Gender Dysphoria and Sexual Euphoria: A Bayesian Perspective on the Influence of Gender-Affirming Hormone Therapy on Sexual Arousal.
Bayesian analysis
Functional magnetic resonance imaging
Gender-affirming hormone therapy
Sexual arousal
Transgender
Ventral striatum
Journal
Archives of sexual behavior
ISSN: 1573-2800
Titre abrégé: Arch Sex Behav
Pays: United States
ID NLM: 1273516
Informations de publication
Date de publication:
12 Jan 2024
12 Jan 2024
Historique:
received:
17
02
2022
accepted:
06
12
2023
revised:
01
12
2023
medline:
13
1
2024
pubmed:
13
1
2024
entrez:
12
1
2024
Statut:
aheadofprint
Résumé
Self-reported sexual orientation of transgender individuals occasionally changes over transition. Using functional magnetic resonance imaging, we tested the hypothesis that neural and behavioral patterns of sexual arousal in transgender individuals would shift from the assigned to the experienced gender (e.g., trans women's responses becoming more dissimilar to those of cis men and more similar to those of cis women). To this aim, trans women (N = 12) and trans men (N = 20) as well as cisgender women (N = 24) and cisgender men (N = 14) rated visual stimuli showing male-female, female-female or male-male intercourse for sexual arousal before and after four months of gender-affirming hormone therapy. A Bayesian framework allowed us to incorporate previous behavioral findings. The hypothesized changes could indeed be observed in the behavioral responses with the strongest results for trans men and female-female scenes. Activation of the ventral striatum supported our hypothesis only for female-female scenes in trans women. The respective application or depletion of androgens in trans men and trans women might partly explain this observation. The prominent role of female-female stimuli might be based on the differential responses they elicit in cis women and men or, in theory, the controversial concept of autogynephilia. We show that correlates of sexual arousal in transgender individuals might change in the direction of the experienced gender. Future investigations should elucidate the mechanistic role of sex hormones and the cause of the differential neural and behavioral findings.The study was registered at ClinicalTrials.gov (NCT02715232), March 22, 2016.
Identifiants
pubmed: 38216784
doi: 10.1007/s10508-023-02778-1
pii: 10.1007/s10508-023-02778-1
doi:
Banques de données
ClinicalTrials.gov
['NCT02715232']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Austrian Science Fund
ID : KLI 504
Organisme : Austrian Science Fund
ID : KLI 516
Organisme : Brain and Behavior Research Foundation
ID : 23741
Organisme : Bundesministerium für Wissenschaft, Forschung und Wirtschaft
ID : Interdisciplinary translational brain research cluster (ITHC) with highfield MR
Organisme : Österreichischen Akademie der Wissenschaften
ID : DOC
Organisme : Österreichischen Akademie der Wissenschaften
ID : DOC
Informations de copyright
© 2024. The Author(s).
