Project Overview

Trans women may take estradiol-based gender affirming hormone therapy (GAHT) into their old age. Yet, we know little about the long-term brain health effects of GAHT. We propose to further our understanding of the earliest causes and signs of cognitive and brain aging effects in women by exploring the effects of GAHT on trans women’s cognition, brain, and embodied experiences of GAHT. We will elucidate these interactions by administering cognitive tasks, brain imaging, and semi-structured interviews to trans women 55 years and older, with at least 5 years of GHAT and compare them to menopausal (>55 years) cis women taking hormone therapy (HT) and not taking HT and cis men. Our objectives are to explore:

1. Whether and to what extent cognitive performance is different in aging trans women than in cis menopausal women taking and not taking hormone therapy and cis men;
2. Whether or not there are structural differences in medial frontal and hippocampal cortices and functional differences in a paired associates task in regions implicated early in AD and in aging women;
3. The embodied experiences of aging trans woman taking GAHT.

We will use a community-based participatory research framework, with a community advisory group of older trans women to guide our work and help us to ensure that we prioritize their needs and interests. This will be, to our knowledge, the first project to probe the effects of aging and GAHT on the brain health as well as embodied experiences of GAHT and aging in trans women. This is critical in order to further elucidate (i) the role of 17- beta estradiol in cognitive and brain aging for all women; (ii) the long-term brain health effects of GAHT in trans women, and (iii) include this long-neglected group of women in aging and dementia research.