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Review

Biological studies of transgender identity: A critical review

, PhD, , MD, MA, , BA & , PhD
Pages 254-283 | Received 31 Dec 2021, Accepted 02 Sep 2022, Published online: 14 Oct 2022

References

  • Arnold, A. P. (2009). The organizational–activational hypothesis as the foundation for a unified theory of sexual differentiation of all mammalian tissues. Hormones and Behavior, 55(5), 570–578. https://doi.org/10.1016/j.yhbeh.2009.03.011
  • Arnold, A. P. (2020). Sexual differentiation of brain and other tissues: Five questions for the next 50 years. Hormones and Behavior, 120, 104691–104691. https://doi.org/10.1016/j.yhbeh.2020.104691
  • Au Yeung, L., & Tse, W. S. (2017). Why does digit ratio research fail to give any implication regarding the organizational effect of prenatal androgen? Journal of Individual Differences, 38(1), 36–45. https://doi.org/10.1027/1614-0001/a000220
  • Auer, M. K., Fuss, J., Stalla, G. K., & Athanasoulia, A. P. (2013). Twenty years of endocrinologic treatment in transsexualism: Analyzing the role of chromosomal analysis and hormonal profiling in the diagnostic work-up. Fertility and Sterility, 100(4), 1103–1110. https://doi.org/10.1016/j.fertnstert.2013.05.047
  • Baldinger-Melich, P., Urquijo Castro, M. F., Seiger, R., Ruef, A., Dwyer, D. B., Kranz, G. S., Klöbl, M., Kambeitz, J., Kaufmann, U., Windischberger, C., Kasper, S., Falkai, P., Lanzenberger, R., & Koutsouleris, N. (2020). Sex matters: A multivariate pattern analysis of sex- and gender-related neuroanatomical differences in cis- and transgender individuals using structural magnetic resonance imaging. Cerebral Cortex, 30(3), 1345–1356. https://doi.org/10.1093/cercor/bhz170
  • Beaulieu, C. (2002). The basis of anisotropic water diffusion in the nervous system—A technical review. NMR in Biomedicine, 15(7–8), 435–455. https://doi.org/10.1002/nbm.782
  • Beemyn, G., & Rankin, S. (2011). The lives of transgender people. Columbia University Press.
  • Benjamin, H. (1966). The transsexual phenomenon. The Julian Press, Inc.
  • Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14(3), 247–261. https://doi.org/10.1007/BF01542107
  • Bornstein, K. (1998). My gender workbook. Routledge.
  • Brown, W. M., Hines, M., Fane, B. A., & Breedlove, S. M. (2002). Masculinized finger length patterns in human males and females with congenital adrenal hyperplasia. Hormones and Behavior, 42(4), 380–386. https://doi.org/10.1006/hbeh.2002.1830
  • Burke, S. M., Kreukels, B. P. C., Cohen-Kettenis, P. T., Veltman, D. J., Klink, D. T., & Bakker, J. (2016). Male-typical visuospatial functioning in gynephilic girls with gender dysphoria—Organizational and activational effects of testosterone. Journal of Psychiatry & Neuroscience: JPN, 41(6), 395–404. https://doi.org/10.1503/jpn.150147
  • Burke, S. M., Manzouri, A. H., Dhejne, C., Bergström, K., Arver, S., Feusner, J. D., & Savic-Berglund, I. (2018). Testosterone effects on the brain in transgender men. Cerebral Cortex (New York, N.Y.: 1991), 28(5), 1582–1596. https://doi.org/10.1093/cercor/bhx054
  • Carrillo, B., Gómez-Gil, E., Rametti, G., Junque, C., Gomez, Á., Karadi, K., Segovia, S., & Guillamon, A. (2010). Cortical activation during mental rotation in male-to-female and female-to-male transsexuals under hormonal treatment. Psychoneuroendocrinology, 35(8), 1213–1222. https://doi.org/10.1016/j.psyneuen.2010.02.010
  • Case, L. K., Brang, D., Landazuri, R., Viswanathan, P., & Ramachandran, V. S. (2017). Altered white matter and sensory response to bodily sensation in female-to-male transgender individuals. Archives of Sexual Behavior, 46(5), 1223–1237. https://doi.org/10.1007/s10508-016-0850-z
  • Clemens, B., Derntl, B., Smith, E., Junger, J., Neulen, J., Mingoia, G., Schneider, F., Abel, T., Bzdok, D., & Habel, U. (2020). Predictive pattern classification can distinguish gender identity subtypes from behavior and brain imaging. Cerebral Cortex (New York, N.Y.: 1991), 30(5), 2755–2765. https://doi.org/10.1093/cercor/bhz272
  • Clemens, B., Junger, J., Pauly, K., Neulen, J., Neuschaefer-Rube, C., Frölich, D., Mingoia, G., Derntl, B., & Habel, U. (2017). Male-to-female gender dysphoria: Gender-specific differences in resting-state networks. Brain and Behavior, 7(5), e00691–e00691. https://doi.org/10.1002/brb3.691
  • Cohen-Kettenis, P. T., & Klink, D. (2015). Adolescents with gender dysphoria. Best Practice & Research. Clinical Endocrinology & Metabolism, 29(3), 485–495. https://doi.org/10.1016/j.beem.2015.01.004
