increase in anger proneness three months after the initiation of gender affirming hormonal therapy (Van Goozen et al., 1995). A more recent study with 52 TM also reported an increase in the number of TM reporting higher anger expression 7 months after the initiation of testosterone treatment (Motta et al., 2018). ...
... It remains unclarified whether anger experience and expression are related to gender (Kopper and Epperson, 1991;Thomas, 1993). Regarding the relationship between anger and testosterone therapy in TM, only two manuscripts have been published: Van Goozen et al. first observed an increase in anger 3 months after the initiation of gender affirming hormone treatment (Van Goozen et al., 1995). However, they did not test for correlations with serum testosterone levels. ...
Introduction:
Anger is a state of emotions ranging from irritation to intense rage. Aggression implies externalizing anger through destructive/punitive behaviour. The World Professional Association for Transgender Health (WPATH) Standards of Care, Edition 7 (SOC7) guidelines warn about aggression in transgender men (TM) on testosterone treatment. We aimed to assess whether anger intensity increases in TM and decreases in transgender women (TW) after initiation of gender affirming hormone therapy and to identify predictors for anger intensity in transgender people.
Methods:
This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Anger intensity was prospectively assessed in 898 participants (440 TM, 468 TW) by STAXI-2 (State-Trait Anger Expression Inventory-2) State Anger (S-Anger) during a three-year follow-up period, starting at the initiation of hormone treatment. Data were analysed cross-sectionally and prospectively.
Results:
There was no change in STAXI-2 S-Anger scores. At three, twelve and thirty-six months of gender affirming hormone therapy, STAXI-2 S-Anger scores were not correlated to serum testosterone levels, although there was a correlation with various psychological measures after three and twelve months. TM experiencing menstrual spotting after three months had higher STAXI-2 S-Anger scores compared to those without (median 26.5 [18.0-29.8] versus 15.0 [15.0-17.0], P = 0.020). Changes in STAXI-2 S-Anger scores were not correlated to changes in serum testosterone levels after three, twelve and thirty-six months in TM or TW.
Conclusions:
State-level anger intensity is associated with psychological and/or psychiatric vulnerability, but not exogenous testosterone therapy or serum testosterone levels in transgender people.
... Cognitive performance also seems to be affected by GAHT. Most studies ( Table 4) suggest that GAHT in FTMs enhances performance on visual memory (Gómez-Gil et al., 2009) and 3D spatial memory tasks (Van Goozen et al., 1994;Slabbekoorn et al., 1999), and worsens verbal fluency (Van Goozen et al., 1994;Van Goozen et al., 1995) and arithmetic answering strategies (Paap et al., 2010). ...
... For example, enhanced spatial ability and deteriorating verbal fluency are clearly associated with as little as 3 months of androgen treatment, though there was no control group for comparison in this sample of 22 FTM participants. Later, this study followed up with an even bigger sample of FTM and MTF transgender individuals and worked with a large battery of tests on aggression, sexual motivation, and cognitive functioning (van Goozen et al., 1995). Administration of androgens to FTMs over 3 months was strongly associated with an increase in aggression, sexual arousal, and spatial ability, as well as a decrease in verbal fluency. ...
... In contrast, longitudinal studies suggest that the opposite is true for hormone manipulations used by males transitioning to female. MTFs show a reduction in performance on 3D visuospatial tasks (van Goozen et al., 1995;Slabbekoorn et al., 1999) and increased verbal fluency. Relatively few studies have concluded that GAHT results in no change in verbal or visual spatial performance among those transitioning from one gender to the other (van Goozen et al., 2002;Haraldsen et al., 2005;Miles et al., 2006). ...
Sex differences and hormonal effects in presumed cisgender individuals have been well-studied and support the concept of a mosaic of both male and female "characteristics" in any given brain. Gonadal steroid increases and fluctuations during peri-puberty and across the reproductive lifespan influence the brain structure and function programmed by testosterone and estradiol exposures in utero. While it is becoming increasingly common for transgender and gender non-binary individuals to block their transition to puberty and/or use gender-affirming hormone therapy (GAHT) to obtain their desired gender phenotype, little is known about the impact of these manipulations on brain structure and function. Using sex differences and the effects of reproductive hormones in cisgender individuals as the backdrop, we summarize here the existing nascent neuroimaging and behavioral literature focusing on potential brain and cognitive differences in transgender individuals at baseline and after GAHT. Research in this area has the potential to inform our understanding of the developmental origins of gender identity and sex difference in response to gonadal steroid manipulations, but care is needed in our research questions and methods to not further stigmatize sex and gender minorities.
... Visuospatial ability of MtFs appears to be minimally affected by HT. Van Goozen et al. [89] found worsening performance on visuospatial ability after 3 months of HT. However, such visuospatial ability deficit is not found when assessed with a different test (i.e., mental rotation test) in other studies. ...
... Data on verbal ability of MtFs on HT were not consistent across studies. In term of language skills, verbal reasoning was not affected by HT [89][90][91], whereas verbal fluency was better after HT in the Van Goozen et al. [89] study, but not in other studies [88,91]. Verbal memory appears to improve for MtFs with HT [92] but, depending on the tests used, conflicting findings have also been reported [88,89,91,92]. ...
... Data on verbal ability of MtFs on HT were not consistent across studies. In term of language skills, verbal reasoning was not affected by HT [89][90][91], whereas verbal fluency was better after HT in the Van Goozen et al. [89] study, but not in other studies [88,91]. Verbal memory appears to improve for MtFs with HT [92] but, depending on the tests used, conflicting findings have also been reported [88,89,91,92]. ...
Background:
Many prostate cancer (PCa) patients are on androgen deprivation therapy (ADT) as part of their cancer treatments but ADT may cause cognitive impairments. ADT depletes men of both androgen and estrogen. Whether estradiol supplementation can improve cognitive impairments in patients on ADT is understudied.
Objective:
To summarize data on the effects of estradiol treatment on cognitive function of androgen-deprived genetic male populations (PCa patients and male-to-female transsexuals) and castrated male animals.
Method:
Publications were identified by a literature search on PubMed and Google Scholar.
Results:
While some studies showed that estradiol improves cognitive function (most notably, spatial ability) for castrated rats, what remain uninvestigated are: 1) whether estradiol can improve cognition after long-term androgen deprivation, 2) how estradiol affects memory retention, and 3) how early vs. delayed estradiol treatment after castration influence cognition. For androgen-deprived genetic males, estradiol treatment may improve some cognitive functions (e.g., verbal and visual memory), but the findings are not consistent due to large variability in the study design between studies.
Conclusion:
Future studies are required to determine what the best estradiol treatment protocol is to maximize cognitive benefits for androgen-deprived genetic males. Tests that assess comparable cognitive domains in human and rodents are needed. What particularly under-investigated is how the effects of estradiol on cognitive ability intersect with other parameters; sleep, depression and physical fatigue. Such studies have clinical implications to improving the quality of life for both PCa patients on ADT as well as for male-to-female transsexuals.
... De aromataseremmer blokkeert de omzetting van androgeen in oestrogeen [20,21], zodat de activerende effecten van oestrogeen werden tegengegaan. In tegenstelling tot deze positieve effecten van hormoontherapie vonden Van Goozen, Cohen-Kettenis, Gooren, Frijda en Van de Poll [27] geen positieve stemmingsveranderingen bij transgender personen tijdens een behandelduur van 3 maanden. ...
... Voor deze bewering op het vlak 'ruimtelijk inzicht' is veel ondersteuning gevonden. In onderzoek presteerden mannen over het algemeen beter dan vrouwen op testen die ruimtelijk inzicht meten [31][32][33] [27]. ...
Transmannen zijn geboren met een vrouwelijk lichaam maar identificeren zich gevoelsmatig als man. In de huidige studie werd de invloed van hormoontherapie op het emotioneel welzijn en het cognitief functioneren van transmannen nagegaan. In het onderzoek participeerden 22 transmannen, en een controlegroep van 20 vrouwen en een van 19 mannen. De transmannen ontvingen gedurende 8 weken een voorbehandeling met een GnRH-analoog waarna als basismeting een testbatterij werd afgenomen. De testbatterij bestond uit vragenlijsten voor het meten van het emotioneel welzijn en bevatte tevens neuropsychologische testen om een aantal cognitieve vaardigheden te onderzoeken. Voor het meten van het emotioneel welzijn werden de Hospital Anxiety and Depression Scale (HADS) en de Symptom Checklist (SCL-90) gebruikt. De SCL-90 bestaat uit de subschalen Angst, Agorafobie, Depressie, Somatische klachten, Insufficiëntie van denken en handelen, Wantrouwen en interpersoonlijke sensitiviteit, Hostiliteit en Slaapproblemen. Na de 8 weken voorbehandeling kregen de transmannen 16 weken testosteron (met daarnaast een GnRH-analoog en een aromataseremmer) toegediend. Hierna werd opnieuw dezelfde testbatterij afgenomen. De controlegroepen ontvingen gedurende het gehele onderzoek geen interventie. Bij alle onderzoeksgroepen werd op dezelfde momenten de testbatterij afgenomen. Verwacht werd dat de hormoonbehandeling een (positief of negatief) effect zou hebben op het emotioneel welzijn (depressie, angst en psychologische symptomen) van de transmannen. Daarnaast werd verwacht dat het cognitieve profiel van de transmannen als gevolg van de hormoonbehandeling zou verschuiven van een relatief ‘vrouw-typisch’ cognitief profiel (sterke verbale vaardigheden) naar een ‘man-typisch’ cognitief profiel (sterk ruimtelijk inzicht). Met betrekking tot executief functioneren en verbaal geheugen werd geen invloed verwacht en ten aanzien van verwerkingssnelheid was het onderzoek exploratief. De resultaten laten geen verandering zien in het emotioneel welzijn ten gevolge van de hormoontherapie. De resultaten konden ook niet alle verwachte cognitieve effecten bevestigen. Het vermoeden dat hormoontherapie geen invloed zou hebben op het executief functioneren en het verbale geheugen van de transmannen werd wel bevestigd in deze studie. Tot slot werd tegen de verwachting in geen effect gevonden van de hormoontherapie op snelheid van de informatieverwerking. Wel gaven de resultaten van de SCL-90 aan dat transmannen gemiddeld hogere scores hadden op de slaap- en hostiliteitsschaal dan vergelijkingsgroepen van vrouwen en mannen. Vervolgonderzoek naar de verschillen tussen transpersonen en controlegroepen en de invloed van hormoonbehandeling op emotioneel welzijn en cognitief functioneren is noodzakelijk om de transgenderzorg indien nodig te verbeteren.
... En las últimas décadas, los profesionales en salud mental sostienen una polémica al respecto de las adiciones no químicas, cuyo objeto representan cierto tipo de actividades y experiencias. En cuanto a estas, los autores hablan de ludopatía, incluyendo adicción a juegos virtuales, adicción al sexo, al amor romántico, a las compras, vigorexia o adicción a la imagen corporal, comida, bronceado, adición al trabajo, y, por último, adicción a medios virtuales, como redes sociales e internet (Pérez del Río y Martin, 2007;Cía, 2013;Weinstein et al., 2014;Griffiths et al., 2014;Gonzales, 2015;Foster et al., 2015;Ascher y Levounis, 2015;Petry, 2016a;Grant et al., 2016;Sussman, 2017). ...
... Es posible que menores puntajes en las variables de autoestima, autoeficacia, satisfacción vital y la tolerancia a la frustración en las adolescentes de la muestra podrían estar relacionados con una mayor vulnerabilidad emocional femenina, sobre todo en la edad de adolescencia, debido a la incidencia de hormonas femeninas en la frecuencia de trastornos afectivos (Van Goozen et al. 1995;Schmidt et al., 1998). Algunos autores afirman que las mujeres, iniciando desde la adolescencia, muestran un mayor nivel de presencia de problemas emocionales, mostrando, a lo largo de la vida, mayores trastornos de la afectividad que los hombres (Ortuño, 2014;Dorn et al., 2008;Chaplin et al., 2009;Patton et al., 1996;Huerta, 2003). ...
Introducción:
El continuo aumento en el uso de redes sociales e Internet, sobre todo en la población de adolescentes, requiere profundizar en el fenómeno, identificando tanto su uso problemático, como los factores relacionados con un posible riesgo de adicción.
Objetivo:
Valorar el riesgo de adicción a redes sociales e Internet y su relación con habilidades para la vida y socioemocionales en una muestra de adolescentes.