Références
Altinay, M., & Anand, A. (2020). Neuroimaging gender dysphoria: A novel psychobiological model. Brain Imaging and Behavior, 14(4), 1281–1297. https://doi.org/10.1007/s11682-019-00121-8
doi: 10.1007/s11682-019-00121-8
pubmed: 31134582
Apostolou, M., Frantzides, N., & Pavlidou, A. (2014). Men competing, men watching: Exploring watching-pattern contingencies in sports. International Journal of Sport Communication, 7(4), 462–476. https://doi.org/10.1123/ijsc.2014-0033
doi: 10.1123/ijsc.2014-0033
Arnow, B. A., Desmond, J. E., Banner, L. L., Glover, G. H., Solomon, A., Polan, M. L., Lue, T. F., & Atlas, S. W. (2002). Brain activation and sexual arousal in healthy, heterosexual males. Brain, 125(5), 1014–1023. https://doi.org/10.1093/brain/awf108
doi: 10.1093/brain/awf108
pubmed: 11960892
Arnow, B. A., Millheiser, L., Garrett, A., Polan, M. L., Glover, G. H., Hill, K. R., Lightbody, A., Watson, C., Banner, L., Smart, T., & Buchanan, T. (2009). Women with hypoactive sexual desire disorder compared to normal females: A functional magnetic resonance imaging study. Neuroscience, 158(2), 484–502. https://doi.org/10.1016/j.neuroscience.2008.09.044
doi: 10.1016/j.neuroscience.2008.09.044
pubmed: 18976696
Auer, M. K., Fuss, J., Höhne, N., Stalla, G. K., & Sievers, C. (2014). Transgender transitioning and change of self-reported sexual orientation. PLoS ONE, 9(10), e110016. https://doi.org/10.1371/journal.pone.0110016
doi: 10.1371/journal.pone.0110016
pubmed: 25299675
pmcid: 4192544
Beall, E. B., & Lowe, M. J. (2007). Isolating physiologic noise sources with independently determined spatial measures. NeuroImage, 37(4), 1286–1300. https://doi.org/10.1016/j.neuroimage.2007.07.004
doi: 10.1016/j.neuroimage.2007.07.004
pubmed: 17689982
Behzadi, Y., Restom, K., Liau, J., & Liu, T. T. (2007). A component based noise correction method (CompCor) for BOLD and perfusion based fMRI. NeuroImage, 37(1), 90–101. https://doi.org/10.1016/j.neuroimage.2007.04.042
doi: 10.1016/j.neuroimage.2007.04.042
pubmed: 17560126
Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177(10), 616–623. https://doi.org/10.1097/00005053-198910000-00004
doi: 10.1097/00005053-198910000-00004
pubmed: 2794988
Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex & Marital Therapy, 17(4), 235–251. https://doi.org/10.1080/00926239108404348
doi: 10.1080/00926239108404348
Bockting, W., Benner, A., & Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38(5), 688–701. https://doi.org/10.1007/s10508-009-9489-3
doi: 10.1007/s10508-009-9489-3
pubmed: 19330439
Brunetti, M., Babiloni, C., Ferretti, A., Del Gratta, C., Merla, A., Olivetti Belardinelli, M., & Romani, G. L. (2008). Hypothalamus, sexual arousal and psychosexual identity in human males: A functional magnetic resonance imaging study. European Journal of Neuroscience, 27(11), 2922–2927. https://doi.org/10.1111/j.1460-9568.2008.06241.x
doi: 10.1111/j.1460-9568.2008.06241.x
pubmed: 18588532
Bürkner, P.-C. (2017). Brms: An R package for Bayesian multilevel models using Stan. Journal of Statistical Software, 80(1), 1–28. https://doi.org/10.18637/jss.v080.i01
doi: 10.18637/jss.v080.i01
Chivers, M. L., Rieger, G., Latty, E., & Bailey, J. M. (2004). A sex difference in the specificity of sexual arousal. Psychological Science, 15(11), 736–744. https://doi.org/10.1111/j.0956-7976.2004.00750.x
