Abstract
There are opportunities to improve neuroscience that include lesbian, gay, bisexual,
and transgender (LGBT) people. In this review, we briefly describe how the history
of LGBT people in psychiatry has influenced neuroimaging approaches; how these attitudes
have shifted over time; and what we can do to ensure that our future work is rigorous,
ethical, and in service of the LGBT community. We suggest ways to refine neuroimaging
methodologies to improve our understanding of marginalization and stigma while shifting
away from research that focuses solely on the “etiology” or origins of LGBT identities.
We also offer suggestions for conducting representative research that is LGBT-inclusive,
regardless of the population of interest.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological Psychiatry: Cognitive Neuroscience and NeuroimagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.National Academies Press, Washinton, DC2011
- Out of DSM: Depathologizing homosexuality.Behav Sci. 2015; 5: 565-575
- Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD.Int Rev Psychiatry. 2015; 27: 386-395
- Gender incongruence/gender dysphoria and its classification history.Int Rev Psychiatry. 2016; 28: 5-12
- The DSM-5 and the politics of diagnosing transpeople.Arch Sex Behav. 2015; 44: 1165-1176
- Dual Intergroup Meanings of Essentialism: Implications for Understanding Prejudice Towards African Americans and Gay Men.Stony Brook University Press, Stony Brook, NY2007
- Sexism and racism: Old-fashioned and modern prejudices.J Pers Soc Psychol. 1995; 68: 199-214
- Final Solutions: Biology, Prejudice, and Genocide.Penn State University Press, University Park, PA1992
- Epistemic injustice in brain studies of (Trans)gender identity.Front Sociol. 2021; 26: 63
- Abandon “race.” Focus on racism.Front Public Health. 2021; 9689462
- Why genes don’t count (for racial differences in health).Am J Public Health. 2000; 90: 1699
- Anthropological insights into the use of race/ethnicity to explore genetic contributions to disparities in health.J Biosoc Sci. 2006; 38: 83-102
- Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.Proc Natl Acad Sci U S A. 2016; 113: 4296-4301
- On the history of biological theories of homosexuality.J Homosex. 2010; 28: 31-56
- Straight: The Surprisingly Short History of Heterosexuality.Beacon Press, Boston2012
- Cerebral sex dimorphism and sexual orientation.Hum Brain Mapp. 2018; 39: 1175-1186
- Cortical brain structure and sexual orientation in adult females with bipolar disorder or attention deficit hyperactivity disorder.Brain Behav. 2018; 8e00998
- Pelvic politics: Sexual dimorphism and racial difference.Signs. 2001; 26: 389-414
- American Eugenics: Race, Queer Anatomy, and the Science of Nationalism.University of Minnesota Press, Minneapolis, MN2003
- A systematic review of the neural correlates of sexual minority stress: Towards an intersectional minority mosaic framework with implications for a future research agenda.Eur J Psychotraumatol. 2022; 132002572
- Corpus callosum anatomy in right-handed homosexual and heterosexual men.Arch Sex Behav. 2008; 37: 857-863
- Sexual orientation and its basis in brain structure and function.Proc Natl Acad Sci U S A. 2008; 105: 10273-10274
- PET and MRI show differences in cerebral asymmetry and functional connectivity between homo- and heterosexual subjects.Proc Natl Acad Sci U S A. 2008; 105: 9403-9408
- A functional endophenotype for sexual orientation in humans.Neuroimage. 2006; 33: 825-833
- Possible neurobiological underpinnings of homosexuality and gender dysphoria.Cereb Cortex. 2019; 29: 2084-2101
- Neural correlates of sexual arousal in homosexual and heterosexual men.Behav Neurosci. 2007; 121: 237-248
- Neural activation toward erotic stimuli in homosexual and heterosexual males.J Sex Med. 2011; 8: 3132-3143
- Neural circuits of disgust induced by sexual stimuli in homosexual and heterosexual men: An fMRI study.Eur J Radiol. 2011; 80: 418-425
- Face perception is modulated by sexual preference.Curr Biol. 2006; 16: 63-68
Levin RN, Erickson-Schroth L, Mak K, Edmiston EK, (in press): Biological studies of transgender identity: A critical review. J Gay Lesbian Ment Health.
