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Epistemic Injustice in Brain Studies of (Trans)Gender Identity

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Frontiers in Sociology 6:608328

DOI:10.3389/fsoc.2021.608328

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Technische Universität Berlin

This study undertakes an analysis of the conceptualization of gender identity in neuroscientific studies of (trans)gender identity that contrast the brains of cisgender and transgender participants. The analysis focuses on instances of epistemic injustice that combine scientific deficiencies and the exclusion of relevant bodies of knowledge. The results of a content analysis show how the ignoring of biosocial, developmental, mosaicist, contextualist, and depathologizing approaches leads to internal conceptual inconsistencies, hermeneutical deficiencies and the upholding of questionable paradigms in the research field. Interviews with researchers involved in these brain studies reveal targeted and diffuse forms of testimonial injustice against alternative approaches, promoted by the hierarchical arrangements of research teams in combination with the careerist and economic logic of research. The analysis points to the exclusion of critical epistemologies of science and the historical oppression of trans people as epistemic agents as the underlying hermeneutical deficiencies.

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ORIGINAL RESEARCH

published: 26 March 2021

doi: 10.3389/fsoc.2021.608328

Frontiers in Sociology | www.frontiersin.org 1March 2021 | Volume 6 | Article 608328

Edited by:

Flora Lysen,

Maastricht University, Netherlands

Reviewed by:

Dawn Sarah Jones,

Glyndwr University, United Kingdom

Kale Edmiston,

University of Pittsburgh, United States

Reubs J. Walsh,

Vrije Universiteit Amsterdam,

Amsterdam, Netherlands, in

collaboration with reviewer KE

*Correspondence:

Eric Llaveria Caselles

llaveriacaselles@tu-berlin.de

Specialty section:

This article was submitted to

Gender, Sex and Sexualities,

a section of the journal

Frontiers in Sociology

Received: 20 September 2020

Accepted: 02 March 2021

Published: 26 March 2021

Citation:

Llaveria Caselles E (2021) Epistemic

Injustice in Brain Studies of

(Trans)Gender Identity.

Front. Sociol. 6:608328.

doi: 10.3389/fsoc.2021.608328

Epistemic Injustice in Brain Studies

of (Trans)Gender Identity

Eric Llaveria Caselles*

Center for Interdisciplinary Women’s and Gender Studies, Technical University Berlin, Berlin, Germany

This study undertakes an analysis of the conceptualization of gender identity in

neuroscientiﬁc studies of (trans)gender identity that contrast the brains of cisgender

and transgender participants. The analysis focuses on instances of epistemic injustice

that combine scientiﬁc deﬁciencies and the exclusion of relevant bodies of knowledge.

The results of a content analysis show how the ignoring of biosocial, developmental,

mosaicist, contextualist, and depathologizing approaches leads to internal conceptual

inconsistencies, hermeneutical deﬁciencies and the upholding of questionable paradigms

in the research ﬁeld. Interviews with researchers involved in these brain studies reveal

targeted and diffuse forms of testimonial injustice against alternative approaches,

promoted by the hierarchical arrangements of research teams in combination with the

careerist and economic logic of research. The analysis points to the exclusion of critical

epistemologies of science and the historical oppression of trans people as epistemic

agents as the underlying hermeneutical deﬁciencies.

Keywords: transgender, neuroscience, epistemology, transdisciplinarity, gender identity, trans studies

INTRODUCTION

The idea of the existence of neurological traits speciﬁc to trans people, is a culturally powerful

narrative that has the potential to impact social perceptions, as well as legislative and medical

regulations of trans people. Crucially, scholars from Trans and Gender Studies have elaborated

a critique of the biomedical construction of trans identities and highlighted the historical and

contextual heterogeneity of trans embodiments, focusing on how stigmatizing ideologies and

various forms of inequality materialize into living conditions and experiences detrimental to

trans people’s lives (Valentine, 2007; Spade, 2010; Snorton, 2017; De Silva, 2018; Fütty, 2019).

Given the relevance of these insights to any research on or with trans people, a transformative

dialogue between the neuroscientists researching the brains of trans people and the knowledge

being produced within Gender and Trans studies is a necessary transdisciplinary project.

In a critical analysis from a Gender Studies perspective of a study comparing the structural

connectivity networks of trans and cis participants (Caselles, 2018) it became apparent that certain

lines of transdisciplinary engagement were already in place. Three fundamental contributions from

these engagements could build the basis for a dialogue between Gender Studies and Neuroscience

on trans research1.

The ﬁrst contribution is the challenging of the “hardwiring” paradigm still dominating

neuroscientiﬁc research on sex diﬀerences. It upholds that the eﬀect of prenatal hormones on the

brain of the fetus determines its future gendered behavior, sexual orientation and gender identity.

1The listed transdisciplinary contributions are not exhaustive, they can be expanded with further critical works from situated

Neuroscience and psychological studies, which were not taken into account in my research.

Llaveria Caselles Epistemic Injustice in Brain Studies

In her thorough analysis of the “hardwiring paradigm,” Rebecca

Jordan-Young problematizes the systematic neglect “of the well-

established evidence that the brain and the neuroendocrine

system (not to mention the rest of the body) are not stable

foundations from which behavior and cognition emerge, but

develop and change in a constant dialectic with social and

material “inputs,” including the individual’s own behavior,

learning, and mood states” (Jordan-Young, 2010, p. 237). A

ﬁrst programmatic attempt at developing a biosocial theoretical

framework of the emergence of sex-related diﬀerences has been

undertaken by Fausto-Sterling et al. (2011a,b).Wood and Eagly

(2009, 2012) have also proposed a biosocial concept of gender

identity and gender role socialization. Central to this biosocial

and developmental approach is the acknowledgment of brain

plasticity, meaning that “the brain changes both structurally and

functionally in response to the environment and experience” and

that “an intrinsic feature of the brain is its sociocultural context

dependence” (Han et al., 2013, p. 338, see also Kolb and Gibb,

2014).

The second contribution is the concept of brain mosaicism

which challenges the notion of brain sexual dimorphism. The

dimorphism model stems from the 3G-model of sex, which

groups the variance of genetic, gonadal and genital expressions

in a male and a female group2. Daphna Joel and her team argue

that thinking of the brain as dimorphic, that is, as existing in a

male or female variation, is a misrepresentation. In a review of

more than 1,400 human brains, Joel and her team found that

sex/gender diﬀerences in the human brain are neither highly

dimorphic, nor internally consistent, “even when considering

only the small group of brain features that show the largest

sex/gender diﬀerences, each brain is a unique mosaic of features”

(Joel et al., 2015, p. 15472). The same team have also empirically

questioned the idea that core gender identity is clearly binary

in cis population (Joel et al., 2014). They developed a Multi-

Gender Identity Questionnaire, administered it to cis and trans

participants and found “that the current view of gender identity

as binary and unitary does not reﬂect the gender experience of

many “normative” individuals” (Joel et al., 2014, p. 315).

Finally, the third contribution stems from the changes in the

diagnostic categories and criteria for trans people. In the DSM-

5 [APA (American Psychiatric Association), 2013], the diagnosis

changed from “gender identity disorder” to “gender dysphoria.”

The aim of the change was to depathologize gender identity

and to focus instead on the suﬀering or discomfort of trans

and gender diverse people. The terminology used in the DSM-

5 describes gender identity and gender roles as spectrums and

avoids binary and dichotomous logic, thereby acknowledging

the existence of gender identity variance. Furthermore, the term

“gender” has been used instead of “sex.” Sexual orientation,

which was a speciﬁer in the DSM-IV, has also been removed

(Cohen-Kettenis and Pfäﬄin, 2010; Beek et al., 2016). But

what makes the DSM-5 so radically diﬀerent from the previous

editions is the shift in its understanding of medical authority.

The DSM-5 experts discussed the diagnostic criteria explicitly in

2“female” =XX, ovaries, uterus, fallopian tubes, vagina, labia minora and majora,

clitoris, and “male” =XY, testes, prostate, seminal vesicles, scrotum, penis.

relation to the stigmatization of trans people, as well as in relation

to access to healthcare. They challenge that the notion that

science can deﬁne what is regarded as normal or pathological:

“There are no scientiﬁcally based criteria to diﬀerentiate normal

and pathological gender identity, and the manner in which any

gender identity develops remains unknown and a matter of

theoretical speculation” (Drescher et al., 2012, p. 573).

In the aforementioned analysis of a study of the connectivity

networks of cis and trans participants (Caselles, 2018) it became

clear that these contributions were not being discussed - despite

their direct relevance. Instead, the neuroscientists remained

committed to the hardwiring paradigm, binary models of

sex/gender and pathologizing understandings of trans identity.

Was this exclusion speciﬁc to this paper or did it aﬀect the

whole ﬁeld? Did the exclusion result from ignorance or was

it intentional?

Normative theories of epistemic injustice provide a

framework to think about these questions. Its central idea

is that discrimination of people as epistemic agents leads not

only to the disadvantage of members of groups discriminated

against, but to an impoverishment of knowledge overall:

“knowledge that is passed on to a hearer is not received. This

is an epistemic disadvantage to the individual hearer, and a

moment of dysfunction in the overall epistemic practice or

system.” (Fricker, 2007, p. 43).

José Medina and Miranda Fricker, two of the main theorists

of epistemic injustice, distinguish between testimonial injustice

and hermeneutical injustice. The core of testimonial injustice

is a prejudicial dysfunction in the attribution of credibility by

a hearer. Credibility excess and credibility deﬁcit are forms

of testimonial injustice, which are systematically linked to

each other. Both Medina and Fricker qualify as unjust those

forms of credibility excess or deﬁcit that are systematic, that

is, “that track the subject through diﬀerent dimension of

social activity - economic, educational, professional, sexual,

legal, political, religious, and so on” (Fricker, 2007, p. 27).

Other forms of testimonial injustice are pre-emptive testimonial

injustice, in which a group is excluded from participating in

epistemic exchange, and epistemic objectiﬁcation, that is, the

denial of epistemic subjectivity to certain groups by conﬁning

them to passivity and excluding them from epistemic co-

operative exchange.

The basis for hermeneutical injustice is the fact that

individuals’ knowledge of the social world and of themselves

is interpretative, meaning that we are all dependent on a

pool of hermeneutical resources to make sense of our social

experiences. Injustice occurs when collectively available resources

to understand oneself and one’s social experiences are unevenly

informed by the experiences of some social groups to the

exclusion of others. Hermeneutical injustice is “the injustice of

having some signiﬁcant area of one’s social experience obscured

from collective understanding owing to a structural identity

prejudice in the collective hermeneutical resource” (Fricker,

2007, p. 155).

My aim is to apply the theoretical framework of epistemic

injustice theories to empirically analyze an actual epistemic

situation between neuroscientiﬁc studies of (trans)gender

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Llaveria Caselles Epistemic Injustice in Brain Studies

identity and alternative approaches. In order to do this, I combine

epistemic injustice theories with an ethnomethodological

approach to the study of scientiﬁc practices, which reveals

the centrality of testimonial and hermeneutical dimensions of

scientiﬁc facts. Latour has argued that it is not the inherent

properties of statements that make them true, but the

incorporation of these statements into new ones by other

actors. In this sense, facts are collective accomplishments

with an essential communicative dimension: “You may have

written a paper that settles a ﬁerce controversy once and

for all, but if readers ignore it cannot be turned into a fact.”

(Latour, 1987, p. 40).

Hermeneutical practices in the production of scientiﬁc

knowledge occur at two levels. The ﬁrst one is based on the

interpretation of observations. At this level, the systematic

privileging of certain interpretations can constitute a form of

hermeneutic marginalization. The second level is connected to

the understanding and meaning of science itself. Diﬀerences are

found for example between monist and pluralist understandings

of science (Kellert et al., 2006, p. xi).

