Theory of Gender Dysphonia Incorporating the Distress

Today, the BNST is no longer a black box but has several identified functions. For example, the BNST is a key component of the fear/distress network. Although chronic distress is a defining characteristic of gender dysphonia, the connection between the functional role of the BNST and its association with gender dysphonia appears to have received little consideration. In contrast, the connection between anatomic changes in the body ownership network and gender dysphonia has been a focus of several recent studies. The results on both the distress and body ownership networks suggest a theory in which each aspect of gender dysphonia is explained by the functional significance of known neuroanatomical differences. Specifically, I hypothesized that in individuals with gender dysphonia, the aspects of chronic distress, gender atypical behaviour, and incongruence between perception of gender identity and body sex are all directly related to the functional implications of the underlying differences in neurobiology. I considered the plausibility of this hypothesis by examining published literature regarding the function and behavioural roles of neuronal substrates found to be different in transgender individuals

Significance Statement

My new model highlights connections between multiple dimensions of gender dysphoria and behavioral neuroscience data, explaining the experience of gender dysphoria using relevant neural substrates and networks. This biology/symptom-based approach provides an updated theory of gender dysphoria, fostering new hypotheses to advance basic understanding of the condition. If supported by future studies, this theory could be the next step towards discovering currently unseen doors for improving the lives of those with gender dysphoria.

Dynamic activity on functional networks

The multisense theory proposes that gender dysphoria is not merely due to static changes in anatomy, as in the previous opposite brain sex theory, but instead includes dynamic activity on interacting, functional networks. This dynamic aspect can explain the distinctness of gender dysphoria from being gender atypical, accounts for the variety of onset ages and both persistent and desistant cases, and is still consistent with the anatomic findings. Changes in sex hormones due to puberty (or aging) could also affect these identified networks, explaining both resolution without treatment in childhood-onset cases and the possibility of late-onset cases. Data now support that each of these dimensions distress, gender conformity, and body ownership/perception are associated with specific functional neural networks, which is part of the basis of the multisense theory. The multisense theory is also consistent with recent meta-analyses, as follows: the data presented show that the brains of transgender individuals are not simply altered along a male/female dimension to be more like their desired gender, even in studies that controlled for sexual orientation. Thus, overall, the available published data are consistent with the multisense theory of gender dysphoria.

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Regards,
Nancy EllaDual Diagnosis: Open Access
Email: dualdiagnosis@emedsci.com
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