Tag Archive for: JEDI

Behind the Science with Cindy Kalenga

Authors: Arrthy Thayaparan and Alex Lukey (Blog Coordinators) || Interviewing: Cindy Kalenga, BSc, PhD/MD candidate, University of Calgary

Published: July 26th, 2021

Pursuing women’s health was a no-brainer for Cindy Kalenga. Finding answers to concerns faced by the women in her life, her community, and even by herself was the obvious choice when she decided on her path as a M.D./Ph.D. candidate at the University of Calgary’s Cumming School of Medicine. 

For this month’s Behind the Science, we speak with Cindy to learn more about her research journey as a future leader in women’s cardiovascular health and as an advocate for the inclusion of minorities in the sciences.

How did you become interested in the sciences and the work you do now?

I think I’ve always had an interest in science, I completed my undergraduate degree in biomedical science at York University. I then moved to Calgary where I started working for the Primary Care Network assisting family physicians with chronic disease management. I focused mainly on things like diabetes, hypertension and mental health. 

After working for a year, I decided to pursue a graduate degree. I was interested in cardiovascular sciences as it had some overlap with my previous work. I ended up finding my research supervisor, Dr. Sofia Ahmed who investigated female-specific cardiovascular risk factors which I thought was really interesting!

Why women’s health?

When I was introduced to research, I noticed a huge disparity in studies that included females. Two thirds of clinical research is conducted in males and applied to both sexes; as you can imagine, some treatment strategies don’t completely translate over. 

When we look even further at research among racialized minorities such as a black women, the data is very scarce. So a lot of my interest and passion stemmed from advocacy within women and racialized minorities as this is an opportunity to better support the health of Canadians and people globally. 

What have you found through your research?

My research investigates the use of exogenous estrogen and cardiovascular markers among women. In young women, we investigate birth control use and in post-menopausal women, we study hormone therapy. Our preliminary data indicates that oral uses of estrogen may be associated with stiffer arteries and potential increases in risk for future cardiovascular risk. 

This data is very important as women ingest these hormones for many years, even several decades, and so any incremental increases in cardiovascular risk may have important impacts down the line. My research provides women and healthcare professionals the information they need to make informed decisions about treatment strategies. 

More longitudinal studies are required before we can make recommendations to clinical practice, however, our results suggest that women should opt for non-oral forms of birth control and estrogen therapy whenever possible, as this may be associated with lower cardiovascular risk. 

Do you think there is enough minority representation in the sciences?

I think we all know what the answer to that is; no there’s not enough representation. 

As a black woman pursuing a combined M.D. and Ph.D. degree, I have encountered very few minorities in leadership positions or as professors within my educational training. Representation is very important as it brings new ideas to the table and helps combat racial bias. 

The lack of representation also impacts the amount of research that’s done in that community. Often researchers are motivated to advocate for diseases that they’ve personally experienced or seen within their family and communities. So, if you don’t have enough black researchers there’s not enough people studying topics that predominantly impact black people. They also have the cultural competency needed to engage with their own community and mobilize them to participate in research. 

For instance, there are alarming racial differences in the material mortality rates. Black women are between 2 to 6 times more likely to die from complications during pregnancy compared to their white counterparts. Furthermore, black women are more likely to develop breast cancer at a younger age and it tends to be more aggressive. 

You can see how advantageous it is to have researchers who feel personally impacted by these statistics as it would motivate them to investigate this further. I’m interested in women’s health and that of racialized minorities, because that’s me, that’s my sister, those are my family members. 

On a final note, what do you hope for the future of your industry?

It’s always important to recognize the good work done by those who came before us. Whether that work was done only in males, we have developed ground breaking treatment strategies because of it. What I’m proposing is that research be expanded to other communities to foster innovation and better health outcomes for all Canadians. 

It’s always about providing racialized minorities a seat at the table. Finding novel ways to encourage minorities to pursue careers in research and medicine as well participate in research studies is the goal.

Behind The Science With Dr. Robert-Paul Juster

Authors: Arrthy Thayaparan and Alex Lukey (Blog Coordinators) 

Published: June 4th, 2021

Interviewee: Dr. Robert-Paul Juster, PhD, University of Montreal 

For this month’s Behind the Science feature, we spoke with Dr. Rober-Paul Juster, an assistant research professor in the department of psychiatry and addiction at the University of Montreal.