  • Cohen-Kettenis, P. T., & Pfäfflin, F. (2010). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39(2), 499–513. https://doi.org/10.1007/s10508-009-9562-y
  • Collins, A. L., Kim, Y., Sklar, P., O’Donovan, M. C., & Sullivan, P. F. (2012). Hypothesis-driven candidate genes for schizophrenia compared to genome-wide association results. Psychological Medicine, 42(3), 607–616. https://doi.org/10.1017/S0033291711001607
  • Coolidge, F. L., Thede, L. L., & Young, S. E. (2002). The heritability of gender identity disorder in a child and adolescent twin sample. Behavior Genetics, 32(4), 251–257. https://doi.org/10.1023/A:1019724712983
  • Cooper, B. (2001). Nature, nurture and mental disorder: Old concepts in the new millennium. The British Journal of Psychiatry. Supplement, 40(S40), s91–s101. https://doi.org/10.1192/bjp.178.40.s91
  • Cowan, W. M. (1979). The development of the brain. Scientific American, 241(3), 113–133. https://doi.org/10.1038/scientificamerican0979-112
  • de Sanctis, V., Soliman, A. T., Elsedfy, H., Soliman, N., Elalaily, R., & Di Maio, S. (2017). Is the second to fourth digit ratio (2D:4D) a biomarker of sex-steroids activity? Pediatric Endocrinology Reviews: PER, 14(4), 378–386. 10.17458/per.vol14.2017.SSE.SexSteroids[PMC][28613048]
  • Ducharme, S., Albaugh, M. D., Hudziak, J. J., Botteron, K. N., Nguyen, T.-V., Truong, C., Evans, A. C., Karama, S., Ball, W. S., Byars, A. W., Schapiro, M., Bommer, W., Carr, A., German, A., Dunn, S., Rivkin, M. J., Waber, D., Mulkern, R., Vajapeyam, S., … O’Neill, J. (2014). Anxious/depressed symptoms are linked to right ventromedial prefrontal cortical thickness maturation in healthy children and young adults. Cerebral Cortex, 24(11), 2941–2950. https://doi.org/10.1093/cercor/bht151
  • Ecker, A. (1875). Some remarks about a varying character in the hand of humans. Archives Fur Anthropology, 8, 68–74.
  • Emory, L. E., Williams, D. H., Cole, C. M., Amparo, E. G., & Meyer, W. J. (1991). Anatomic variation of the corpus callosum in persons with gender dysphoria. Archives of Sexual Behavior, 20(4), 409–417. https://doi.org/10.1007/BF01542620
  • Feng, J., Spence, I., & Pratt, J. (2007). Playing an action video game reduces gender differences in spatial cognition. Psychological Science, 18(10), 850–855. https://doi.org/10.1111/j.1467-9280.2007.01990.x
  • Fernández, R., Cortés-Cortés, J., Esteva, I., Gómez-Gil, E., Almaraz, M. C., Lema, E., Rumbo, T., Haro-Mora, J.-J., Roda, E., Guillamón, A., & Pásaro, E. (2015). The CYP17 MspA1 polymorphism and the gender dysphoria. The Journal of Sexual Medicine, 12(6), 1329–1333. https://doi.org/10.1111/jsm.12895
  • Fernández, R., Esteva, I., Gómez-Gil, E., Rumbo, T., Almaraz, M. C., Roda, E., Haro-Mora, J.-J., Guillamón, A., & Pásaro, E. (2014). Association study of ERβ, AR, and CYP19A1 genes and MtF transsexualism. The Journal of Sexual Medicine, 11(12), 2986–2994. https://doi.org/10.1111/jsm.12673
  • Fernández, R., Guillamon, A., Cortés-Cortés, J., Gómez-Gil, E., Jácome, A., Esteva, I., Almaraz, M., Mora, M., Aranda, G., & Pásaro, E. (2018a). Molecular basis of gender dysphoria: Androgen and estrogen receptor interaction. Psychoneuroendocrinology, 98, 161–167. https://doi.org/10.1016/j.psyneuen.2018.07.032
  • Fernández, R., Guillamón, A., Gómez-Gil, E., Esteva, I., Almaraz, M. C., Cortés-Cortés, J., Lamas, B., Lema, E., & Pásaro, E. (2018b). Analyses of karyotype by G-banding and high-resolution microarrays in a gender dysphoria population. Genes & Genomics, 40(5), 465–473. https://doi.org/10.1007/s13258-017-0646-0
  • Fisher, A. D., Ristori, J., Castellini, G., Cocchetti, C., Cassioli, E., Orsolini, S., Sensi, C., Romani, A., Mazzoli, F., Cipriani, A., Ricca, V., Vignozzi, L., Viggiano, M. P., Mascalchi, M., Maggi, M., & Gavazzi, G. (2020). Neural correlates of gender face perception in transgender people. Journal of Clinical Medicine, 9(6), 1731–1731. https://doi.org/10.3390/jcm9061731
  • Flint, C., Förster, K., Koser, S. A., Konrad, C., Zwitserlood, P., Berger, K., Hermesdorf, M., Kircher, T., Nenadic, I., Krug, A., Baune, B. T., Dohm, K., Redlich, R., Opel, N., Arolt, V., Hahn, T., Jiang, X., Dannlowski, U., & Grotegerd, D. (2020). Biological sex classification with structural MRI data shows increased misclassification in transgender women. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 45(10), 1758–1765. https://doi.org/10.1038/s41386-020-0666-3
  • Flores, A. R., Herman, J. L., Gates, G. J., & Brown, T. N. T. (2016). How many adults identify as transgender in the United States? The Williams Institute.