Método:
Un estudio cuantitativo, no experimental, de nivel correlacional, con un diseño transversal; la muestra fue compuesta por 221 estudiantes de un colegio público; se empleó la Escala de Riesgo de Adicción a las Redes Sociales e Internet (ERA-RSI), escala de Habilidades para la Vida y varias escalas para valorar las habilidades socioemocionales.
Resultados:
Se identificó un nivel medio de riesgo de adicción en la muestra del estudio M 2,5 (Dt 0,6), mostrando la diferencia estadísticamente significativa en síntomas de adicción (p=0,001), uso social (p=0,044) y nomofobia (p=0,002) a favor del género femenino, y en rasgos frikis (p=0,001) a favor del género masculino. Los puntajes entre M 1,4 (Dt 0,2) y M 2,0 (Dt 0,8) indicaron un nivel bajo en las habilidades para la vida, con una diferencia significativa estadísticamente en todas las diez dimensiones constitutivas a favor del género femenino. Las habilidades socioemocionales mostraron la diferencia estadísticamente significativa en autoestima (p=0,002), autoeficacia (p=0,000), satisfacción vital (p=0,001) y la tolerancia a la frustración (p=0,001) a favor del género masculino. La resiliencia (p=0,019) y las habilidades sociales (p=0,015) fueron significativamente mayores en mujeres. Se identificaron las correlaciones negativas entre las variables: Total de riesgo de adicción con las habilidades para la vida (r=-0,475/p=0,009); rasgos frikis con empatía (r=-0,140/p=0,037), manejo de emociones (r=-0,159/ p=0,018), resiliencia (r=-0,245/p=0,000) y autoeficacia (r=-0,238/p=0,000); nomofobia con autoeficacia (r=-0,163/p=0,015) y tolerancia a la frustración (r=-0,223/p=0,001); síntomas de adicción con satisfacción vital (r=-0,119/p=0,008) y tolerancia a la frustración (r=-0,357/p=0,000); uso social de redes con el manejo de tensiones y estrés (r=-0,169/p=0,012). Igualmente, se identificaron correlaciones positivas entre el uso de redes sociales y varias dimensiones constituyentes de las habilidades sociales.
Conclusiones:
Las deficiencias en las habilidades blandas de los adolescentes podrían estar relacionadas con el aumento de riesgo de adicción a redes sociales e Internet. Por otro lado, un buen desarrollo de estas habilidades, sumado a otros factores protectores, podrían contribuir a un manejo responsable y cuidadoso del mundo virtual.
... Evidence for the effects of activational hormones -both testosterone and oestrogen -comes from clinical and non-clinical samples. A substantial increase in visuospatial performance occurred among female-to-male transsexuals treated with androgens for 3 months (van Goozen et al., 1994(van Goozen et al., , 1995 and for longer periods (Slabbekoorn et al., 1999). A summary of 13 correlational studies in non-clinical populations up to the mid-2000s indicated mixed results (see Table 1 in Thilers, MacDonald, & Herlitz, 2006), although three of five male samples that exceeded 100 participants showed a positive association between testosterone and spatial performance. ...
... (c) Evidence for evolutionary origins Kung et al. (2016) found that salivary testosterone levels measured at 1 to 3 months of age were negatively correlated with expressive vocabulary at 16 to 30 months, and that they mediated the higher values in girls than in boys at this age, suggesting that any differences cannot be attributed to the slower development of boys than girls. There is some evidence from adults that verbal fluency is lower when circulating testosterone levels are higher: for example, a negative correlation in a large sample (N = 1276) of women aged 35 to 90 years ( Table 1 in Thilers et al., 2006); a decline following 3-months of testosterone administration in female-to-male transsexuals (van Goozen et al., 1994(van Goozen et al., , 1995; and an improvement when women's testosterone levels were reduced in a small clinical sample (Schattmann & Sherwin, 2007). In apparent contrast, another study found greater verbal fluency following injections of supra-physiological levels of testosterone in a non-clinical sample of men (O'Connor et al., 2001). ...
The aims of this article are: (i) to provide a quantitative overview of sex differences in human psychological attributes; and (ii) to consider evidence for their possible evolutionary origins. Sex differences were identified from a systematic literature search of meta‐analyses and large‐sample studies. These were organized in terms of evolutionary significance as follows: (i) characteristics arising from inter‐male competition (within‐sex aggression; impulsiveness and sensation‐seeking; fearfulness; visuospatial and object‐location memory; object‐centred orientations); (ii) those concerning social relations that are likely to have arisen from women's adaptations for small‐group interactions and men's for larger co‐operative groups (person‐centred orientation and social skills; language; depression and anxiety); (iii) those arising from female choice (sexuality; mate choice; sexual conflict). There were sex differences in all categories, whose magnitudes ranged from (i) small (object location memory; negative emotions), to (ii) medium (mental rotation; anxiety disorders; impulsivity; sex drive; interest in casual sex), to (iii) large (social interests and abilities; sociosexuality); and (iv) very large (escalated aggression; systemizing; sexual violence). Evolutionary explanations were evaluated according to whether: (i) similar differences occur in other mammals; (ii) there is cross‐cultural consistency; (iii) the origin was early in life or at puberty; (iv) there was evidence for hormonal influences; and (v), where possible, whether there was evidence for evolutionarily derived design features. The evidence was positive for most features in most categories, suggesting evolutionary origins for a broad range of sex differences. Attributes for which there was no sex difference are also noted. Within‐sex variations are discussed as limitations to the emphasis on sex differences.
... 27,29 To date, there is no evidence for a direct causal link between testosterone administration and aggression in humans 33 and guidelines warning for aggression in trans men taking testosterone therapy are based on scarce evidence. 12 ...
... 47 Research on the effect of gender-affirming hormonal therapy on aggression in transgender people is scarce and was carried out more than 2 decades ago. 12 However, a more recent study by Ettner et al 49 evaluated the prevalence of aggression toward mental health care professionals by transgender and nontransgender clients using a 34-item questionnaire. The study found that transgender people committed significantly fewer acts of direct and indirect aggression toward mental health care providers compared with non-transgender clients. ...
... 27,29 To date, there is no evidence for a direct causal link between testosterone administration and aggression in humans 33 and guidelines warning for aggression in trans men taking testosterone therapy are based on scarce evidence. 12 ...
... 47 Research on the effect of gender-affirming hormonal therapy on aggression in transgender people is scarce and was carried out more than 2 decades ago. 12 However, a more recent study by Ettner et al 49 evaluated the prevalence of aggression toward mental health care professionals by transgender and nontransgender clients using a 34-item questionnaire. The study found that transgender people committed significantly fewer acts of direct and indirect aggression toward mental health care providers compared with non-transgender clients. ...
Background:
Although research on the relation between testosterone and aggression in humans is inconclusive, guidelines (including the World Professional Association for Transgender Health Standards of Care, edition 7) have warned for an increase in aggression in transgender men taking testosterone treatment.
Aims:
To investigate the association between levels of testosterone and aggression in treatment-seeking transgender people and explore the role of mental health psychopathology (anxiety and depressive symptoms) and social support in aggression in this population.
Methods:
Every transgender person invited for assessment at a national transgender health clinic in the United Kingdom during a 3-year period (2012-2015) completed self-report measures for interpersonal problems, including levels of aggression (Inventory of Interpersonal Problems [IIP-32]), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), social support (Multidimensional Scale of Perceived Social Support), and experiences of transphobia before and 1 year after the initiation of gender-affirming hormonal therapy. Correlations between prospective scores for the IIP-32 factor "too aggressive" and prospective levels of sex steroids, prospective psychological (HADS), and baseline psychosocial measurements were tested.
Outcomes:
Prospective scores for the factor "too aggressive" were not correlated to prospective serum testosterone levels.
Results:
Results of 140 people (56 transgender men, 84 transgender women) were analyzed. A prospective increase in scores for the factor "too aggressive" of the IIP-32 in transgender men 1 year after being treated with testosterone treatment or a decrease of the IIP-32 aggression scores in transgender women 1 year after gender-affirming hormonal therapy was not found. However, a positive correlation was found between increasing HADS anxiety scores and increasing scores for the IIP-32 "too aggressive" score in the entire study population and a positive correlation with lower support from friends in transgender women.
Clinical implications:
Hormone-prescribing physicians can be reassured that the long-term administration of testosterone in transgender men does not increase aggressive behavior.
Strengths and limitations:
This is the 1st prospective study to assess the effect of gender-affirming hormonal care on aggression. Limitations included the use of different laboratories, the use of a patient-reported outcome measure, and the lack of aggression subtypes.
Conclusions:
Testosterone therapy was not associated with an increase in levels of aggression in transgender men or a decrease in aggressive behavior in transgender women on antiandrogen and estrogen therapy, but other psychological and/or social factors, such as anxiety levels, appear to contribute to self-reported aggression in transgender people. Defreyne J, T'Sjoen G, Bouman WP, et al. Prospective Evaluation of Self-Reported Aggression in Transgender Persons. J Sex Med 2018;15:768-776.
... Concerning sex hormone influences on verbal fluency, testosterone tends to have a blocking effect on verbal abilities in general (Van Goozen et al., 1995;Wolf et al., 2000), and verbal fluency in particular, especially in women (Wolf and Kirschbaum, 2002;Thilers et al., 2006). Regarding the female sex hormones estradiol and progesterone, some studies report a positive relationship to verbal fluency performance (Maki et al., 2002). ...
... Against our hypothesis, testosterone levels did not affect performance in the navigation or verbal fluency task. These results are contrary to numerous previous findings suggesting a positive effect of testosterone on spatial performance and a negative effect on verbal fluency (Gordon and Lee, 1986;Van Goozen et al., 1995;Silverman et al., 1999;Hausmann et al., 2000Hausmann et al., , 2009Aleman et al., 2004;Hooven et al., 2004;Discroll et al., 2005;Thilers et al., 2006;Burkitt et al., 2007;Mueller et al., 2008b). However, the literature regarding sex hormone influences on cognitive performance is by no means consistent and several studies have -like the present study -suggested opposite relationships or even inverted u-shaped relationships (Shute et al., 1983;McKeever et al., 1987;Gouchie and Kimura, 1991;Kampen and Sherwin, 1996;Moffat and Hampson, 1996;Janowsky et al., 1998;Halari et al., 2005;Puts et al., 2010). ...
Men typically outperform women in spatial navigation tasks, while the advantage of women in verbal fluency is more controversial. Sex differences in cognitive abilities have been related to sex-specific cognitive strategies on the one hand and sex hormone influences on the other hand. However, sex hormone and menstrual cycle influences on cognitive strategies have not been previously investigated. In the present study we assessed cognitive strategy use during spatial navigation and verbal fluency in 51 men and 49 women. In order to evaluate sex hormone influences, all participants completed two test sessions, which were time-locked to the early follicular (low estradiol and progesterone) and mid-luteal cycle phase (high estradiol and progesterone) in women. As hypothesized, men outperformed women in navigation, whereas women outperformed men in phonemic verbal fluency. Furthermore, women switched more often between categories in the phonemic fluency condition, compared to men, indicating sex-specific strategy use. Sex differences in strategy use during navigation did, however, not follow the expected pattern. Menstrual cycle phase, however, did modulate strategy use during navigation as expected, with improved performance with the landmark strategy in the luteal, compared to the follicular phase. No menstrual cycle effects were observed on clustering or switching during verbal fluency. This suggests a modulation of cognitive strategy use during spatial navigation, but not during verbal fluency, by relative hormone increases during the luteal phase of the menstrual cycle.
... 17 Among research that specifically examines the cognitive changes brought about by hormone therapy, a majority of studies have focused on spatial rotation and verbal fluency. 5,21 Increases in spatial ability have been the most robust findings related to testosterone therapy, 38 although some studies have not found significant improvement in spatial ability related to testosterone. 21 In 1 uncontrolled study, 20 trans men were shown to have increased scores on a measure of spatial rotation and decreases in verbal ability after 3 months on testosterone treatment. ...
... 21 In 1 uncontrolled study, 20 trans men were shown to have increased scores on a measure of spatial rotation and decreases in verbal ability after 3 months on testosterone treatment. A later study, which used cisgender men or women as controls, 38 found similar results. A long-term follow-up study that used transgender women as controls was able to replicate spatial increases; however, findings indicated that verbal ability did not diminish in transgender men after over 1 year on testosterone. ...