doi: 10.1111/j.0956-7976.2004.00750.x
pubmed: 15482445
Corona, G., Isidori, A. M., Aversa, A., Burnett, A. L., & Maggi, M. (2016). Endocrinologic control of men’s sexual desire and arousal/erection. Journal of Sexual Medicine, 13(3), 317–337. https://doi.org/10.1016/j.jsxm.2016.01.007
doi: 10.1016/j.jsxm.2016.01.007
pubmed: 26944463
Flores, R. D., Sanders, C. A., Duan, S. X., Bishop-Chrzanowski, B. M., Oyler, D. L., Shim, H., Clocksin, H. E., Miller, A. P., & Merkle, E. C. (2022). Before/after Bayes: A comparison of frequentist and Bayesian mixed-effects models in applied psychological research. British Journal of Psychology, 113(4), 1164–1194. https://doi.org/10.1111/bjop.12585
doi: 10.1111/bjop.12585
pubmed: 35906743
Folch-Fortuny, A., Arteaga, F., & Ferrer, A. (2016). Missing data imputation toolbox for MATLAB. Chemometrics and Intelligent Laboratory Systems, 154, 93–100. https://doi.org/10.1016/j.chemolab.2016.03.019
doi: 10.1016/j.chemolab.2016.03.019
Friston, K. J., Williams, S., Howard, R., Frackowiak, R. S., & Turner, R. (1996). Movement-related effects in fMRI time-series. Magnetic Resonance in Medicine, 35(3), 346–355. https://doi.org/10.1002/mrm.1910350312
doi: 10.1002/mrm.1910350312
pubmed: 8699946
Gantz, W., & Wenner, L. A. (1991). Men, women, and sports: Audience experiences and effects. Journal of Broadcasting & Electronic Media, 35(2), 233–243. https://doi.org/10.1080/08838159109364120
doi: 10.1080/08838159109364120
Gelman, A., Hill, J., & Yajima, M. (2012). Why we (usually) don’t have to worry about multiple comparisons. Journal of Research on Educational Effectiveness, 5(2), 189–211. https://doi.org/10.1080/19345747.2011.618213
doi: 10.1080/19345747.2011.618213
Gil-Llario, M. D., Gil-Juliá, B., Giménez-García, C., Bergero-Miguel, T., & Ballester-Arnal, R. (2021). Sexual behavior and sexual health of transgender women and men before treatment: Similarities and differences. International Journal of Transgender Health, 22(3), 304–315. https://doi.org/10.1080/26895269.2020.1838386
doi: 10.1080/26895269.2020.1838386
pubmed: 34240073
Gizewski, E. R., Krause, E., Schlamann, M., Happich, F., Ladd, M. E., Forsting, M., & Senf, W. (2009). Specific cerebral activation due to visual erotic stimuli in male-to-female transsexuals compared with male and female controls: An fMRI study. Journal of Sexual Medicine, 6(2), 440–448. https://doi.org/10.1111/j.1743-6109.2008.00981.x
doi: 10.1111/j.1743-6109.2008.00981.x
pubmed: 18761592
Gu, Z., Gu, L., Eils, R., Schlesner, M., & Brors, B. (2014). Circlize implements and enhances circular visualization in R. Bioinformatics, 30(19), 2811–2812. https://doi.org/10.1093/bioinformatics/btu393
doi: 10.1093/bioinformatics/btu393
pubmed: 24930139
Heany, S. J., van Honk, J., Stein, D. J., & Brooks, S. J. (2016). A quantitative and qualitative review of the effects of testosterone on the function and structure of the human social-emotional brain. Metabolic Brain Disease, 31(1), 157–167. https://doi.org/10.1007/s11011-015-9692-y
doi: 10.1007/s11011-015-9692-y
pubmed: 26073231
Jarcho, J. M., Berkman, E. T., & Lieberman, M. D. (2010). The neural basis of rationalization: Cognitive dissonance reduction during decision-making. Social Cognitive and Affective Neuroscience, 6(4), 460–467. https://doi.org/10.1093/scan/nsq054