As Dr. Juster is a proud member and advocate for research with the LGBTQ2S+ community, we discussed the challenges faced by this community in the sciences. In honour of Pride month, we hope that these discussions bring to light the challenges faced by queer and gender diverse communities.

Additionally, we talked about Dr. Juster’s work on sex and gender research to understand the effects of stress and adversity. He is currently conducting an ongoing survey of COVID-19 that focuses on sex and gender. If you are interested in learning more or participating in his work, check this link out

But without further ado, we introduce Dr. Juster…

How did you get into the sex and gender research field?

The first scientific project that I was involved in looked at sex differences in cognition, which was something I was learning in a class at the time. Then I remembered learning about gender roles, masculinity, and femininity in another class. I just sort of put them all together and was particularly interested in the LGBTQ2S+ community. I ignored these interests a bit during my master’s. But then, in my PhD, I had the opportunity again to revisit and look into them further. 

I’m a gay man. So I think the best research often has a personal meaning to the person. I think we can debate whether that makes us purely objective, but I think I had a real desire to contribute to the community and engage in activism through my science. So I think that was always sort of there in my mind, that I wanted to be involved through science. And it so happened that that’s probably been one of the most interesting and fruitful parts of my career so far.

Why is it important to have research that focuses on and includes diverse communities like the LGBTQ2S+ community?

That’s a great question. I think underrepresentation is something that we talk about not just in the field of sex and gender. More broadly, there is still so little research tat has been done with consideration of women. I’ve always felt a real alliance with women, in particular. I think gay men and heterosexual cisgender women have a pretty interesting alliance. My dedication to advancing research and especially health research among the LGBTQ2S+ community is really focused on the desire to really represent better. I think representation is really the most important thing for my research.

Is there enough representation of the LGBTQ2S+ community within the sciences?

I don’t think so, especially for trans and/or non-binary people. I think there’s not a sufficient amount of representation. It’s something new as an ally, I can do my best to lend my interest and my research focus to these and other underrepresented communities. But I feel like so many areas that have not received sufficient representation in science and health research are often the ignored people of those communities. 

So I think there is a slowly growing number of people from the LGBTQ2S+ community represented in academia and in STEM. But I think there’s always more that’s needed. 

I think we talk a lot about equity, diversity and inclusion. More needs to be done to really be aware of that reality and to be sensitive to the fact that even though you’re an ally with an identity that is also marginalized, you can never truly understand the experiences of every subgroup that you’re interested in. 

That’s been an interesting process for me of humility, being really humble and always being aware of the realities of other groups that have not received the same representation. Nor the same privileges. As a white cisgender male, I have a lot of privileges that I think a lot of other groups don’t and it’s important to acknowledge that.

When working with diverse communities, there’s always the potential to create harm when conducting research. How can that harm be mitigated?

Even researchers with the best possible intentions can go into research among a group and not identify their real needs. I think particularly for the transgender and/or gender non-binary communities, there’s been a lot of research that has focused on the origins of difference. Same thing for sexual minorities to try and identify brain regions that are different. This inquiry aims to explain why people are gay or why they’re trans. 

I mean, human beings are curious, and we want to identify the causes of things. But I’m not sure that that research really speaks to any sort of direct needs of the community. Being mindful about what is important to the communities that you want to study and serve is really the essential thing. We can have all kinds of great ideas about research that would be great among the communities that we’re interested in, but it just doesn’t speak to their needs.

And that’s potentially damaging, because there’s no investment of taxpayers dollars to an issue that might not actually be pertinent to the communities that you’re studying. So I think it’s so important to be engaged in participatory research and to really be attentive to the needs of the community and being able to adjust research accordingly.

Can you explain your research to us?

My research aims to understand how men, women, and gender diverse people each have unique health and wellness needs. Beyond binary sex or any kind of focus on categories of groups of people, my work is really focused on the nuance within sex. So trying to identify how things, like sexual orientation, sex hormones, gender roles, or combinations and social economics in relation to your gender, all relates to your health and well-being. 

