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

项目总结/摘要 性别认同和自己的身体感知-对性别焦虑的神经生物学影响 患有性别焦虑症（GD）的人在他们的性别认同和他们的性别认同之间存在鲜明的对比。 出生时的性别。这些个体在发育早期或生命后期发现，他们的身体 不符合他们的性别认同。持续的欲望的身体特征和社会角色的 异性也会导致焦虑公众对性别经历多样性的认识正在提高， 与自我认同、身体形象和医疗干预相关的GD患者越来越公开 在地球仪上讨论。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 确认或性别重置手术和交叉性激素治疗。许多人将获得这些 昂贵的，通常是不可逆的，侵入性的，有时是危险的措施，以解决他们之间的不一致性， 性别认同和身体。这正在迅速成为一个关键的全球健康问题;然而， 了解哪些发展，神经生物学和社会文化因素有助于GD，以及谁 可能会或可能不会从这些程序中受益，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，与自我相关的静息状态网络中的功能连接存在差异， 参考思维，以及与身体感知相关的功能性神经回路的差异。的 这项研究的目的是解决GD的核心症状-不满和疏远自己的身体， 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， 研究GD患者与cis- 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连接和身体的纵向影响 表型，以及大脑结构/功能，身体表型和激素预处理如何预测谁 将在改善烦躁和生活质量方面受益。作为一个探索性的目标，我们将研究一个 新的身体形态视觉加工任务的研究和临床使用的信度和效度。研究 瑞典和美国的研究人员也将允许我们研究压力的影响， 与对不符合性别角色的不同文化污名化有关。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的影响的信息，并承诺 揭示功能或结构神经模式，可以预测身体形象和质量方面的结果 在跨性别激素治疗后的生命，这最终可以用来帮助医疗决策。

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.