Using theories of epistemic injustice involves a commitment

toward a more just production of knowledge. It is in this

sense a necessarily interventionist project. Based on a vision of

dissent as a democratic epistemic practice, Medina advocates

for epistemic friction, which he deﬁnes as “contending with,”

rather than “contending against” (Medina, 2013, p. 16). In this

account of epistemic cooperation, he defends the principles of

acknowledgment, engagement, and epistemic equilibrium. The

ﬁrst of which means that “all forces that we encounter must be

acknowledged and, insofar as it becomes possible, they must be

in some way engaged,” the second one is the imperative to search

“for equilibrium in the interplay of cognitive forces, without some

forces overpowering others, without some cognitive inﬂuences

becoming unchecked and unbalanced” (Medina, 2013, p. 50).

He places a special hermeneutical responsibility on institutions

and people in positions of power, but stresses that “we all share

the collective responsibility to facilitate the hermeneutical agency

of all communicators, especially if they have been marginalized”

(Medina, 2013, p. 110).

This political and ethical commitment also is found within

feminist philosophy of science. Donna Haraway’s concept of

situated knowledges captures this sense of the individual and

collective responsibility of researchers within an understanding

of science as historically contingent, constituted through

language and meaning, as well as committed to “faithful accounts

of a “real” world” (Haraway, 1988, p. 579). Upholding the

value of embodied objectivity against traditional epistemology

and social constructivist relativism, Haraway argues for “partial,

locatable, critical knowledges sustaining the possibility of webs of

connection called solidarity in politics and shared conversations

in epistemology” (Haraway, 1988, p. 584). The possibility of

objectivity and rational knowledge lies then in the “process of

ongoing critical interpretation among “ﬁelds” of interpreters and

decoders,” in knowledges “ruled by partial sight and limited

voice (...) for the sake of the connections and unexpected

openings (...)” (Haraway, 1988, p. 587). I see this account

as in harmony with Medina’s normative account of epistemic

cooperation that provides the theoretical and normative basis for

my research.

Building on these frameworks I formulate my research

question as follows:

Which forms of epistemic injustice can be identiﬁed in the

conceptualization of gender identity in the brain studies of

(trans)gender identity?3

Within the context of this research question, I align with

an approach that can be deﬁned as biosocial, developmental,

mosaicist, contextualist, and depathologizing. My understanding

of “conceptualization” includes both the formal deﬁnitions

presented in the published studies and the process by which these

deﬁnitions were established.

In order to empirically assess epistemic injustice, a transparent

operationalization is needed. The criteria formulated below are

tailored to the context of scientiﬁc research and target the

moments of decision-making among alternative options within

the research process, including the formulation of research

questions, design of experiments or the interpretation of ﬁndings.

The criteria are not meant to lead to conclusive “yes/no” answers

on the question of whether epistemic injustice is to be found in a

particular case. Instead, they are meant to provide an evaluative

framework to interpret the data gathered.

First, the question of epistemic injustice can only be

adequately raised if a number of preconditions are met in an

epistemic situation:

A1. Multiple epistemic agents (individual, collective,

institutional) participate actively in the production of

knowledge4.

A2. There is a shared question or inquiry involving all

epistemic agents.

A3. The knowledge produced by the epistemic agents follows

a shared set of values and rules, and is of relevance to

the inquiry.

A4. There must be a power diﬀerential in the epistemic

situation that corresponds to relations of oppression active

in society.

The epistemic situation of this study involves on the one

hand the scholars advancing biosocial, developmental, mosaicist,

contextualized and depathologizing approaches to brain research

and sex/gender and trans identities. On the other hand, it involves

3In order to establish a dialogue between diﬀerent disciplines and approaches,

I chose a pragmatic approach to the use of terminology. The terms

“transgender”/“trans” and “cisgender”/“cis” are extracted from the ﬁeld, following

the vocabulary of recent neuroscientiﬁc papers (see Burke et al., 2017; Nota

et al., 2017; Manzouri and Savic, 2018 for example) that seemed the most

compatible with terms as used in gender and trans studies. The same applies

to the use of “gender identity”, taken from the ﬁeld. The downside is that

through this pragmatic approach, limitations, and problems bound to these terms

are reproduced.

4I am limiting the epistemic agents in my analysis to those who actively participate

in the production of knowledge within the delimited epistemic situation because of

my focus on the question of responsibility and accountability for unjust epistemic

practices. This excludes the cis and trans participants from my consideration.

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Llaveria Caselles Epistemic Injustice in Brain Studies

brain studies of gender identity (BSGI). The term “brain studies

of gender identity” is used in this paper in a narrow sense.

It refers to neuroimaging studies that state “gender identity”

as their main object of research, operate by comparing the

brain structure and function of trans and cis participants, and

aim toward a neurological theory of gender identity formation.

Consistent with my praxeological approach, the use of the term

is descriptive and captures how the studies present themselves.

It is important to note that this use of terminology reproduces

a problematic and undiﬀerentiated notion of gender identity as

a one-dimensional self-contained category, a conceptual issue

that is investigated and discussed in sections Conceptualization

of Gender Identity in Published Brain Studies of (Trans)Gender

Identity, Epistemic Attitudes From Researchers of Brain Studies

of (Trans)Gender Identity, and On Epistemic Injustice in Brain

Studies of (Trans)Gender Identity of this paper. The BSGI do not

include neuroimaging studies with trans participants looking into

the eﬀects of hormone replacement therapy on brain structure or

function (see for example Burke et al., 2018), nor studies with

trans participants with research objects that are not explicitly

gender identity, such as ostracism (for example Mueller et al.,

2018) or reaction to stimulation of body parts (see for example

Case et al., 2017).

These two sets of epistemic agents conﬁgure an epistemic

situation in which they are all directly involved in seeking to

understand gender identity and are accountable to scientiﬁc

standards for empirical research, even if they deploy diﬀerent

methodologies. As a baseline, all of the epistemic agents hold

positions in universities or research institutions and have

published their work in peer review journals to which the other

researchers have access.

The power diﬀerential between these epistemic agents (A4)

is, however, more diﬃcult to argue. This is because I have

narrowed down the epistemic injustice situation as occurring

within the realm of science, that is, between epistemic agents that

qualify as scientists, which is a position of social privilege. The

diﬀerence between the epistemic agents that I am considering is

not one of gender identity, sexual orientation, race, class or other

category of social inequality. There is however a key diﬀerence

in that some epistemic agents operate within dominant and

hegemonic discourses, while biosocial, developmental, mosaicist,

contextualist, and depathologizing views represent counter-

hegemonic positions. The counter-hegemonic stance is directed

against two central dispositives of western modernity: the

sex/gender binary norm, and the scientiﬁc authority over what

constitutes nature. Historically, these two strands have come

together in the normative legal and biomedical deﬁnitions of

manhood and womanhood as the only two possibilities of social

and political existence in western nation-states.

Thus, the four preconditions that enable one to analyze

whether an epistemic situation is shaped by epistemic

unjust behavior are met. The focus of my inquiry are

therefore the following four conditions, which establish

the framework to assess epistemic injustice and guide my

research design:

B1. The wrong of the dominant epistemic agent must amount

to blocking the epistemic labor of others, devaluating the

epistemic labor of others, and/or appropriating the epistemic

labor of others.

B2. There must be a form of exclusion or limitation in

the participation in the production of knowledge that keeps

epistemic agents isolated from one another and/or there must

be a breach in the relationship of trust between the epistemic

agents involved.

B3. The harming of the oppressed epistemic agent must

beneﬁt the dominant epistemic agent in the perpetuation of

the privileges granted through the relations of dominance and

oppression which structure society.

B4. The harm produced by the dominant epistemic agent must

amount to a failing within the rules of the epistemic system, to

a failure of the epistemic system or to the inadequacy of the

system altogether.

In order to make the criteria less exigent, I narrow them to

alternatives that operate within the same epistemic system, in

this case, empirical scientiﬁc research in general and biology

and neuroscience in particular. This is to be seen as a strategic

restriction, since I would defend that epistemic agents have a

responsibility to pay attention and engage with knowledge from

epistemic systems other than their own.

MATERIALS AND METHODS

Content Analysis

The ﬁrst part of the study is a qualitative content analysis

(Mayring, 2015; Krippendorﬀ, 2018) of BSGI to analyze how

gender identity is deﬁned in published studies. The qualitative

content analysis can establish whether the deﬁnitions of gender

identity meet quality criteria of conceptual work such as clarity,

speciﬁcity, coherence, or consistency. This analysis can also

show whether the conceptualization engages with biosocial,

developmental, mosaicist, contextualist, and depathologizing

approaches. Therefore, the qualitative content analysis is an

adequate method to evaluate the conditions B1 (blocking,

devaluing, or appropriating the epistemic labor of others), B2

(exclusion or limitation in the participation in the production

of knowledge), and B4 (failing within the values of the

epistemic system).

The content analysis was divided into two steps: ﬁrst, a

detailed analysis of four early studies (2011–2014), and second,

a targeted analysis of six recent studies (2016–2018). The sample

for the ﬁrst analysis was based on the relevance of the ﬁndings for

the BSGI ﬁeld: Savic and Arver (2011),Rametti et al. (2011a,b),

and Kranz et al. (2014). The sample of the recent studies was

based on publication date, inclusion of diﬀerent approaches,

relevance of the ﬁndings, and availability of researchers for the

interview: Guillamón et al. (2016), Burke et al. (2017),Feusner

et al. (2017),Manzouri et al. (2017),Nota et al. (2017), and

Manzouri and Savic (2018).

The procedure for the analysis was developed with a pre-

test of a previous study (Berglund et al., 2008). In the

analysis I considered the terms “gender identity,” “sex,” “gender,”

“transgender” (and related terms such as “gender dysphoria,”

“gender identity disorder,” “transsexualism”), “women/female,”

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Llaveria Caselles Epistemic Injustice in Brain Studies

“men/masculine” and terms related to “sexual orientation.” I

accounted for explicit deﬁnitions and the use of the terms5.

In the analysis of the early studies, I conducted a quantitative

assessment of the frequency of use of the terms6. For the

qualitative analysis of the most frequently used terms, I took into

account explicit deﬁnition and uses of the terms. I diﬀerentiated

the uses within theoretical expositions, operationalizations or

interpretations of ﬁndings. I also analyzed the use of diﬀerent

terms in relation to each other. Then, I analyzed expressions

of sexual diﬀerentiation of the brain, that is, expressions that

communicate the measurements obtained in a study (own or

other) and interpret them in relation to O/A hypotheses. Finally,

I included in the analysis explicit deﬁnition of the considered

terms from cited theoretical papers. The ﬁndings of the analysis

of the early studies are presented in section Conceptualization

of Gender Identity in the Recent Brain Studies of (Trans)Gender

Identity (2011–2014).

The analysis of the recent studies was a comparative analysis,

focused on changes in relation to the earlier studies. In order

to do this, I accounted for theoretical shifts in the ﬁeld.

The conceptualizations of gender identity were then analyzed

separately for the two hypotheses proposed in the recent studies.

I analyzed explicit deﬁnitions and uses of “gender identity”

and the aforementioned terms in the theoretical expositions,

operationalization, and interpretation of ﬁndings. The ﬁndings

of the analysis of the recent studies are presented in section

Conceptualization of Gender Identity in the Recent Brain Studies

of (Trans)Gender Identity (2016–2018), while a joint discussion

of the ﬁndings in the early and recent brain studies follows in

section Summary of ﬁndings of the conceptualization of gender

identity in published brain studies of (trans)gender identity.

