Minority Stress and the Effects on Emotion Processing in Transgender Men and Cisgender People: A Study Combining fMRI and Proton Magnetic Resonance Spectroscopy ( 1H-MRS)

Background Minority stress via discrimination, stigmatization, and exposure to violence can lead to development of mood and anxiety disorders and underlying neurobiochemical changes. To date, the neural and neurochemical correlates of emotion processing in transgender people (and their interaction) are unknown. Methods This study combined functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy ( 1H-MRS) to uncover the effects of anxiety and perceived stress on the neural and neurochemical substrates, specifically Choline, on emotion processing in transgender men. Thirty transgender men (TM), 30 cisgender men (CM), and 35 cisgender women (CW) passively viewed angry, neutral, happy, and surprise faces in the fMRI scanner, underwent a 1H-MRS scan and filled out mood and anxiety related questionnaires. Results As predicted, Choline levels modulated the relationship between anxiety and stress symptoms and the neural response to angry and surprise (but not happy faces) in the amygdala. This was only the case for TM but not cisgender comparisons. More generally, neural responses in the left amygdala, left middle frontal gyrus, and medial frontal gyrus to emotional faces in TM resembled that of CW. Conclusions These results provide first evidence of a critical interaction between levels of analysis and that Choline may influence neural processing of emotion in individuals prone to minority stress.