Neither consensus on best practice nor validated neuropsychological, intelligence, or personality testing batteries exist for assessment and psychological testing on the transgender population. Historically, assessment has been used in a gate-keeping fashion with transgender clients. There are no firm standards of care when considering the content and appropriateness of evaluations conducted presurgically. These evaluations are discussed in the setting of other presurgical evaluations, with a recommendation to move toward a competency to make a medical decisions model. Additional considerations are discussed, such as effects of transition on mood and how to interpret scores in a field where normative data are often gender stratified.
... Another study in the United States (Miller and Grollman, 2015) found that trans people who have received hormones reported significantly increased odds of alcohol abuse than those who have not received gender-affirming care. Studies showed that many factors, including the necessity of coming out and related stigma (Pullen Sansfaçon et al., 2019), social stigma (Murad et al., 2010), and sex-and-gender group (Van Goozen et al., 1995) could influence gender-affirming care. This could partly explain the different effects of gender-affirming care on HAD between sex-and-gender groups in our study. ...
Purpose:
Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada.
Methods:
Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada.
Results:
Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups.
Conclusion:
The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.
... The Sa network has been associated with "conscious integration of autonomic feedback and responses with internal goals and environmental demands" (Weis et al., 2008). This network has also been conceptualized as an "integral hub" for facilitating communication between the DMN and central executive networks in a triple network model (Van Goozen et al., 1995). Notably, dysfunction in the Sa network has been linked to reduced cognitive performance in older adults (Dimech et al., 2019) and increased connectivity in this network has been linked to Alzheimer's disease (Morrison et al., 2006). ...
Males and females show differential patterns in connectivity in resting-state networks (RSNs) during normal aging, from early adulthood to late middle age. Age-related differences in network integration (effectiveness of specialized communication at the global network level) and segregation (functional specialization at the local level of specific brain regions) may also differ by sex. These differences may be due at least in part to endogenous hormonal fluctuation, such as that which occurs in females during midlife with the transition to menopause when levels of estrogens and progesterone drop markedly. A limited number of studies that have investigated sex differences in the action of steroid hormones in brain networks. Here we investigated how sex steroid hormones relate to age-network relationships in both males and females, with a focus on network segregation. Females displayed a significant quadratic relationship between age and network segregation for the cerebellar-basal ganglia and salience networks. In both cases, segregation was still increasing through adulthood, highest in midlife, and with a downturn thereafter. However, there were no significant relationships between sex steroid hormone levels and network segregation levels in females, and they did not exhibit significant associations between progesterone or 17β-estradiol and network segregation. Patterns of connectivity between the cerebellum and basal ganglia have been associated with cognitive performance and self-reported balance confidence in older adults. Together, these findings suggest that network segregation patterns with age in females vary by network, and that sex steroid hormones are not associated with this measure of connectivity in this cross-sectional analysis. Though this is a null effect, it remains critical for understanding the extent to which hormones relate to brain network architecture.
... Another recent meta-analysis also failed to find support for the prenatal androgen theory (Collaer & Hines, 2020). Other studies have looked for a change in spatial ability test performance in individuals who have undergone hormone treatment as part of a gender transition (for example: Miles et al., 1998;Slabbekoorn et al., 1999;Van Goozen et al., 1995). These studies have found that hormones do not offer a straightforward explanation for differences in spatial ability, as men with lower levels of testosterone tended to perform better on tests of spatial abilities than men with higher levels of testosterone, while the reverse was true for women (Kimura, 2002). ...
Spatial ability has long been regarded as important in STEM, and mental rotation, a subcategory of spatial ability, is widely accepted as the cognitive ability with the largest gender difference in favor of men. Multiple meta-analyses of various tests of spatial ability have found large gender differences in outcomes of the mental rotation test (MRT). In this paper, we argue that more recent literature suggests that the MRT is not a valid measure of mental rotation ability. More importantly, we argue that the construct of “spatial ability” itself has been co-constructed with gender, and thus has not been devised in a neutral way, but in a manner that is influenced by gender beliefs. We discuss that though spatial thinking is also required in feminized fields, past research has cast spatial ability as only necessary in masculinized STEM fields. Due to a prevailing belief that spatial ability was an inherently male ability, researchers “selectively bred” some spatial assessment instruments to maximize gender differences, rather than to precisely measure a spatial construct. We argue that such instruments, of which the MRT is one, cannot validly assess between-group differences, and ideas about biological or evolutionary causes of sex differences in spatial ability lack empirical evidence. Instead, the co-construction of gender and spatial ability better explains observed patterns. We also provide recommendations for spatial researchers moving forward.
... Cross-cultural studies show that human sex differences in spatial abilities are not universal, but are influenced by cultural and population-specific factors such as mobility related to lifestyle (Berry, 1966;Cashdan et al., 2012;Jang et al., 2019;Trumble et al., 2016). Higher androgen levels in mammals enhance spatial performance through effects on neural development and plasticity (Dawson et al., 1975;Galea et al., 1995;Isgor and Sengelaub, 1998;Joseph et al., 1978;Neave et al., 1999;Roof and Havens, 1992;Schulz and Korz, 2010;Sherry and Hampson, 1997;Stewart et al., 1975;Van Goozen et al., 1995;Williams et al., 1990). In humans, female performance in spatial ability tasks correlates positively with androgen levels and improves with androgen treatments (Aleman et al., 2004;Burkitt et al., 2007;Driscoll et al., 2005). ...
Sex differences in vertebrate spatial abilities are typically interpreted under the adaptive specialization hypothesis, which posits that male reproductive success is linked to larger home ranges and better navigational skills. The androgen spillover hypothesis counters that enhanced male spatial performance may be a byproduct of higher androgen levels. Animal groups that include species where females are expected to outperform males based on life-history traits are key for disentangling these hypotheses. We investigated the association between sex differences in reproductive strategies, spatial behavior, and androgen levels in three species of poison frogs. We tracked individuals in natural environments to show that contrasting parental sex roles shape sex differences in space use, where the sex performing parental duties shows wider-ranging movements. We then translocated frogs from their home areas to test their navigational performance and found that the caring sex outperformed the non-caring sex only in one out of three species. In addition, males across species displayed more explorative behavior than females and androgen levels correlated with explorative behavior and homing accuracy. Overall, we reveal that poison frog reproductive strategies shape movement patterns but not necessarily navigational performance. Together this work suggests that prevailing adaptive hypotheses provide an incomplete explanation of sex differences in spatial abilities.
... [69]), with no significant changes for either transgender men or women in verbal memory, verbal reasoning, verbal working memory, computation, or motor coordination. There is an estrogen therapy-related change in transgender women if treated for longer than 12 months with a decreased proneness towards anger and aggressiveness [70]. ...
There is increasing debate as to whether transwoman athletes should be included in the elite female competition. Most elite sports are divided into male and female divisions because of the greater athletic performance displayed by males. Without the sex division, females would have little chance of winning because males are faster, stronger, and have greater endurance capacity. Male physiology underpins their better athletic performance including increased muscle mass and strength, stronger bones, different skeletal structure, better adapted cardiorespiratory systems, and early developmental effects on brain networks that wires males to be inherently more competitive and aggressive. Testosterone secreted before birth, postnatally, and then after puberty is the major factor that drives these physiological sex differences, and as adults, testosterone levels are ten to fifteen times higher in males than females. The non-overlapping ranges of testosterone between the sexes has led sports regulators, such as the International Olympic Committee, to use 10 nmol/L testosterone as a sole physiological parameter to divide the male and female sporting divisions. Using testosterone levels as a basis for separating female and male elite athletes is arguably flawed. Male physiology cannot be reformatted by estrogen therapy in transwoman athletes because testosterone has driven permanent effects through early life exposure. This descriptive critical review discusses the inherent male physiological advantages that lead to superior athletic performance and then addresses how estrogen therapy fails to create a female-like physiology in the male. Ultimately, the former male physiology of transwoman athletes provides them with a physiological advantage over the cis-female athlete.
... Although in rodents androgens and estrogens regulate aggressive behaviours, but estrogens are particularly essential for the regulation of aggression, as aromatase-and ER-gene KO male mice show greatly reduced aggressive behaviour (Matsumoto et al., 2003;Ogawa et al., 2004). In various vertebrate species, there is sexual dimorphism in the hormonal control of aggressive behaviours, where sex hormones are necessary to maintain aggression in adult males but not in females (Adkins-Regan and Robinson, 1993;Arnott and Elwood, 2009;Ogawa et al., 2005;Van Goozen et al., 1995). In addition, social context of aggression is different between males and females. ...
Habenula is an evolutionarily conserved structure in the brain of vertebrates. Recent reports have drawn attention to the habenula as a processing centre for emotional decision-making and its role in psychiatric disorders. Emotional decision-making process is also known to be closely associated with reproductive conditions. The habenula receives innervations from reproductive centres within the brain and signals from key reproductive neuroendocrine regulators such as gonadal steroids, gonadotropin-release hormone (GnRH), and kisspeptin. In this review, based on morphological, biochemical, physiological, and pharmacological evidence we discuss an emerging role of the habenula in reproduction. Further, we discuss the modulatory role of reproductive endocrine factors in the habenula and their association with socio-reproductive behaviours such as mating, anxiety and aggression.
... The external physical changes induced by GAHT produce positive psychological effects, increase self-confidence, and facilitate conviviality and social interaction. In addition, GAHT-associated changes reinforce gender affirmation and social recognition (7)(8)(9). ...
Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the sex assigned at birth and the gender identity, lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy (GAHT) may improve quality of life (QoL).
Objectives: We aimed to assess perceived QoL, to compare QoL scores between trans women and men and to identify possible contributing factors related to GAHT in a sample of transgender women and transgender men.
Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled and completed the study (60 trans women and 53 trans men).
Results: QoL scores did not differ between trans women and trans men. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoL domain scores. In trans men, higher domain scores were found in individuals in a stable relationship, with increased body hair, engaging in physical activity, and being employed.
Conclusion: Data from this study suggest that GAHT-related physical characteristics, such as breast development in trans women and increased body hair in trans men, are similar between groups, are associated with higher QoL scores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoL in transgender individuals.
... [40][41] However, a study by van Goozen and colleagues showed improved verbal fluency (a supposedly female-favoring cognitive domain) and decreased performance on a visuospatial task (supposedly malefavoring) in transgender women after receiving GHT for three months. 42 In contrast, in the current study transgender women scored equal to or lower than cisgender women on the femalefavoring domains (assessed with Fluency and 15WT tasks), and (slightly) higher on MMSE which also includes male-favoring tasks. Though, it must be mentioned that the transgender women included in the study by van Goozen were significantly younger (mean age = 32.4 ...
Background
Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioning in this population.
Aim
We aimed to assess differences in cognitive functioning between transgender women, and non-transgender (cisgender) women and men, and investigated the contribution of cardiovascular risk factors and psychological factors on these differences.
Methods
In this study, 37 transgender women (age range 55 to 69) receiving GHT for at least ten years (range 10.2 to 41.6) were examined, and their cognitive functioning was compared to an age and education level matched cohort consisting of 222 cisgender women and men from the Longitudinal Aging Study Amsterdam. Linear regression analyses were performed.
Outcomes
Cognitive functioning was assessed by neuropsychological tests including Mini-Mental State Examination (MMSE), Category Fluency animals, Letter Fluency D, 15-Word test (15WT) immediate and delayed recall. Additionally, cardiovascular risk factors and psychological factors such as cardiovascular disease, hypertension, antihypertensive use, statin use, diabetes mellitus, overweight, smoking, alcohol consumption, psychopharmaceutical use, anxiety and depression symptoms were collected.
Results
Transgender women had higher MMSE scores compared with cisgender women (+0.9, 95% CI 0.4 to 1.5), and cisgender men (+1.1, 95% CI 0.4 to 1.8). On all other tests transgender women performed similar to cisgender men. Transgender women performed at a lower level than cisgender women on 15WT immediate recall, -5.5, 95% CI -7.6 to -3.4, and 15WT delayed recall, -2.7, 95% CI -3.7 to -1.7, and equal to cisgender women on Fluency animals and Fluency D. Cardiovascular and psychological factors (i.e., cardiovascular disease and depression symptoms) partly explained differences on MMSE score between transgender women and cisgender-control groups.
Clinical Implications
The results of this study do not indicate a need for tailored hormone treatment strategies for older transgender women, based on cognitive aspects after long-term GHT.
Strengths & Limitations
As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study.
Conclusion
Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal.
van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021;XX:XXX–XXX.