Expert Interviews

The second part of the study is an assessment of the researchers’

epistemic attitudes toward the alternative approaches. I used

qualitative expert interviews for this purpose (Kaiser, 2014).

The interviews combine exploratory questions to generate

new insights in the conceptualization process, with structured

questions to evaluate the following necessary conditions for

epistemic injustice: B1 (blocking, devaluing or appropriating the

epistemic labor of others), B2 (exclusion or limitation in the

participation in the production of knowledge), B3 (perpetuation

of privilege granted through relations of dominance and

oppression), and B4 (failing within the values of the epistemic

system, failure or inadequacy of the epistemic system altogether).

The interview script was designed to introduce epistemic

friction by asking about conceptual problems of the BSGI, as

well as about biosocial, developmental, mosaicist, contextualist,

and depathologizing approaches. The challenge was to avoid an

oppositional framing and instead promote a dialogue between

dissenting stances.

5The Supplementary Materials include an extended report on the selection

procedure and a full list of the analyzed terms.

6I excluded Rametti et al. (2011b) from the quantitative assessment because of the

parallels in use of the terms to Rametti et al. (2011a).

I approached this by establishing a common ground between

myself as the interviewer, the BSGI researchers, and alternative

conceptualizations. This common ground was based on four

openings in the recent studies: (1) the dismissal of the inverted

brains hypothesis in favor of a reconceptualization of trans brains

as a composite of masculinized and feminized traits, potentially

opening the research toward a mosaicist model of brain sex

diﬀerentiation, (2) emphasis on development which enables

the discussion of brain plasticity and environmental factors,

potentially moving away from biological determinist models of

gender identity, (3) the introduction the diagnosis of “gender

dysphoria” in the DSM-5 which acknowledges non-binary gender

identities, potentially opening the ﬁeld toward multidimensional

and socially contextualized understanding of gender identity

for trans people, and toward a denaturalization of diagnostic

categories, and (4) consideration of social experience as a factor

shaping brain networks, potentially opening research toward

multidimensional, intersectional and socially contextualized

understandings of gender identity for both trans and cis people.

I developed questions that create a space for discussion: “How

relevant do you consider theory x for the neuroscientiﬁc study

of gender identity?,” “What beneﬁts and problems do you see

in approach x at a theoretical and methodological level?,” “Was

this conceptualization x topic of discussion?.” For questions with

an either-or logic, I attempted to establish in the formulation a

collaborative focus, for example: “Do you think that x should

inform neuroscientiﬁc research on gender identity?7.”

I sent interview requests to 11 researchers and received 4

positive responses, 4 declines, and 3 unanswered. I conducted

four interviews that lasted between 37 and 70 min and recorded

the audio. I adapted the interview script to each researcher

focusing on the area of expertise. I transcribed the interviews

following a simple transcription method (Dressing and Pehl,

2015). A ﬁrst transcription was sent to the interviewees for

revision. In order to create a relationship of trust, but also

to reﬂect potential changes in the epistemic attitude of the

interviewees, I allowed them to introduce modiﬁcations to the

transcription. One researcher decided to retract the interview

after reading the transcript, which is why the analysis is limited

to three interviews. Researcher B introduced modiﬁcations in the

transcript, which became much shorter and closer to a written

text and left out many questions and answers. The interview

transcripts were then anonymized.

The interviews were analyzed following a simple qualitative

content analysis focusing on two categories. The ﬁrst,

communicative context, reﬂects the interviewees’ construction

of the social ﬁeld8in which they situate their own work and

that provides the background for their conceptual decision-

making. This category enables a description of the epistemic

attitude in relation to the constraints that dominate the social

7See full interview script in the Supplementary Material.

8The concept of social ﬁeld follows Bourdieu’s deﬁnition of social ﬁeld as “a ﬁeld

of forces, whose necessity is imposed on agents who are engaged in it, and as a ﬁeld

of struggles within which agents confront each other, with diﬀerentiated means

and ends according to their position in the structure of the ﬁeld of forces, thus

contributing to conserving or transforming its structure” (Bourdieu, 1998, p. 32).

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Llaveria Caselles Epistemic Injustice in Brain Studies

ﬁeld. The ﬁndings of this analysis are presented in section

Communicative Contexts. The second category is epistemic

behavior, speciﬁcally in relation to the conceptual problems

and alternative approaches. This category is a praxeological

one, framing the reaction in terms of “doing”: what does the

researcher do with the conﬂict? How does the researcher handle

it? This takes into account both the content level and the

performative level of communication, paying attention to the

arguments oﬀered and how they function within a range from

refusal or blocking to engagement and agreement. The results of

this analysis are presented in section Epistemic Behavior.

CONCEPTUALIZATION OF GENDER

IDENTITY IN PUBLISHED BRAIN STUDIES

OF (TRANS)GENDER IDENTITY

Conceptualization of Gender Identity in the

Recent Brain Studies of (Trans)Gender

Identity (2011–2014)

Frequency of Use of Sex/Gender Related Terms

The use of sex/gender related terms diﬀers in absolute numbers

between the three studies, but shows a consistent pattern

(see Table 1). The terms most used are “men/male” and

“women/female,” followed by terms related to “trans” and “sex.”

The numbers show a consistently low frequency of use of

“gender” related terms, despite it being the main object of the

studies’ research.

Explicit Deﬁnitions of Gender Identity

None of the four studies included an explicit deﬁnition of

“gender identity.” The most elaborate were formulations such as

“perceptions of the own sex” (Savic and Arver, 2011) or “the male

controls have a gender identity as men (. . . ) and control women

have a gender identity as women” (Rametti et al., 2011b). This is

remarkably poor considering the centrality of gender identity in

the research question.

The theoretical papers cited in the studies contained two

brief deﬁnitions, both within a parenthesis. In the ﬁrst one,

gender identity is distinguished from “sex,” deﬁned as a

form of belonging, and limited to a masculine or feminine

identity as mutually exclusive and homogeneous categories:

“Gender identity (gender identity refers to an identity experience

expressed in terms of masculine or feminine “belongingness,”

independent of the anatomical reality of the sex) (...)” (Swaab,

2004, p. 303). In the second one, this “feeling of belonging”

is related to gender, without explaining the term any further

and remaining within the male-female dichotomy: “. . . gender

identity (the conviction that one belongs to the male or female

gender)...” (Bao and Swaab, 2011, p. 215). Both deﬁnitions

are embedded in explanations of transsexuality, establishing a

normative dimension by which the main aspect of gender identity

is the distinction between ordered (cis) or disordered (trans).

This subordinates the concept of gender identity to the deﬁnition

of transsexuality and centers cis identities as an invisible norm.

Etiological Deﬁnition of Gender Identity

The theoretical framework of the four studies is the brain

organization/activation (O/A) hypothesis, particularly the

discussion thereof by Swaab (2004, 2007),Garcia-Falgueras and

Swaab (2008), and Bao and Swaab (2011). The O/A hypothesis

proposes that a permanent structuring (“hardwiring”) of the

brain into a male or a female variation occurs based on the

inﬂuence of gonadal testosterone on the developing brain of

the fetus and immediately after birth. These “hardwired” brain

patters are proposed to cause diﬀerences between men and

women in gender and gender identity, including behavior,

personality traits and feeling of belonging (see Bao and Swaab,

2011, p. 215).

Gender identity is introduced in the hypothesis to explain

transsexuality through the separate timing of genital and brain

diﬀerentiation during pregnancy. The separate timing opens up

the possibility of changes in the hormonal environment in which

brain and genital diﬀerentiation happen:

“These fetal and neonatal peaks of testosterone, together with

functional changes in steroid receptors, are thought to program

to a major degree the development of structures and circuits in

a boy’s brain for the rest of his life. As sexual diﬀerentiation of

the genitals takes places much earlier in development (i.e., in the

ﬁrst 2 months of pregnancy) than sexual diﬀerentiation of the

brain (the second half of pregnancy), these two processes may

be inﬂuenced independently. In rare cases, this may result in

transsexuality, i.e., people with male sex organs who nevertheless

have a female identity, or vice versa. It also means that in

the event of an ambiguous sex organ at birth, the degree of

masculinization of the genitals may not always reﬂect the degree

of masculinization of the brain” (Bao and Swaab, 2011, p. 215).

The implication of this etiological hypothesis is that

chromosomal and genital sex need to be seen in all people

as independent from gender identity and, by extension, that

neither chromosomal xx/xy variation, nor the presence of a

penis or a vagina, can be used as reliable indicators of the

hormonal environment during the fetal brain development. This

implication is ignored by the authors in BSGI and the proponents

of the O/A hypothesis, but it has far reaching consequences

for the whole ﬁeld of studies of sex/gender diﬀerences in the

brain. Studies that use chromosomal, genital or gonadal sex

as indicators of the hormonal environment during fetal brain

development or as an indicator for the gender or gender identity

of the participants can’t be seen as reliable. Based on the O/A

hypothesis itself, this combination of inferences is not valid,

meaning that gender and gender identity need to be assessed in

all people independently from 3G-sex and that 3G-sex can’t be

used as a reliable indicator of hormonal environment during

brain development. The undetected logical inconsistency in the

application of the hypothesis in BSGI shows the detrimental

impact of unreﬂected cultural and normative assumptions of

sex/gender on the research ﬁeld.

Operational Deﬁnitions of Gender Identity

In all four studies, participants were selected based on sex and

gender identity. None of the studies mentions how the gender

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TABLE 1 | Absolute and relative frequency of use of sex/gender related terms in selected studies.

Savic and Arver (2011) Rametti et al. (2011a) Kranz et al. (2014) Total

“sex” 50 25,6% 44 19,4% 54 18,1% 148 20,55%

“gender” 2 1% 18 7,9% 27 9% 47 6,5%

“men/male,” “women/female” 59 30,3% 82 36,1% 110 36,9% 251 34,9%

“sexuality” 40 20,5% 12 5,3% 24 8,1% 76 10,55%

“trans” 44 22,6% 71 31,3% 83 27,9% 198 27,5%

195 100% 227 100% 298 100% 720 100%

identity of the cis participants was established. At the same

time, trans participants underwent an exhaustive control of their

gender identity based on diagnostic procedures and criteria of

the DSM-IV and ICD-10. The fact that only the gender identity

of trans participants was operationalized shows the extent to

which the conceptualization of gender identity is dependent of

the ordered/disordered dimension of a medical diagnosis and

how a cis bias stands in the way of a thorough interrogation of

the category of gender identity.

The use of a medical category for the assessment of gender

identity in combination with the etiological model proposed

by the O/A hypothesis by which gender identity is hardwired

through the eﬀect of prenatal hormones on the brain leads

to a fundamental hermeneutical problem in the BSGI. The

biologization of transsexuality erases the historical and political

dimension not only of sex and gender, but also of medical

categories and techniques.

On the Use of “Brain Sex,” “Biological Sex”

In the studies, the term sex is used in expressions such as

“biological sex” and “brain sex.” In “biological sex” it refers

to a series of elements such as genital phenotype, reproductive

organs, gonads, production of androgens and estrogens, and

chromosomes. These factors are linked by a chain of events and

processes. Within the O/A hypothesis, the development of the

brain is determined by “sex” in the sense that it is assumed to

be shaped permanently by the gonadal hormones. It is in this

sense that “brain sex” can be understood as expressing the causal

subordination of brain structure and function, as well as their

outcomes (behavior, attitudes, cognition, emotion, identity, etc.),

to factors of biological sex (see Savic et al., 2010, p. 15).

The term “brain sex” is misleading in a crucial way.