doi: 10.1093/scan/nsq054
pubmed: 20621961
pmcid: 3150852
Karama, S., Lecours, A. R., Leroux, J. M., Bourgouin, P., Beaudoin, G., Joubert, S., & Beauregard, M. (2002). Areas of brain activation in males and females during viewing of erotic film excerpts. Human Brain Mapping, 16(1), 1–13. https://doi.org/10.1002/hbm.10014
doi: 10.1002/hbm.10014
pubmed: 11870922
pmcid: 6871831
Katz-Wise, S. L., Reisner, S. L., Hughto, J. W., & St. Amand, C. (2016). Differences in sexual orientation diversity and sexual fluidity in attractions among gender minority adults in Massachusetts. Journal of Sex Research, 53(1), 74–84. https://doi.org/10.1080/00224499.2014.1003028
doi: 10.1080/00224499.2014.1003028
pubmed: 26156113
Kilpatrick, L. A., Holmberg, M., Manzouri, A., & Savic, I. (2019). Cross sex hormone treatment is linked with a reversal of cerebral patterns associated with gender dysphoria to the baseline of cisgender controls. European Journal of Neuroscience, 50(8), 3269–3281. https://doi.org/10.1111/ejn.14420
doi: 10.1111/ejn.14420
pubmed: 30991464
Kim, G.-W., & Jeong, G.-W. (2014). Neural mechanisms underlying sexual arousal in connection with sexual hormone levels: A comparative study of the postoperative male-to-female transsexuals and premenopausal and menopausal women. NeuroReport, 25(9), 693–700. https://doi.org/10.1097/wnr.0000000000000159
doi: 10.1097/wnr.0000000000000159
pubmed: 24800986
Kim, G.-W., Kim, S.-K., & Jeong, G.-W. (2016a). Neural activation-based sexual orientation and its correlation with free testosterone level in postoperative female-to-male transsexuals: Preliminary study with 3.0-T fMRI. Surgical and Radiologic Anatomy, 38(2), 245–252. https://doi.org/10.1007/s00276-015-1547-z
doi: 10.1007/s00276-015-1547-z
pubmed: 26319407
Kim, T. H., Kim, G. W., Kim, S. K., & Jeong, G. W. (2016b). Brain activation-based sexual orientation in female-to-male transsexuals. International Journal of Impotence Research, 28(1), 31–38. https://doi.org/10.1038/ijir.2015.29
doi: 10.1038/ijir.2015.29
pubmed: 26581912
Klein, C., & Gorzalka, B. B. (2009). Sexual functioning in transsexuals following hormone therapy and genital surgery: A review. Journal of Sexual Medicine, 6(11), 2922–2939. https://doi.org/10.1111/j.1743-6109.2009.01370.x
doi: 10.1111/j.1743-6109.2009.01370.x
pubmed: 20092545
Klöbl, M., Michenthaler, P., Godbersen, G. M., Robinson, S., Hahn, A., & Lanzenberger, R. (2020). Reinforcement and punishment shape the learning dynamics in fMRI neurofeedback. Frontiers in Human Neuroscience, 14, 304. https://doi.org/10.3389/fnhum.2020.00304
doi: 10.3389/fnhum.2020.00304
pubmed: 32792929
pmcid: 7393482
Kranz, G. S., Hahn, A., Kaufmann, U., Tik, M., Ganger, S., Seiger, R., Hummer, A., Windischberger, C., Kasper, S., & Lanzenberger, R. (2018). Effects of testosterone treatment on hypothalamic neuroplasticity in female-to-male transgender individuals. Brain Structure and Function, 223(1), 321–328. https://doi.org/10.1007/s00429-017-1494-z
doi: 10.1007/s00429-017-1494-z
pubmed: 28819863
Kranz, G. S., Seiger, R., Kaufmann, U., Hummer, A., Hahn, A., Ganger, S., Tik, M., Windischberger, C., Kasper, S., & Lanzenberger, R. (2017). Effects of sex hormone treatment on white matter microstructure in individuals with gender dysphoria. NeuroImage, 150, 60–67. https://doi.org/10.1016/j.neuroimage.2017.02.027