... The evidence is particularly strong for estradiol, which is on average higher in normally cycling women than in men (Mazer, 2009) and for which positive associations with verbal fluency were reported (Kimura & Hampson, 1994). The link was established through studies looking at menstrual-cycle related changes in verbal fluency in women (Hampson, 1990a), in studies assessing estradiol directly (Hampson, 1990b;Maki, Rich, & Rosenbaum, 2002;Wolf & Kirschbaum, 2002), and in research examining effects of hormone administration (Cherrier et al., 2005;Van Goozen, Cohen Kettenis, Gooren, Frijda, & Van De Poll, 1995). The positive association between verbal fluency and estradiol was also found in other species capable of symbolic sign language (Patterson, Holts, & Saphire, 1991). ...
Objective:
Despite evidence for an estradiol-linked sex difference in verbal fluency favoring women, recent reviews question this difference. We therefore examined the issue based on a narrative task that we have administered to different populations for over 20 years.
Method:
We meta-analyzed 98 studies (N = 11,528) conducted by our laboratories and that featured measures of biological sex and storytelling. We ran primary-data analyses (N = 797) on an overlapping subset of these studies that also included salivary hormone and digit ratio measures.
Results:
Women told longer stories than men, d = 0.31, 95% CI [0.24, 0.38], an effect that did not vary by geographic region but was moderated by cue type (verbal: d = 0.57, [0.44, 0.71]; pictures: d = 0.29, [0.22, 0.36]), response modality (oral: d = -0.04, [-0.18, 0.09]; handwriting: d = 0.39, [0.31, 0.47]; typing: d = 0.31, [0.21, 0.42]), and age (prepubertal children: d = 0.13, [-0.04, 0.30]; pubescents: d = 0.48, [0.23, 0.74]; premenopausal adults: d = 0.36, [0.29, 0.42]; postmenopausal adults: d = -0.09, [-0.35, 0.16]). Consistent with the age effect, estradiol, a sex-dimorphic hormone during the reproductive life stage, was a specific mediator of the sex difference in narrative-writing fluency. This mediation effect was moderated by prenatal hormone exposure, estimated via digit ratio.
Conclusions:
When verbal fluency is assessed through narrative writing, a robust female advantage becomes evident. It is associated with the reproductive life stage and variations in current estradiol concentrations, particularly in individuals prenatally exposed to relatively more estradiol than testosterone. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... It was also shown that androgen deficient men (androgens being male sex hormones, including testosterone), were less skilful at visuospatial tasks (Hier, 1982) than men with normal or higher androgen levels. A further study looking at people undergoing hormone replacement therapy showed that higher testosterone levels resulted in females improving their visuospatial ability whereas lower levels of androgens and higher levels of oestrogens resulted in decreased visuospatial ability for males (Van Goozen, 1995). As well as concluding upon the link between sex and visuospatial performance, these findings importantly reveal that visuospatial skill is a dynamic skill, and something in which people can become better (and worse). ...
Everyone can be susceptible to motion sickness (except those with complete loss of labyrinth function) and around one in three are known to be servery susceptible. Motion sickness can be experienced in many domains, including car travel, on a boat, using virtual reality headsets and simulator use amongst others. It is expected that due to potential designs and use cases, self-driving cars will increase motion sickness onset likelihood and severity for many car travellers. Besides medication, there are limited methods through which one can actively reduce their motion sickness susceptibility. This research develops a novel visuospatial training tool and explores the effect of visuospatial training on motion sickness. With a combined sample of 42 participants split between driving simulator trials (n =20), and on-road trials (n =22) baseline visuospatial skills and motion sickness were first measured. After a 14-day training period where participates completed 15-min of pen and paper tasks per day, it was found that visuospatial skills improved by 40%. This increase in visuospatial ability was shown to be directly responsible for a reduction in motion sickness by 51% in the simulator (with a 60% reduction in participant dropouts) and a 58% reduction in the on-road trial. This research has successfully identified a new method to reduce motion sickness susceptibility and the impact of these findings have wide reaching implications for motion sickness research, especially in the field of self-driving vehicles
... Another study was excluded due to insufficient data for the quantitative synthesis (Van Goozen et al., 1995). Following the exclusion of these five studies due to the aforementioned reasons (Supplementary Table 3), 10 studies were deemed eligible for this systematic review (Burke et al., 2016a;Friedman, 2000;Gomez-Gil et al., 2009;Haraldsen et al., 2005;Miles et al., 2006;Miles et al., 1998;Schoning et al., 2010;Slabbekoorn et al., 1999;Van Goozen et al., 1994;Van Goozen et al., 2002). ...
Background
Previous studies have examined whether steroid hormone treatment in transgender individuals may affect cognitive function; yet, their limited power does not allow firm conclusions to be drawn. We leveraged data from to-date literature aiming to explore the effect of gender-affirming hormone administration on cognitive function in transgender individuals.
Methods
A search strategy of MEDLINE was developed (through June 1, 2019) using the key terms transgender, hormone therapy and cognitive function. Eligible were (i) cohort studies examining the longitudinal effect of hormone therapy on cognition, and (ii) cross-sectional studies comparing the cognitive function between treated and non-treated individuals. Standardized mean differences (Hedges’ g) were pooled using random-effects models. Study quality was evaluated using the Newcastle-Ottawa Scale.
Outcomes
Ten studies (seven cohort and three cross-sectional) were eligible representing 234 birth-assigned males (aM) and 150 birth-assigned females (aF). The synthesis of cohort studies (n = 5) for visuospatial ability following hormone treatment showed a statistically significant enhancement among aF (g = 0.55, 95% confidence intervals [CI]: 0.29, 0.82) and an improvement with a trend towards statistical significance among aM (g = 0.28, 95%CI: -0.01, 0.58). By contrast, no adverse effects of hormone administration were shown. No heterogeneity was evident in most meta-analyses.
Interpretation
Current evidence does not support an adverse impact of hormone therapy on cognitive function, whereas a statistically significant enhancing effect on visuospatial ability was shown in aF. New longitudinal studies with longer follow-up should explore the long-term effects of hormone therapy, especially the effects on younger individuals, where there is greater scarcity of data.
... Female infants with this condition often identify themselves as a member of the male gender, even if congenital adrenal hyperplasia is treated after birth. According to this view, the brain of transgender individuals would be organized incoherently to their body already at birth [5,6,2]. ...
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.
... Testosterone also enhanced verbal fluency. Hypogonadal men performed worse on tests of verbal fluency than eugonadal men, and showed improvement after testosterone replacement (110,301,302). In transsexual males (303), administration of anti-androgen and estrogen, prior to surgery for gender reassignment, decreased anger and aggression proneness, sexual arousability, and spatial skills, and increased verbal fluency ability. ...
In male mammals, changes at all levels of the hypothalamic-pituitary-testicular axis, including alterations in the GnRH pulse generator, gonadotropin secretion, and testicular steroidogenesis, in addition to alterations of feed-forward and feedback relationships contribute to the age-related decline in circulating testosterone concentrations. The rate of age-related decline in testosterone levels is affected by the presence of chronic illness, adiposity, medication, sampling time, and the methods of testosterone measurement. Epidemiologic surveys reveal an association of low testosterone levels with changes in body composition, physical function and mobility, risk of diabetes, metabolic syndrome, coronary artery disease, and fracture risk. Age-related decline in testosterone should be distinguished from classical hypogonadism due to known diseases of the hypothalamus, pituitary and the testis. In young hypogonadal men who have a known disease of the hypothalamus, pituitary and testis, testosterone therapy is generally beneficial and has been associated with a low frequency of adverse events. However, neither the long-term benefits in improved health outcomes nor the long-term risks of testosterone therapy are known in older men with age-related decline in testosterone levels. Well-conducted studies of up to one-year duration have found improvements in sexual desire, erectile function, and overall sexual activity; mobility; and volumetric bone density, and correction of anemia with testosterone replacement of older men with unequivocally low testosterone levels. Although testicular morphology, semen production, and fertility are maintained up to a very old age in men, there is clear evidence of decreased fecundity with advancing age and an increased risk of specific genetic disorders related to paternal age among the offspring of older men. Thus, reproductive aging of men is emerging as an important public health problem whose serious societal consequences go far beyond the quality of life issues related to low testosterone levels.
Freely available at Endotext.org
... It has also been demonstrated the cognitive consequences of testosterone replacement therapies: testosterone treatment in men with low levels of this hormone improved both their spatial and verbal performance (Cherrier, 1999). Additional information supporting the role of testosterone levels in cognitive functioning comes from studies in female-to-male transsexuals, who were treated with high doses of testosterone previous to the sex change therapy (Fingelkurts and Fingelkurts, 2002;Van Goozen et al., 1995). ...
Among many definitions, it is acceptable to say that intelligence is the capacity to reason, design, solve problems, think abstractly, comprehend complex ideas, acquire knowledge, and learn from experience. Intelligence is at the pinnacle of a model of intellectual abilities that include the cognitive domains of verbal and spatial capacities and memory (Plomin and Deary 2015).
Gifted individuals are those who demonstrate outstanding levels of aptitude (defined as an exceptional ability to reason and learn) or competence in one or more areas. Genetic studies of gifted children are based on measuring cognitive ability using a general cognitive ability index called “g” which is the standard indicator of giftedness. The pioneers researching this field were Francis Galton, Lewis Terman, and Leta Hollingworth, who carried out studies on gifted children and concluded that giftedness is inherited. Heritability of g was estimated as 50%, therefore the rest of the variance can be attributed to environmental factors.
Genotype-environment correlation plays a major role in the development of giftedness and talent and may be the reason why the heritability of intelligence increases with age. At least one project to study quantitative trait loci (QTL) of IQ has sought to establish QTLs associated with g; some of the g related genes that have been studied in this project are APOE, COMT, and AR among others.
A study on monozygotic male twins argues the existence of a connection between high intelligence and high testosterone levels in the prenatal fetus; however, recently published data suggest it can be only one of the possible biological factors involved in brain organization and cognitive functions modulation (Durdiaková et al., 2016).
Heritability of intelligence has become increasingly more comprehensible; however, the biologic mechanism of genes involved in this heritability is not clear; therefore it is imperative to carry out multivariate genetic analyses with the power to estimate changes in gene and environmental influences.
... Feminizing hormone therapy (Doorduin & Van Berlo, 2014;Van Goozen, Cohen-Kettenis, Gooren, Frijda, & Van De Poll, 1995) can contribute to lower perceived sexual desire or function. In a Belgian sample of transfeminine patients on hormone therapy, 70% believed that their current sexual desire was lower than before beginning hormone therapy, and a similar proportion reported never or rarely experiencing either spontaneous or responsive sexual desire (Wierckx et al., 2014). ...
Sexual health research with transfeminine persons (individuals assigned male at birth who identify as female or feminine) has focused on HIV infection and sexual function following medical treatments. Yet, approximately half of transfeminine persons in Ontario, Canada, reported no partnered sex in the previous year. Therefore, we identified sociodemographic, social, and psychosocial factors associated with past-year sexual inactivity among transfeminine Ontarians. A multi-mode respondent-driven sampling survey of transgender people was conducted in 2009–2010 (N = 433), including 173 transfeminine individuals who had ever been sexually active. Frequencies and regression models were weighted using RDS II methods; prevalence ratios were estimated from logistic regression models using average marginal predictions. Of sexually experienced transfeminine persons, 43% (95% CI [31, 55]) reported no past-year sex partners. Sexual inactivity was independently associated with older age, childhood sexual abuse, and residing outside of the province’s largest city. Transfeminine persons who had genital surgery for gender affirmation were less likely to be abstinent, as compared to those who were living in their felt gender without surgery. Transphobic harassment and higher levels of trans-related sexual body image worries were also associated with sexual inactivity, as was reduced sexual satisfaction. Implications for research and clinical practice are discussed.
... Zaobserwowaną zależność może wyjaśnić wyższy poziom androgenów w okresie prenatalnym u kobiet ze skłonnościami homoseksualnymi. Z kolei w badaniu zespołu Stephanie Van Goozen (Van Goozen, Cohen-Kettenis, Gooren, Frijda i Vande Poll, 1995) kobiety, którym podano androgeny, gorzej wykonywały zadania werbalne, a lepiej zadania przestrzenne w porównaniu do kobiet, którym nie podano androgenów. W 1961 r. ...