Taking the O/A hypothesis seriously, that genitals and brain

diﬀerentiation occur at diﬀerent times during pregnancy, “sex”

in “brain sex” stands for the hormonal environment during the

brain development phase of the fetus in which the “gender”

gets hardwired. However, as the hypothesis proposes in the

explanation of transsexuality, this hormonal environment can’t

be assumed from chromosomal, genital or gonadal sex, and the

outcome as male/female gender identity can’t be predicted by

either gonadal sex or chromosomal sex or genital sex. Thus,

the use of “brain sex” creates a false correspondence between

chromosomal sex, gonadal sex, genitals, brain structure, gender,

and gender identity in a male expression or a female expression.

Deﬁnition of Transgender Identities and Sexual

Orientation

The most elaborate deﬁnition in the studies refers to terms

related to transgender identities. The authors of all studies

include a diagnostic deﬁnition based on the criteria of DSM-IV

and ICD-10:

“(1) A desire to live and be accepted as a member of the

opposite sex, usually accompanied by a sense of discomfort

with the subject’s anatomical sex and a wish to have surgery

and hormonal treatment to make the body as congruent as

possible with the body of the preferred sex.

(2) The transsexual identity has existed for at least 2 years.

(3) The syndrome cannot be explained by any other

psychiatric disorder or by chromosomal abnormality. Thus,

any evidence of an abnormal male phenotype or genotype (i.e.,

hypospadias, cryptorchism, micropenis, and chromosome

complement other than 46XY) excluded enrollment to the

study” (Savic and Arver, 2011, p. 2,526).

Based on the O/A hypothesis, transgender identity is also

understood as “a mismatch between gender-speciﬁc brain

development and the development of body and genitals” (Kranz

et al., 2014). They combine these two deﬁnitions with the

typological diﬀerentiation of trans people in a “homosexual”

and “non-homosexual” category based on Blanchard’s discredited

hypothesis. The typological deﬁnition is used by the researchers

to control for sexual orientation as a factor.

“All FtM transsexuals selected had early-onset gender

non-conformity (before puberty), were erotically attracted to

females, and wanted sex reassignment (Gómez-Gil et al., 2009).

This group corresponds to the one typically referred to as

“homosexual type” (Blanchard et al., 1987; Smith et al., 2005; but

see Gooren, 2006). Sexual orientation in patients was established

by asking what partner (a man, a woman, both or neither) the

patient would prefer or feel attraction to if they were completely

free to choose and the body did not interfere” (Rametti et al.,

2011b, p. 950).

The reason for the assessment of sexual orientation is that

the O/A hypothesis also applies to the “hardwiring” of a sexual

orientation. Therefore, the variable sexual orientation is assessed

to either limit the selection of participants to “heterosexuality”

or to use it as covariate. Following Gooren (2006),Moser (2010)

and Veale et al. (2012) critique of the Blanchard typology, the

operationalization of sexual orientation for the cis and trans

participants is contradictory. For example, trans men attracted

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Llaveria Caselles Epistemic Injustice in Brain Studies

to women are deﬁned as homosexual (Rametti et al., 2011a, p.

200). The Kranz et al. study is the only one that accounts for

diﬀerent possibilities to operationalize sexual orientation based

on a scale of attraction toward males and females, on a spectrum

of homosexuality and heterosexuality based on genetic sex and

on the same spectrum based on gender identity (see Kranz et al.,

2014, p. 15469).

The studies’ use of multiple deﬁnitions of transgender

identities without acknowledging incompatibilities and the

contradictory assessment of sexual orientation contribute to the

lack of conceptual clarity and accountability.

Conceptualization of Gender Identity in the

Recent Brain Studies of (Trans)Gender

Identity (2016–2018)

In order to assess the recent BSGI it is necessary to account

for theoretical shifts in the ﬁeld. The changes were necessary

because the ﬁndings didn’t show a “brain sex reversal” in trans

participants, but a mix of traits: “the MtF brain is not completely

feminized but presents a mixture of masculine, feminine, and

demasculinized traits” (Guillamón et al., 2016, p. 1627). The

ﬁrst hypothesis used to explain these ﬁndings is the cortical

development hypothesis (CD), which adapts the O/A theory

to match the ﬁndings. The second hypothesis is the self-

referential thinking and body perception hypothesis (SR/BP),

which operates within neurological theories of the self. Another

development that aﬀected recent studies was the release of the

DSM-5, which introduced relevant changes in nomenclature

from “gender identity disorder” to “gender dysphoria,” and

demonstrated a deeper understanding of transgender identities.

Cortical Development Hypothesis

This hypothesis is presented in a review paper and has not

been empirically tested. It proposes “a slowing (or a stop)

in the cortical thinning process in females, MtFs, and FtMs

compared to the thinning process in males,” which would create

diﬀerent cortical phenotypes: “this hypothetical process, based on

diﬀerential developmental processes in speciﬁc cortical regions,

would inﬂuence the development of gender identity for all: male,

female, MtF, and FtM” (Guillamón et al., 2016, p. 1637).

In relation to the conceptualization of gender identity, the CD

hypothesis does not provide any further elaboration on the O/A

model. The shift is that gender identity is deﬁned not through a

male and female pattern that is reversed in the trans brain, but

through a “thinner than male” cortical thickness pattern. While

the ﬁrst pattern was proposed based on a binary oppositional

concept of sex and gender, this new pattern has no logical

correspondence to the conceptual deﬁnition of sex/gender, which

is maintained as binary and oppositional.

The CD hypothesis does not integrate the changes in

conceptualization of the DSM-5, despite citing it as a reference.

Instead, the CD hypothesis makes extensive use of Blanchard’s

typology of transsexuality and “feminine essence theory”

(Blanchard, 2005, 2008), disregarding it’s sexist and homophobic

logic and its incompatibility with the understanding of gender

incongruence of the DSM-5.

Self-Referential Thinking and Body Perception

Hypothesis

This alternative hypothesis seeks to describe the networks

involved in accomplishing tasks such as recognizing one’s own

body as one’s own. It includes a deﬁnition of gender identity

that considers a series of factors: “gender identity denotes a

complex interrelationship among an individual’s genital sex,

one’s internal sense of self, and one’s outward presentations and

behaviors (gender expression)” (Manzouri and Savic, 2018, p. 1).

However, there is no acknowledgment that the internal sense of

self and one’s outward presentations and behaviors are related to

sex/gender, due to the fact that neurological theories of the self

don’t have a concept of gender (see Northoﬀ et al., 2006, p. 454).

Gender dysphoria is thus redeﬁned as “body dysphoria and body-

related avoidance” (Feusner et al., 2017, p. 965), erasing gender as

a dimension.

The conceptualization of gender dysphoria away from

sex/gender models introduces a shift in the question of causation.

The authors move away from a “neurobiological determinant”

to a “neurobiological substrate,” taking into account plasticity

and development in what can be understood as a shift toward

a biosocial reconceptualization (see Manzouri et al., 2017,

p. 1008). Some studies introduce a developmental understanding

of gender dysphoria, focusing on aging and brain maturation and

activational eﬀects of hormones in puberty, and disregarding the

eﬀects of diﬀering social experiences (see Nota et al., 2017).

In the SR/BP hypothesis sexual orientation ﬁgures as a

separate phenomenon, leading to the interpretation that “the

neuroanatomical signature of transgenderism is related to brain

areas processing the perception of self and body ownership,

whereas homosexuality seems to be associated with less cerebral

sexual diﬀerentiation” (Burke et al., 2017, p. 1). The conceptual

entanglement of gender identity and sexual orientation is

not considered.

Summary of Findings of the

Conceptualization of Gender Identity in

Published Brain Studies of (Trans)Gender

Identity

Overall, the deﬁnitions and use of the terms “gender identity,”

“sex,” and “gender” fail to meet suﬃcient levels of accuracy and

diﬀerentiation. In addition to the studies’ general lack of clarity, I

see three severe conceptual problems.

The ﬁrst conceptual problem lies in their disregard of the

theoretical and methodological implications of the postulated

temporal separation of 3G-sex and gender identity. This problem

can be understood as a form of internal conceptual inconsistency.

In relation to the conditions deﬁned in the operationalization

of epistemic injustice, this conceptual inconsistency represents a

problem within the rules of the experimental method.

The second problem is the hermeneutical misconception

by which cultural norms, practices and techniques of gender

are naturalized and turned into biological entities. This is

evident in the usage of transsexuality as the only explicit

frame of reference for gender identity, as well as in the

failure to operationalize gender identity for cis participants. The

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hermeneutical misconception points to a possible inadequacy

of the theoretical and experimental approach of the BSGI to

acknowledge the socio-cultural dimension of its research object

and stands in the way of a complex understanding of gender

identity for all people.

The third problem is the upholding of questionable

paradigms, such as biological reductionism and determinism,

as well as the binary model of thinking about sex/gender and

brain. These frameworks contradict knowledge of the biosocial

and dynamic quality of brain development and the evidence of

sex/gender diversity presented in the introduction. While there

is an emphasis on the developmental logic in both SR/BP and the

CD hypotheses, and the SR/BP is open to the acknowledgment

of brain plasticity, no social or cultural variables aﬀecting gender

identity or brain development were considered relevant. While

it is important to acknowledge the opening and to take its

potential for future research seriously, both hypotheses remain

attached to reductionist thinking. This third conceptual problem

represents a failure to acknowledge relevant bodies of work,

and thus a failure of the epistemic system to detect and prevent

harmful ignorance.

EPISTEMIC ATTITUDES FROM

RESEARCHERS OF BRAIN STUDIES OF

(TRANS)GENDER IDENTITY

Communicative Contexts

The interviewed researchers of the BSGI belong to diﬀerent

research teams and have diﬀerent tasks, experience levels and

academic status. This leads to contrasting perceptions of the work

in the research teams, the broader scientiﬁc community and the

socio-political context of the studies.

Researcher A

Researcher A works as a doctor in a gender clinic and is thus

accountable to diagnostic manuals such as the ICD and DSM,

national laws on name and sex change registration and healthcare

system regulatory bodies. Researcher A also works closely with

trans patients and trans organizations and is aware of the conﬂict

between the regulatory framework of the gender clinic and the

healthcare needs of trans people who go there. Researcher A is

recruited to work on the BSGI and entered the research team in a

subordinated relationship with the principal investigator, who is

the funding receiver and ultimate decision-maker. The question

of access to funding highlights the entanglements between career

logic and the logic of knowledge production. However, researcher

A points to the crucial diﬀerence of having a regular salary as

a doctor and the situation of researchers, who have to “spend

half of their work time to apply for money (. . . ) and in that, they

need to sell.”

Researcher A brings into the team an awareness of the political

dimension of scientiﬁc research on trans topics: “(...) you have to

ﬁght if you do studies with people who are not in trans medicine,

they want to use what they think is simple language. So, why

complicate it, it’s a female-to-male (...) and there’s whole other

studies using this, we cannot not use it.” For researcher A the

political dimension of medical and scientiﬁc work with trans

people makes it necessary for researchers to intervene in public

debates to prevent harmful use of ﬁndings. This involves a self-

positioning in relation to the distributions of privilege and power

involved in research: “I am privileged, I have a reputation, I have

a salary (. . . ) and I can feel stressed by being in these sometimes

hostile surroundings (. . . ). But t he trans patient (. . . ) is of course

even more in this needle of a hurricane.” Researcher A sees a need

to involve trans people when planning research to think about

“what questions are more urgent to answer, what is interesting,

what is important?.” This stance of Researcher A includes an

awareness that trans people “have diﬀerent views of things” and

that some trans organizations think that there should be “no

medical people at all.”

Researcher B

Researcher B has been studying sex diﬀerences in the brains of

mammals for over four decades. Their involvement in BSGI with

trans patients was motivated by technological developments in

neuroimaging techniques. Researcher B sees the collaboration

with other research groups and institutions as a “functional team

that is constituted to answer questions about gender identity and

involves several universities and hospitals.” The gender unit is for

researcher B purely instrumental: “the gender unit of the hospital

is the one that has nourished all the studies that we have carried

out” (my emphasis).