doi: 10.1016/j.neuroimage.2017.02.027
pubmed: 28196668
Kranz, G. S., Zhang, B. B. B., Handschuh, P., Ritter, V., & Lanzenberger, R. (2020). Gender-affirming hormone treatment: A unique approach to study the effects of sex hormones on brain structure and function. Cortex, 129, 68–79. https://doi.org/10.1016/j.cortex.2020.04.005
doi: 10.1016/j.cortex.2020.04.005
pubmed: 32438011
Ku, H. L., Lin, C. S., Chao, H. T., Tu, P. C., Li, C. T., Cheng, C. M., Su, T. P., Lee, Y. C., & Hsieh, J. C. (2013). Brain signature characterizing the body-brain-mind axis of transsexuals. PLoS ONE, 8(7), e70808. https://doi.org/10.1371/journal.pone.0070808
doi: 10.1371/journal.pone.0070808
pubmed: 23923023
pmcid: 3724787
Laube, J. S., Auer, M. K., Biedermann, S. V., Schröder, J., Hildebrandt, T., Nieder, T. O., Briken, P., & Fuss, J. (2020). Sexual behavior, desire, and psychosexual experience in gynephilic and androphilic trans women: A cross-sectional multicenter study. Journal of Sexual Medicine, 17(6), 1182–1194. https://doi.org/10.1016/j.jsxm.2020.01.030
doi: 10.1016/j.jsxm.2020.01.030
pubmed: 32147311
Lawrence, A. A., Latty, E. M., Chivers, M. L., & Bailey, J. M. (2005). Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography. Archives of Sexual Behavior, 34(2), 135–145. https://doi.org/10.1007/s10508-005-1792-z
doi: 10.1007/s10508-005-1792-z
pubmed: 15803248
Makris, N., Swaab, D. F., van der Kouwe, A., Abbs, B., Boriel, D., Handa, R. J., Tobet, S., & Goldstein, J. M. (2013). Volumetric parcellation methodology of the human hypothalamus in neuroimaging: Normative data and sex differences. NeuroImage, 69, 1–10. https://doi.org/10.1016/j.neuroimage.2012.12.008
doi: 10.1016/j.neuroimage.2012.12.008
pubmed: 23247186
Meier, S. C., Pardo, S. T., Labuski, C., & Babcock, J. (2013). Measures of clinical health among female-to-male transgender persons as a function of sexual orientation. Archives of Sexual Behavior, 42(3), 463–474. https://doi.org/10.1007/s10508-012-0052-2
doi: 10.1007/s10508-012-0052-2
pubmed: 23307422
Meston, C. M., & Stanton, A. M. (2019). Understanding sexual arousal and subjective-genital arousal desynchrony in women. Nature Reviews Urology, 16(2), 107–120. https://doi.org/10.1038/s41585-018-0142-6
doi: 10.1038/s41585-018-0142-6
pubmed: 30664743
Mitricheva, E., Kimura, R., Logothetis, N. K., & Noori, H. R. (2019). Neural substrates of sexual arousal are not sex dependent. Proceedings of the National Academy of Sciences, 116(31), 15671–15676. https://doi.org/10.1073/pnas.1904975116
doi: 10.1073/pnas.1904975116
Mori, A., Klöbl, M., Okada, G., Reed, M. B., Takamura, M., Michenthaler, P., Takagaki, K., Handschuh, P. A., Yokoyama, S., Murgas, M., Ichikawa, N., Gryglewski, G., Shibasaki, C., Spies, M., Yoshino, A., Hahn, A., Okamoto, Y., Lanzenberger, R., Yamawaki, S., & Kasper, S. (2019). Predicting ventral striatal activation during reward anticipation from functional connectivity at rest. Frontiers in Human Neuroscience, 13, 289. https://doi.org/10.3389/fnhum.2019.00289
doi: 10.3389/fnhum.2019.00289
pubmed: 31507394
pmcid: 6718467