Zdolności przestrzenne są jednymi z najsilniejszych determinant wyników w naukach ścisłych. Celem artykułu jest przedstawienie i usystematyzowanie najnowszych wyników badań na temat związków między poziomem zdolności przestrzennych a wynikami z nauk ścisłych. W pierwszej części artykułu zdefiniowano rodzaje zdolności przestrzennych, następnie przedstawiono ich uwarunkowania. W kolejnych częściach omówiono wyniki badań pokazujące związki między poziomem zdolności przestrzennych a kompetencjami z nauk ścisłych. Artykuł kończy się przedstawieniem sprawdzonych empirycznie możliwości rozwijania poziomu zdolności przestrzennych u uczniów. Opisane badań pokazują, jak poprzez rozwój zdolności przestrzennych można poprawić wyniki uczniów w naukach ścisłych.
... In einer sehr frühen testpsychologischen Studie nahm das räumliche Vorstellungsvermögen unter der androgenen Hormontherapie bei Frau-zu-Mann-Trans*Menschen zu, wohingegen sich bei Mann-zu-Frau-Trans*Menschen die sprachlichen Fähigkeiten verbesserten; bei der Transition in das jeweils andere Geschlecht zeigte sich der gegenläufige Effekt [43,44]. Das visuelle Gedächtnis wurde bei Frauzu-Mann-Trans*Menschen unter der Hormontherapie besser [11]. ...
In der funktionellen Magnetresonanztomographie (fMRT) können Aktivitätsmuster in bestimmten Hirnregionen dargestellt werden. Bei der Ausführung bestimmter Aufgaben oder Handlungen und bei Präsentation verschiedener Reize lassen sich spezifische Muster darstellen, die sich in definierten Kollektiven unterscheiden. Mit neueren Methoden wie der Resting-state-fMRT werden zudem die spontanen Hirnaktivitäten analysiert, die ebenfalls spezifische Veränderungen in unterschiedlichen Gruppen zeigen können. So gibt es auch geschlechtstypische Aktivitätsmuster bei Männern und Frauen. Es wurde zunächst angenommen, dass Trans*Menschen hierbei Ergebnisse zeigen, die zwischen den Geschlechtern liegen. Die Studien müssen jedoch differenzierter interpretiert werden und zeigen widersprüchliche Resultate, gerade in Abhängigkeit von den präsentierten Reizen. Der Einfluss der Hormontherapie auf kognitive Fähigkeiten und Korrelate in den zerebralen Aktivitätsmustern wird ebenso kontrovers diskutiert. Insgesamt spiegeln die Ergebnisse bildgebender Verfahren bei Trans*Menschen ein spannendes Zusammenspiel von gesellschaftlichen, biologischen, kognitiven und beispielsweise sexuellen Komponenten wider, zeigen aber auch die Grenzen der Methodik auf.
This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.
Differences between the two genders are widespread in nature (Fig. 17.1) and concern a variety of characteristics, including not only the external appearance but also inclinations and skills, as well as the way of thinking and the overall behavior.
Transgender veterans have a long history with the military. They face a variety of health and social disparities, which affect areas such as housing and employment. Transgender clients are also more likely to experience suicidal ideation, attempt suicide, and experience other mental health disorders. Furthermore, this population utilizes health care at a lower rate than others. Transgender veterans are more likely to experience military sexual trauma while previously on active duty with rates as high as one in five transmen are sexually assaulted. This chapter further explores the unique experiences of both male to female (MTF) and female to male (FTM) transgender veterans. Treatment considerations, including responding to and providing holistic treatment as well as psychological assessment and guidelines for hormone therapy, are further explored and discussed.KeywordsTransgenderVeteran MTFVeteran FTMGender non-conformingTGNCHormone therapy
The main estrogens: estradiol, estrone, and their acyl-esters have been studied essentially related to their classical estrogenic and pharmacologic functions. However, their main effect in the body is probably the sustained control of core energy metabolism. Estrogen nuclear and membrane receptors show an extraordinary flexibility in the modulation of metabolic responses, and largely explain gender and age differences in energy metabolism: part of these mechanisms is already sufficiently known to justify both. With regard to energy, the estrogen molecular species act essentially through four key functions: (1) Facilitation of insulin secretion and control of glucose availability; (2) Modulation of energy partition, favoring the use of lipid as the main energy substrate when more available than carbohydrates; (3) Functional protection through antioxidant mechanisms; and (4) Central effects (largely through neural modulation) on whole body energy management. Analyzing the different actions of estrone, estradiol and their acyl esters, a tentative classification based on structure/effects has been postulated. Either separately or as a group, estrogens provide a comprehensive explanation that not all their quite diverse actions are related solely to specific molecules. As a group, they constitute a powerful synergic action complex. In consequence, estrogens may be considered wardens of energy homeostasis.
Social group memberships are primarily studied in quasi-experimental contexts, but how can culture, class and gender be manipulated in true experimental designs? This review highlights the different empirical strategies that can be used to manipulate “culture” as it relates to race/ethnicity (activation of thinking styles, language, and priming of cultural constructs), class (social standing, group status, or perceived social status), and gender (role salience, gender identity, sex hormone administration). I review measurement issues related to manipulation checks and the problem of what construct is tapped by the manipulation, appropriate control groups, and intersectional identities or group memberships.
Background
Transgender men are assigned female sex at birth, but identify as men. The anabolic and androgenic sex hormone testosterone has been positively associated with aggression. Therefore, transgender men are warned of increasing aggression when initiating testosterone therapy.
Aim
To explore the literature regarding the effects of testosterone therapy on aggression-related constructs in transgender men.
Methods
Following PRISMA-guidelines, PsycINFO, MEDLINE®, EMBASE, and PubMed® were searched in November 2019. Risk of bias was analyzed using the Newcastle-Ottawa-Scale, and result-synthesis was grouped by aggression-outcome.
Results
Seven prospective cohort studies investigating aggression-dimensions pre- and post-testosterone therapy, reporting on data from 664 transgender men, were eligible. The studies had moderate to high risk of bias due to non-randomization, lack of appropriate control groups, and reliance on self-report. The behavioral tendency to react aggressively increased in three studies out of four (at three months follow-up), whereas only one study out of five found angry emotions to increase (at seven months follow-up). In contrast, one out of three studies reported a decrease in hostility after initiation of testosterone therapy. The remaining studies found no change in aggressive behavior, anger or hostility during hormone therapy.
Discussion and conclusion
Four out of seven studies reported an increase in aggression-related constructs, while one study reported a decrease. In all studies reporting changes, the follow-up period was less than 12 months, indicating that gender-affirming testosterone therapy could have a short-term impact on aggression-related constructs. However, the available studies carried a risk of bias, which indicates a need for further research.
Background:
Gender dysphoria is described as a mismatch between an individual's experienced or expressed gender and their assigned gender, based on primary or secondary sexual characteristics. Gender dysphoria can be associated with clinically significant psychological distress and may result in a desire to change sexual characteristics. The process of adapting a person's sexual characteristics to their desired sex is called 'transition.' Current guidelines suggest hormonal and, if needed, surgical intervention to aid transition in transgender women, i.e. persons who aim to transition from male to female. In adults, hormone therapy aims to reverse the body's male attributes and to support the development of female attributes. It usually includes estradiol, antiandrogens, or a combination of both. Many individuals first receive hormone therapy alone, without surgical interventions. However, this is not always sufficient to change such attributes as facial bone structure, breasts, and genitalia, as desired. For these transgender women, surgery may then be used to support transition.
Objectives:
We aimed to assess the efficacy and safety of hormone therapy with antiandrogens, estradiol, or both, compared to each other or placebo, in transgender women in transition.
Search methods:
We searched MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Biosis Preview, PsycINFO, and PSYNDEX. We carried out our final searches on 19 December 2019.
Selection criteria:
We aimed to include randomised controlled trials (RCTs), quasi-RCTs, and cohort studies that enrolled transgender women, age 16 years and over, in transition from male to female. Eligible studies investigated antiandrogen and estradiol hormone therapies alone or in combination, in comparison to another form of the active intervention, or placebo control.
Data collection and analysis:
We used standard methodological procedures expected by Cochrane to establish study eligibility.
Main results:
Our database searches identified 1057 references, and after removing duplicates we screened 787 of these. We checked 13 studies for eligibility at the full text screening stage. We excluded 12 studies and identified one as an ongoing study. We did not identify any completed studies that met our inclusion criteria. The single ongoing study is an RCT conducted in Thailand, comparing estradiol valerate plus cyproterone treatment with estradiol valerate plus spironolactone treatment. The primary outcome will be testosterone level at three month follow-up.
Authors' conclusions:
We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition. This lack of studies shows a gap between current clinical practice and clinical research. Robust RCTs and controlled cohort studies are needed to assess the benefits and harms of hormone therapy (used alone or in combination) for transgender women in transition. Studies should specifically focus on short-, medium-, and long-term adverse effects, quality of life, and participant satisfaction with the change in male to female body characteristics of antiandrogen and estradiol therapy alone, and in combination. They should also focus on the relative effects of these hormones when administered orally, transdermally, and intramuscularly. We will include non-controlled cohort studies in the next iteration of this review, as our review has shown that such studies provide the highest quality evidence currently available in the field. We will take into account methodological limitations when doing so.
Aim:
To assess age- and gender-associated differences in cognitive and psychomotor abilities measured by the Complex Reactionmeter Drenovac (CRD-series) tests.
Methods:
This cross-sectional study, conducted between 2009 and 2019, enrolled 3420 participants (2012 women) in the age ranging from 18 to 88 years. The participants solved three CRD-series chronometric tests: discrimination of the light signal position (CRD311), complex psychomotor coordination (CRD411), and simple arithmetic operations (CRD11). We analyzed total test solving time (TTST), minimum single task solving time (MinT), number of errors, initial dissociation, and start, end, and total ballasts as measures of wasted time in the first half of the test, second half of the test, and total test time, respectively.
Results:
Age was positively associated with MinT and TTST in all used tests (P<0.001), while initial dissociation, start ballast, and end ballast significantly increased with age (P<0.001). On the CRD11 test, men had shorter TTST than women (P=0.012), shorter start, end, and total ballasts (P<0.001), and made fewer errors than women (P<0.001). On the CRD311 test, women had shorter start (P=0.002), end, and total ballast (P<0.001) than men. On the CRD411 test, men performed better than women on all variables (P<0.001).
Conclusion:
Decreased cognitive and psychomotor abilities measured by the CRD-series tests were associated with advanced age. Men performed better than women on simple arithmetic and complex psychomotor coordination tests, whereas women lost less time on the test of light signal position discrimination.
Transgender individuals (TIs) show brain-structural alterations that differ from their biological sex as well as their perceived gender. To substantiate evidence that the brain structure of TIs 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% holdout 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 = 26 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 TIs show specific brain-structural alterations leading to a different pattern of brain structure than CG-individuals.
Introduction:
Although many studies on the short- and long-term effects of hormonal treatment (HT) in trans people focus on objective changes such as body composition or bone density, few studies have evaluated self-reported effects of HT.
Aim:
To evaluate self-reported symptoms during the first year of HT in trans people.
Methods:
This study is part of the European Network for the Investigation of Gender Incongruence, a multicenter prospective cohort study. For this study, 205 trans women and 193 trans men from the gender clinics of Amsterdam, Ghent, and Florence, who were >18 years of age and started hormonal treatment were included. Questionnaires, self-developed based on the Menopause Rating scale and clinical experiences, were completed, and changes in symptom scores were analyzed using linear mixed models.
Main outcome measures:
Self-reported psycho vegetative symptoms, as well as physical, cognitive, emotional, sexual and genital complaints, and pain were evaluated at baseline and after 3, 6, and 12 months of HT using a 4-point Likert scale (no, mild, moderate, or severe complaints).
Results:
In trans men, with a median age of 23, transient increases were reported in night sweats, weight gain, and clitoral pain. Persistent increases were reported for hot flashes, balding, voice instability, acne, and increase in sexual desire, whereas emotional instability, fear, and menses decreased. For trans women, with a median age of 29, hot flashes, night sweats, fatigue, weight gain, changes in olfactory sense, brittle nails, emotional instability, mood swings, and breast tenderness increased persistently during 12 months of HT, whereas a decrease was observed for balding and sexual desire. Sleeping difficulties decreased temporarily. No changes were observed in palpitations, dizziness, abdominal complaints, anxiety, panic attacks, cognition, and pain, except for clitoral and breast pain.
Clinical implications:
Knowledge on the occurrence of these self-reported, subjective effects and their course over time may help physicians informing trans people starting with and during HT.