I’m also really interested in groups that are exposed to different forms of stress and can develop inspiring resilience. What are the things that they do to help minimize their stress? What are the factors that contribute to their protection or resilience to certain conditions? I want to spend my career answering those questions

So studying the LGBTQIA2S+ community, for me, is fascinating because there’s so much gender diversity, and just so much lived experience that is mixed with adversity and resilience. It provides a really strong lens from which to identify how people can become quite tough in terms of facing problems in the future. 

Any last thoughts you’d like to share?

Studying sex and gender research is much more complicated than it seems. Each and every different group combines with other factors like social economics, geography, age, race, and ethnicity, that collectively influence people’s health. We have a tendency, I think the general public and scientists sort of silo off different groups of people. But the bottom line is that every individual has multiple identities that can protect them, but can also affect their health in negative ways, based on stigma and inequalities. The take home message is that allowing groups and subgroups to really express their lived experiences. It’s so important to be attentive, sensitive and engaged to find ways to be an ally. 

You know a lot of the time, people will talk about the transgender community and they’ll be like, ‘Well, you know, [transgender people] only represents one to two per cent.’ That’s still a substantial number of people. And I think there’s a tendency for a lot of the general public, as well as scientists, to sort of dismiss that if it’s a small group of people, then it’s not really going to affect everyone else. But I really argue that you’re all connected. It’s so important to be able to represent all these different groups and to learn from them. Because I think a lot of people that are underrepresented and have been marginalized, engage in very unique and very powerful coping responses that make them resilient. Being able to understand those mechanisms is actually kind of a hopeful message for all. 

And this applies for the rest of society as well. It doesn’t just become about doom and gloom and how society stigmatizes you and your poor health, but more about how you navigate these issues that we’re trying to slowly fix as society progresses, so that we can work on those different factors in the future. In the context of COVID-19, different groups within the LGBTQ2S+ community are engaging in different coping strategies. And while for instance, trans and non-binary people are dealing with a lot of mental health problems, like so many other people they’re also engaging in seeking social supports in virtual ways. In any kind of situation where there’s adversity, people that have faced adversity for reasons of their identity are going to engage in ways that the rest of society can learn from.

Barriers in Transgender Research

Author: Keila Turino Miranda, BSc Honours in Pharmacology, University of Alberta, Twitter: @keila_turino | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: October 29th, 2020

The transgender community is a growing and underserved population estimated to reach over one million in the USA alone. In comparison to their cis-counterparts, where sex (biological attributes) and gender (socially constructed roles, behaviours, expressions and identities) align, transgender individuals experience gender dysphoria. Gender dysphoria is defined as a persistent feeling that an individual’s biological sex does not match their gender identity. As a result, transgender individuals experience severe distress, which significantly impairs their ability to function in society. This condition occurs on a spectrum, where transgender individuals are at the extreme end. This clinical diagnosis results in gender-affirming hormone therapy initiation, where feminization or masculinization goals are initiated. For transgender women, gender-affirming hormone therapy consists of the use of exogenous synthetic estrogens often in conjunction with anti-androgens to promote feminization (breast growth, decreased facial and body hair, genital atrophy, etc.) and minimize the effects of endogenous androgens like testosterone (deepening of the voice, differential distribution of body fat and muscle).

Protocols for Transgender Care

Estrogen gender-affirming hormone therapy formulation, dose, administration route, and co-administration with anti-androgens vary on individual goals for transitioning. Higher doses may be used for a more pronounced transitioning, while lower doses may be used if the individual is predisposed to other health complications. Additionally, the administration route may vary based on personal preference or recommendation by the health care practitioner. An example of this is seen in the preference for non-oral (transdermal patch, intravenous injection, etc.) estrogen gender-affirming hormone therapy over oral routes. This preference is a direct result of experimental data in cis-women showing that oral estrogen therapy, whether for contraceptive or postmenopausal use, is associated with an increased cardiovascular risk compared to non-oral estrogen. As a result, transgender women over the age of 45 or with a predisposition to cardiovascular disease are prescribed non-oral forms of estrogen to minimize risk. However, no current research suggests that this finding is also consistent or applicable to transgender women. Therefore, protocols for the care of transgender women have been modelled after research done in cis-women populations. However, this can become problematic as these two populations differ by biological attributes, societal pressures and other factors. Whether or not this is appropriate can only be determined through further research into gender-affirming hormone therapy routes of administration.