As a principal investigator, Researcher B seeks to enter into

dialogue with the wider scientiﬁc community working on the

same or related questions. Central to being able to participate

in this dialogue is the use of a shared methodological approach

that facilitates the integration of results “I decided, according to

previous researchers, to approach the issue of gender identity in

a very simple way: contrasting the brains of transgender men and

women with non-transgender men and women.”

In researcher B’s understanding, science and politics should

be kept separate, since “research needs serenity and not looking

for results that conﬁrm particular ideas about what human

nature looks like.” Researcher B rejects the use of terms such

as “cisgender” because it was “invented by Volkmar Sigusch

more than 20 years ago” and because it is not known by

“people in the street.” This raises the question of what makes

the category of “cisgender” more “invented” or politically

motivated than categories such as “transsexualism,” “gynephilia,”

or “gender dysphoria.” This shows that the boundary between

natural/scientiﬁc categories and socio-political categories for

researcher B is not dependent on the origin of the categories but

of how established they are in scientiﬁc discourse. At the same

time, Researcher B holds the view that “it is important (...) to

use a vocabulary that is respectful and recognizes the variety of

our species.”

Researcher C

Researcher C got involved in the BSGI in order to complete

a PhD and was new to the topic at the time. Researcher C

worked on BSGI in two diﬀerent research groups. For researcher

C, their participation in the research is structured around

their relationship to a supervisor, who owns the research data.

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Researcher C also highlights the importance of funding policies

and the diﬃculties to get money as “the transgender topic is

not super sexy to funders,” mainly because “it’s still only a small

minority that are aﬀected by it.” This economic situation keeps

the ﬁeld of BSGI small and concentrated into a few established

teams. The only way for younger or less established researchers

who are interested in pursuing innovative hypotheses is to work

unpaid “in the evening hours and weekends.”

In the entanglement between the career logic and the logic of

knowledge production there is a tension between collaboration

and exchange on the one hand and protectionism on the other

hand. Researcher C recounts instances in which collaboration

requests from researchers with alternative approaches were

denied because the heads of research were “very suspicious on

opening up, allowing others to test their hypotheses on their

data.” Researcher C participates and advocates for collaborative

projects with shared data pools as a way to avoid the

concentration of power in the knowledge production in “certain

personalities” who decide “why certain hypotheses were tested

and others were not.”

Epistemic Behavior

Biological Determinism and Biosocial Approaches

In the ﬁrst conceptual question I asked the interviewees

thought how relevant they considered biosocial frameworks

for the neuroscientiﬁc understanding of gender identity and

gender incongruence.

Researcher A’s understanding of gender identity was based on

Fausto-Sterling’s theory of gender identity development, rejecting

mechanistic and reductionist models: “the concept of self could

not be (. . . ) in one nucleus deciding if we are male or female as a

matter if they are big or small. It must be a network giving us this.

And I also think that the way we see our body is also in a network

- that we, no matter whether we are gender incongruent or not,

but how we see our body is formed by connection between your

body and your brain and how you interpret that.”

Researcher B preferred in this question to their own theory as

“a ﬁrst explanation of all possibilities” and deﬁned gender identity

as “the feeling of congruence or incongruence in relation to the

sex assigned at birth” and as a “function of the brain.” Researcher

B’s response delimits gender identity to “the interaction between

very complex functional brain networks” and remains within

a biologically deterministic framework. The implication is that

researcher B does not consider biosocial frameworks as very

relevant to the ﬁeld, but rather than acknowledging or actively

rejecting this alternative framework, the researcher blocks the

dialogical space with their own theory.

Researcher C takes a synthesizing approach in which the

SR/BP hypothesis is combined with the O/A hypothesis. This

model considers “sex hormones and especially puberty” as

“extremely important” for the development of gender identity

and the concept of the self, but includes a dimension described

as “identity development in general, so “how ok you are yourself

with your body? how positive or negative you think about

yourself.” Not just in terms of body image, but more generally.”

This latter aspect could be interpreted as a possible opening to

biosocial thinking, although it is presented in an additive rather

than interactionist or dynamic manner.

Brain Sex Dimorphism and Brain Mosaicism

Here, I interrogated the stance of the interviewees regarding

brain mosaicism as a conceptualization of brain diﬀerences

between men and women, as well as the critiques of the

dimorphic model.

Researcher B stated to “know the work that you mean”

and moved on to reject it based on its lack of correspondence

with their own data: “I don’t agree with that kind of approach

because it’s not what I’ve seen.” However, in the next sentence,

researcher B expresses a diﬀerent stance without acknowledging

the contradiction, reframing the brain mosaicist model as a

political attitude: “I understand the feminist attitude and agree

that dimorphic diﬀerences (two diﬀerent forms) are observed

only in the reproductive system and that the rest of the diﬀerences

can be called sex eﬀects.” Despite the aﬃrmation of knowing

this line of work, Researcher B misrepresents the brain mosaicist

approach, which does not hold that the measured traits in the

brain are “sex eﬀects,” but dynamic interactions between multiple

social and biological factors.

Researcher B goes on to emphasize the importance of

the sex diﬀerences in relation to “morphology, physiology,

behavior,” as well as “genetic expression,” “prevalence of

psychiatric and neurodegenerative diseases,” “pharmacokinetics

and pharmacodynamics,” and “neuroimmunology,” ﬁnishing

with the rhetorical question “How do we explain all this

from environmental factors and from a theory of patriarchy?

Impossible.” Again, the researcher misrepresents the mosaicist

model as denying or downplaying existing diﬀerences

between people of diﬀerent sexes/genders and frames it as

a political theory.

Researcher C does not directly present their own stance on the

question but instead reports a situation in which a proponent of

the mosaicist model reached out to a supervisor of the researcher

whose research is situated within a dimorphic model, in order

to collaborate and test the mosaicist hypothesis with the data

of the supervisor. Researcher C argues that “it would have been

of value to collaborate on that part, I think it is very relevant,”

acknowledging the value of the brain mosaicist approach.

Intersectionality and Categorization

I asked the interviewees to consider whether intersectional

approaches should inform neuroscientiﬁc research and what

diﬃculties this would entail. Researcher A engaged openly with

the question, thinking about the relevance of the category “race.”

Researcher A makes the appropriateness of an intersectional

approach dependent on the research question and argues that it

might be important to include the category “race” in the study

of “gender identity” if a researcher wants to account for the

fact “that stress or being in a minority position aﬀects your

brain.” When speculating about the possible ways in which race,

gender identity and context of upbringing might interact with

each other and aﬀect brain development, Researcher A raises the

problem of the feasibility of such a study: “there are too many

millions of confounding factors which you cannot really control

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for.” In the response, Researcher A shows an understanding of

intersectionality, engages with its implications and points to the

limitations of neuroimaging studies for a complex understanding

of gender identity development.

Researcher C, on the other hand, is unfamiliar with the

concept but engages with it after asking me to explain

it with an example. Researcher C proposes the use of

covariants such as race or sexual orientation as a way to

introduce an intersectional perspective. This misses the point

of intersectionality as covariants follow an additional logic of

the diﬀerent factors and work toward the isolation of one

“pure” factor, while the idea of intersectionality is precisely

the entanglement of the diﬀerent dimensions. Thinking about

the interactions between the categories of gender identity and

sexual orientation, Researcher C recalled unexpected ﬁndings

where “cis lesbian groups” have values in brain measurements

that “are even more male-typical than the trans males” and

wonders “what’s going on there? Did they use anabolics, for

example?.” This train of thought reﬂects the diﬃculties in

moving away from a paradigm of clear categories, as well as

the tendency to focus on biological and quantiﬁable factors.

However, beyond disciplinary and methodological barriers, the

inaccurate understanding of intersectionality might also reﬂect

my inability to make these points clear in the context of

the interview.

Operationalization of Gender Identity in Cisgender

Participants

I asked the interviewees to explain how the gender identity

of cis participants was assessed in the studies that they were

involved in.

Researcher A reported ﬁrst that they were assumed but then

became unsure and pointed to the principal investigator as the

person who could answer my question.

Researcher B refused to answer and left the question out of the

edited transcript altogether.

Researcher C recalls using a questionnaire with subscales for

both cis and trans participants but adds “we never mentioned

that, that’s true.” The researcher explains how for cis participants

“who have never had any identity issues, it’s the most simple

question to ask: are you a boy or a girl? They say ’yeah, of course,

I am that’.” Since I was interested in the theoretical or conceptual

challenge of understanding gender identity for cis and trans

people, I pointed to the fact that “it can still mean diﬀerent things

when two cis people say “I am a boy” or “I am a woman.” What

that means can still vary because they have diﬀerent ideas of what

that means.” Researcher C agreed with the importance “from a

methodological point of view” to “characterize your sample in

a more detailed way,” but immediately linked this to controlling

“that none of your cisgender people struggles with identity

issues.” The response shows again that the conceptualization of

gender identity in the BSGI is constructed around the distinction

of trans/incongruent and cis/congruent, erasing the complexity

of the category. The rationale oﬀered is a pragmatic one: “the

simple distinction is to include someone with a diagnosis and

those who not.”

Gender Diversity and Non-binary Identities

The interviewees were asked about the implications of the

acknowledgment of non-binary gender identities in the DSM-5

for the ﬁeld. The question aimed to challenge the assumption

of bipolar and dichotomous gender identities that dominated

the BSGI.

Researcher A explains the novelty of non-binary identities as

a result that “few people told us” in the beginning, “even if they

of course existed.” Researcher A explains the exclusion of non-

binary participants because in “this type of research you need

to have, in quotation marks, “clean” group as possible.” The

acknowledgment of non-binary identities leads researcher A to a

profound interrogation of the meaning of gender identity in both

trans and cis populations “(...) if you ask 10 cisgender women how

can you describe your female gender identity? you get diﬀerent

explanations. That’s the main problem with gender identity, that

it is so subjective for each individual.”

For researcher B, non-binary identities are contained within

gender incongruence as a “minority that is not binary, present

incongruence with the assigned sex or feel that they belong to

another gender, or experience changes over time with respect

to gender identity, or feel that they do not belong to any

gender.” This framing of non-binary identities leave the binary

model of two genders and distinction congruent/incongruent as

structuring notions largely unchallenged.

Researcher C welcomes changes in terminology as less

stigmatizing for trans people but expresses diﬃculties

grasping non-binary identities. Researcher C states to not

really “understand what it is to be gender non-binary,” unlike

binary trans people, who “request testosterone treatment then

and surgical changes (. . . ) in order to get my body the way I feel

I am.” The medicalized trajectory of a binary sex change is a real

phenomenon to Researcher C, but not non-binary identities.

Researcher C wonders “how real that phenomenon is? Is that

really (. . . ) from people who experience actually this feeling and

who only now dare to share that, or is it more some kind of

trend that allows you to get the autonomy of deﬁning yourself

as whatever you like because it is possible?.” The inﬂuence of

cultural context on the articulation and expression of gender

identities (“trend”) is used to challenge and potentially dismiss

non-binary identities as a form of ﬁction, while unexplored

and unaccounted in relation to binary masculine or feminine

identities and their relative social privileges. This view shows a

bias toward a binary model, but also represents an awareness of

the deep implications of non-binary identities for the BSGI and

the challenges it poses to current models.

Understanding of Transgender Identities

My question about the changing criteria that deﬁne gender

incongruence in the DSM-5 was a way to engage the interviewees

in a conversation about transgender identity and gender identity

overall as shaped by both biological factors and socio-cultural

factors, moving away from the biologically deterministic models

of the BSGI.

