Gender identity and own body perception implications for the neurobiology of gender dysphoria

项目摘要/摘要 标题：性别认同和自身身体知觉--性别焦虑症的神经生物学意义 患有性别焦虑症(GD)的个体在他们的性别认同和他们的 出生时指定的性别。这些人在发育早期或生命后期发现，他们的身体是 与他们的性别认同不一致。对女性的身体特征和社会角色的执着渴望 异性也会导致烦躁不安。公众对性别体验多样性的认识正在上升， 在那些患有GD的人中，与自我认同、身体形象和医疗干预相关的因素变得更加公开 在全球范围内被讨论。随着这种情况的发生，越来越多的人正在考虑，或者实际上 接受治疗以改变他们的荷尔蒙和身体，试图更好地符合他们的性别 身份。这些干预措施称为医学性别(身份)确认干预措施，包括性别 确认或变性手术和跨性激素治疗。许多个人将获得这些 昂贵的、通常是不可逆转的、侵入性的、有时甚至是危险的措施，以解决其 性别认同和她们的身体。这正在迅速成为一个关键的全球健康问题；然而，几乎没有 了解发育、神经生物学和社会文化因素对GD的影响，以及谁 可能受益于这些程序，也可能不受益，包括那些经历性别模糊而不是 烦躁不安。然而，对大脑结构的研究发现，大脑中线结构异常， 最近的研究发现，静息状态网络中与自我相关的功能连通性存在差异 参照性思维，以及与身体感知相关的功能神经回路的差异。这个 这项研究的目的是解决GD的核心症状-不满和与自己身体的疏远， 和自我参照思维-通过使用行为实验和功能和结构神经成像来 研究GD患者与顺应性疾病患者的大脑网络调节自身身体知觉的比较。 性控制，以及它们与主观身体自我不协调的关系。我们还将调查 雌激素和睾酮治疗对脑功能联系和身体的纵向影响 表型，以及大脑结构/功能、身体表型和激素治疗前如何预测谁 将在改善烦躁不安和生活质量方面受益。作为一个探索性目标，我们将调查一个 新型形体视觉加工任务的信度和效度研究及临床应用。学习 瑞典和美国的个人还将允许我们调查压力的影响 与对不一致的性别角色的不同文化污名有关。这项研究将提供有价值的 关于GD的神经生物学基础和性激素影响的信息，并承诺 揭示可以根据身体形象和质量预测结果的功能或结构神经模式 在跨性别荷尔蒙治疗后的生活质量，这最终可能被用来协助医疗决策。

Project Summary/Abstract Title: Gender identity and own body perception – implications for the neurobiology of gender dysphoria Individuals with gender dysphoria (GD) experience a stark contrast between their gender identity and their gender assigned at birth. These individuals discover, early in development or later in life, that their body is incongruent with their gender identity. Persistent desire for the physical characteristics and social roles of the other sex contributes to dysphoria. Public awareness of the diversity of gender experience is rising, and issues of those with GD related to self-identity, body image, and medical interventions are becoming more openly discussed across the globe. As this is occurring, more and more individuals are considering, or actually undergoing, treatments to alter their hormones and physical body in attempt to better conform to their gender identity. These interventions, termed medical gender (identity) confirming interventions include gender confirming or sex reassignment surgery and cross sex hormone treatment. Many individuals will obtain these costly, usually irreversible, invasive, and sometimes risky measures to address incongruence between their gender identity and their body. This is quickly becoming a critical global health issue; yet there is very little understanding of what developmental, neurobiological, and sociocultural factors contribute to GD, and who may or may not benefit from these procedures, including those who experience gender ambiguity rather than dysphoria. However, studies of brain structure have found abnormalities in cerebral midline structures, and recent studies found differences in functional connectivity within resting state networks associated with self- referential thinking, as well as differences in the functional neural circuitry related to body perception. The purpose of this study is to address core symptoms of GD–dissatisfaction and estrangement from the own body, and self-referential thinking–by using behavioral experiments and functional and structural neuroimaging to investigate the cerebral networks mediating own body perception in individuals with GD compared to cis- sexual controls, and how they relate to subjective body self-incongruence. We will also investigate the longitudinal effects of estrogen and testosterone treatment on brain functional connections and body phenotype, and how brain structure/function, body phenotype, and hormones pre-treatment may predict who will benefit in terms of improvement of dysphoria and quality of life. As an exploratory aim we will investigate a novel body-morph visual processing task in its reliability and validity for research and clinical use. Studying individuals in both Sweden and the United States will additionally allow us to investigate the effect of stress related to differential cultural stigmatization of non-conforming gender roles. This study will provide valuable information on the neurobiological underpinning of GD and the effects of sex hormones, and promises to uncover functional or structural neural patterns that could predict outcome in terms of body image and quality of life after cross-sex hormone treatment, which ultimately could be used to assist in medical decision-making.