Mueller, S. C., Wierckx, K., & T’Sjoen, G. (2020). Neural and hormonal correlates of sexual arousal in transgender persons. Journal of Sexual Medicine, 17(12), 2495–2507. https://doi.org/10.1016/j.jsxm.2020.08.021
doi: 10.1016/j.jsxm.2020.08.021
pubmed: 33223427
Muggleton, N. K., Tarran, S. R., & Fincher, C. L. (2019). Who punishes promiscuous women? Both women and men are prejudiced towards sexually-accessible women, but only women inflict costly punishment. Evolution and Human Behavior, 40(3), 259–268. https://doi.org/10.1016/j.evolhumbehav.2018.12.003
doi: 10.1016/j.evolhumbehav.2018.12.003
Murnen, S. K., & Stockton, M. (1997). Gender and self-reported sexual arousal in response to sexual stimuli: A meta-analytic review. Sex Roles, 37(3), 135–153. https://doi.org/10.1023/A:1025639609402
doi: 10.1023/A:1025639609402
Nolan, I. T., Kuhner, C. J., & Dy, G. W. (2019). Demographic and temporal trends in transgender identities and gender confirming surgery. Translational Andrology and Urology, 8(3), 184–190. https://doi.org/10.21037/tau.2019.04.09
doi: 10.21037/tau.2019.04.09
pubmed: 31380225
pmcid: 6626314
Ogawa, A., Osada, T., Tanaka, M., Kamagata, K., Aoki, S., & Konishi, S. (2020). Connectivity-based localization of human hypothalamic nuclei in functional images of standard voxel size. NeuroImage, 221, 117205. https://doi.org/10.1016/j.neuroimage.2020.117205
doi: 10.1016/j.neuroimage.2020.117205
pubmed: 32735999
Osada, T., Suzuki, R., Ogawa, A., Tanaka, M., Hori, M., Aoki, S., Tamura, Y., Watada, H., Kawamori, R., & Konishi, S. (2017). Functional subdivisions of the hypothalamus using areal parcellation and their signal changes related to glucose metabolism. NeuroImage, 162, 1–12. https://doi.org/10.1016/j.neuroimage.2017.08.056
doi: 10.1016/j.neuroimage.2017.08.056
pubmed: 28844890
Patel, A. X., Kundu, P., Rubinov, M., Jones, P. S., Vértes, P. E., Ersche, K. D., Suckling, J., & Bullmore, E. T. (2014). A wavelet method for modeling and despiking motion artifacts from resting-state fMRI time series. NeuroImage, 95(100), 287–304. https://doi.org/10.1016/j.neuroimage.2014.03.012
doi: 10.1016/j.neuroimage.2014.03.012
pubmed: 24657353
Ponseti, J., Bosinski, H. A., Wolff, S., Peller, M., Jansen, O., Mehdorn, H. M., Büchel, C., & Siebner, H. R. (2006). A functional endophenotype for sexual orientation in humans. NeuroImage, 33(3), 825–833. https://doi.org/10.1016/j.neuroimage.2006.08.002
doi: 10.1016/j.neuroimage.2006.08.002
pubmed: 16979350
Raines, J., Holmes, L., Watts-Overall, T. M., Slettevold, E., Gruia, D. C., Orbell, S., & Rieger, G. (2021). Patterns of genital sexual arousal in transgender men. Psychological Science, 32(4), 485–495. https://doi.org/10.1177/0956797620971654
doi: 10.1177/0956797620971654
pubmed: 33635743
Rolls, E. T., Huang, C. C., Lin, C. P., Feng, J., & Joliot, M. (2020). Automated anatomical labelling atlas 3. NeuroImage, 206, 116189. https://doi.org/10.1016/j.neuroimage.2019.116189
doi: 10.1016/j.neuroimage.2019.116189
pubmed: 31521825
Safron, A., Barch, B., Bailey, J. M., Gitelman, D. R., Parrish, T. B., & Reber, P. J. (2007). Neural correlates of sexual arousal in homosexual and heterosexual men. Behavioral Neuroscience, 121(2), 237–248. https://doi.org/10.1037/0735-7044.121.2.237
doi: 10.1037/0735-7044.121.2.237
pubmed: 17469913