Current Research in the Transgender Field

Transgender women face healthcare disparities and have higher rates of substance use disorders, depression, anxiety and suicidality. Moreover, transgender women receiving gender-affirming hormone therapy are disproportionally affected by cardiovascular disease. Despite the growing number of the transgender population and the increased prevalence of gender-affirming hormone therapy use, research outside of HIV prevalence is limited. A newly published study on HIV prevention reported the positive impact greater social support in discussing HIV-related issues has on HIV prevention knowledge. These results point to the growing body of thought regarding minority stress. Stigmatized minority groups, such as the transgender population, show chronically elevated levels of stress. In addition to the limited research seen in transgender health, there is a lack of acknowledgement of minority stress and its implications on disease progression.

Barriers in Transgender Research 

As an up-and-coming field, transgender research is limited by its heterogeneity in terminology and study quality. Researchers in this field must often consider the variability and advancement of the use of transgender terminology in active avoidance of transphobia. For example, outdated terms such as she-male, cross-sex and trans-sexual are often seen in previous literature, and Alberta Health Services contraindicates its use. Additionally, systematic reviewers in the field must consider these terms to capture relevant transgender research adequately. 

As previously discussed, there is great variability in gender-affirming hormone therapy dose, formulation and administration route. As a result, there is significant heterogeneity in available studies, which is a barrier for appropriate quantification of their effects on transgender health and disease progression. Route of gender-affirming hormone therapy administration is postulated as partly responsible for this as the pharmacokinetics (drug absorption, distribution, metabolism and excretion) and pharmacodynamics (drug action and mechanism) vary. Pharmacokinetics is an important consideration as oral and non-oral therapies are subjected to differential levels of metabolism, total systemic dose, excretion rates, and other variables, which affect their drug actions and mechanism (pharmacodynamics). These are vital considerations as drug interactions affect disease progression, and in long term cases, morbidity and mortality. 

In addition to experimental group variability, there are also inappropriate control groups, thus serving as an additional barrier. The psychological benefits provided by gender-affirming hormone therapy renders the use of placebo groups unethical. Researchers are limited to recruiting transgender individuals who have not initiated gender-affirming hormone therapy in search of an appropriate control. Although it would be unlikely to recruit these individuals and abstain from therapy initiation throughout the study, this would provide an appropriate control group as these individuals would share the same gender-identity. Additionally, researchers may opt to use cis-men as a sex (biological attributes) control. With this, studies looking to compare morbidity and mortality of diseases would be better equipped to assess transgender health as it pertains to gender-affirming hormone therapy use.

Cross-sectional studies aiming to obtain estimates of disease incidence and prevalence are limited by the inadequate collection of gender identity information in clinics and national surveys. This further prevents accurate and up-to-date epidemiological analysis of transgender health and serves as a further barrier for researchers and clinicians looking to address this population’s health adversities.

Future Directions 

Listed research barriers should be addressed through appropriate stratification of gender-affirming hormone therapy by dose, formation, administration route, and use of anti-androgens. Additionally, the implementation of appropriate control groups, cis-men and/or transgender women without therapy, is essential for adequate quantification of disease progression, morbidity and mortality. These modifications, accompanied by large cohort studies with sufficient follow-up, will allow for the advancement of clinical understandings and protocols.  Lastly, practicing clinicians caring for transgender patients should appreciate gender-affirming hormone therapy’s psychological benefits when considering the potential risks associated.

