Prioritizing Brain Health for All
by Women’s Brain Health Initiative:
Trans Women and the Aging Brain Research Project
As one of the leaders of a groundbreaking research project involving trans women, Dr. Reubs Walsh approaches the task with a deep sensitivity toward the community to be studied, a community of which they are a member.
“One of the big things to remember is that historically, trans people have not been treated well by medical personnel, and it still exists in some places,” Dr. Walsh told Mind Over Matter®.
The subject of the study has obvious resonance for the community. The researchers are exploring the long-term cognitive effects of gender-affirming hormone/estradiol therapy (GAET) on older trans women, analyzing them in the context of stress and aging. To the team’s knowledge, it is the first project of its kind ever undertaken.
Dr. Walsh, a post-doctoral fellow at the University of Toronto (U of T), is working with Dr. Gillian Einstein, who holds the Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging at the university. The project is supported by funding from Brain Canada Foundation (Brain Canada) and Women’s Brain Health Initiative (WBHI), with post-doctoral salary for Dr. Walsh being supported by WBHI and the U of T Faculty of Arts and Science.
Dr. Walsh, a native of England who pursued doctoral studies in the Netherlands, has just received ethics approval and is now recruiting participants for the study.
We want to build a foundation of trust, and that’s why we’re going slowly.
Dr. Walsh continued, “We are doing something that they [trans women] want to know, too, and we want to ensure that they trust us to be the ones to try to learn it.”
The basic questions are the same that any person taking long-term treatments would have: What are the long-term impacts? Are the treatments beneficial or detrimental? Which cognitive domains and brain regions do they affect? How do the people who take these treatments feel about them? What is their experience?
“It’s a research project that’s long overdue,” said Dr. Walsh. “I don’t think I’ve met a trans person and told them what I’m doing without them having 50 questions. People want to know the answer about any side effects.”
IN THEIR QUEST TO LEARN MORE, THE RESEARCHERS MUST ALSO NAVIGATE A CHALLENGING POLITICAL LANDSCAPE SURROUNDING TRANS ISSUES.
“This is a complicated study. We must get the information we need without upsetting or triggering people. A lot of trans people, especially older ones, have had some traumatic experiences, and we don’t want to make it worse,” Dr. Walsh added.
“We’re not politically motivated. The biology itself isn’t politically motivated,” said Dr. Einstein.
“We do have to think about the politics because that is what every trans person, themselves, faces, but most importantly, this project is about the people who participate. They may be worried about what is found and how it may be used. We have to be sensitive to that,” she added.
Biology is shaped by social conditions, including stigma. Ultimately, we want this research to help and inform.
The research will go beyond studying the effect of hormones. The team is also interested in exploring the impact of the different kinds of stress, including trauma, endured by many trans people.
There are other potential risk factors for the cognition of trans people. Walsh points out that some isolate themselves socially as a form of protection, which elevates the risk of developing dementia.
“You don’t know if you’ll be safe or facing a threat. That’s going to make you less likely to go out and be among people, and a kind of wear and tear takes place.”
Dr. Einstein added: “One hypothesis might be that the stigma of being trans might outweigh any biological risks that gender-affirming hormone therapy might lead to.”
There are questions beyond the impact on cognition. For example, there is evidence that trans women have an elevated risk of
heart disease.
THE ASSUMPTION UP UNTIL NOW HAS BEEN THAT HORMONE THERAPY WAS RESPONSIBLE, BUT DR. EINSTEIN AND HER COLLEAGUES WONDER WHETHER STRESS MAY PLAY A CENTRAL ROLE.
They hope to start recruiting as many as 40 trans women in the new year, reaching out to various community groups from which to recruit participants. Dr. Walsh is hopeful that there will be great interest.
“Something about the trans community, as I’ve experienced it in Europe and here, is that it’s very tight-knit, and sooner or later, everybody knows everybody. There’s a good chance that once we’ve built good relationships with the first participants, it’ll
just snowball.”
As a first step, participants will be asked to come in for a qualitative interview, during which they will be asked to speak about their experiences with hormone therapy and how it has affected their lived experiences.
The researchers will compare those stories with how participants score on certain tasks, such as the mental rotation test, in which people are asked to look at 3D images of objects from different angles and determine whether they are looking at the same object.
This particular test has typically shown a difference between the sexes. Cis men are thought to perform better on mental rotation tasks. However, researchers in Dr. Einstein’s lab have challenged that belief, having found evidence that women tend to do just as well as men during their menstrual cycle when estradiol levels are lower. The researchers are interested in seeing how GAET might affect performance.
The funders of the research share their excitement about the project. “This research aligns with our goal to advance sex and gender brain science and remove systemic barriers and biases to ensure that all individuals have equal access to – and will benefit from – the results of bold brain research,” says Brain Canada President and CEO Viviane Poupon, PhD.
“Reubs and Gillian are breaking new ground in an area that needs more exploration,” said WBHI President and CEO Lynn Posluns. “We’re proud to support them.”
Dr. Einstein says this kind of research would be impossible without the assistance of funders like Brain Canada and WBHI, who aren’t just interested in the next logical step and want to fund out-of-the-box, groundbreaking research.
They, as well as the Faculty of Arts and Science, who wanted to fund an outstanding young scholar in their next career step, understand that the results of the project could have profound meaning for trans people, providing them with information that everyone considering any treatment deserves and which allows for truly informed consent.
THERE ARE RISKS AND BENEFITS TO EVERYTHING,” SAID DR. EINSTEIN. “THE TRANS COMMUNITY NEEDS TO HEAR ABOUT BOTH SIDES, BUT IT IS DIFFICULT FOR SMALLER GROUPS TO GET THIS KIND OF HEALTH INFORMATION. WE ARE TRULY GRATEFUL TO OUR FUNDERS FOR SUPPORTING OUR PROJECT AND THE COMMUNITY.
As researchers increasingly recognize the importance of exploring sex differences, Dr. Walsh believes that their project will resonate beyond this one community, providing a deeper understanding of the implications of hormone therapy.
“This research program could have really positive consequences for medical care across gender lines,” they said. “Everybody has a stake in this. Everybody will be better off.”