Researcher bios and how their research backgrounds relate to this study
Gillian Einstein is a faculty member in the Department of Psychology at the University of Toronto, Adjunct Scientist at Women’s College Research Institute as well as the Rotman Research Institute at Baycrest Hospital, and a member of both the Institute for Life Course & Aging and the Centre for Sexual Diversity Studies at the University of Toronto. She is also the Founder of the Collaborative Specialization in Women’s Health at the University of Toronto, The Wilfred and Joyce Posluns Chair of Women’s Brain Health and Aging, and Guest Professor of Gender and Health, Linköping University, Linköping, Sweden. Dr. Einstein’s research uses a multidisciplinary and whole-body approach to explore the brain and behaviour in the context of other body systems and in the context of people’s lives.
Reubs J Walsh is a multidisciplinary scientist with degrees in human physiology, cognitive neuropsychology, and clinical developmental psychology. Their work focusses on understanding how the social environment shapes individuals’ biology, especially their brains, and draws on the philosophical and political works of neurodivergent, queer/trans and intersectional feminist movements and scholars. As a postdoctoral fellow in the Einstein lab, they investigate how biosocial processes related to gender/sex – including gender-affirming medical treatments using hormones, and social stress and isolation – influence how the brains of trans women and non binary people PAMAB change in older age. Their project uses neuropsychological testing, multimodal neuroimaging, and qualitative methods to obtain a deeper understanding of these participants’ experiences, and how those experiences may have influenced the health of their aging brains.
Purpose of this research project
The objective of the project is to understand the cognitive and brain effects accompanying taking E2 through studies of transfeminine people taking GAET (hereafter TFP+GAET). This will be accomplished by studying those with and without GAET from 5-20 years post-transition. The motivation for this study arises from a lack of peer-reviewed evidence to enable GAET-related decision making (i.e., whether/when to initiate/terminate) to include weighing the benefits for wellbeing against the possible increased risk of age-related cognitive decline. Retrospective self-report, between-participant analyses, and biochemical analysis of hair samples will be used to support tentative inferences about effects over time.
Estradiol is widely thought to have an important role in regulating lasting changes in the brain during development, and in more transient modulation of the brain’s functional activity. Decreases in estradiol in young women with ovarian removal is associated with increased risk of late-life dementia including Alzheimer’s Disease (AD), which affects almost twice as many cisgender women as cisgender men; this cannot be explained by differences in longevity alone (Ferretti et al., 2018; Snyder et al., 2016). Studies examining the pace and extent of age-related cognitive decline in women whose endocrinology has been altered by medical interventions (e.g. HT for spontaneous menopause or BSO) continue to advance our understanding of the mechanisms underlying this disparity, with consequences for both fundamental and clinical knowledge about the role(s) of estradiol in adult and ageing brains, and in AD development and progression. However, transgender people also have their own exposure to sex-related hormones altered as part of their routine healthcare, and very little is known about how this influences the pace and extent of age-related cognitive decline as they age with long term GAET. We also know very little about these persons’ experience of aging while taking GAET.
Prior studies in TFP who sought and were provided GAET have associated the treatment with: significant improvements in wellbeing (Costa & Colizzi, 2016; Gomez-Gil et al., 2012); small-to-moderate effects on performance on sex-correlated cognitive tasks, changes in brain structure and task-related activation (Nguyen et al., 2019), and an increased risk of dementia, seemingly due to (minority) stress effects (Brady et al., 2023; Guo et al., 2022; Hughto, et al., 2023). However, the following are not yet understood:
- What is it like to age as a TFP?
- The brain and behavioural effects of long-term GAET on cognitive ageing, and how that is influenced by sex at birth, genetic risk factors for AD, stigma (stress) and sense of self.
- Does estradiol replacement have efficacious effects in menopausal women only on a genetic background of XX or is it cognitively efficacious on a genetic background of XY?
How this research will help LGBT2SQ people and communities
This project will contribute to our understanding of how GAHT influences brain health
in the long term and whether change in hormonal status in older transfeminine persons plays a role in cognitive decline. This is critical in order to further elucidate (i) the role of E2 in aging; (ii) the aging process for trans women; and (iii) the long term brain health effects of GHAT in trans
women.
Participants
We are recruiting participants who are 50+ years of age including: Transfeminine people (transgender women and non-binary people assigned male at birth), cisgender men, and cisgender women. We are interested in recruiting participants in any of the above groups who are using hormone therapy (e.g., gender-affirming hormones, estrogen therapy for menopause). For TFP participants, we are recruiting individuals who have been using GAET for 5+ years and individuals who have been out as trans for 5+ years without the use of GAET.
Inclusion criteria for all groups: able to speak and understand neuropsychological tests administered in English.
Compensation
Participants receive $50.00 for each completed study component from the following:
Qualitative interview
Neuropsychological testing
MRI brain scan
Biosample collection (blood, hair, saliva samples)
As well as a $30.00 Amazon gift card if participants choose to complete an online study component.
We will also compensate participants for reasonable travel expenses such as transit or parking costs.
Mitigation measures
Qualitative interviews will be carried out by a transfeminine postdoctoral fellow with significant experience in navigating these topics sensitively. Should a participant become exceedingly distressed or desire further support, the researchers will have on hand resources relevant to transgender mental health and wellbeing (from Rainbow Health Ontario) as well as contacts for on-campus support (CAPS services).
Participants in the in-person and online part of the GAET substudy are provided with a list of resources for psychological support. The resources on this list include, but aren’t limited to: Ontario mental health helpline; Gerstein crisis centre; Trans life line; The 519; Sherbourne Health Centre; Mind your mind; the Trevor Project; Family Service Toronto
Promoting the Study
We have advertised the study via community boards and organizations, local businesses, Facebook ads, and word of mouth.