Researcher A demonstrated a complex understanding of

transgender identity. Researcher A takes into account self-

determination as a ﬁrst component: “we ask the patient “what

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Llaveria Caselles Epistemic Injustice in Brain Studies

do you call your gender identity?”.” The second component is

forms of distress stemming from the self, and the third is forms

of distress stemming from the social environment: “in what way

does that gender identity mismatch or distress you when you look

at yourself or think of your own body? (. . . ) how much does the

distress that surrounding sees you, misgenders you, or belonging

to that gender role?.” Another aspect is a critique of othering and

of the distinction between cis and trans: “we should stop seeing

trans people as exotic or special, where there are more things in

common.” Researcher A situates gender identity and perceptions

of the body in relation to normative ideas of masculinity and

femininity: “the way you think about your body is reﬂected from

what society norms. Like, old female bodies are not nice, but

25-year-old females in a cis heteronormative world are, so. It’s

probably impossible to think, to separate them and to even know.

Am I unhappy of my breast size due to that I’m really unhappy

about them or that there are society norms for breast size?.”

Researcher C, has an understanding of transgender identities

tied to diagnostic categories and biological factors. I urged

the researcher to take into account the historical and cultural

dimension and think about “how, before there was something

called trans, did people who now would be understood as such,

live, and what ways of understanding themselves did they have?.”

In their reaction, the researcher ﬁrst focuses on the role of

technology and techniques as means to express gender identity,

such as “medical possibilities” and “the internet,” where “you can

photoshop yourself until it ﬁts the identity you have actually.”

This follows a logic of “true” and “fake” identities and the sense of

a prior gender identity as stemming from the self. But researcher

C then elaborated on the development of cis or transgender

identities in a triad of “sexual maturation” and “interest in the

other, usually in the opposite sex,” “reorientation with social

changes from family to peers” and “thinking about yourself, who

am I, not only in terms of boy or girl, but also in terms of who

am I in this world.” This understanding of transgender identities,

while still focused on the cis and trans distinction is much more

complex than the deﬁnitions found in the BSGI and shows many

possibilities for introducing contextual factors as constitutive of

gender identity development.

ON EPISTEMIC INJUSTICE IN BRAIN

STUDIES OF (TRANS)GENDER IDENTITY

In this section, I ﬁnally address the central question of my

paper “Which forms of epistemic injustice can be identiﬁed in

the conceptualization of gender identity in the brain studies

of (trans)gender identity?.” Before presenting my conclusions,

certain remarks on the validity of this research are due.

My analysis is based on my open alignment with biosocial,

developmental, mosaicist, contextualist and depathologizing

approaches, I am not a neutral observer but a situated agent.

Therefore, the whole project is founded on acceptance of feminist

and social epistemologies of science. Regarding my analysis of

the conceptualization of gender identity in BSGI, the results are

limited to the sample and can’t be automatically extrapolated

to represent similar BSGI. Regarding the expert interviews, it

needs to be taken into account that these types of interviews are

not meant to provide results to be generalized. My assessment

of the interviewees’ epistemic attitudes only holds true, in a

strict sense, in the context of the dialogue which unfolded in

the interview and cannot be assumed to characterize past or

future positions of the interviewees. Regarding the assessment

of epistemic attitudes, the categories of analysis oﬀer a margin

for interpretation. Perceptions of epistemic behaviors might vary

between diﬀerent analysts, as well as judgments of relevance of

diﬀerent dimensions. Despite these restrictions, the ﬁndings of

my analysis are consistent and relevant enough to open up a

critical discussion of the conceptualization practices identiﬁed in

the studies.

Testimonial Injustice in Published Brain

Studies of (Trans)Gender Identity

In the early published studies biosocial, developmental,

mosaicist, contextualist and depathologizing approaches were

completely ignored. Taking into account the direct relevance

of these approaches as well as the responsibility of researchers

to engage with the current state of knowledge on the topic of

research, I argue that the early published papers represent a

form of active silencing or blocking of these lines of work. The

exclusion of this knowledge is connected to the conceptual

problems identiﬁed in the studies, namely internal conceptual

inconsistency, hermeneutical misconception and the upholding

of questionable paradigms. The epistemic injustice involved

in the exclusion of counter-hegemonic positions represents at

the same time a failure of the epistemic system of empirical

scientiﬁc work.

For the recent studies, I want to acknowledge that while

biosocial researchers were not explicitly acknowledged, the CD

and SR/BP hypotheses mention environmental and experiential

factors. However, this is not reﬂected in changes in research

design nor in an adequate theoretical discussion, which is why

I argue that the testimonial exclusion of scientists working on

biosocial approaches of sex/gender is perpetuated in the more

recent studies, but acknowledge that the theoretical opening

holds the possibility of a future correction. Also, while the criteria

for gender dysphoria in the DSM-5 are incorporated, there is

no engagement with the conceptual implications of the changes.

Instead, the CD hypothesis relies on Blanchard’s typology of

trans, and the SR/BP hypothesis erases gender as a dimension.

The changes introduced in the recent studies show that

the epistemic system of the BSGI has a selective sensitivity. It

responds to dissonance between predicted ﬁndings and observed

ﬁndings, giving impetus to the search for new theoretical

references and modiﬁcation of the O/A framework. Despite

these developments, the problems of conceptual inconsistency,

hermeneutical fallacy and questionable paradigms persist.

But can the epistemic agents involved in the BSGI be

said to beneﬁt from the exclusion of biosocial, developmental,

mosaicist, contextualist and depathologizing approaches? To

answer this question, it is helpful to consider Latour’s account

of the establishment of scientiﬁc facts. He shows the facts

are established as such through the uptake and use by

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Llaveria Caselles Epistemic Injustice in Brain Studies

other researchers to ground further claims. In this sense, the

testimonial silencing of alternative approaches has two eﬀects.

First, it prevents a challenging of the claims upon which the

BSGI are built, strengthening the research’s value in terms

of credibility. This results in relative career advancement and

greater access to grants, for example. Second, through silencing,

the BSGI actively work toward an exclusion of the positions of

the alternative approaches as scientiﬁcally relevant. These eﬀects

combined make it possible that the epistemic agents involved

in the BSGI suﬀer no loss of epistemic status or credibility

despite the deﬁciencies of the knowledge produced. Further, the

epistemic agents of the BSGI can generate more studies and

results through not engaging with complex conceptual questions,

which would be a time-intense form of work with less revenue

than the production of empirical data. From this examination,

I conclude that the testimonial silencing and lack of sensitivity

toward biosocial, developmental, mosaicist, contextualist, and

depathologizing approaches in the published studies of the BSGI

represent a case of epistemic injustice that needs to be addressed.

Testimonial Injustice in the Research

Process of Brain Studies of (Trans)Gender

Identity

The ﬁrst insight from the interviews on the question of

testimonial injustice against biosocial, developmental, mosaicist,

contextualist, and depathologizing approaches in the BSGI is the

visibility of diﬀerent positions of the researchers involved in the

BSGI. The epistemic attitudes toward the alternative approaches

ranged from acceptance and familiarity, favorable assessments

and openness, to resistance and blocking. Further, the interviews

also showed the role of the hierarchical organization of research

teams in the suppression of dissent and alternative approaches.

This is enabled by concentration of the decision-making power

in the role of the principal investigator, who is also the receiver

of funds and the owner of research data. The fact that epistemic

agents directly involved in the BSGI, such as researcher A,

are familiar and favorable to counter-hegemonic approaches, or

open to engage with them, such as researcher C, suggests that

one mechanism of the epistemic injustice is through epistemic

devaluation of dissenting voices within research teams, especially

the ones of subordinated researchers.

The second insight from the interviews was the identiﬁcation

of speciﬁc instances of harmful testimonial practices against

proponents of counter-hegemonic approaches, such as the refusal

to collaborate reported by researcher C or their active devaluation

as unscientiﬁc by researcher B. Both instances are enactments

of willful ignorance, of not wanting to know. In the ﬁrst case,

the knowledge that could be gained through the collaboration is

blocked. In the second case, there is a need to suppress certain

knowledge in order to maintain an epistemic situation, despite

the dissonance embedded in this suppression.

A third insight was that besides targeted forms of exclusion,

there are more diﬀuse forms of testimonial exclusion at work

in the BSGI. One instance is the ignorance of social theories

of sex and gender exempliﬁed by researcher B and C, showing

the insensitivity of the epistemic system to the exclusion of

whole disciplines. A second instance is the devaluation of the

claims of epistemic agents that were perceived as motivated

by political interests, such as feminist scientists, “militant”

or “activist” researchers. Noting that only counter-hegemonic

positions challenging the status quo of society are perceived as

political, while positions resisting change are perceived as neutral

and capable of objectivity, this exclusion indicates a diﬀerent kind

of failure of the epistemic system of the BSGI. It is an epistemic

system that is not able to reﬂect and integrate into its knowledge

production process the positionality of its researchers in relation

to their topic of research. It fails to account for the ways in which

the situatedness of the researchers shapes perceptions, categories,

hypothesis or interpretations. This critique has been also raised

from within the ﬁeld of neuroscience of gender identity (see

Walsh, 2015).

I argue that the active and targeted exclusions of counter-

hegemonic approaches and their epistemic agents is enabled

and promoted by systemic factors related to the organization of

scientiﬁc work such as the projectiﬁcation of science, which tends

“to privilege already codiﬁed over novel, uncertain knowledge;

theory and application of methodology over building upon it;

hypothesis testing over creation or, in short, “normal science”

over revolutionary, risky or unorthodox science” (Torka, 2018,

p. 61). On this basis, strategic epistemic practices can be

suggested toward developing a higher sensitivity toward the

diﬀuse and targeted exclusion of alternative and counter-

hegemonic approaches: individual openness, transparency of

internal disagreements and multiplicity of interpretations within

research teams, the promotion of exchange across disciplines,

building inter- and transdisciplinary networks and collaborations

centered on a common question, open data initiatives, and

the reassessment of funding and review criteria in order to

promote theoretical innovation and sensitivity to the exclusion

of marginalized or counter-hegemonic approaches.

Underlying Hermeneutical Deﬁciencies in

the Brain Studies of (Trans)Gender Identity

One hermeneutical deﬁciency of the BSGI stems from the

suppression of critical epistemologies in biology and natural

sciences. These critical epistemologies have been informed by

an acknowledgment of the social embeddedness of research

and knowledge, as has been shown by works from history and

sociology of science. It is only through the suppression of these

works that the internal/external division between science and

society can be upheld. Critical epistemologies also challenge the

notion of “nature” as that which is really true, and as opposed

to phenomena that are seen as socially constituted. In order to

move toward a more epistemically just situation it is important to

establish an understanding of science that is able to acknowledge

the situatedness of research and the hybrid social and biological

constitution of phenomena.

A second hermeneutical deﬁciency results from the historic

epistemic oppression of trans people as epistemic agents. The

current regime of legal and diagnostic procedures is built on

a denial of credibility of trans people regarding their own

gender identities. Despite the move toward depathologization

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Llaveria Caselles Epistemic Injustice in Brain Studies

of medical and clinical vocabulary, the epistemic oppression of

trans people persists in the dependence on medical experts. The

BSGI are not only embedded in this epistemic situation, they

also enact this same devaluation of trans people’s credibility.

This is exempliﬁed in the diﬀerent assessment procedures to

determine the gender identity of trans and cis participants, as

well as the diﬃculties to acknowledge non-binary identities as

a real phenomenon. The historical suppression of trans and

gender diverse people’s statements regarding their gender identity

has created a hermeneutical system that lacks the resources to

make sense of the existence of trans and gender diverse people,

and that is inadequate to understand gender identity in all

its expressions.