Safron, A., Sylva, D., Klimaj, V., Rosenthal, A. M., & Bailey, J. M. (2020). Neural responses to sexual stimuli in heterosexual and homosexual men and women: Men’s responses are more specific. Archives of Sexual Behavior, 49(2), 433–445. https://doi.org/10.1007/s10508-019-01521-z
doi: 10.1007/s10508-019-01521-z
pubmed: 31399924
Safron, A., Sylva, D., Klimaj, V., Rosenthal, A. M., Li, M., Walter, M., & Bailey, J. M. (2017). Neural correlates of sexual orientation in heterosexual, bisexual, and homosexual men. Scientific Reports, 7, 41314. https://doi.org/10.1038/srep41314
doi: 10.1038/srep41314
pubmed: 28145518
pmcid: 5286516
Schober, J. M., & Pfaff, D. (2007). The neurophysiology of sexual arousal. Best Practice & Research Clinical Endocrinology & Metabolism, 21(3), 445–461. https://doi.org/10.1016/j.beem.2007.04.006
doi: 10.1016/j.beem.2007.04.006
Schulster, M., Bernie, A. M., & Ramasamy, R. (2016). The role of estradiol in male reproductive function. Asian Journal of Andrology, 18(3), 435–440. https://doi.org/10.4103/1008-682x.173932
doi: 10.4103/1008-682x.173932
pubmed: 26908066
pmcid: 4854098
Sharot, T., De Martino, B., & Dolan, R. J. (2009). How choice reveals and shapes expected hedonic outcome. Journal of Neuroscience, 29(12), 3760–3765. https://doi.org/10.1523/jneurosci.4972-08.2009
doi: 10.1523/jneurosci.4972-08.2009
pubmed: 19321772
Sierra, J. C., Álvarez-Muelas, A., Arcos-Romero, A. I., Calvillo, C., Torres-Obregón, R., & Granados, R. (2019). Relación entre la excitación sexual subjetiva y la respuesta genital: Diferencias entre hombres y mujeres. Revista Internacional de Andrologia, 17(1), 24–30. https://doi.org/10.1016/j.androl.2017.12.004
doi: 10.1016/j.androl.2017.12.004
pubmed: 30691588
Slettevold, E., Holmes, L., Gruia, D., Nyssen, C. P., Watts-Overall, T. M., & Rieger, G. (2019). Bisexual men with bisexual and monosexual genital arousal patterns. Biological Psychology, 148, 107763. https://doi.org/10.1016/j.biopsycho.2019.107763
doi: 10.1016/j.biopsycho.2019.107763
pubmed: 31494194
Stoléru, S., Fonteille, V., Cornélis, C., Joyal, C., & Moulier, V. (2012). Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: A review and meta-analysis. Neuroscience & Biobehavioral Reviews, 36(6), 1481–1509. https://doi.org/10.1016/j.neubiorev.2012.03.006
doi: 10.1016/j.neubiorev.2012.03.006
Sylva, D., Safron, A., Rosenthal, A. M., Reber, P. J., Parrish, T. B., & Bailey, J. M. (2013). Neural correlates of sexual arousal in heterosexual and homosexual women and men. Hormones and Behavior, 64(4), 673–684. https://doi.org/10.1016/j.yhbeh.2013.08.003
doi: 10.1016/j.yhbeh.2013.08.003
pubmed: 23958585
Vegunta, S., Kling, J. M., & Kapoor, E. (2020). Androgen therapy in women. Journal of Women’s Health, 29(1), 57–64. https://doi.org/10.1089/jwh.2018.7494
doi: 10.1089/jwh.2018.7494
pubmed: 31687883
Walter, M., Bermpohl, F., Mouras, H., Schiltz, K., Tempelmann, C., Rotte, M., Heinze, H. J., Bogerts, B., & Northoff, G. (2008). Distinguishing specific sexual and general emotional effects in fMRI-subcortical and cortical arousal during erotic picture viewing. NeuroImage, 40(4), 1482–1494. https://doi.org/10.1016/j.neuroimage.2008.01.040
doi: 10.1016/j.neuroimage.2008.01.040
pubmed: 18329905
Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14(5), 404–411. https://doi.org/10.1071/SH17067
doi: 10.1071/SH17067
pubmed: 28838353