Bibliography

1. Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender Population Size in the United States: A Meta-Regression of Population-Based Probability Samples. American Journal of Public Health, 107(2). doi:10.2105/ajph.2016.303578

2. Reback, C. J., Clark, K., Holloway, I. W., & Fletcher, J. B. (2018). Health Disparities, Risk Behaviors and Healthcare Utilization Among Transgender Women in Los Angeles County: A Comparison from 1998–1999 to 2015–2016. AIDS and Behavior, 22(8), 2524-2533. doi:10.1007/s10461-018-2165-7

3. Alzahrani, T., Nguyen, T., Ryan, A., Dwairy, A., Mccaffrey, J., Yunus, R., . . . Reiner, J. (2019). Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circulation: Cardiovascular Quality and Outcomes, 12(4). doi:10.1161/circoutcomes.119.005597

4. Gosiker, B. J., Lesko, C. R., Rich, A. J., Crane, H. M., Kitahata, M. M., Reisner, S. L., . . . Poteat, T. C. (2020). Cardiovascular disease risk among transgender women living with HIV in the United States. Plos One, 15(7). doi:10.1371/journal.pone.0236177

5. White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health. 2016;1:21-31. [PMID: 27595141]

6. Brown, G., By, Brown, G., & Last full review/revision Aug 2019| Content last modified Aug 2019. (n.d.). Overview of Sexuality – Mental Health Disorders. Retrieved October 24, 2020, from https://www.merckmanuals.com/home/mental-health-disorders/sexuality-and-sexual-disorders/overview-of-sexuality

7. Lelutiu-Weinberger, C., Wilton, L., Koblin, B. A., Hoover, D. R., Hirshfield, S., Chiasson, M. A., Frye, V. (2020). The Role of Social Support in HIV Testing and PrEP Awareness among Young Black Men and Transgender Women Who Have Sex with Men or Transgender Women. Journal of Urban Health, 97(5), 715-727. doi:10.1007/s11524-019-00396-8

8. Meyer IH. Does an improved social environment for sexual and gender minorities have implications for a new minority stress re- search agenda? Psychol Sex Rev. 2016;7:81-90. [PMID: 27642514]

9. Streed, C. G., Harfouch, O., Marvel, F., Blumenthal, R. S., Martin, S. S., & Mukherjee, M. (2017). Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy. Annals of Internal Medicine, 167(4), 256. doi:10.7326/m17-0577

10.  Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al; Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004;291:1701-12. [PMID: 15082697]

11. Terms and Phrases to Avoid* – Alberta Health Services. (n.d.). Retrieved October 24, 2020, from https://www.albertahealthservices.ca/assets/info/pf/div/if-pf-div-terms-and-phrases-to-avoid.pdf

12. Velzen, D. M., Paldino, A., Klaver, M., Nota, N. M., Defreyne, J., Hovingh, G. K., . . . Heijer, M. D. (2019). Cardiometabolic Effects of Testosterone in Transmen and Estrogen Plus Cyproterone Acetate in Transwomen. The Journal of Clinical Endocrinology & Metabolism, 104(6), 1937-1947. doi:10.1210/jc.2018-02138

Image courtesy of Denin Lawley on Unsplash

Diversity in Academia: Personal Experience & Advice from a Post Doctoral Fellow


Hi everyone! My name is Dr. Travis E. Hodges and I wanted to take this opportunity to introduce myself to you and share a little of my personal journey in my academic career. I was born in Winnipeg, Manitoba, Canada, where I also did my undergraduate studies. I completed graduate studies at Brock University in St. Catharines, Ontario (Canada) in the laboratory of Dr. Cheryl McCormick, and I am now a postdoctoral fellow and Institute of Mental Health Marshall Fellow in the laboratory of Dr. Liisa Galea at the University of British Columbia (Vancouver, BC, Canada). My current research focus is on sex differences in neural mechanisms underlying cognitive bias across the lifespan, and how these may change under stressful conditions. My long-term goal is to become a professor/primary investigator and establish a laboratory of my own with a research focus on mechanisms underlying the transmission of behavioural and neural function from stressed parents to their offspring, and the role of age and sex in that transmission. I am a member of the WHRC and co-lead of the WHRC Trainee Presentation Series Organization Committee.