  • Galis, F., Ten Broek, C. M. A., Van Dongen, S., & Wijnaendts, L. C. D. (2010). Sexual dimorphism in the prenatal digit ratio (2D:4D). Archives of Sexual Behavior, 39(1), 57–62. https://doi.org/10.1007/s10508-009-9485-7
  • Galupo, M. P., Henise, S. B., & Mercer, N. L. (2016). “The labels don’t work very well”: Transgender individuals’ conceptualizations of sexual orientation and sexual identity. International Journal of Transgenderism, 17(2), 93–104. https://doi.org/10.1080/15532739.2016.1189373
  • Garcia-Falgueras, A., Ligtenberg, L., Kruijver, F. P. M., & Swaab, D. F. (2011). Galanin neurons in the intermediate nucleus (InM) of the human hypothalamus in relation to sex, age, and gender identity. The Journal of Comparative Neurology, 519(15), 3061–3084. https://doi.org/10.1002/cne.22666
  • Garcia-Falgueras, A., & Swaab, D. F. (2008). A sex difference in the hypothalamic uncinate nucleus: Relationship to gender identity. Brain, 131(12), 3132–3146. https://doi.org/10.1093/brain/awn276
  • Giedd, J. N., Raznahan, A., Mills, K. L., & Lenroot, R. K. (2012). Review: Magnetic resonance imaging of male/female differences in human adolescent brain anatomy. Biology of Sex Differences, 3(1), 19–19. https://doi.org/10.1186/2042-6410-3-19
  • Gómez-Gil, E., Esteva, I., Carrasco, R., Almaraz, M. C., Pasaro, E., Salamero, M., & Guillamon, A. (2011). Birth order and ratio of brothers to sisters in Spanish transsexuals. Archives of Sexual Behavior, 40(3), 505–510. https://doi.org/10.1007/s10508-010-9614-3
  • Hahn, A., Kranz, G. S., Küblböck, M., Kaufmann, U., Ganger, S., Hummer, A., Seiger, R., Spies, M., Winkler, D., Kasper, S., Windischberger, C., Swaab, D. F., & Lanzenberger, R. (2015). Structural connectivity networks of transgender people. Cerebral Cortex (New York, N.Y.: 1991), 25(10), 3527–3534. https://doi.org/10.1093/cercor/bhu194
  • Hampson, E., & Sankar, J. S. (2012). Re-examining the Manning hypothesis: Androgen receptor polymorphism and the 2D:4D digit ratio. Evolution and Human Behavior, 33(5), 557–561. https://doi.org/10.1016/j.evolhumbehav.2012.02.003
  • Haraldsen, I. R., Opjordsmoen, S., Egeland, T., & Finset, A. (2003). Sex-sensitive cognitive performance in untreated patients with early onset gender identity disorder. Psychoneuroendocrinology, 28(7), 906–915. https://doi.org/10.1016/S0306-4530(02)00107-5
  • Hare, L., Bernard, P., Sánchez, F. J., Baird, P. N., Vilain, E., Kennedy, T., & Harley, V. R. (2009). Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biological Psychiatry, 65(1), 93–96. https://doi.org/10.1016/j.biopsych.2008.08.033
  • Heylens, G., De Cuypere, G., Zucker, K. J., Schelfaut, C., Elaut, E., Vanden Bossche, H., De Baere, E., & T’Sjoen, G. (2012). Gender identity disorder in twins: A review of the case report literature. The Journal of Sexual Medicine, 9(3), 751–757. https://doi.org/10.1111/j.1743-6109.2011.02567.x
  • Hines, M., Constantinescu, M., & Spencer, D. (2015). Early androgen exposure and human gender development. Biology of Sex Differences, 6(1), 3–3. https://doi.org/10.1186/s13293-015-0022-1
  • Hoekzema, E., Schagen, S. E. E., Kreukels, B. P. C., Veltman, D. J., Cohen-Kettenis, P. T., Delemarre-van de Waal, H., & Bakker, J. (2015). Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology, 55, 59–71. https://doi.org/10.1016/j.psyneuen.2015.01.016
  • Inoubli, A., De Cuypere, G., Rubens, R., Heylens, G., Elaut, E., Van Caenegem, E., Menten, B., & T’Sjoen, G. (2011). Karyotyping, is it worthwhile in transsexualism? The Journal of Sexual Medicine, 8(2), 475–478. https://doi.org/10.1111/j.1743-6109.2010.02130.x
  • James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. transgender survey.
