Busting Barriers - Unique Research for the Transgender Community

by Women's Brain Health Initiative:

It is not uncommon for a researcher to show an interest in science at an early age. Growing up, Reubs Walsh was more precocious than most children her age.

As a young child, she sought out books on the brain and neuroscience – literature that she now admits to barely understanding at the time. At the age of 14, the budding scientist even managed to land a short-term position working at Imperial College London’s Tissue Bank, one of the world’s leading repositories of donated brain tissue from individuals who had suffered from neurodegenerative diseases.

Reubs was driven by a strong personal motivation: the experience of watching her mother cope with multiple sclerosis.“When she’d have a relapse, my way of dealing with the consequences was to try to take control by trying to understand it,” said Reubs.

Her studies brought her to the University of Oxford in the U.K., where she majored in physiology, and now to Vrije Universiteit Amsterdam in the Netherlands, where she is pursuing a PhD in Neuro-Developmental Psychology. Along the way, her focus evolved as she began a new chapter in her life. Reubs came out as trans and her research interests turned to the sex and gender aspects of the brain.

Then, in 2016, she met Dr. Gillian Einstein.Dr. Einstein, who holds the Wilfred and Joyce Posluns Chair in Women's Brain Health and Aging at the University of Toronto, was participating in a conference held in Frankfurt, Germany. She was giving a speech entitled “Beyond the Binary: The Corporeal Lives of Trans Individuals.”

Dr. Einstein spoke about the complexity of gender identification, drawing upon her research involving trans men, a project suggested by a trans man who was an undergraduate student at the University of Toronto.“When I saw Jill’s work at the conference in Frankfurt, I more or less said to myself that I needed to talk to this woman some more,” said Reubs in a video conference call with Dr. Einstein and Mind Over Matter®.

“And, as I recall, I basically cornered [Dr. Einstein] and said ‘shall we go to dinner?’”

IT WAS A SERENDIPITOUS MEETING FOR DR. EINSTEIN BECAUSE SHE WAS SEARCHING FOR THE RIGHT PERSON TO TAKE ON A PROJECT TO EXPAND OUR KNOWLEDGE OF THE LONG-TERM BRAIN HEALTH OF TRANS INDIVIDUALS.

Much of her research explores the impact of hormones on cognition of women as they age. Initially, the focus of her research was on cis women (i.e. those who identify as women and were assigned female at birth) until she received a visit from a trans woman.“

She said, ‘you are studying women, why aren’t you studying us?’”

People who come out as trans frequently undergo hormone therapy, but there has been little research conducted on the long-term implications of this treatment.“We don’t really know anything about memory and aging in trans individuals,” said Dr. Einstein. “I started thinking that this is very much in line with Women’s Brain Heath Initiative (WBHI) and one of their principal partners, Brain Canada, and it’s very much in line with my own interests in terms of hormones shaping behaviour, and also really understanding the interplay between the social and the biological.”

Undergraduate students had conducted some initial work, but she needed someone who could put in the long hours to take the research to the next level, including the challenge of recruiting individuals to participate in the study. Ideally, Dr. Einstein hoped to find someone from the trans community.“The saying, ‘nothing about us without us’ is really important in this case,” she said. “And then I had the great fortune of meeting Reubs.”After their Frankfurt meeting, the two collaborated on a paper and started talking about a new research project, which has now been approved for funding by WBHI and co-funded by The Citrine Foundation of Canada, and will be launched in the months to come, once pandemic restrictions lift and Reubs moves from Amsterdam to Toronto.

Their goal is to recruit at least 20 trans women who will undergo neuroimaging, cognition tests, and blood analysis. Ruebs believes that her personal experiences will help inform the study, notably the impact of stress. In her case, the wait for hormone treatments was long and trying, which added to the inherent societal stresses that trans people face.

“I would like to come away having at least more of an understanding of this interplay between neurodegenerative diseases and sex hormones, stress hormones, and sex factors related to hormones,” said Reubs.

WHILE IT IS WELL KNOWN THAT CIS WOMEN DEVELOP ALZHEIMER’S DISEASE AT A MUCH HIGHER RATE THAN MEN, WE DO NOT YET KNOW IF THAT ALSO APPLIES TO TRANS WOMEN.

“There just isn't enough knowledge to even really hypothesize what the long-term effects of gender-affirming hormone therapy might be,” said Dr. Einstein.“By definition, it’s quite an exploratory project, because ordinarily there is a large existing bank of literature. But the unknowns are many. There is very little work in general looking at older trans people from a medical point of view,” Reubs added.

She brings to the project an intimate understanding of the sensitivities of studying a group of individuals who have faced (and continue to face) many barriers. She will be consulting with community advisors on research methods – mindful of the potential risk of causing any further stress for those participating in the study.

There is also what Reubs refers to as a “delicate dance” for trans researchers who wish to study the impacts of hormone therapy. Having fought for so long to gain acceptance and access to treatment, concerns linger about how the results might be interpreted.

“I would like the opportunity to ask the question, ‘what are the long-term effects of these treatments,’ without someone saying ‘yes, we shouldn’t be doing them.’ The long-term effects of eliminating these treatments are already known to be disastrous,” said Reubs.

Dr. Einstein noted that all medications have both benefits and risks. Knowledge and informed consent are critical for patients. “It’s the right of all groups to know something about the effects of treatments that they’re taking,” said Dr. Einstein.The funding of this latest project is consistent with the ever-growing focus on diversity at WBHI.

“I’m very excited about this focus of WBHI. It’s the right thing to do.”For Reubs, it is an opportunity to expand knowledge and understanding about the aging process for trans individuals. “If I can manage to do this important research, then I will be pulled up along with the rest of the trans community.”

Source: Mind Over Matter V12