Strengths & limitations:
This study was performed in a large cohort of trans people. The follow-up period was limited to 12 months.
Conclusion:
Changes in self-reported symptoms were mentioned in all investigated areas, except cognition. Most symptoms were as expected and even desired, whereas others may be considered unpleasant by some trans people. van Dijk D, Dekker MJHJ, Conemans EB, et al. Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People-Results from the European Network for the Investigation of Gender Incongruence. J Sex Med 2019;16:1297-1309.
Objective:
The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in the transgender population versus no use of cross-sex hormones.
Introduction:
Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic.
Inclusion criteria:
Studies were considered that included participants who were trans women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where the hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery among those who used hormones were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety.
Methods:
A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and grey literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the Joanna Briggs Institute protocols, standardized critical appraisal and data extraction tools.
Results:
Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred.
Conclusions:
Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.
The phenomenon of gender incongruence is hypothesized to arise from a discrepant sexual development of the brain and the genitals, contingent on genetic and hormonal mechanisms. We aimed at visualizing transgender identity on a neurobiological level, assuming a higher functional similarity to individuals of the aspired rather than assigned sex. Implementing a gender perception paradigm featuring male and female voice stimuli, behavioral and functional imaging data of transmen were compared to men and women, and to transwomen, respectively. Men had decreased activation in response to voices of the other sex in regions across the frontoparietal and insular cortex, while the activation patterns of women and transmen were characterized by little or no differentiation between male and female voices. Further, transmen had a comparatively high discrimination performance for ambiguous male voices, possibly reflecting a high sensitivity for voices of the aspired sex. Comparing transmen and transwomen yielded only few differences in the processing of male compared to female voices. In the insula, we observed a pattern similar to that of men and women, the neural responses of the transgender group being in accordance with their gender identity rather than assigned sex. Notwithstanding the similarities found dependent on biological sex, the findings support the hypothesis of gender incongruence being a condition in which neural processing modes are partly incongruent with one's assigned sex.
Across three different domains, there are similar sex differences in how men and women process information. There tends to be a male advantage in attending to and remembering the gist (essential central information of a scene or situation), but a female advantage in attending to and remembering the details (non-essential peripheral information of a scene or situation). This is seen in emotional memory, where emotion enhances gist memory more for males than for females, but enhances detail memory more for females than for males. It also occurs in spatial memory, where men tend to notice and remember the gist of where they or objects are in space, allowing them to more flexibly manipulate themselves or objects within that space, whereas women tend to recall the details of the space around them, allowing them to accurately remember the locations of objects. Finally, such sex differences have also been noted in perception of stimuli such that men attend to global aspects of stimuli (such as a large letter A) more than women, whereas women attend more to the local aspects (such as the many smaller letter Ts making up the A). We review the parallel sex differences seen across these domains in this paper and how they relate to the different brain systems involved in each of these task domains. In addition, we discuss how sex differences in evolutionary pressures and in the locus coeruleus and norepinephrine system may account for why parallel sex differences occur across these different task domains.
Even with the well‐recognized benefits of exercise, levels of physical activity are on the decline, while weight gain levels are increasing. The purpose of this evidence‐based literature review was to investigate the relationship between physical fitness, sexual functioning and overall health. There is too little information about these relationships to the detriment of educational programming efforts designed to help protect the public against noncommunicable diseases and their associated individual, family, organization, and societal costs. The literature review revealed that even modest increases in physical activity were positively associated with enhanced sexual functioning. Sexual functioning was also strongly linked to overall health, supporting the usefulness of including sensitively‐presented information about the benefits of exercise and being physically fit as it relates to sexual functioning in adult health education curricula. Gender and age differences, physical self‐concept, and well‐being also emerged as important factors when considering the links between physical fitness, sexual functioning and overall health. Recommendations for research included (a) controlling for possible social desirability effects and (b) designing new research that follows the association between physical activity, sexual functioning and overall health longitudinally in more international settings beyond the U.S. and western Europe.
Introduction
In many societies, mathematics is often considered a male domain (Nosek et al., 2009). Males tend to have higher motivation and self-efficacy for mathematics in comparison to females (e.g. Skaalvik & Skaalvik, 2004). On the other hand, gender differences in mathematics achievement are not that unambiguous. While girls usually have higher school grades during the entire education period (Duckworth & Seligman, 2006; Hicks, Johnson, Iacono & McGue, 2008), males have somewhat higher results on standardized mathematics tests (e.g. De Fruyt et al., 2008).
However, findings of the meta-analyses indicate that male advantage in mathematics test achievement has decreased or even disappeared in the last decades (De Lisi & McGillicuddy-De Lisi, 2002; Lindberg, Hyde, Petersen & Linn, 2010). Male advantage in test results is more often found in adolescence and in highly selected samples. Furthermore, male results have somewhat larger variability than female results (Hyde, Fennema & Lamon, 1990; Lindberg, Hyde, Petersen & Linn, 2010).
The main objective of this study was to explore the taxonomy of mathematics items’ characteristics that are expected to yield gender differences in performance on these items (Gallagher et al., 2000). This taxonomy was based on a psychobiosocial model (Halpern, 1997; 2000), which emphasizes the reciprocal relationships among different types of variables (psychological, biological and social) in the process of learning.
According to this taxonomy, males will have higher results on items with multiple solution paths and items that require spatial skills. Females will have higher results on items that require verbal skills and items that require application of routine mathematical solutions (items that require application of routine mathematical solutions to a new unfamiliar situation, items that require application of routine mathematical solutions to a familiar situation, items that require memorization and items that require the use of symbolic processes; Gierl, Bisanz, Bisanz & Boughton, 2003).
In exploring this taxonomy, researchers usually compared average scores of males and females on mathematics items (Gallagher, Levin & Cahalan, 2002). This strategy is problematic because it ignores the effects of the Simpson’s paradox (1951). In this study, a confirmatory approach to testing the taxonomy hypotheses was used in the context of the Croatian State Matura exam, based on a combination of different methodologies that are more adequate for this purpose.
Research problems
1. To examine gender differences in mathematical problem-solving performance.
2. To examine the congruence of item classifications in taxonomy categories; the first one made by mathematics teachers, and the second one made based on the students’ remarks while solving individual items.
3. To compare gender differences in mathematical problem-solving performance among general grammar school students and science and mathematics grammar school students.
4. To examine if it is possible to reduce gender difference in mathematical problem-solving performance by manipulating the item characteristics.
Methodology
The data used in this study were obtained from final-year general grammar school and science and mathematics grammar school students who participated in the 2010 and 2011 administrations of the Croatian secondary school final examinations in Mathematics (higher level). In 2010, there were 3425 students from general grammar schools who attended this examination (1361 males and 2064 females) as well as 1577 students from science and mathematics grammar schools (954 males and 623 females). In 2011, 3650 students from general grammar schools (1419 males and 2231 females) and 1531 students from science and mathematics grammar schools (923 males and 608 females) attended the examination. Gender differences in the results on items from every category were analysed using different approaches: the analysis of mean gender differences, differential item functioning (DIF) and differential bundle functioning (DBF) analysis. The DBF analysis has higher statistical power in comparison to analyses conducted on individual items. Therefore, it is more suitable for testing hypotheses about items' characteristics responsible for gender differences in performance on these items. However, it is still relatively rarely used in educational context. In this research, DIF and DBF analyses were performed using Mantel-Haenszel test, SIBTEST / Poly-SIBTEST methodology and empirical curves.
Two types of item classifications in taxonomy categories were compared: the first one was made by mathematics teachers, and the second one was made based on the students’ remarks that were recorded after they tried to solve individual items. More specifically, in a small sample of final-year general grammar school students (N = 16; 8 males and 8 females), think aloud protocols were used to inspect students' ways of understanding and solving items. Transcripts were coded according to the descriptions of taxonomy categories. Congruence of the two classifications is necessary if we want to draw conclusions about relationships between values and directions of gender differences on items on the one hand and the belonging taxonomy category on the other hand.
Furthermore, gender differences among general grammar school students and science and mathematics grammar school students were compared. Students that attend science and mathematics grammar schools chose to enroll in these schools at least partially based on their motivation for mathematics. On average, these students achieve higher results on the final examinations in Mathematics than students from general grammar schools. The comparison of gender differences within these two groups of students was used to test the hypothesis about larger male advantage in highly selected samples.
In order to check if it is possible to reduce gender difference by manipulating the item characteristics, items that require verbal skills (the taxonomy category in which largest gender differences were found) were modified and different versions of the same items were applied on a sample of university students (N = 205; 81 males and 124 females).
Results and discussion
Gender differences in average total scores on examinations were negligible, which is in accordance with the results of meta-analyses (De Lisi i McGillicuddy-De Lisi, 2002; Lindberg, Hyde, Petersen i Linn, 2010). The taxonomy hypotheses were only partially confirmed. Namely, the results confirmed male advantage on items with multiple solution paths and items that require spatial skills. Females had higher results on items that require application of routine mathematical solutions to a familiar situation. These findings were in accordance with the hypotheses. However, gender differences were ambiguous on items that require memorization and items that require the use of symbolic processes. Furthermore, males had somewhat higher results on items that require application of routine mathematical solutions to a new unfamiliar situation. The largest difference in favour of male students was found on items requiring verbal skills and this finding was contradictory to the hypothesis. This finding was supported with different types of analyses (analysis of mean gender differences, DIF and DBF). These items were also measuring content domain mathematical modelling. Other items from this content domain yield gender differences in the same direction. Gender differences in other categories of taxonomy were rather small and of no practical importance. Based on these findings, further investigation of gender differences in verbal problems was conducted.
Gender difference on problems requiring verbal skills was replicated on a sample of university students but only when Mathematics high school grades were used as covariate. The value of gender difference did not change statistically significantly when rule / algorithm for problem solving was explicitly added in the verbal problem. Gender differences were not found in some additional variables that were used in this part of the research (results on the test of verbal series and the inventory of use of mathematics in everyday life).
The teachers' classification of items matched the classification that was based on students' statements to a great extent. The comparison of gender differences between general grammar and science and mathematics grammar school students’ results did not give unambiguous results. In other words, the hypothesis of larger male advantage in highly selected samples was not confirmed.
Conclusion
Different methodologies used in this study led to similar findings regarding the largest gender differences in mathematical verbal problems. Although this research did not yield clear conclusions regarding the reasons behind these differences, the results indicate that more attention should be given to the girls' acquisition of the strategies involved in solving mathematical verbal problems.
According to the author's best knowledge, this is the first study that combines the aforementioned methodological approaches in the research of gender differences in performance on mathematics tasks. The confirmatory approach to testing hypotheses about group differences in item performance used in this research can be used in various contexts, e.g. different school subjects.
Furthermore, this is the first comprehensive study of gender differences in the context of the Croatian State Matura Mathematics examinations. These examinations are gender-neutral to a great extent.
Objective:
The purpose of this paper is to provide an overview of helpful clinical practices when working with transgender adult individuals.
Method:
While the number of openly transgender individuals appears to be growing with society's increased acceptance and awareness, many neuropsychologists have had few opportunities to gain experience with this patient population. In this article, we review the existing literature as it relates to clinical neuropsychological practice.
Results:
We describe important terminology, ideals for creating an environment of respect, and how existing clinical guidelines for transgender individuals may apply to neuropsychology. In addition, we review the primary steps in the assessment process and provide a set of principles and recommendations for conducting neuropsychological assessments with transgender patients.
Conclusions:
There is a paucity of guidance in the field for working with transgender individuals. This article represents a step forward in the dialog and we look forward to future research that develops appropriate normative information, increases understanding of psychosocial factors, and better appreciates the range of hormonal influences for transgender individuals.
This chapter considers the endocrine treatment possibilities for non-binary adults. It discusses the various medicines and interventions which are commonly used and also considers the pros and cons of less commonly used interventions. It also explores the sensitivities necessary when working with this patient group so as to establish good rapport, and the best form of multidisciplinary working for endocrinologists and the wider multidisciplinary team. Lastly, it details the possibilities and limitations of current medicine with regard to effecting non-binary physical changes.
The kindergarten curriculum has undergone fundamental change over the past 50 years. The shift in curriculum in favor of reading preparedness has had the effect of emphasizing boys' weaknesses and girls' strengths. Two changes are proposed. First, alternative kindergartens emphasizing group activities and nonverbal skills must be established. Second, boys must be encouraged to enter such a kindergarten when they turn 5 years old. After 1 year of alternative kindergarten, the boy would enter contemporary kindergarten at age 6. Girls would continue to enter kindergarten at age 5. Most boys would therefore enter first grade at age 7, most girls at age 6. Substantial evidence suggests that such a change would have many benefits, particularly for boys.