- Stigma, mental health, and resilience in an online sample of the US transgender population.Am J Public Health. 2013; 103: 943-951
- Minority Stress and Lesbian Women.Lexington Books, Lexington, MA1981
- Minority stress and mental health in gay men.J Health Soc Behav. 1995; 36: 38-56
- Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence.Psychol Bull. 2003; 129: 674-697
- Cerebral gray matter volume variation in female-to-male transsexuals: A voxel-based morphometric study.Neuroreport. 2015; 26: 1119-1125
- Increased cortical thickness in male-to-female transsexualism.J Behav Brain Sci. 2012; 2: 357-362
- Altered white matter and sensory response to bodily sensation in female-to-male transgender individuals.Arch Sex Behav. 2017; 46: 1223-1237
- Notice of retraction of “A new theory of gender dysphoria incorporating the distress, social behavioral, and body-ownership networks” [retraction of: Gliske SV. In: eNeuro 2019 6(6):ENEURO.0183-19.2019].eNeuro 2020. 2019; 7 (ENEURO.0149-20.2020)
- Position statement on conversion therapy and LGBTQ patients.(Available at:)https://www.psychiatry.org/getattachment/3d23f2f4-1497-4537-b4de-fe32fe8761bf/Position-Conversion-Therapy.pdfDate: 2018Date accessed: July 9, 2022
- Gender-affirming hormone therapy induces specific DNA methylation changes in blood.Clin Epigenetics. 2022; 14: 24
- How computational modeling can force theory building in psychological science.Perspect Psychol Sci. 2021; 16: 789-802
- Theory construction methodology: A practical framework for building theories in psychology.Perspect Psychol Sci. 2021; 16: 756-766
- Theory before the test: How to build high-verisimilitude explanatory theories in psychological science.Perspect Psychol Sci. 2021; 16: 682-697
- Impact of stress and strain on current LGBT health disparities.in: Eckstrand K. Potter J. Trauma, Resilience, and Health Promotion for LGBT Patients: What Every Healthcare Provider Should Know. Springer Press, New York2017: 35-48
- Family acceptance in adolescence and the health of LGBT young adults.J Child Adolesc Psychiatr Nurs. 2010; 23: 205-213
- The experience of parents who support their children’s gender variance.Journal of LGBT Youth. 2015; 12: 39-63
- Guidance and ethical considerations for undertaking transgender health research and institutional review boards adjudicating this research.Transgend Health. 2017; 2: 165-175
- Special report: 3.4% of U.S. adults identify as LGBT. Gallup. October 18..(Available at:)https://news.gallup.com/poll/158066/special-report-adults-identify-lgbt.aspxDate: 2012Date accessed: July 12, 2022
- Standards of care: Uncertainty and risk in Harry Benjamin’s transsexual classifications.Transgender Stud Q. 2021; 8: 462-480
- Characteristics of adolescents referred to a gender clinic: Are youth seen now different from those in initial reports?.Horm Res Paediatr. 2018; 89: 434-441
- Decision-making criteria when contemplating disclosure of transgender identity to medical providers.Health Commun. 2022; 37: 1031-1040
- Sex dimorphism of the brain in male-to-female transsexuals.Cereb Cortex. 2011; 21: 2525-2533
- Brain signature characterizing the body-brain-mind axis of transsexuals.PLoS One. 2013; 8e70808
- Neural network of body representation differs between transsexuals and cissexuals.PLoS One. 2014; 9e85914
- White matter microstructure in transsexuals and controls investigated by diffusion tensor imaging.J Neurosci. 2014; 34: 15466-15475
- More than just two sexes: The neural correlates of voice gender perception in gender dysphoria.PLoS One. 2014; 9e111672
- Subcortical gray matter changes in transgender subjects after long-term cross-sex hormone administration.Psychoneuroendocrinology. 2016; 74: 371-379
- Anatomical and functional findings in female-to-male transsexuals: Testing a new hypothesis.Cereb Cortex. 2017; 27: 998-1010
- Brain sexual differentiation and effects of cross-sex hormone therapy in transpeople: A resting-state functional magnetic resonance study.Neurophysiol Clin. 2017; 47: 361-370
- Testosterone effects on functional amygdala lateralization: A study in adolescent transgender boys and cisgender boys and girls.Psychoneuroendocrinology. 2020; 111104461
- Brain network interactions in transgender individuals with gender incongruence.Neuroimage. 2020; 211116613
- Replication of previous findings? Comparing gray matter volumes in transgender individuals with gender incongruence and cisgender individuals.J Clin Med. 2021; 10: 1454
- Male-to-female gender dysphoria: Gender-specific differences in resting-state networks.Brain Behav. 2017; 7: 691
- Regional gray matter variation in male-to-female transsexualism.Neuroimage. 2009; 46: 904
- Social epidemiology of depression and anxiety by gender identity.J Adolesc Health. 2016; 59: 203-208
- Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th ed.(Available at:)https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdfDate: 2011Date accessed: July 9, 2022
- “I don’t think they thought I was ready”: How pre-transition assessments create care inequities for trans people with complex mental health in Canada.International Journal of Mental Health. 2020; 49: 56-80
- Reluctant educators and self-advocates: Older trans adults’ experiences of health-care services and practitioners in seeking gender-affirming services.Health Expect. 2020; 23: 1231-1240
- Transgender/gender nonconforming adults’ worries and coping actions related to discrimination: Relevance to pharmacist care.Am J Health Pharm. 2019; 76: 512-520
