Sex, Hormones and Identity affect Nociceptive Expression (SHINE)

性别、激素和身份影响伤害性表达（SHINE） 经常有报道说，女性表现出较低的疼痛阈值和较高的敏感性比男性， 实验性疼痛测试然而，“性”和“性别”经常互换使用，以描述这些 性别认同和遗传性别并不总是一致的。因此，人类受试者可能 根据基因性别分类为男性或女性，即使他们不确定为男性或女性， 分别跨性别（trans-men and women，简称TM和TW）是一个少数群体，其性别认同是 不同于他们的遗传性别（相对于顺性别男性和女性; CM和CW）。因此，TM和 TW可能会经历耻辱，偏见和抑郁，使他们面临更大的负面健康结果风险 影响了生活质量。因此，这个未被充分研究的社区提供了一个独特的机会来调查 性别认同的作用（反式与顺式），出生时的性别分配（男性与女性）和激素状态（升高） 睾酮与升高的雌激素）对疼痛和幸福的影响，同时更好地了解 社区。本研究的具体目的包括：1.为了确定性别认同的影响， 和激素状态对疼痛敏感性的影响。2.研究社会和心理因素，以促进 疼痛敏感度的差异3.为了量化免疫细胞群体和活性的差异，我们 组在当地社区利益相关者的协助下，我们将招募以下群体：CM，CW，TM+T （目前服用外源性睾酮）、TW+E（外源性雌二醇）、TM和TW（n=20/组）。我们将使用 定量感觉测试，通过标准化方案评估对冷、压力和热的敏感性。血液 将采集样本用于评估压力和生殖激素水平、免疫细胞群和 刺激的细胞因子释放，以及唾液样品以测量应激反应性。最后，问卷将 测量疼痛状态、生活质量、声音生活质量、身体形象、外观、自我报告的健康状况， 男性/女性，社区连通性，性别角色，睡眠，抑郁，社会支持，不良 童年经历和耻辱。总之，这将是第一次探索性别认同的影响， 出生时分配和激素状态对生活质量，疼痛敏感性和免疫细胞活性的影响， 个体这项调查还将提供关于这一服务不足群体的需求的重要信息。 和未被充分研究的人群

Sex, Hormones and Identity affect Nociceptive Expression (SHINE)Project Summary It is often reported that females demonstrate lower pain thresholds and higher sensitivity than males in experimental pain tests. However, “sex” and “gender” are often used interchangeably to describe these differences, but genetic sex and gender identity are not always congruent. As a result, human subjects may be categorized as male or female based upon genetic sex even if they do not identify as a man or woman, respectively. Transgender (trans) men and women (TM and TW) are a minority group whose gender identity is different than their genetic sex (as opposed to cisgender men and women; CM and CW). As a result, TM and TW may experience stigma, prejudice and depression, putting them at greater risk for negative health outcomes and impacted quality of life. Thus, this understudied community provides a unique opportunity to investigate the role of gender identity (trans vs. cis), sex assigned at birth (male vs. female) and hormonal status (elevated testosterone vs. elevated estrogen) on pain and well-being, while providing a better understanding of the needs of the community. Specific aims of this study include: 1. To determine the impact of gender identity, sex assigned at birth and hormone status on pain sensitivity. 2. To examine social and psychological factors to contribute to pain sensitivity in our groups. 3.To quantify differences in immune cell populations and activity between our groups. With the assistance of local community stakeholders we will recruit the following groups: CM, CW, TM+T (currently taking exogenous testosterone), TW+E (exogenous estradiol), TM, and TW (n=20/group). We will use quantitative sensory testing to assess sensitivity to cold, pressure, and heat via standardized protocols. Blood samples will be taken for assessment of stress and reproductive hormone levels, immune cell populations and stimulated cytokine release, as well as salivary samples to measure stress reactivity. Finally, questionnaires will measure pain state, quality of life, voice quality of life, body image, appearance, self-reported health, masculinity/femininity, community connectedness, gender role, sleep, depression, social support, adverse childhood experiences and stigma. Together, this will be the first exploration of the impact of gender identity, sex assigned at birth and hormonal status on quality of life, pain sensitivity and immune cell activity in trans individuals. This investigation will also provide critical information with respect to the needs of this underserved and critically understudied population.