I argue that the instances of testimonial injustice against

the epistemic agents of alternative approaches in the BSGI

are secondary to the historic epistemic oppression of trans

and gender variant people, and to the suppression of critical

epistemologies. These suppressions lead to hermeneutical

deﬁciencies that cause the BSGI’s epistemic system in its current

practices and structures to generate deﬁcient knowledge about

gender identities. In order to move toward an epistemically

just situation, changes in science education are necessary, such

as the introduction of pluralist and critical epistemologies.

Further, the administratively inscribed epistemic devaluation

of trans people in procedures for legal name and sex change

and access to trans healthcare needs to be dismantled. Only

then, by ensuring the autonomy of trans people from medical

and scientiﬁc authorities in their access to fundamental rights

and involving them in the research process, can a situation

be generated in which trans people regain epistemic agency

and trust.

DATA AVAILABILITY STATEMENT

The raw data supporting the conclusions of this article will be

made available by the author, without undue reservation.

ETHICS STATEMENT

Ethical review and approval was not required for the study on

human participants in accordance with the local legislation and

institutional requirements. The patients/participants provided

their written informed consent to participate in this study.

Written informed consent was obtained from the individual(s)

for the publication of any potentially identiﬁable images or data

included in this article.

AUTHOR CONTRIBUTIONS

The author conﬁrms being the sole contributor of this work and

has approved it for publication.

ACKNOWLEDGMENTS

I want to express my gratitude for the encouragement,

guidance, and constructive criticism to Dr. Sigrid Schmitz and

Prof. Dr. Kerstin Palm.

SUPPLEMENTARY MATERIAL

The Supplementary Material for this article can be found

online at: https://www.frontiersin.org/articles/10.3389/fsoc.2021.

608328/full#supplementary-material

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Conﬂict of Interest: The author declares that the research was conducted in the

absence of any commercial or ﬁnancial relationships that could be construed as a

potential conﬂict of interest.

under the terms of the Creative Commons Attribution License (CC BY). The use,

distribution or reproduction in other forums is permitted, provided the original

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in this journal is cited, in accordance with accepted academic practice. No use,

distribution or reproduction is permitted which does not comply with these terms.

Frontiers in Sociology | www.frontiersin.org 15 March 2021 | Volume 6 | Article 608328

Sex, gender diversity, and brain structure in early adolescence

Article

Full-text available

Apr 2024
HUM BRAIN MAPP

There remains little consensus about the relationship between sex and brain structure, particularly in early adolescence. Moreover, few pediatric neuroimaging studies have analyzed both sex and gender as variables of interest—many of which included small sample sizes and relied on binary definitions of gender. The current study examined gender diversity with a continuous felt‐gender score and categorized sex based on X and Y allele frequency in a large sample of children ages 9–11 years old ( N = 7195). Then, a statistical model‐building approach was employed to determine whether gender diversity and sex independently or jointly relate to brain morphology, including subcortical volume, cortical thickness, gyrification, and white matter microstructure. Additional sensitivity analyses found that male versus female differences in gyrification and white matter were largely accounted for by total brain volume, rather than sex per se. The model with sex, but not gender diversity, was the best‐fitting model in 60.1% of gray matter regions and 61.9% of white matter regions after adjusting for brain volume. The proportion of variance accounted for by sex was negligible to small in all cases. While models including felt‐gender explained a greater amount of variance in a few regions, the felt‐gender score alone was not a significant predictor on its own for any white or gray matter regions examined. Overall, these findings demonstrate that at ages 9–11 years old, sex accounts for a small proportion of variance in brain structure, while gender diversity is not directly associated with neurostructural diversity.

Researchers' sex/gender identity influences how sex/gender question is investigated in neuroscience: an example from an OHBM meeting

Article

Full-text available

Feb 2024
BRAIN STRUCT FUNCT

Gender inequality and diversity in STEM is a challenging field of research. Although the relation between the sex/gender of the researcher and the scientific research practices has been previously examined, less interest has been demonstrated towards the relation between sex/gender of the researcher and the way sex/gender as a variable is explored. Here, we examine, from a neurofeminist perspective, both questions: whether sex/gender identity is related to the examination of sex/gender as a variable and whether different approaches towards examining sex/gender are being used in different topics of study within neuroscience. Using the database of submitted posters to the Organization of Human Brain Mapping 2022 annual conference, we identified abstracts examining a sex/gender-related research question. Among these target abstracts, we identified four analytical categories, varying in their degree of content-related complexity: (1) sex/gender as a covariate, (2) sex/gender as a binary variable for the study of sex/gender differences, (3) sex/gender with additional biological information, and (4) sex/gender with additional social information. Statistical comparisons between sex/gender of researcher and the target abstract showed that the proportion of abstracts from Non-binary or Other first authors compared to both Women and Men was lower for all submitted abstracts than for the target abstracts; that more researchers with sex/gender-identity other than man implemented analytical category of sex/gender with additional social information; and, for instance, that research involving cognitive, affective, and behavioural neuroscience more frequently fit into the sex/gender with additional social information-category. Word cloud analysis confirmed the validity of the four exploratorily identified analytical categories. We conclude by discussing how raising awareness about contemporary neurofeminist approaches, including perspectives from the global south, is critical to neuroscientific and societal progress.

Gender Identity, Sexual Orientation, and the Prenatal Androgen Theory: Reevaluating Definitions, Cognitive Tests, and Somatic Markers

Article

Full-text available

Sep 2023

Historically, scientific studies have searched for a “cause” of transgender identity, focusing on prenatal androgen exposure. Participants are usually recruited from gender clinics and correlations are sought between biomarkers and gender identity, often with inconsistent results. We evaluated this approach by examining the utility of two commonly used biomarkers, digit ratio and mental rotation tasks, using community-based recruitment that included both transgender and nonbinary identities, unlike previous research. Participants (N = 1,200) were asked to describe their identities using both self-labeling and gender and sexual orientation scales, took a mental rotation test, and had their hands scanned for digit ratio measurement. We found that digit ratio and mental rotation scores were consistent with sex assigned at birth rather than gender identity, using both categorical gender groupings and continuous gender scales. We also found no evidence supporting the historical typology of “homosexual” and “nonhomosexual” groupings of transgender individuals. In addition, we found that 32% of transgender women (n = 168) and 45% of transgender men (n = 175) experienced changes in their sexual orientation with gender transition and, at least for transgender women, there was an increased chance of a change in sexuality among those using hormones. Finally, our data suggest an interaction of race/ethnicity with how sexuality is experienced and/or reported by transgender women. These results highlight the importance of taking an inclusive, community-based approach and call for an examination of underlying assumptions and measures used to explore the development of gender identity and sexual orientation.

Rethinking Gender/Sex Identity

Article

Apr 2025
AM J HUM BIOL

Anne Fausto-Sterling

Until quite recently, investigations of gender/sex development operated from a baseline assumption that gender/sex is dichotomous or binary. Most such studies constructed gender/sex outside of or adjacent to specific cultures, and for the most part studied children from Western, Educated, Industrialized, Rich, Democratic (WEIRD) countries. In this paper I first advocate for four research guidelines—inclusivity, epistemic justice, materiality, and empiricism. I sketch out the historical background that still shapes contemporary studies into the psychology of gender/sex identity in infants and toddlers. Next, I point toward methods for the study of gender/sex in infants and toddlers that have the potential to make nonbinary development visible and to develop culturally diverse concepts of identity development. Finally, I challenge psychologists and others to view and operationalize the study of identity as a relational, phenomenological entity rather than a fixed feature of the individual psyche.

"Precision Medicine" and the Failed Search for Binary Brain Sex Differences to Address Gender Behavioral Health Disparities

Article

Full-text available

Apr 2025
AM J HUM BIOL

Lise Eliot

Human brain imaging took off in the 1980s and has since flooded the zone in the analysis of gender differences in behavior and mental health. Couched in the aims of “precision medicine,” the vast majority of this research has taken a binary approach, dividing participants according to the M/F box at intake and asserting that the sex differences found in neuroimaging will lead to important advances for treating neuropsychiatric disorders. However, the actual findings from this 40‐year project have not lived up to its promise, in part because of the over‐binarization of sex and general ignorance of gender as a complex variable influencing human behavior and brain function. This paper reviews the history of failed claims about male–female brain difference in the modern era, illuminates the deep‐pocketed incentives driving such research, and examines the limitations of this binary approach for understanding gender‐related behavior and health disparities. It then considers more recent efforts to “break the binary” by using measures of “gender” in addition to “sex” as an independent variable in brain imaging studies. Given the multidimensional nature of gender—as identity, expression, roles and relations—this is challenging to implement, with initial efforts producing little of substance. Better approaches to addressing male–female disparities in brain health will require focusing on specific behaviors (e.g., anxiety, risk‐taking, verbal memory, spatial navigation) and specific components of sex and gender (e.g., body size, hormone levels, gene expression, caregiver role, financial independence, discrimination) when seeking brain‐behavior correlates in a diverse population.

The Linguistic Construction of Gender: Masculinity and Femininity in Arabic Grammar

Article

Full-text available

Apr 2025

Studies of gender have generally focused on the relationship between men and women within the context of social reality, rather than the construction of gender through language. This paper thus explores how language, specifically Arabic, contributes to the construction of gender and how the intersection of text and context shapes understandings of gender. The study reveals that Arabic words and sentences connote specific masculine and feminine identities that influence the social construction of gender. Texts provide spaces for the relationships between men and women to be discussed, and language influences their dynamics. This paper concludes that gender relations not only influence social reality, but also textual reality. As such, an understanding of social reality necessitates an understanding of the text. This paper thus emphasizes the importance of analytically linking language with social reality and framing language as a reflection of social reality.

Autism and Gender and Sexuality Diversity

Chapter

Aug 2024

The inclusion of a chapter on intersectional autism and LGBTQ+ identities within a book focused on autism in girls and women accords with calls for greater attention to both gender and assigned sex in autism research. For example, any study of autistic “girls” or “women” or “female” autistic people must consider gender identity, assigned sex, and broader gender expression-related characteristics. The chapter provides an overview of the existing literature on intersectional autism and gender and sexuality diversity. It also provides a critique regarding notable gaps in the literature, contextualizing the particular focus researchers have placed on intersectional autism and gender diversity and the relative lack of research on autism and sexual orientation diversity. The chapter begins by presenting a conceptual framework for understanding gender and sexuality diversity in autism. A review of the literature on broad LGBTQ+ identities and autism is followed by reviews of gender diversity and autism and sexual diversity and autism. Co-created by an authorship team of autistic LGBTQ+ co-authors, the chapter concludes with a contemporary commentary on the state of the literature, as contextualized by autistic LGBTQ+ people. The autistic LGBTQ+ co-authors also reflect on the daily lives of autistic LGBTQ+ individuals across a range of contexts. Several themes emerge in the commentary including the importance of research and advocacy across nations (as much research has been conducted in more affirming countries), the need for attention to mental health and clinical needs, and the need for societal acceptance and inclusion for individuals with multiple marginalized identities.

Heed lessons from past studies involving transgender people: first, do no harm

Article

May 2024

After the trans brain: a critique of the neurobiological accounts of embodied trans* identities

Article

Full-text available

Feb 2024
HIST PHIL LIFE SCI

Maite Arraiza Zabalegui

This paper critically analyses three main neurobiological hypotheses on trans* identities: the neurobiological theory about the origin of gender dysphoria, the neurodevelopmental cortical hypothesis, and the alternative hypothesis of self-referential thinking and body perception. In this study I focus then the attention on three elements: the issue of (de)pathologisation, the idea of the trans brain, and the aetiology of trans* identities. While the neurobiological theory about the origin of gender dysphoria and the neurodevelopmental cortical hypothesis claim the existence of the trans brain, each offering its own neurobiological depiction, the hypothesis of self-referential thinking and body perception doesn’t postulate a distinctive neurobiological trait for all trans* people. I problematize both portrayals of the trans brain departing from the findings and conceptualizations of the paradigm shifting brain mosaicism. Unlike the hypothesis of self-referential thinking and body perception that keeps the question of causation open, both the neurobiological theory about the origin of gender dysphoria and the neurodevelopmental cortical hypothesis situate the origin of trans* identities in the neurobiological domain. I challenge the biological deterministic framework in which this aetiology is inscribed from a dynamic processual entanglement perspective. Finally, concerning the issue of (de)pathologisation of trans* identities, an evolution can be seen in each of the hypothesis and among them, from the least to the most depathologising. However, I question their complete departure from a pathologising framework.