  • Joel, D., Garcia-Falgueras, A., & Swaab, D. (2020). The complex relationships between sex and the brain. The Neuroscientist, 26(2), 156–169. 10.1177/1073858419867298
  • Karalexi, M. A., Georgakis, M. K., Dimitriou, N. G., Vichos, T., Katsimpris, A., Petridou, E. T., & Papadopoulos, F. C. (2020). Gender-affirming hormone treatment and cognitive function in transgender young adults: A systematic review and meta-analysis. Psychoneuroendocrinology, 119, 104721–104721. https://doi.org/10.1016/j.psyneuen.2020.104721
  • Karstens, A. J., Ajilore, O., Rubin, L. H., Yang, S., Zhang, A., Leow, A., Kumar, A., & Lamar, M. (2017). Investigating the separate and interactive associations of trauma and depression on brain structure: Implications for cognition and aging. International Journal of Geriatric Psychiatry, 32(11), 1190–1199. https://doi.org/10.1002/gps.4755
  • Khorashad, B. S., Manzouri, A., Feusner, J. D., & Savic, I. (2021). Cross-sex hormone treatment and own-body perception: Behavioral and brain connectivity profiles. Scientific Reports, 11(1), 2799–2799. https://doi.org/10.1038/s41598-020-80687-2
  • Kilpatrick, L. A., Holmberg, M., Manzouri, A., & Savic, I. (2019). Cross sex hormone treatment is linked with a reversal of cerebral patterns associated with gender dysphoria to the baseline of cisgender controls. The European Journal of Neuroscience, 50(8), 3269–3281. https://doi.org/10.1111/ejn.14420
  • Kim, G.-W., Kim, S.-K., & Jeong, G.-W. (2016). Neural activation-based sexual orientation and its correlation with free testosterone level in postoperative female-to-male transsexuals: Preliminary study with 3.0-T fMRI. Surgical and Radiologic Anatomy, 38(2), 245–252. https://doi.org/10.1007/s00276-015-1547-z
  • Kim, T.-H., Kim, G.-W., Kim, S.-K., & Jeong, G.-W. (2016). Brain activation-based sexual orientation in female-to-male transsexuals. International Journal of Impotence Research, 28(1), 31–38. https://doi.org/10.1038/ijir.2015.29
  • Koenecke, A., Nam, A., Lake, E., Nudell, J., Quartey, M., Mengesha, Z., Toups, C., Rickford, J. R., Jurafsky, D., & Goel, S. (2020). Racial disparities in automated speech recognition. Proceedings of the National Academy of Sciences of the United States of America, 117(14), 7684–7689. https://doi.org/10.1073/pnas.1915768117
  • Kraemer, B., Hobi, S., Rufer, M., Hepp, U., Büchi, S., & Schnyder, U. (2010). Partnerschaft und Sexualität von Frau-zu-Mann transsexuellen Männern. Psychotherapie, Psychosomatik, Medizinische Psychologie, 60(1), 25–30. https://doi.org/10.1055/s-0028-1103264
  • Kranz, G. S., Hahn, A., Kaufmann, U., Kublbock, M., Hummer, A., Ganger, S., Seiger, R., Winkler, D., Swaab, D. F., Windischberger, C., Kasper, S., & Lanzenberger, R. (2014). White matter microstructure in transsexuals and controls investigated by diffusion tensor imaging. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 34(46), 15466–15475. https://doi.org/10.1523/JNEUROSCI.2488-14.2014
  • Kruijver, F. P. M., Fernández-Guasti, A., Fodor, M., Kraan, E. M., & Swaab, D. F. (2001). Sex differences in androgen receptors of the human mamillary bodies are related to endocrine status rather than to sexual orientation or transsexuality. The Journal of Clinical Endocrinology and Metabolism, 86(2), 818–827. https://doi.org/10.1210/jcem.86.2.7258
  • Kruijver, F. P. M., Zhou, J.-N., Pool, C. W., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (2000). Male-to-female transsexuals have female neuron numbers in a limbic nucleus. The Journal of Clinical Endocrinology & Metabolism, 85(5), 2034–2041. https://doi.org/10.1210/jcem.85.5.6564
  • Ku, H.-L., Lin, C.-S., Chao, H.-T., Tu, P.-C., Li, C.-T., Cheng, C.-M., Su, T.-P., Lee, Y.-C., & Hsieh, J.-C. (2013). Brain signature characterizing the body-brain-mind axis of transsexuals. PloS One, 8(7), e70808–e70808. https://doi.org/10.1371/journal.pone.0070808
  • Kuper, L. E., Nussbaum, R., & Mustanski, B. (2011). Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. Journal of Sex Research, 49, 244–254 https://doi.org/10.1080/00224499.2011.596954
  • Leiner, J. E. M., Scherndl, T., & Ortner, T. M. (2018). How do men and women perceive a high-stakes test situation? Frontiers in Psychology, 9, 2216–2216. https://doi.org/10.3389/fpsyg.2018.02216
  • Leinung, M., & Wu, C. (2017). The biologic basis of transgender identity: 2D:4D finger length ratios implicate a role for prenatal androgen activity. Endocrine Practice, 23(6), 669–671. https://doi.org/10.4158/EP161528.OR
  • Lenroot, R. K., Gogtay, N., Greenstein, D. K., Wells, E. M., Wallace, G. L., Clasen, L. S., Blumenthal, J. D., Lerch, J., Zijdenbos, A. P., Evans, A. C., Thompson, P. M., & Giedd, J. N. (2007). Sexual dimorphism of brain developmental trajectories during childhood and adolescence. NeuroImage, 36(4), 1065–1073. https://doi.org/10.1016/j.neuroimage.2007.03.053