- CPATH Ethical Guidelines for Research Involving Transgender People & Communities.Canadian Professional Association for Transgender Health, Canada2019
- Accounting for research fatigue in research ethics.Bioethics. 2020; 35: 270-276
- Studying trans: Recommendations for ethical recruitment and collaboration with transgender participants in academic research.Psychology & Sexuality. 2018; 9: 102-116
- “Counting” transgender and gender-nonconforming adults in health research: Recommendation from the Gender Identity in US Surveillance Group.TSQ Transgender Studies Quarterly. 2015; 2: 34-57
- Transgender rights rely on inclusive language.Science. 2021; 374: 1568-1569
- Comment on “Large-scale GWAS reveals insights into the genetic architecture of same-sex sexual behavior.Science. 2021; 37: 6536
- Sex hormones adjust “sex-specific” reactive and diurnal cortisol profiles.Psychoneuroendocrinology. 2016; 63: 282-290
- Beyond the binary: Rethinking sex and the brain.Neurosci Biobehav Rev. 2021; 122: 165-175
- The future of sex and gender in psychology: Five challenges to the gender binary.Am Psychol. 2018; 74: 171-193
- Sex beyond the genitalia: The human brain mosaic.Proc Natl Acad Sci U S A. 2015; 112: 15468-15473
- Sex differences in the structural connectome of the human brain.Proc Natl Acad Sci U S A. 2014; 111: 823-828
- Gender & Sex in Methods & Measurement Research Equity Toolkit.Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, BC2022
- A review of instruments that measure LGBTQ affirmation and discrimination constructs in adults.J LGBT Issues Couns. 2017; 11: 230-246
- Measuring multiple minority stress: The LGBT People of Color microaggressions scale.Cultur Divers Ethnic Minor Psychol. 2011; 17: 163-174
- LGBTQ microaggressions and microaffirmations in families: Scale development and validation study.J Homosex. 2020; 67: 600-619
- Advancing research on LGBTQ microaggressions: A psychometric scoping review of measures.J Homosex. 2019; 66: 1345-1379
- An fMRI study on the neural correlates of social conformity to a sexual minority.Sci Rep. 2019; 9: 4691
- Inappropriate comparisons: The LGB population’s missing reference group.J LGBT Issues Couns. 2017; 11: 247-258
- Stigma and diurnal cortisol among transitioning transgender men.Psychoneuroendocrinology. 2017; 82: 59-66
- Lived experience and allostatic load among transmasculine people living in the United States.Psychoneuroendocrinology. 2022; 143105849
- Snapshot: LGBTQ equality by state.(Available at:)https://LGBTmap.org/equality-mapsDate accessed: May 30, 2022
- Experiences of discrimination are associated with greater resting amygdala activity and functional connectivity.Biol Psychiatry Cogn Neurosci Neuroimaging. 2018; 3: 367-378
- Neural correlates of ostracism in transgender persons living according to their gender identity: A potential risk marker for psychopathology?.Psychol Med. 2018; 48: 2313-2320
- Sex differences and gender diversity in stress responses and allostatic load among workers and LGBT people.Curr Psychiatry Rep. 2019; 21: 110
- Daily stressors and diurnal cortisol among sexual and gender minority young adults.Health Psychol. 2021; 40: 145-154
- Cardiovascular and cortisol responses to experimentally-induced minority stress.Health Psychol. 2021; 40: 316-325
- Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men.Psychoneuroendocrinology. 2021; 131105325
- Gay men’s stress response to a general and a specific social stressor.J Neural Transm. 2021; 128: 1325-1333
- The cardiovascular conundrum in ethnic and sexual minorities: A potential biomarker of constant coping with discrimination.Front Neurosci. 2021; 15619171
- Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria.J Adolesc Health. 2015; 57: 374-380
- Sexual orientation and diurnal cortisol patterns in a cohort of U.S. young adults.Psychoneuroendocrinology. 2016; 69: 197-208
- Trait rumination predicts elevated evening cortisol in sexual and gender minority young adults.Int J Environ Res Public Health. 2017; 14: 1365
- Challenges to identitiy integration indirectly link experiences of heterosexist and racist discrimination to lower waking salivary cortisol in sexually diverse Latinx emerging adults.Front Psychol. 2020; 11: 228
- Allostatic load among Black sexual minority women.J Womens Health. 2021; 30: 1165-1170
- Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation.Arch Sex Behav. 2003; 32: 403-417
- Systemic inequalities for LGBTQ professionals in STEM.Sci Adv. 2021; 7eabe0933
- Johannes Heinrich Schultz and National Socialism.Isr J Psychiatry Relat Sci. 2008; 45: 257-262
- “Our one great national malady”: Neurasthenia and American imperial and masculine anxiety at the turn of the twentieth century.J Med Hist. 2021; 30: 393-432
- Eugenic concerns, scientific practices: International relations in the establishment of psychiatric genetics in Germany, Britain, the USA and Scandinavia, c.1910-60.Hist Psychiatry. 2019; 30: 19-37
- Health equity tourism: Ravaging the justice landscape.J Med Syst. 2022; 46: 17
- Unknowing researcher’s vulnerability: Re-searching inequality on an uneven playing field.Journal of Social and Political Psychology. 2016; 4: 521-536
Article Info
Publication History
Published online: August 05, 2022
Accepted:
July 20,
2022
Received in revised form:
July 13,
2022
Received:
March 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