Researchers' sex/gender identity influences how sex/gender question is investigated in neuroscience: An example from an OHBM meeting

Preprint

Full-text available

Sep 2023

Gender inequality and diversity in STEM is a challenging field of research. Although the relation between the sex/gender of the researcher and the scientific research practices has been previously examined, less interest has been demonstrated towards the relation between sex/gender of the researcher and the research topic. Here, we examine, from a neurofeminist perspective, both questions: whether sex/gender diversity is related to the examination of sex/gender as a variable and whether sex/gender diversity is related to the topic of study. Using the database of submitted posters to the Organization of Human Brain Mapping 2022 annual conference, we identified abstracts examining a sex/gender-related research question. Among these target abstracts, we identified four analytical categories , varying in their degree of content-related complexity: (1) sex/gender as a covariate , (2) sex/gender as a binary variable for the study of sex/gender differences , (3) sex/gender with additional biological information , and (4) sex/gender with additional social information . Statistical comparisons between sex/gender of researcher and the research topics showed that the proportion of abstracts from Non-binary or Other first authors compared to both Women and Men was lower for all submitted abstracts than for the target abstracts; that more researchers with sex/gender-identity other than Man implemented analytical category 4; and, for instance, that research involving cognitive, affective, and behavioural neuroscience more frequently fit into categories 4. Word cloud analysis confirmed the validity of the four exploratorily identified analytical categories . We conclude by discussing how raising awareness about contemporary neurofeminist approaches, including perspectives from the global south, is critical to neuroscientific and societal progress.

Dismantling the Transgender Brain

Article

Full-text available

Jan 2018

Eric Llaveria Caselles

In this paper, I analyze in detail a neuroscientific research paper that investigates the structural connectome of transmen and transwomen in relation to cismen and ciswomen. Situated within the frame of Feminist Science Studies and from an outsider-within perspective, my analysis meets three objectives. First, it provides an understanding of the research presented in the paper: what is the research question, which methods are they using, which paradigms do they fol-low? Second, it problematizes the findings of the research paper and the interpretation thereof by focusing on different conceptualizations of sex/gender within neuroscience; the limits of neuroimaging technologies and the privileging of particular lines of interpretations. Finally, it reflects upon the challenges of this exercise by asking about the role of ignorance and learning in interdisciplinary work; the impact of epistemic hierarchies and the political and ethical dimensions of the research paper. My conclusion is that the lack of engagement of the neurosci-entists with perspectives from gender studies and with the voices of trans people constitutes a severe neglect of the social and political responsibility of researchers and reinforces the oppression of the trans community. Published in the Graduate Journal of Social Science, Sept. 2018, Vol. 14, Issue 2, pp. 135–159

Gender und Biopolitik - Normative und intersektionale Gewalt gegen Trans*Menschen

Book

Full-text available

Feb 2019

Gender und Biopolitik Normative und intersektionale Gewalt gegen Trans*Menschen Das Zweigeschlechtermodell ist schon lange ein umkämpfter Schauplatz von Transformation sowie Versuchen der Fixierung binärer Identitätskonzepte. Tamás Jules Joshua Fütty geht der Frage nach, was Normen mit Geschlecht, Gewalt, Staatlichkeit und Biopolitik zu tun haben. Im Gegensatz zu der Reduktion auf ›transphobe Hassgewalt‹ wird ein erweitertes Gewaltverständnis begründet: als normative und intersektionale Gewalt, die v.a. über Recht und Medizin institutionell verankert ist und ungleiche Lebenschancen für Trans*Menschen hervorbringt. Innerhalb bestehender Sicherheitsdispositive und ihrer Grenzregime sind mehrfachdiskriminierte Trans*Menschen besonders stark für lebensbedrohliche Gewalt und vorzeitigen Tod exponiert.

Negotiating the Borders of the Gender Regime: Developments and Debates on Trans(sexuality) in the Federal Republic of Germany

Book

Full-text available

Dec 2018

Adrian de Silva

While social change regarding trans(sexuality) has evolved within an expanding nexus of concepts, practices, regulations and institutions, this process has barely been analysed systematically. Against the background of legislative processes on gender recognition in a society shaped by heteronormative hegemony, Adrian de Silva traces how sexology, the law, federal politics and the trans movement interacted to generate or challenge concepts of trans(sexuality) from the mid-1960s to 2014 in the Federal Republic of Germany. The interdisciplinary study draws upon and contributes to debates in (trans)gender and queer studies, political science, sociology of law, sexology and the social movement.

Projectification of Doctoral Training? How Research Fields Respond to a New Funding Regime

Article

Full-text available

Mar 2018
MINERVA

Marc Torka

Funding is an important mechanism for exercising influence over ever more parts of academic systems. In order to do so, funding agencies attempt to export their functional and normative prerequisites for financing to new fields. One essential requirement for fundees is then to construct research processes in the form of a project beforehand, one that is limited in time, scope and content. This article demonstrates how the public funding of doctoral programs expands this model of project research from experienced academics to the socialization process for the new academic generation. This process of “projectification” underlies funding-driven institutional changes in doctoral training. A multi-level comparative study of German policies, funding mechanisms and organizational frameworks for doctoral training demonstrates the emergence of a specific model of predefined PhD projects. The investigation of doctoral training practices reveals that socio-epistemic preconditions regulate whether research fields adopted or rejected this demanding model. This result contradicts widespread claims about a radical change in doctoral training and suggests focusing on the actual practices of field-specific doctoral research.

Structural connections in the brain in relation to gender identity and sexual orientation

Article

Full-text available

Dec 2017

Both transgenderism and homosexuality are facets of human biology, believed to derive from different sexual differentiation of the brain. The two phenomena are, however, fundamentally unalike, despite an increased prevalence of homosexuality among transgender populations. Transgenderism is associated with strong feelings of incongruence between one's physical sex and experienced gender, not reported in homosexual persons. The present study searches to find neural correlates for the respective conditions, using fractional anisotropy (FA) as a measure of white matter connections that has consistently shown sex differences. We compared FA in 40 transgender men (female birth-assigned sex) and 27 transgender women (male birth-assigned sex), with both homosexual (29 male, 30 female) and heterosexual (40 male, 40 female) cisgender controls. Previously reported sex differences in FA were reproduced in cis-heterosexual groups, but were not found among the cis-homosexual groups. After controlling for sexual orientation, the transgender groups showed sex-typical FA-values. The only exception was the right inferior fronto-occipital tract, connecting parietal and frontal brain areas that mediate own body perception. Our findings suggest that the neuroanatomical signature of transgenderism is related to brain areas processing the perception of self and body ownership, whereas homosexuality seems to be associated with less cerebral sexual differentiation.

Normal Life: Administrative Violence, Critical Trans Politics, and the Limits of Law

Book

Jul 2015

Dean Spade

Black on Both Sides: A Racial History of Trans Identity

Book

Oct 2017

C. Riley Snorton

The story of Christine Jorgensen, America’s first prominent transsexual, famously narrated trans embodiment in the postwar era. Her celebrity, however, has obscured other mid-century trans narratives—ones lived by African Americans such as Lucy Hicks Anderson and James McHarris. Their erasure from trans history masks the profound ways race has figured prominently in the construction and representation of transgender subjects. In Black on Both Sides, C. Riley Snorton identifies multiple intersections between blackness and transness from the mid-nineteenth century to present-day anti-black and anti-trans legislation and violence. Drawing on a deep and varied archive of materials—early sexological texts, fugitive slave narratives, Afro-modernist literature, sensationalist journalism, Hollywood films—Snorton attends to how slavery and the production of racialized gender provided the foundations for an understanding of gender as mutable. In tracing the twinned genealogies of blackness and transness, Snorton follows multiple trajectories, from the medical experiments conducted on enslaved black women by J. Marion Sims, the “father of American gynecology,” to the negation of blackness that makes transnormativity possible. Revealing instances of personal sovereignty among blacks living in the antebellum North that were mapped in terms of “cross dressing” and canonical black literary works that express black men’s access to the “female within,” Black on Both Sides concludes with a reading of the fate of Phillip DeVine, who was murdered alongside Brandon Teena in 1993, a fact omitted from the film Boys Don’t Cry out of narrative convenience. Reconstructing these theoretical and historical trajectories furthers our imaginative capacities to conceive more livable black and trans worlds. © 2017 by the Regents of the University of Minnesota. All rights reserved.

Possible Neurobiological Underpinnings of Homosexuality and Gender Dysphoria

Article

Jul 2018
CEREB CORTEX

Although frequently discussed in terms of sex dimorphism, the neurobiology of sexual orientation and identity is unknown. We report multimodal magnetic resonance imaging data, including cortical thickness (Cth), subcortical volumes, and resting state functional magnetic resonance imaging, from 27 transgender women (TrW), 40 transgender men (TrM), and 80 heterosexual (40 men) and 60 homosexual cisgender controls (30 men). These data show that whereas homosexuality is linked to cerebral sex dimorphism, gender dysphoria primarily involves cerebral networks mediating self-body perception. Among the homosexual cisgender controls, weaker sex dimorphism was found in white matter connections and a partly reversed sex dimorphism in Cth. Similar patterns were detected in transgender persons compared with heterosexual cisgender controls, but the significant clusters disappeared when adding homosexual controls, and correcting for sexual orientation. Instead, both TrW and TrM displayed singular features, showing greater Cth as well as weaker structural and functional connections in the anterior cingulate-precuneus and right occipito-parietal cortex, regions known to process own body perception in the context of self.

Neural correlates of ostracism in transgender persons living according to their gender identity: A potential risk marker for psychopathology?

Article

Jan 2018

Background Stigmatization in society carries a high risk for development of psychopathology. Transgender persons are at particularly high risk for such stigmatization and social rejection by others. However, the neural correlates of ostracism in this group have not been captured. Method Twenty transgender men (TM, female-to-male) and 19 transgender women (TW, male-to-female) already living in their gender identity and 20 cisgender men (CM) and 20 cisgender women (CW) completed a cyberball task assessing both exclusion and re-inclusion during functional magnetic resonance imaging (fMRI). Results During psychosocial stress between-group differences were found in the dorsal and ventral anterior cingulate cortex (ACC) and the inferior frontal gyrus (IFG). Patterns were consistent with sex assigned at birth, i.e. CW showed greater activation in dorsal ACC and IFG relative to CM and TW. During re-inclusion, transgender persons showed greater ventral ACC activity relative to CW, possibly indicating persistent feelings of exclusion. Functional connectivity analyses supported these findings but showed a particularly altered functional connectivity between ACC and lateral prefrontal cortex in TM, which may suggest reduced emotional regulation to the ostracism experience in this group. Depressive symptoms or hormonal levels were not associated with these findings. Conclusion The results bear implications for the role of social exclusion in development of mental health problems in socially marginalized groups.

Brain functional connectivity patterns in children and adolescents with gender dysphoria: Sex-atypical or not?

Article

Sep 2017
PSYCHONEUROENDOCRINO

Epistemic Injustice in Brain Studies of (Trans)Gender Identity

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