  • Leslie, M. (2019). The mismeasure of hands? Science (New York, N.Y.), 364(6444), 923–925. https://doi.org/10.1126/science.364.6444.923
  • Lin, C.-S., Ku, H.-L., Chao, H.-T., Tu, P.-C., Li, C.-T., Cheng, C.-M., Su, T.-P., Lee, Y.-C., & Hsieh, J.-C. (2014). Neural network of body representation differs between transsexuals and cissexuals. PloS One, 9(1), e85914–e85914. https://doi.org/10.1371/journal.pone.0085914
  • Lolli, L., Batterham, A. M., Kratochvíl, L., Flegr, J., Weston, K. L., & Atkinson, G. (2017). A comprehensive allometric analysis of 2nd digit length to 4th digit length in humans. Proceedings of the Royal Society B: Biological Sciences, 284(1857), 20170356–20170356. https://doi.org/10.1098/rspb.2017.0356
  • Lombardo, F., Toselli, L., Grassetti, D., Paoli, D., Masciandaro, P., Valentini, F., Lenzi, A., & Gandini, L. (2013). Hormone and genetic study in male to female transsexual patients. Journal of Endocrinological Investigation, 36(8), 550–557. https://doi.org/10.3275/8813[PMC][23324476]
  • Luders, E., Sánchez, F. J., Gaser, C., Toga, A. W., Narr, K. L., Hamilton, L. S., & Vilain, E. (2009). Regional gray matter variation in male-to-female transsexualism. NeuroImage, 46(4), 904–907. https://doi.org/10.1016/j.neuroimage.2009.03.048
  • Lutchmaya, S., Baron-Cohen, S., Raggatt, P., Knickmeyer, R., & Manning, J. T. (2004). 2nd to 4th digit ratios, fetal testosterone and estradiol. Early Human Development, 77(1–2), 23–28. https://doi.org/10.1016/j.earlhumdev.2003.12.002
  • Majid, D. S. A., Burke, S. M., Manzouri, A., Moody, T. D., Dhejne, C., Feusner, J. D., & Savic, I. (2020). Neural systems for own-body processing align with gender identity rather than birth-assigned sex. Cerebral Cortex (New York, N.Y.: 1991), 30(5), 2897–2909. https://doi.org/10.1093/cercor/bhz282
  • Manning, J. T. (2017). Prenatal sex steroids and transgender identity: Is there a link with digit ratio? Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 23(6), 738–740. https://doi.org/10.4158/EP171843.CO
  • Manning, J. T., Churchill, A. J. G., & Peters, M. (2007). The effects of sex, ethnicity, and sexual orientation on self-measured digit ratio (2D:4D). Archives of Sexual Behavior, 36(2), 223–233. https://doi.org/10.1007/s10508-007-9171-6
  • Manning, J. T., & Fink, B. (2008). Digit ratio (2D:4D), dominance, reproductive success, asymmetry, and sociosexuality in the BBC Internet Study. American Journal of Human Biology: The Official Journal of the Human Biology Council, 20(4), 451–461. https://doi.org/10.1002/ajhb.20767
  • Manning, J. T., Scutt, D., Wilson, J., & Lewis-Jones, D. I. (1998). The ratio of 2nd to 4th digit length: A predictor of sperm numbers and concentrations of testosterone, ­luteinizing hormone and oestrogen. Human Reproduction (Oxford, England), 13(11), 3000–3004. https://doi.org/10.1093/humrep/13.11.3000
  • Manzouri, A., Kosidou, K., & Savic, I. (2017). Anatomical and functional findings in female-to-male transsexuals: Testing a new hypothesis. Cerebral Cortex, 27(2), 998–1010. https://doi.org/10.1093/cercor/bhv278
  • Manzouri, A., & Savic, I. (2019). Possible neurobiological underpinnings of homosexuality and gender dysphoria. Cerebral Cortex (New York, N.Y.: 1991), 29(5), 2084–2101. https://doi.org/10.1093/cercor/bhy090
  • Matsuno, E., & Budge, S. L. (2017). Non-binary/genderqueer identities: A critical review of the literature. Current Sexual Health Reports, 9(3), 116–120. 10.1007/s11930-017-0111-8
  • Moser, C. (2010). Blanchard’s autogynephilia theory: A critique. Journal of Homosexuality, 57(6), 790–809. https://doi.org/10.1080/00918369.2010.486241
  • Mueller, S. C., Landré, L., Wierckx, K., & T’Sjoen, G. (2017). A structural magnetic resonance imaging study in transgender persons on cross-sex hormone therapy. Neuroendocrinology, 105(2), 123–130. https://doi.org/10.1159/000448787
  • Mueller, S. C., Wierckx, K., Jackson, K., & T’Sjoen, G. (2016). Circulating androgens correlate with resting-state MRI in transgender men. Psychoneuroendocrinology, 73, 91–98. https://doi.org/10.1016/j.psyneuen.2016.07.212
  • Nota, N. M., Burke, S. M., den Heijer, M., Soleman, R. S., Lambalk, C. B., Cohen-Kettenis, P. T., Veltman, D. J., & Kreukels, B. P. (2017a). Brain sexual differentiation and effects of cross-sex hormone therapy in transpeople: A resting-state functional magnetic resonance study. Neurophysiologie Clinique = Clinical Neurophysiology, 47(5-6), 361–370. https://doi.org/10.1016/j.neucli.2017.09.001
  • Nota, N. M., Kreukels, B. P. C., den Heijer, M., Veltman, D. J., Cohen-Kettenis, P. T., Burke, S. M., & Bakker, J. (2017b). Brain functional connectivity patterns in children and adolescents with gender dysphoria: Sex-atypical or not? Psychoneuroendocrinology, 86, 187–195. https://doi.org/10.1016/j.psyneuen.2017.09.014
  • Pauly, I. (1998). Current concepts in transgender identity (p. 248), D. Denny (Ed.). Garland Publishing, Inc.
