ReviewChild and adolescent psychiatry and mental health2025
Neuroimaging insights into transgender and gender nonconfirming youth: a scoping review.
Review in Child and adolescent psychiatry and mental health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGender incongruence in adolescents is a relevant condition in which the gender identity of a person does not correspond with the birth-assigned sex. Individuals with gender dysphoria can experience a distressing burden. The etiology seems to be predominantly biological, but only a few neurobiological correlates have been identified and are not yet embedded in a broader context. The aim of this review is to present an overview about the current state of the literature regarding MRI brain findings in adolescents < 22 years of age with GD/GI also including non-binary identifying adolescents < 22 years. Findings will be discussed considering (a) sample characteristics, (b) the status of possible hormonal therapy including puberty blockers and (c) non-binary identifying persons and from a general ethical perspective.
methodsA systematic review was conducted using PubMed/Medline with keywords: "gender dysphoria," "gender incongruence," "gender identity," "non-binary," "MRI," and "adolescents." The term "transsexualism" was used to include literature published before the term change related to ICD-11. The protocol was pre-registered (INPLASY2023110074).
resultsWe scanned 360 articles and finally included n = 20 studies in the review. We found that studies on adolescents with gender dysphoria are mostly addressing functional imaging. Studies were predominantly limited by cross-sectional designs. N = 3 longitudinal studies were performed in female-to-male-transgender persons before and after beginning with gender affirming hormonal therapy (GAHT). To our knowledge there has never been performed a longitudinal study in male to female adolescents during GAHT. Non-binary aspects were mostly not taken into account. Ethical implications concerning the interpretation of neuroimaging findings in this field have been rarely discussed.
conclusionThere is a lack of robust neuroimaging data on GI/GD adolescents, particularly from longitudinal studies, which are crucial for understanding neurobiological processes. Non-binary identifying adolescents should be given more consideration in research. Future research should include non-binary adolescents and integrate ethical considerations to prevent misinterpretation or stigmatization. Neuroimaging should not reduce gender diversity to neurobiology but rather contribute to a more nuanced understanding of gender identity.
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