The effects of hormone treatment of transsexuals on the emotional state and sexual feelings have been studied less extensively than the effects on physical appearance and functioning. Most of the research in the field of hormone-behavior relationships has been carried out in non-patient groups or in patient groups other than transsexuals. Results of the few available studies of transsexuals are generally consistent with this research. In the existing literature the following hormonal effects on sexuality are reported: an enhancement of sexual interest, fantasies and initiative after androgen administration in female-to-male transsexuals; a loss of sexual interest as well as a loss of erections and the capacity to reach orgasm in male-to-female transsexuals after the use of antiandrogens. Less thoroughly investigated are the effects of hormone treatment on moods. In transsexuals, the following effects are reported: in male-to-female transsexuals less feelings of tension and more feelings of relaxation after anti-androgen intake and a calming down of emotional disturbances after estrogen intake; a greater sense of well-being in female-to-male transsexuals using androgens. No systematic effects of androgens on aggression and anger were found. Non-androgen factors appear to be more important determinants of aggression than androgens.
Administered a cognitive test battery that emphasized spatial ability, verbal fluency, and perceptual speed and accuracy to 17 females (aged 12.7–23.2 yrs) and 8 males (aged 13–29.9 yrs) with congenital adrenal hyperplasia (CAH) and 13 normal female relatives (aged 11.4–31.1 yrs) and 14 unaffected male relatives (aged 12.5–28.8 yrs). In addition, 13 fathers and 15 mothers of CAH patients participated. Ss also completed the Progressive Matrices, a vocabulary test, and an early life activities questionnaire (ELAQ). Findings indicate that CAH females, as compared with normal females, showed significantly enhanced performance on hidden pattern, card rotation, and mental rotation tests of spatial ability. On the ELAQ, CAH females, relative to normal females, showed significantly lower frequencies of participation in activities involving verbal expression and a trend toward greater participation in spatial manipulation activities. However, differences between CAH females and normal females in early childhood activities did not account for observed differences in spatial ability, given the absence of a significant correlation between the spatial manipulation activity scale and spatial ability. There was an absence of reliable differences between male CAH patients and controls across spatial tasks. Results are consistent with an effect of pre- and perinatal androgenizing hormones on the development of spatial ability. (58 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Sexuality, aggression, and mood were investigated in 14 presurgical male-to-female transsexuals, undergoing antiandrogenic treatment with anandron, a pure antiandrogen. Subjects were given a test battery the morning prior to treatment onset and after 8 weeks of treatment. In addition they were requested to complete daily forms concerned with sexual behavior and mood. Morning erections and the frequency of thoughts and fantasies about sex decreased after anandron intake. Aggressive feelings were uncorrelated with testosterone level. Moods such as level of energy, feelings of relaxation, fatigue, and feelings of tension and anxiety appeared to fluctuate more as a consequence of anandron intake than did moods such as cheerful, sociable and friendly, gloomy and unhappy, irritated and changeable. The latter remained at a constant level.
The authors present a set of hypotheses about the biologic mechanisms of lateralization, ie, the processes which lead to an asymmetrical nervous system. It would have been difficult even 20 years ago to formulate such a theory in the face of the prevalent belief that cerebral dominance lacked an anatomic correlate. It is proposed that cerebral dominance is based in most instances on asymmetries of structure. Although genetic factors are important we will lay stress on several factors that, in the course of development, both prenatal and postnatal, modify the direction and extent of these structural differences. Special attention will be directed to the intra-uterine environment as a determinant of the pattern of asymmetries, and in particular sex hormones, eg, testosterone or related factors. We will discuss the associations of anamalous cerebral dominance which include not only developmental disorders such as dylexia and certain talents but also alterations in many bodily systems, including the immune system, the skin, and the skeleton. It is proposed that the same influences that modify structural asymmetry in the brain also modify other systems.
It is commonly believed that the biological changes of puberty exert a strong influence upon adolescent adaptation. Interest in associations between biological change and psychological functioning has always existed within the field of early adolescent developmental psychology (Freud, 1948; Freud, 1905; Hall, 1904). Early psychoanalytic theorists hypothesized that hormonal changes cause libidinal (or sexual instinctual) transformations at puberty (Freud, 1905) as well as accounting for a host of psychological defense mechanisms (Freud, 1948) used by young adolescents to combat these overwhelming libidinal drives. Hall (1904) viewed puberty as inherently stressful and conflictual, describing adolescence as a period of “storm und drang,” or storm and stress.
Two experiments providing additional validity data on the Profile of Mood States and the Thayer Activation-Deactivation Adjective Check List were performed. In the third and main experiment, seven normally menstruating women filled out both questionnaires at the same time every day for 90 days. They were not aware that they were participating in a study of menstruation. Analysis of the time series records of individual women revealed relatively few significant fluctuations in moods and activation levels. Analysis of the group data showed that Fatigue, Confusion, Deactivation/Sleep, and Depression/Dejection were significantly lower in the premenstrual phase than in the periovulatory phase of the cycle, while General Activation was higher. Anger/Hostility and Confusion were both lower in the menstrual phase than in the periovulatory phase. On a retrospective menstrual distress questionnaire, these same subjects say that they experience increases in anxiety, irritability, depression, and tension in the premenstrual phase of the cycle. The differences between individual and group data and the apparent discrepancy between daily self-reports and retrospective questionnaires are discussed.
Accumulated evidence suggests that testosterone enhances sexual motivation in both men and women. Hormone replacement studies in hypogonadal men and in ovariectomized women suggest that, above a certain threshold, increased quantities of testosterone are behaviorally irrelevant in both sexes. The observation that sexual motivation in females is enhanced by levels of testosterone much below those required for normal sexual interest in men raises the possibility of a difference in neural sensitivity to testosterone. An alternative explanation for such findings, based on the evidence that changes in levels of hormones may be more important for behavior than absolute levels, is proposed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated the possibility that the perinatal hormonal environment is related to the development of cognitive sex differences in humans by comparing 25 women who had been exposed prenatally to DES, a synthetic estrogen, to their unexposed sisters. All Ss completed word fluency and spatial relations tests, the Wonderlic Personnel Test, and a dichotic listening task. The DES-exposed Ss showed a more masculine pattern of lateralization (i.e., a stronger right-ear advantage) than did their sisters on a verbal dichotic task. However, no differences were observed between exposed and unexposed Ss in verbal or visuospatial ability. Although interpretation of these data must be cautious, they provide some support for a relationship between high prenatal estrogen levels and the development of masculine-typical function in humans. Implications for previous studies of biological contributions to cognitive sex differences and possible mechanisms for estrogenic effects on the development of lateralization are discussed. (114 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Dual functional brain asymmetry refers to the notion that in most individuals the left cerebral hemisphere is specialized for language functions, whereas the right cerebral hemisphere is more important than the left for the perception, construction, and recall of stimuli that are difficult to verbalize. In the last twenty years there have been scattered reports of sex differences in degree of hemispheric specialization. This review provides a critical framework within which two related topics are discussed: Do meaningful sex differences in verbal or spatial cerebral lateralization exist? and, if so, Is the brain of one sex more symmetrically organized than the other? Data gathered on right-handed adults are examined from clinical studies of patients with unilateral brain lesions; from dichotic listening, tachistoscopic, and sensorimotor studies of functional asymmetries in non-brain-damaged subjects; from anatomical and electrophysiological investigations, as well as from the developmental literature. Retrospective and descriptive findings predominate over prospective and experimental methodologies. Nevertheless, there is an impressive accummulation of evidence suggesting that the male brain may be more asymmetrically organized than the female brain, both for verbal and nonverbal functions. These trends are rarely found in childhood but are often significant in the mature organism.
In the present series of studies existing hostility and anger trait questionnaires were examined. We found them to be unsuitable for our subjects and purpose, A new questionnaire based on novel principles, the Anger Situation Questionnaire (ASQ), was developed to measure anger proneness in women. The ASQ consists of 33 vignettes or scenarios, Each vignette has three dimensions: emotional experience, intensity of emotional experience, and action readiness mode. The ASQ was administered to 146 female students. Out of this sample two extreme groups were selected of 30 subjects each: one group scoring low on self-reported anger and angry readiness, the other group scoring high on both aspects. An anger-induction paradigm was developed consisting of essentially three elements: a physically aversive situation, the performance of some frustrative tasks, as well as an unpleasantly acting female experimenter. The ASQ was validated in this paradigm: subjects scoring high on the ASQ became more angry due to these manipulations; moreover, in most of the subjects at one moment or another a state of anger was induced. © 1994 wiley-Liss, Inc.
Eleven patients with Turner's syndrome (ages 13 to 23 years) were compared on a battery of neuropsychological measures with a control group matched for age and subtests of the Verbal IQ Scale of the Wechsler tests. Patients performed less well than controls on word fluency, perception of left and right, visuo-motor co-ordination, visual memory and motor learning. They also showed a higher incidence of left-ear advantage on a dichotic listening test for phonemic stimuli than did controls. There was no clear evidence for a specific deficit in spatial ability in the patients tested.
We report on two studies of anger and aggression in women. One study concerns an experimental study of anger induction in aggressive and non-aggressive sportswomen. It was found that sports choice in itself, contrary to expectation, does not predict anger arousal and aggressive behavior in the laboratory. However, at an individual level the anger proneness of the subject, as measured by a questionnaire we developed, was related to the intensity of aggressive behavior and subjectively reported anger. The second study concerns the activating effects of androgens on aggression and anger proneness. In a group of 22 female-to-male transsexuals, a battery of anger proneness and aggression questionnaires was administered twice: shortly before and 3 months after the start of androgen treatment. Administration of androgens was clearly associated with an increaese in anger proneness, although there were no changes in several aspects of overt aggressive behavior. © 1994 Wiley-Liss, Inc.
The cognitive functioning of 27 female patients with congenital adrenal hyperplasia (CAH) (aged 11-41 yrs) and 13 of their healthy sisters (13-31 yrs) was compared using short versions of age-appropriate Wechsler scales. In contrast to other studies, neither a higher than average IQ level for CAH patients (mean: 99.0) nor for their sisters (97.7) was found. Unexpectedly, and in contrast to other reports, the subgroup of salt-wasting (SW) patients>16 yrs (N=6; mean score: 111.5) differed from their sisters as well as from simple-virilizing (SV) patients in "full IQ" (p<0.05) and subtest scorings for "Information", "Similarities", and "Picture Completion" (p<0.05-<0.10). SW patients displayed "more masculine" behaviour (vs. SV patients and sisters) which, in turn, was related to differential prenatal hormonal influences. No clear-cut relationships between IQ/cognitive (subtest) findings and gender-role behaviour were found.
Fourteen women served as subjects in a study of the relationships between emotional states, enjoyment of activities, and reproductive hormones. Each subject was psychologically and physically healthy, had a documented history of normal and regular menstrual cycles, was not taking oral contraceptives, and was involved in an ongoing heterosexual relationship. Each woman participated for at least two complete menstrual cycles. The Profile of Mood States and the Social-Sexual Activities Log were filled out daily; other questionnaires were completed less frequently. Blood was drawn between 3 and 5 times/week and was analyzed, using radioimmunoassay methods, from plasma levels of estradiol, progesterone, and luteinizing hormone. Twenty-seven of the twenty-eight cycles appeared to be normal and ovulatory, according to accepted endocrinological criteria. Results showed that in this sample of healthy women there was no relationship between mood states or enjoyment of activities and phase of the menstrual cycle, and no relationship between these psychological states and absolute levels of the reproductive hormones estradiol and progesterone.
Eleven couples, ages 21-31 years and married for at least 1 year, were studied intensively over a three menstrual cycle period from both an endocrine and a sexual behavioral standpoint. Each subject was interviewed individually and had a blood sample drawn twice weekly. Interviews were rated independently by two psychiatrists for degree of sexual initiation, responsivity, avoidance, couple interaction, and mood. Wives rated themselves also for degree of sexual gratification (responsivity). Plasma levels of testosterone and cortisol were determined for both husbands and wives while progesterone and estradiol levels were determined additionally for wives. Husband's initiation scores were significantly correlated with their wives responsivity (clinically rated) scores for 10 of the 11 couples; wives' initiation scores were significantly related to their husband's responsivity scores for 8 of the 11 couples. When either set of correlation coefficients was treated as a new variable and intercorrelated with the husband's average testosterone levels, a significant relationship was obtained. Intercourse frequency, while not related to either partner's average testosterone levels, was related to wives' testosterone levels at their ovulatory peaks. The wivess' self-rated gratification scores correlated significantly with their own plasma testosterone levels. Inspection of each wife's plasma testosterone profile across the three cycles indicated that a dichotomy coccurred, with some women showing a high baseline level and others showing a low baseline level. When wives were dichotomized on this basis, it was found that high baseline testosterone level was significantly related to high self-rated gratification score and to ability to form good interpersonal relationships.