  • Peters, M., Lehmann, W., Takahira, S., Takeuchi, Y., & Jordan, K. (2006). Mental rotation test performance in four cross-cultural samples (n = 3367): Overall sex differences and the role of academic program in performance. Cortex; A Journal Devoted to the Study of the Nervous System and Behavior, 42(7), 1005–1014. https://doi.org/10.1016/S0010-9452(08)70206-5
  • Phoenix, C. H., Goy, R. W., Gerall, A. A., & Young, W. C. (1959). Organizing action of prenatally administered testosterone propionate on the tissues mediating behavior in the female guinea pig. Endocrinology, 65(3), 369–382. https://doi.org/10.1210/endo-65-3-369
  • Puckett, J. A., Glozier, K., Kimball, D., Giffel, R. (2021). A systematic review of sexuality measurement in transgender and gender diverse populations. Psychology of Sexual Orientation and Gender Diversity, 8(3), 276–291. https://doi.org/10.1037/sgd0000523
  • Puts, D. A., McDaniel, M. A., Jordan, C. L., & Breedlove, S. M. (2008). Spatial ability and prenatal androgens: Meta-analyses of congenital adrenal hyperplasia and digit ratio (2D:4D) studies. Archives of Sexual Behavior, 37(1), 100–111. https://doi.org/10.1007/s10508-007-9271-3
  • Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Segovia, S., Gomez, Á., & Guillamon, A. (2011). White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. Journal of Psychiatric Research, 45(2), 199–204. https://doi.org/10.1016/j.jpsychires.2010.05.006
  • Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Zubiarre-Elorza, L., Segovia, S., Gomez, Á., & Guillamon, A. (2011). The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study. Journal of Psychiatric Research, 45(7), 949–954. https://doi.org/10.1016/j.jpsychires.2010.11.007
  • Reisner, S. L., Deutsch, M. B., Bhasin, S., Bockting, W., Brown, G. R., Feldman, J., Garofalo, R., Kreukels, B., Radix, A., Safer, J. D., Tangpricha, V., TʼSjoen, G., & Goodman, M. (2016). Advancing methods for US transgender health research. Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 198–207. https://doi.org/10.1097/MED.0000000000000229
  • Ribeiro, E., Neave, N., Morais, R. N., & Manning, J. T. (2016). Direct versus indirect measurement of digit ratio (2D:4D). Evolutionary Psychology, 14(1), 147470491663253–147470491663253. https://doi.org/10.1177/1474704916632536
  • Richards, G., Browne, W. V., Aydin, E., Constantinescu, M., Nave, G., Kim, M. S., & Watson, S. J. (2020). Digit ratio (2D:4D) and congenital adrenal hyperplasia (CAH): Systematic literature review and meta-analysis. Hormones and Behavior, 126, 104867–104867. https://doi.org/10.1016/j.yhbeh.2020.104867
  • Rosenfeld, C. S. (2017). Brain sexual differentiation and requirement of SRY: Why or why not? Frontiers in Neuroscience, 11, 632. https://doi.org/10.3389/fnins.2017.00632
  • Sadr, M., Khorashad, B. S., Talaei, A., Fazeli, N., & Hönekopp, J. (2020). 2D:4D suggests a role of prenatal testosterone in gender dysphoria. Archives of Sexual Behavior, 49(2), 421–432. https://doi.org/10.1007/s10508-020-01630-0
  • Sanders, A. R., Duan, J., Levinson, D. F., Shi, J., He, D., Hou, C., Burrell, G. J., Rice, J. P., Nertney, D. A., Olincy, A., Rozic, P., Vinogradov, S., Buccola, N. G., Mowry, B. J., Freedman, R., Amin, F., Black, D. W., Silverman, J. M., Byerley, W. F., … Gejman, P. V. (2008). No significant association of 14 candidate genes with Schizophrenia in a large European ancestry sample: Implications for psychiatric genetics. The American Journal of Psychiatry, 165(4), 497–506. https://doi.org/10.1176/appi.ajp.2007.07101573
  • Savic, I., & Arver, S. (2011). Sex dimorphism of the brain in male-to-female transsexuals. Cerebral Cortex (New York, N.Y.: 1991), 21(11), 2525–2533. https://doi.org/10.1093/cercor/bhr032
  • Schneider, H., Pickel, J., & Stalla, G. (2006). Typical female 2nd–4th finger length (2D:4D) ratios in male-to-female transsexuals—Possible implications for prenatal androgen exposure. Psychoneuroendocrinology, 31(2), 265–269. https://doi.org/10.1016/j.psyneuen.2005.07.005
  • Schneider, M. A., Spritzer, P. M., Minuzzi, L., Frey, B. N., Syan, S. K., Fighera, T. M., Schwarz, K., Costa, Â. B., da Silva, D. C., Garcia, C. C. G., Fontanari, A. M. V., Real, A. G., Anes, M., Castan, J. U., Cunegatto, F. R., & Lobato, M. I. R. (2019). Effects of estradiol therapy on resting-state functional connectivity of transgender women after gender-affirming related gonadectomy. Frontiers in Neuroscience, 13, 817. https://doi.org/10.3389/fnins.2019.00817
