Gender-affirming hormone treatment and cognitive function in transgender young adults: a systematic review and meta-analysis. (September 2020)

• Record Type: Journal Article
• Authors: Karalexi, Maria A.; Georgakis, Marios K.; Dimitriou, Nikolaos G.; Vichos, Theodoros; Katsimpris, Andreas; Petridou, Eleni Th.; Papadopoulos, Fotios C.
• Is Part Of: Psychoneuroendocrinology. Volume 119(2020)
• Publication Date: 2020-09
• Subjects: gender-affirming hormone treatment -- transgender -- gender incongruence -- cognitive function -- visuospatial ability -- meta-analysis; Psychoneuroendocrinology -- Periodicals; Endocrinology -- Periodicals; Neurology -- Periodicals; Psychiatry -- Periodicals; Neuropsychoendocrinologie -- Périodiques; 616.8
• DOI: 10.1016/j.psyneuen.2020.104721
• Languages: English
• ISSNs: 0306-4530

Abstract

Highlights: Current evidence does not support an adverse impact of gender-affirming hormone therapy on cognitive performance in birth-assigned either male or female transgender individuals An enhanced effect on visuospatial ability following post-pubertal hormone therapy was shown in assigned females Pooling data from cross-sectional studies showed a higher performance in verbal working memory in treated assigned males New longitudinal studies with longer follow-up should explore the long-term effects of hormone therapy, especially the effects on younger individuals, where there is greater scarcity of data Abstract: Background: Previous studies have examined whether steroid hormone treatment in transgender individuals may affect cognitive function; yet, their limited power does not allow firm conclusions to be drawn. We leveraged data from to-date literature aiming to explore the effect of gender-affirming hormone administration on cognitive function in transgender individuals. Methods: A search strategy of MEDLINE was developed (through June 1, 2019) using the key terms transgender, hormone therapy and cognitive function. Eligible were (i) cohort studies examining the longitudinal effect of hormone therapy on cognition, and (ii) cross-sectional studies comparing the cognitive function between treated and non-treated individuals. Standardized mean differences (Hedges' g ) were pooled using random-effects models. Study quality was evaluated using the Newcastle-Ottawa Scale. Outcomes: Ten studies (seven cohort and three cross-sectional) were eligible representing 234 birth-assigned males (aM) and 150 birth-assigned females (aF). The synthesis of cohort studies (n = 5) for visuospatial ability following hormone treatment showed a statistically significant enhancement among aF (g = 0.55, 95% confidence intervals [CI]: 0.29, 0.82) and an improvement with a trend towards statistical significance among aM (g = 0.28, 95%CI: -0.01, 0.58). By contrast, no adverse effects of hormone administration were shown. No heterogeneity was evident in most meta-analyses. Interpretation: Current evidence does not support an adverse impact of hormone therapy on cognitive function, whereas a statistically significant enhancing effect on visuospatial ability was shown in aF. New longitudinal studies with longer follow-up should explore the long-term effects of hormone therapy, especially the effects on younger individuals, where there is greater scarcity of data.