This study was designed to test the hypothesis that women exhibit peaks of sexual activity at ovulation, as would be predicted from estrous effects in animals. Married women who used contraceptive devices other than oral contraceptives experienced a significant increase in their sexual behavior at the time of ovulation. This peak was statistically significant for all female-initiated behavior, including both autosexual and female-initiated heterosexual behavior, but was not present for male-initiated behavior except under certain conditions of contraceptive use. Previous failures to find an ovulatory peak may be due to use of measures of sexual behavior that are primarily determined by initiation of the male partner. Women using oral contraceptives did not show a rise in female-initiated sexual activity at the corresponding time in their menstrual cycles, probably owing to the suppression of ovulatory increases in hormone secretion by the oral contraceptives.
Thirty-two couples with the presenting problem of female sexual unresponsiveness were treated in a controlled study using a balanced factorial design. Treatment involved a combination of drug therapy and counselling. Half the subjects received testosterone and half diazepam, half received weekly and half monthly counselling. They were assessed before treatment, at the end of treatment and at six months follow-up.
Those receiving testosterone did significantly better on a number of behavioural and attitudinal measures than the diazepam group. There were no notable differences in outcome between the two counselling regimes. There were no undesirable side-effects with the testosterone.
Further work is needed to establish the indications for testosterone therapy for unresponsive women.
The present report has demonstrated an absence of a direct relationship between plasma estradiol levels obtained from young, premenopausal women and three measures of sexual behaviour including arousal, intercourse frequency, and sexual gratification. There was also an absence of a relationship between plasma estradiol level and capacity to form interpersonal relationships, an intimacy measure closely involved in the establishment of sexual attachments. This absence of relationship occurred regardless of whether the estrogen level reflected primarily ovarian or adrenocortical secretion.
As part of a comprehensive interview study, 34 female patients with congenital adrenal hyperplasia (CAH) plus 14 control sisters (ages 11-41 yr.) reported on their psychosexual development and sexual orientation (90 items). Fewer patients than sisters had ever experienced love relationships and sexual activities with male partners (p < 0.05 to 0.001). Twenty percent of the patients and none of the sisters wished for and/or had had homosexual relationships; in the patients > 21 yr 44% expressed this interest (p < 0.07). For most items, patients with the salt-wasting variant of CAH (SW) differed more clearly from the sisters than the simple-virilizing patients (SV). For two scales "indicating" homosexual (HOM) and heterosexual orientation (HET) and for two indices of HOM/HET differences), the patients also revealed relatively stronger homosexual and/or weaker heterosexual interests than the sisters (p < 0.05 to 0.001). Here, too, the SW/sister differences were more clear-cut. These results corroborate earlier reports on both delays in reaching psychosexual milestones and increased rates of bisexual/homosexual fantasies and experiences in CAH women.
This chapter discusses the putative hypothalamic contributions that influence the human behaviors––sexuality and aggression––behavioral feedback mechanisms in which the hypothalamus seems to play a part, and the human female's polycystic ovary (PCO) syndrome and some preliminary psychological data as a further illustration of the complexities of hypothalamic function. The evidence presented shows the representation of sexual and aggressive behaviors at the level of the hypothalamus to be more prominent than in all other brain areas involved. The results indicate that the unconditioned behavioral stimuli or the consequences of behavior, also stimuli conditioned to emotionally relevant events, may drastically alter hypothalamic hormonal regulation. Most importantly, these hormonal consequences in themselves again seem to determine further behavior and responses in relevant situations. It is equally well possible that the hypothalamus plays a role in certain forms of learning and memory as well, as indeed hormones derived from or drastically influenced by its nuclei.
The cognitive performance of normal men and women was studied, grouped according to whether the subjects had relatively high or low salivary testosterone (T) concentrations. Men with lower T performed better than other groups on measures of spatial/mathematical ability, tasks at which men normally excel. Women with high T scored higher than low-T women on these same measures. T concentrations did not relate significantly to scores on tests that usually favor women or that do not typically show a sex difference. These results support suggestions of a nonlinear relationship between T concentrations and spatial ability, and demonstrate some task specificity in this respect.
Nineteen studies on the behavioral effects of prenatal exposure to hormones administered for the treatment of at-risk human pregnancy are reviewed. Because the role of prenatal exposure to hormones in the development of human behavioral sex differences is potentially confounded by society's differential treatment of the sexes, comparisons between exposed and unexposed subjects were evaluated and summarized separately for male and female subjects. Therefore, this review focuses on data for individuals whose prenatal hormone environments were atypical relative to what is normal for their own sex. Overall, it appears that prenatal exposure to androgen-based synthetic progestin exerted a masculinizing and/or defeminizing influence on human behavioral development, whereas prenatal exposure to natural progesterone and progesterone-based synthetic progestin had a feminizing and/or demasculinizing influence, particularly among female subjects. The data on prenatal exposure to synthetic estrogen derive primarily from subjects exposed to diethylstibestrol (DES). DES-exposed male subjects appeared to be feminized and/or demasculinized, and there is some evidence that exposed female subjects were masculinized. These findings are discussed in the context of prenatal hormonal contributions to sexually dimorphic behavioral development both within and between the sexes. Recommendations for the conduct of future research in developmental behavioral endocrinology are presented.
Sex differences in human brain organization and behavior are documented by several converging lines of evidence based on patterns of functional asymmetry and cognitive abilities in normal adults and children, in patients with unilateral brain damage, and in clinical groups having atypical levels of sex hormones. Sex differences also exist in the structure of the human brain, and these are reviewed in detail herein. In addition, dichotomous differences, rather than just differences along a continuum, are noted in anatomical-functional correlations between men and women. Many of the anatomical differences cluster in the temporo-parietal regions of the brain, which subserve the asymmetric representation of some linguistic, motoric and spatial functions. The hypothesis is presented that development of the temporo-parietal region of the human brain is an anatomic network dependent on the organizing effects of sex hormones during embryonic or perinatal sexual differentiation, and that in each sex the pattern of functional asymmetries and cognitive attributes is differentially influenced by early sex hormone exposure. It is further suggested that the naturally occurring regressive events of cell death and axon elimination in early brain development contribute to the variation in the structure of the temporo-parietal region, and that this mechanism is differentially influenced by sex hormones in each sex. The specific, directional hypothesis put forward is that in early development of the male brain, lower levels of androgenic hormones or receptors lead to less regressive events in some brain regions, such as the temporo-parietal region, resulting in a larger isthmus of the corpus callosum, less cerebral functional asymmetry, and some cognitive correlates. Some supporting evidence for this hypothesis from neuropsychological studies of clinical groups and homosexual individuals is presented. The neuroanatomical correlate of functional asymmetry in posterior brain regions in women is not evident. The neural regressive events which occur in each sex may be related differently to lateralization. The concept of sexual mosaicism in the human brain is discussed.
Animal studies show clear evidence for a causal link between testosterone and aggression. This review assesses studies involving androgens, principally testosterone, and human aggression. Evidence for a possible effect of prenatal androgens is inconclusive. In adults, higher testosterone levels are found in groups selected for high levels of aggressiveness. Correlations between testosterone and aggression were low when hostility inventories were used, but higher (r = .38) when aggressiveness was rated by others. Regression analysis data and studies of boys at puberty were inconclusive. Other studies show that the outcome of aggressive and competitive encounters can alter testosterone levels, thus confounding interpretation of the correlational evidence. The design of future studies to reveal evidence of a causal link is considered. Suggestions concerning two important methodological problems, the experimental manipulation of hormone levels and the nature of the dependent variable, are made.
Testicular hormones play a decisive role in the sexual differentiation of the genitalia. There is now also an impressive body of knowledge, gathered predominantly from laboratory animals, of the influence of gonadal steroid hormones on the prenatal/perinatal sexual differentiation of the brain. The well-documented mechanisms in animals have been extrapolated, sometimes dogmatically, to the development of sexual orientation and gender identity/role in humans. In principle, it is doubtful that an animal model of human gender identity can be found. Studies in humans have shown that levels of circulating sex steroids and estrogen feedback on luteinizing hormone do not differ between transsexuals and controls. The only reliable sources of information on hormonal influences on human gender identity formation are clinical syndromes in which the hormonal environment of the fetus has been atypical. Follow-up studies of such patients have provided evidence for possible effects of prenatal sex steroids on brain lateralization, sexual orientation and gender role stereotypes. However, a straightforward hormonal effect on gender identity (self-identification as male or female) has been difficult to ascertain up to the present time.
Sex differences in human cognitive and motor skills may in part be due to organizational or activational effects of sex hormones on the brain. In this study, an extensive battery of cognitive and motor tests was administered to normally cycling women at two phases of the menstrual cycle, in order to detect any hormone-mediated changes in performance. Results confirmed changes across the menstrual cycle on a variety of speeded manual and articulatory measures, and on some nonverbal/spatial tests. The results provide qualified support for the hypothesis that the high levels of gonadal steroids provide qualified support for the hypothesis that the high levels of gonadal steroids present at the luteal phase of the cycle may facilitate skills favoring females, but be detrimental to skills favoring males. The implications of these results for research in the area of human sex differences are discussed.
We studied the relationship among behavior, mood, pubertal development, hormonal levels, and psychological functioning in 100 adolescent white girls between the ages of 10.6-13.3 yr. The girls were grouped by pubertal breast stages and four stages of estradiol secretion. No significant mood or behavior changes were found as a function of pubertal stages, controlling for age effects, except for a decrease in interest in sports. The hormonal stages revealed a significant curvilinear trend for depressive affect (increase, then decrease; P less than 0.01), impulse control (decrease, then increase; P less than 0.04), and psychopathology (increase, then decrease; P less than 0.03) scales, indicating significant changes in these behaviors during times of rapid increases in hormone levels. These data suggest that hormonal changes may be more important than the physical changes as determinants of certain mood and behavior patterns at adolescence.
Empirical analyses conducted within a causal-analytic framework (path analysis) on a sample of normal adolescent human males suggested that circulating levels of testosterone in the blood had a direct causal influence on provoked aggressive behavior (self-reports): A high level of testosterone led to an increased readiness to respond vigorously and assertively to provocations and threats. Testosterone also had an indirect and weaker affect on another aggression dimension: High levels of testosterone made the boys more impatient and irritable, which in turn increased their propensity to engage in aggressive-destructive behavior. Two somewhat parallel dimensions of behavior, intermale and irritable aggression, have been identified in animal research to be under testosterone control.
Normal adult women showed systematic performance fluctuations across the menstrual cycle on several motor and perceptual tests that typically yield sex differences in performance. The midluteal phase, characterized by high levels of estradiol and progesterone, was associated with improved performance on tests of speeded motor coordination and impaired performance on a perceptual-spatial test, relative to performance during menses. Variations in gonadal steroid levels may contribute substantially to the sex differences reported in human cognitive and motor skills.
Blood and saliva samples were obtained from 117 healthy young men, following which radioimmunoassays were used to determine the serum concentrations of testosterone (Tser), 5 alpha-dihydrotestosterone (DHT), and the level of free testosterone (Tsal) in the saliva. The cognitive functioning was determined by five spatial and six verbal ipsative test scores, reflecting intra-individual variance in the performance of these tasks, independent of the person's general level of achievement. Within the normal physiological range of androgen levels--especially Tser and to a lesser extent DHT and Tsal--showed a significantly positive correlation with measures of spatial ability and field dependence-independence and a significantly negative correlation with measures of verbal production.
Increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in men by injection of luteinizing hormone releasing hormone (LHRH) prevented improvement in a spatial orientation test relative to a placebo condition. By contrast, performance on a fluency task was significantly increased after LHRH injection relative to the placebo condition. These data support between-subject results where FSH was negatively correlated with visuospatial skills and positively correlated with fluency. There was no change in cognitive function in males following injection of testosterone. There were also no fluctuations in cognitive function that coincided with hormonal fluctuations of the menstrual cycle in women.