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expert reaction to paper discussing the neurobiological basis of gender dysphoria

A study, published in eNeuro, argues that the symptoms of gender dysphoria are due to changes in network activity, rather than incorrect brain sex.


Prof Derek Hill, Professor of Medical Imaging, UCL, said:

“Gender dysphoria – a conflict between a person’s physical gender and the gender they identify with – is a topic of considerable interest to the research community and general public.  This is partly because there has been a rapid increase in the number of people having medical treatment for this condition over recent years.  Research into the underlying biology of the condition is therefore very welcome.  It is however a challenging research area – as many people with gender dysphoria also have psychological conditions such as anxiety and depression.

“There is a long standing theory that gender dysphoria is associated with underlying difference in the size of brain structures, based on experimental work done in the 1990s.  This latest research involves an analysis of the existing literature on brain scanning in gender dysphoria in order to evaluate whether this brain scanning data supports such a difference in brain structure, or finds any other findings might better account for the differences between individuals with and without gender dysphoria.  The authors find that the size of brain structures alone isn’t a very strong explanation for differences, and propose a new theory of the functional brain mechanisms underlying gender dysphoria.

“The theory the authors propose has support from previous brain scanning studies – however it must be considered quite speculative until further tested.  Brain scanning studies in this area tend to be on small numbers of subjects, with poorly standardised methodology for data collection and analysis, and with varying approaches to controlling for other conditions the individuals suffer from such as anxiety and depression, which could impact the results.  It is quite possible, therefore, that some of the associations suggested here by the authors between gender dysphoria and brain function are chance random findings – the underlying data the authors have looked at is very noisy so the assumptions that underpin their theory are all subject to uncertainty.  Further work to test their theory prospectively would be very helpful in determining whether the theory could be helpful in managing and planning treatment of these individuals.”


Prof Catherina Becker, Acting Director of the Centre for Discovery Brain Sciences, University of Edinburgh, said:

“The present paper is a review and reinterpretation of other studies without providing significant new experimental or epidemiological data.  The author suggests changing current clinical practice and to base treatments for gender dysphoria on his theory instead.  What these treatments should be remains unspecified and these recommendations should therefore be taken with caution.”


‘A new theory of gender dysphoria incorporating the distress, social behavioral, and body-ownership networks’ by Stephen V. Gliske was published in eNeuro at 18:00 UK time on Monday 2 December 2019. 

DOI: 10.1523/ENEURO.0183-19.2019


Declared interests

Prof Derek Hill: “No conflicts of interest.”

Prof Catherina Becker: “No interests to declare.”

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