Transgender women (male-to-female) were invited to participate in this study to test the impact of Cross-Sex Hormone Therapy (CSHT) in the brain. Neuroimaging and cognitive assessment were performed in different time-points to compare the impact of CSHT in the brain.
Sex hormones are known to exert several effect on the brain white matter, cerebral cortex, functional connectivity and neurotransmission. Furthermore, in transgender people, CSHT is know to induce anatomical and functional changes in the brain. However, only a few studies have already been conducted to investigate the effects of sex hormones on the brain accounting for the interference of endogenous gonadal hormones. Also, there is a lack of knowledge about the importance of CSHT after Gender Affirming Surgery (GAS) regarding induced hypogonadism that follows this surgical procedure. Therefore, neuroimaging studies designed to isolate the effect of endogenous gonadal hormones in people with GD urge to be developed. To fulfil this purpose, transgender women that have already performed GAS and/or were under Gonadotrophin Release Hormone analogues treatment (in order to induce hypogonadism similar to GAS) were invited to interrupt CSHT for at least 30 days to promote sex hormones washout. At the end of the washout, participants performed magnetic resonance imaging, laboratorial analyses for sex hormones and neuro-cognitive assessment. After this first time-point, participants received a new prescription for CSHT containing estradiol (without progesterone) to be used continuously for 60 days, when the same assessments from the end of washout were repeated 60 days after CSHT to compare brain and cognitive longitudinal changes. At all the time-points, variations in depression scores and anxiety levels were assessed with specific scales.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Induced hypogonadism and re-institution of CSHT
Hospital de Clínicas de Porto Alegre
Porto Alegre, Rio Grande do Sul, Brazil
RECRUITINGGlutamate concentration in the left hippocampus
Proton Spectroscopy - magnetic resonance imaging; Glutamate concentration in the left hippocampus will be primarily correlated to working memory scores.
Time frame: 90 days
Cortical Thickness
Anatomical magnetic resonance imaging
Time frame: 90 days
Diffusion track imaging
Micro-Structural magnetic resonance imaging
Time frame: 90 days
functional connectivity
functional magnetic resonance imaging
Time frame: 90 days
Glutamate concentration in the anterior cingulate cortex and left dorsolateral prefrontal cortex
Proton spectroscopy - magnetic resonance imaging; Glutamate concentration in the left dorsolateral prefrontal cortex will be correlated to over all measures of cognition and executive functioning.
Time frame: 90 days
Cognition
Instrument: Wechsler Adult Intelligence Scale (WAIS) version 3. Subscale: Full Scale Intelligence coefficient. Mean: 100 Standard deviation (SD):15 for Brazilian population. Range of classification: 69 and below - Extremely Low 70-79 - Borderline 80-89 - Low Average 90-109 - Average 110-119 - High Average 120-129 - Superior 130 and above - very superior
Time frame: 90 days
Operational memory
Subscale from Wechsler Adult Intelligence Scale (WAIS) version 3. Mean: 100 Standard deviation (SD):15 for Brazilian population. 69 and below - Extremely Low 70-79 - Borderline 80-89 - Low Average 90-109 - Average 110-119 - High Average 120-129 - Superior 130 and above - very superior
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Time frame: 90 days
Verbal memory
Rey Auditory-Verbal Learning Test (RAVLT). Mean and range for Brazilian population: 1. A1 (Verbal Memory - Immediate recall). Range (in Z-scores): Z \<-1.5 are classified as deficit; Z \>-1.5 are expected 2. A5 (Verbal Memory - immediate recall). Range (in Z-scores): Z \<-1.5 are classified as deficit; Z \>-1.5 are expected 3. A7 (Verbal Memory - late recall). Range in (Z-scores): Z \<-1.5 are classified as deficit; Z \>-1.5 are expected 4. Learning Over Trial (LOT) (Learning capacity). Range (in Z-scores): Z \<-1.5 are classified as deficit; Z \>-1.5 are expected (please, note the reference for Brazilian population in the section "references" where the mean and standard deviation according to Brazilian population are described for each of the subtest; Salgado et al. (2011).
Time frame: 90 days
Language (Verbal Fluency)
Verbal Fluency Tests: (FAS) and Animals. Mean and standard deviation (SD) according to age range and years of education: Age range for the test: 16-59 years Score classification according to years of education: 1. From 0 to 8 years of education: Mean: 38.8 SD: 12.0 2. From 9 to 12 years of education: Mean: 40.5 SD: 10.7 3. From 12 to 21 years of education: Mean: 44.7 SD:11.2 Range in Z-scores: Z \<-1.5 are classified as deficit; Z \>-1.5 are expected
Time frame: 90 days
Executive function
Stroop Test -Victoria Version. Mean and standard deviation (SD) according to the age range and years of education: For 19-39 years old + 5-8 years of education: Mean: 33.3 SD:11.35 For 19-39 years old + 9 or more years of education: Mean: 41.73 SD: 9.85 For 40-59 years old + 5-8 years of education: Mean: 28 SD: 7.76 For 40-59 years old + 9 or more years of education: Mean: 37.17 SD: 9.98 Range in Z-scores: Z \<-1.5 are classified as deficit; Z \>-1.5 are expected
Time frame: 90 days