Developmental Correlates and Hormone Therapy Effects in Gender Dysphoria

Study Overview
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Brief Summary
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The aim of the research is to study longitudinally the effects of reassignment hormonotherapy on the connectome of MtF (biological men who are transitioning to the female gender) dysphoric subjects after 6 months of hormone therapy. The subjects will be compared to a control group of healthy subjects taking into account sexual orientation

Detailed Description
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The pathophysiology of gender dysphoria is still poorly understood, but a number of clues point to an origin derived from biological and environmental factors, particularly studies of twins, birth order, and family groups. Several explanatory models have been put forward. In particular, the differentiation of genitals taking place in the first half of pregnancy while that of the brain in the second makes it possible to imagine a different differentiation between the external phenotype and the cerebral gender. Several developmental features have thus been found in gender dysphoric subjects, including the finger length ratio D2 / D4, lateralization. Some neuroimaging studies have shown brain features in gender dysphoric subjects that seem original compared to control subjects. Nevertheless, the results are scarce, poorly reproduced, and for some, the differences highlighted may be related to phenotypic variability including the non-consideration of sexual orientation. Moreover, some of these studies combine subjects treated or not with hormone therapy which is a bias because it is likely that hormone therapy may have structural and functional effects on brain function. The investigators team deals with dysphoric gender issues as part of a coordinated course of hormone-surgical reassignment. We wish to better characterize the brain effects, at the level of the connectome of the reassignment hormone therapy in a population of dysphoric subjects, taking into account signs of pre-natal hormonal impregnation (D2 / D4 ratio), developmental features (onset of dysphoria, lateralization, size), and controlling sexual orientation as a potential confounding factor. The aim of the research is then to study longitudinally the effects of reassignment hormonotherapy on the connectome of MtF dysphoric subjects after 6 months of hormone therapy. The subjects will be compared to a control group of healthy subjects taking into account sexual orientation. This is a prospective longitudinal study that includes, in a consecutive manner, open-label patients with MtF gender dysphoria (biological men who are transitioning to the female gender) attending the forensic psychiatric consultation for a request for hormone-surgical reassignment. Subjects will receive initial clinical assessment and MRI before and 6 months after initiation of hormone therapy; the imaging data will be compared to a control group (n = 20).

Official Title
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Developmental Correlates and Hormone Therapy Effects in Gender Dysphoria

Conditions
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Gender Dysphoria

Intervention / Treatment
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* Other: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: gender dysphoric subjects MtF right handed androphilic orientation without hormone therapy Control group of male subjects: right handed without any psychiatric or medical history androphilic orientation Exclusion Criteria: MRI contraindication vulnerable adults mental retardation psychiatric or neurological disease including autism spectrum disorders, psychotropic medication hormonal or genetic condition

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Comparison between Mtf and control subjects.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: gender dysphoria subjects<br>Patients with MtF gender dysphoria (biological men who are transitioning to the female gender) attending the forensic psychiatric consultation for a request for hormone-surgical reassignment. Subjects will receive initial clinical assessment and MRI before and 6 months after initiation of hormone therapy | Other: MRI<br>* Subjects will receive structural and functional (resting state) MRI<br>|
| Other: control subjects<br>Control group inclusions, of open-label patients without gender dysphoria. | Other: MRI<br>* Subjects will receive structural and functional (resting state) MRI<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brain connectome 6 months after the hormone therapy beginning | Structural and functional MRI before and after 6 months of hormone therapy will be analysed in order to make a comparison before/after | 6 months after the beginning of the hormone therapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brain connectome in gender dysphoric and control subjects | The MRI images will be analysed in order to construct a brain  connectome  which reflects brain connectivity, using the graph theory. At baseline, these networks will be compared between dysphoric and control subjects. | baseline | 
| Gender dysphoria phenotype description | The MRI images will be analysed in order to construct a brain  connectome  which reflects brain connectivity, using the graph theory. Correlations will be made at baseline between brain connectome of the dysphoric subjects and testosteronemia, and developmental measures : age at beginning of gender dysphoria, finger lenghth D2/D4 ratio, birth weight, laterality using Edimbourg scale. | baseline and 6 months after the beginning of the hormone therapy | 
| Brain connectome variations | The MRI images will be analysed in order to construct a brain  connectome  which reflects brain connectivity, using the graph theory. Evolutions of the brain connectome of dysphoric subjects will be compared after 6 months of hormone therapy, taking into acount gender dysphoria decrease measured using Utrecht Gender Dysphoria Scale. | 6 months after the beginning of the hormone therapy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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gender dysphoria, neuroimaging, hormone-surgical reassignment