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Cereb Cortex. 2018 May 1;28(5):1582-1596. doi: 10.1093/cercor/bhx054.

Testosterone Effects on the Brain in Transgender Men.

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Department of Women's and Children's Health, Karolinska Institutet and University Hospital, SE-171 76 Stockholm, Sweden.
Stressmotagningen, 112 38 Stockholm, Sweden.
ANOVA, Center of Expertise in Andrology, Sexual Medicine, and Transgender Medicine, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Department of Medicine/Huddinge, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA.


Transgender individuals experience incongruence between their gender identity and birth-assigned sex. The resulting gender dysphoria (GD), which some gender-incongruent individuals experience, is theorized to be a consequence of atypical cerebral sexual differentiation, but support for this assertion is inconsistent. We recently found that GD is associated with disconnected networks involved in self-referential thinking and own body perception. Here, we investigate how these networks in trans men (assigned female at birth with male gender identity) are affected by testosterone. In 22 trans men, we obtained T1-weighted, diffusion-weighted, and resting-state functional magnetic resonance imaging scans before and after testosterone treatment, measuring cortical thickness (Cth), subcortical volumes, fractional anisotropy (FA), and functional connectivity. Nineteen cisgender controls (male and female) were also scanned twice. The medial prefrontal cortex (mPFC) was thicker in trans men than controls pretreatment, and remained unchanged posttreatment. Testosterone treatment resulted in increased Cth in the insular cortex, changes in cortico-cortical thickness covariation between mPFC and occipital cortex, increased FA in the fronto-occipital tract connecting these regions, and increased functional connectivity between mPFC and temporo-parietal junction, compared with controls. Concluding, in trans men testosterone treatment resulted in functional and structural changes in self-referential and own body perception areas.

[Available on 2019-05-01]

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