During this time of global conversations concerning the rights and academic experiences of people of colour (see #blackintheivory/#ShutDownSTEM for reference) and people of the LGBTQIA1s+ community (see #LGBTQhealth/#QueerinSTEM for reference) I am happy that I was invited by the International Behavioral Neuroscience Society (IBNS) and the WHRC to share some of my own experiences and dispense some advice that has helped me navigate through my own academic journey. The experiences that I have had as a gay and black scientist may differ from most in these communities – I feel very fortunate to have received a lot of love and support from my peers, colleagues, and supervisors. But I have also faced obstacles. Before I left Winnipeg to start my graduate studies in Ontario, I was told by family and friends multiple times that it would be almost impossible for me to get a PhD because I was black; I was told by management at a store where I worked during my undergrad that pursuing a Masters or a PhD would be a waste of time because my skills were better suited for packing shelves. Thankfully, since starting my academic journey, all of my supervisors (undergraduate honours, graduate, postdoctoral) have been incredibly accepting and continue to show me nothing but support in all of my endeavors. Additionally, I have been told that I am (and I know I am) an extreme optimist, but I wouldn’t be this positive without my treasured past and present friends and laboratory families. I still keep in touch with my graduate school cohort and watching their efforts supporting the LGBTIQA2s+ community and the Black Lives Matter movement in their respective parts of the world (Canada, US, UK, Europe) bring me to happy tears. Other trainees and past mentees of mine that have become my friends and family have been bright lights piercing through the darkness that has enveloped the current state of affairs across the world. 

However, I would be remiss without disclosing that finding these accepting and loving academic work environments has been intentional on my part with a bit of luck thrown in.  I have sought broad professional advice from past supervisors and done my due diligence by meeting with potential new supervisors and laboratory mates. In contrast to my positive experiences, I have friends that have had horrible laboratory and university experiences that ruined their love for science. Based on both my positive experiences as well as what I have seen around me, I offer here some pieces of advice to trainees who may be facing adversity related to their race and/or sexual orientation either in their laboratory or even directly from their supervisor: 

  1. There are kind-hearted supervisors and welcoming laboratories out there! Do not be afraid to leave your current negative laboratory situation and transfer to a new one. I have close friends that transferred out of negative laboratory situations (one in their second year and one in their fourth year of graduate school) and they both found new laboratories that were a much better fit and less taxing on their mental health. Fit with a supervisor and laboratory is very hard to gauge at a glance, so one of the best things to do is speak with current or past members of a laboratory you are interested in pursuing. Take time to find a good laboratory that fits your ideals not just from a science perspective but also from a positive training environment perspective. 
  2. If negative experiences are progressing in your current laboratory, feel free to ask your fellow trainees about their own experiences to learn more about laboratory culture among supervisors and their labs. Use this information either to find other trainees that may be in similar situations or to determine what laboratory you might feel more comfortable in. Finding other trainees that share even just a couple of your negative experiences will hopefully help you feel less alone and hopefully you can start offering each other social support. Moreover, finding a different supervisor you are more comfortable with at the same university is also useful if you need help navigating reporting bias/discrimination and figuring out how to switch laboratories. 
  3. If you feel like you are unable to talk to another PI about the adversity you are facing, then search for a fellow trainee to talk to for advice – especially a trainee you respect and has shared experience working in a laboratory (e.g., a senior graduate student or postdoctoral fellow). Even though my past experiences were mostly positive, it was my graduate school cohort at Brock University that helped me keep my sanity during the most stressful and uncertain times. So, I can’t stress enough how important it is to have social support. Good social networks are essential in navigating and combating feelings of despair.

To all trainees: whether or not you are currently experiencing adversity in your own laboratory do try to be a friend or a listening ear to fellow trainees that you see are having a hard time. This can make a big difference in the laboratory environment experience for everyone involved and especially for trainees that are feeling very alone in their situation. 

To trainees of colour, members of the LGBTQIA2s+ community, and all others facing adversity in the laboratory: all of our training experiences are unique, but I really hope that you can find a positive and nurturing laboratory environment (they are out there!). I also hope that you find a cohort of trainees and supervisors that support all that you do. Take care of yourselves, stay strong, and trust in your feelings concerning any situation that you are in.

Sincerely and with utmost love,

Travis Ellington Hodges

PhD, Postdoctoral Fellow, University of British Columbia, Djavad Mowafaghian Centre for Brain Health, Department of Psychology/Psychiatry Email: Travis.Hodges@psych.ubc.ca