  • Schöning, S., Engelien, A., Bauer, C., Kugel, H., Kersting, A., Roestel, C., Zwitserlood, P., Pyka, M., Dannlowski, U., Lehmann, W., Heindel, W., Arolt, V., & Konrad, C. (2010). Neuroimaging differences in spatial cognition between men and male-to-female transsexuals before and during hormone therapy. The Journal of Sexual Medicine, 7(5), 1858–1867. https://doi.org/10.1111/j.1743-6109.2009.01484.x
  • Seiger, R., Hahn, A., Hummer, A., Kranz, G. S., Ganger, S., Woletz, M., Kraus, C., Sladky, R., Kautzky, A., Kasper, S., Windischberger, C., & Lanzenberger, R. (2016). Subcortical gray matter changes in transgender subjects after long-term cross-sex hormone administration. Psychoneuroendocrinology, 74, 371–379. https://doi.org/10.1016/j.psyneuen.2016.09.028
  • Siegmann, E.-M., Müller, T., Dziadeck, I., Mühle, C., Lenz, B., & Kornhuber, J. (2020). Digit ratio (2D:4D) and transgender identity: New original data and a meta-analysis. Scientific Reports, 10(1), 19326–19326. https://doi.org/10.1038/s41598-020-72486-6
  • Simon, L., Kozák, L. R., Simon, V., Czobor, P., Unoka, Z., Szabó, Á., & Csukly, G. (2013). Regional grey matter structure differences between transsexuals and healthy controls—A voxel based morphometry study. PloS One, 8(12), e83947–e83947. https://doi.org/10.1371/journal.pone.0083947
  • Smith, E., Junger, J., Pauly, K., Kellermann, T., Neulen, J., Neuschaefer-Rube, C., Derntl, B., & Habel, U. (2018). Gender incongruence and the brain – Behavioral and neural correlates of voice gender perception in transgender people. Hormones and Behavior, 105, 11–21. https://doi.org/10.1016/j.yhbeh.2018.07.001
  • Smith, E. S., Junger, J., Derntl, B., & Habel, U. (2015). The transsexual brain—A review of findings on the neural basis of transsexualism. Neuroscience and Biobehavioral Reviews, 59, 251–266. https://doi.org/10.1016/j.neubiorev.2015.09.008
  • Soleman, R. S., Schagen, S. E. E., Veltman, D. J., Kreukels, B. P. C., Cohen-Kettenis, P. T., Lambalk, C. B., Wouters, F., & Delemarre-van de Waal, H. A. (2013). Sex differences in verbal fluency during adolescence: A functional magnetic resonance imaging study in gender dysphoric and control boys and girls. The Journal of Sexual Medicine, 10(8), 1969–1977. https://doi.org/10.1111/jsm.12083
  • Sosa, M., Jódar, E., Arbelo, E., Domínguez, C., Saavedra, P., Torres, A., Salido, E., Limiñana, J. M., Gómez De Tejada, M. J., & Hernández, D. (2004). Serum lipids and estrogen receptor gene polymorphisms in male-to-female transsexuals: Effects of estrogen treatment. European Journal of Internal Medicine, 15(4), 231–237. https://doi.org/10.1016/j.ejim.2004.04.009
  • Spies, M., Hahn, A., Kranz, G. S., Sladky, R., Kaufmann, U., Hummer, A., Ganger, S., Kraus, C., Winkler, D., Seiger, R., Comasco, E., Windischberger, C., Kasper, S., & Lanzenberger, R. (2016). Gender transition affects neural correlates of empathy: A resting state functional connectivity study with ultra high-field 7T MR imaging. NeuroImage, 138, 257–265. https://doi.org/10.1016/j.neuroimage.2016.05.060
  • Stryker, S. (2017). Transgender history: The roots of today’s revolution. Seal Press.
  • Taziaux, M., Staphorsius, A. S., Ghatei, M. A., Bloom, S. R., Swaab, D. F., & Bakker, J. (2016). Kisspeptin expression in the human infundibular nucleus in relation to sex, gender identity, and sexual orientation. The Journal of Clinical Endocrinology and Metabolism, 101(6), 2380–2389. https://doi.org/10.1210/jc.2015-4175
  • Taziaux, M., Swaab, D. F., & Bakker, J. (2012). Sex differences in the neurokinin B system in the human infundibular nucleus. The Journal of Clinical Endocrinology and Metabolism, 97(12), E2210–E2220. https://doi.org/10.1210/jc.2012-1554
  • Terlecki, M. S., & Newcombe, N. S. (2005). How important is the digital divide? The relation of computer and videogame usage to gender differences in mental rotation ability. Sex Roles, 53(5-6), 433–441. https://doi.org/10.1007/s11199-005-6765-0
  • Terlecki, M. S., Newcombe, N. S., & Little, M. (2008). Durable and generalized effects of spatial experience on mental rotation: Gender differences in growth patterns. Applied Cognitive Psychology, 22(7), 996–1013. https://doi.org/10.1002/acp.1420
  • Ujike, H., Otani, K., Nakatsuka, M., Ishii, K., Sasaki, A., Oishi, T., Sato, T., Okahisa, Y., Matsumoto, Y., Namba, Y., Kimata, Y., & Kuroda, S. (2009). Association study of gender identity disorder and sex hormone-related genes. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 33(7), 1241–1244. https://doi.org/10.1016/j.pnpbp.2009.07.008
  • Uribe, C., Junque, C., Gómez-Gil, E., Abos, A., Mueller, S. C., & Guillamon, A. (2020). Data for functional MRI connectivity in transgender people with gender incongruence and cisgender individuals. Data in Brief, 31, 105691–105691. https://doi.org/10.1016/j.dib.2020.105691
  • Van Goozen, S. H. M., Slabbekoorn, D., Gooren, L. J. G., Sanders, G., & Cohen-Kettenis, P. T. (2002). Organizing and activating effects of sex hormones in homosexual transsexuals. Behavioral Neuroscience, 116(6), 982–988. https://doi.org/10.1037/0735-7044.116.6.982
  • Veale, J. F. (2014). Evidence against a typology: A taxometric analysis of the sexuality of male-to-female transsexuals. Archives of Sexual Behavior, 43(6), 1177–1186. https://doi.org/10.1007/s10508-014-0275-5
  • Veale, J. F., Clarke, D. E., & Lomax, T. C. (2010). Biological and psychosocial correlates of adult gender-variant identities. Personality and Individual Differences, 48, 252–257. https://doi.org/10.1016/j.paid.2009.09.018
  • Veale, J. F., Deutsch, M. B., Devor, A. H., Kuper, L. E., Motmans, J., Radix, A. E., & Amand, C. S. (2022). Setting a research agenda in trans health: An expert assessment of priorities and issues by trans and nonbinary researchers. International Journal of Transgender Health, 1–17. https://doi.org/10.1080/26895269.2022.2044425
  • Voracek, M. (2014). No effects of androgen receptor gene CAG and GGC repeat polymorphisms on digit ratio (2D:4D): A comprehensive meta-analysis and critical evaluation of research. Evolution and Human Behavior, 35(5), 430–437. https://doi.org/10.1016/j.evolhumbehav.2014.05.009
  • Voracek, M., Kaden, A., Kossmeier, M., Pietschnig, J., & Tran, U. S. (2018). Meta-analysis shows associations of digit ratio (2D:4D) and transgender identity are small at best. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 24(4), 386–390. https://doi.org/10.4158/EP-2017-0024
  • Voracek, M., & Loibl, L. M. (2009). Scientometric analysis and bibliography of digit ratio (2D:4D) research, 1998–2008. Psychological Reports, 104(3), 922–956. https://doi.org/10.2466/PR0.104.3.922-956
  • Voracek, M., Manning, J. T., & Dressler, S. G. (2007). Repeatability and interobserver error of digit ratio (2D:4D) measurements made by experts. American Journal of Human Biology: The Official Journal of the Human Biology Council, 19(1), 142–146. https://doi.org/10.1002/ajhb.20581
  • Voyer, D., & Bryden, M. P. (1990). Gender, level of spatial ability, and lateralization of mental rotation. Brain and Cognition, 13(1), 18–29. https://doi.org/10.1016/0278-2626(90)90037-O
  • Wallien, M. S., Zucker, K. J., Steensma, T. D., & Cohen-Kettenis, P. T. (2008). 2D: 4D finger-length ratios in children and adults with gender identity disorder. Hormones and Behavior, 54, 450–454.
  • Wong, W. I., & Hines, M. (2016). Interpreting digit ratio (2D:4D)–behavior correlations: 2D:4D sex difference, stability, and behavioral correlates and their replicability in young children. Hormones and Behavior, 78, 86–94. https://doi.org/10.1016/j.yhbeh.2015.10.022
  • Woo, C.-W., Krishnan, A., & Wager, T. D. (2014). Cluster-extent based thresholding in fMRI analyses: Pitfalls and recommendations. NeuroImage, 91, 412–419. https://doi.org/10.1016/j.neuroimage.2013.12.058
  • Young, W. C., Goy, R. W., & Phoenix, C. H. (1964). Hormones and sexual behavior: Broad relationships exist between the gonadal hormones and behavior. Science (New York, N.Y.), 143(3603), 212–218. https://doi.org/10.1126/science.143.3603.212
  • Zhou, H.-X., Chen, X., Shen, Y.-Q., Li, L., Chen, N.-X., Zhu, Z.-C., Castellanos, F. X., & Yan, C.-G. (2020). Rumination and the default mode network: Meta-analysis of brain imaging studies and implications for depression. NeuroImage, 206, 116287–116287. https://doi.org/10.1016/j.neuroimage.2019.116287
  • Zhou, J.-N., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (1995). A sex difference in the human brain and its relation to transsexuality. Nature, 378(6552), 68–70. https://doi.org/10.1038/378068a0
  • Zou, J., & Schiebinger, L. (2018). AI can be sexist and racist—It’s time to make it fair. Nature, 559(7714), 324–326. https://doi.org/10.1038/d41586-018-05707-8
  • Zubiaurre-Elorza, L., Junque, C., Gómez-Gil, E., & Guillamon, A. (2014). Effects of cross-sex hormone treatment on cortical thickness in transsexual individuals. The Journal of Sexual Medicine, 11(5), 1248–1261. https://doi.org/10.1111/jsm.12491
  • Zubiaurre-Elorza, L., Junque, C., Gomez-Gil, E., Segovia, S., Carrillo, B., Rametti, G., & Guillamon, A. (2013). Cortical thickness in untreated transsexuals. Cerebral Cortex (New York, N.Y.: 1991), 23(12), 2855–2862. https://doi.org/10.1093/cercor/bhs267

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