Tag Archive for: stress

Importance of considering minority stress when conducting cardiovascular health research in transgender, gender-diverse and non-binary populations

Authors: Raquel Rodriguez, BSc Kinesiology, McGill University | Editors: Romina Garcia de leon, Janielle Richards (Blog Co-Coordinators) | Expert Reviewer: Lindsey Thurston

Published: Friday November 1st, 2024

Transgender, gender-diverse, and non-binary (TGD) individuals are people whose gender identity does not align with their sex assigned at birth. TGD people face unique stressors related to their stigmatized gender identity and expression and are thus more likely to experience mental health issues compared to cisgender individuals, whose sex assigned at birth aligns with their gender identity. These unique stressors are known as minority stressors which include external conditions and events (i.e., discrimination and victimization) as well as internal factors (i.e., expectations of discrimination and internalization of negative societal attitudes). Increasing evidence indicates that TGD individuals face disparities in various cardiovascular (CV) risk factors and higher rates of CV morbidity and mortality compared to their cisgender peers. The population of individuals who identify as TGD is growing, as such, it is important to quantify minority stress when conducting cardiovascular research in TGD populations.

TGD & Minority Stress

The leading explanation for the health disparities observed between TGD and cisgender individuals is the minority stress theory. This theory states that, in addition to the common stressors faced by everyone, members of minority groups, including the TGD community, endure a greater range of unique stressors due to their minority status. These unique stressors are either external in nature (i.e., distal stressors) or are felt internally by the individual (i.e., proximal stressors). Distal stressors include experiences such as misgendering, stigma, discrimination, rejection, and victimization based on their gender identity. Proximal stressors include internalized stigma or transphobia, negative expectations, and concealing one’s gender identity. The theory also states that some of these individuals may also experience individual- and/or community-level resilience as a result of their minority status, allowing them to persist and thrive in the face of adversity against these stressors.

Minority Stress & How it Affects Cardiovascular Outcomes

Both internal and external stressors can negatively affect the body’s homeostasis. Psychosocial stress is an inevitable part of daily life and it is linked to an increased risk of CV disease (CVD) events. Acute and chronic mental stress are both associated with the long-term development of CV issues. Distal and proximal stressors raise the overall stress levels of TGD individuals beyond those faced by the cisgender population, negatively affecting CV health behaviours and increasing the risk of various poor mental and physical health outcomes, including CVD.

Minority Stress & Cardiovascular Health Behaviours

TGD populations have higher chances of negative CV outcomes and associated risk factors as a result of a variety of multifaceted health behaviours. TGD persons may participate less in regular physical activity than the cisgender population which puts them at a higher risk of developing CVD. Moreover, TGD adolescents have self-reported more disproportionately unsafe weight management and disordered eating behaviours compared to their cisgender peers. Research has reported elevated levels of alcohol use within the TGD population compared to the general population as a result of victimization, bullying, and minority stress.

Future Directions

Research in TGD populations should prioritize the unique impact of minority stress on cardiovascular health outcomes. Unlike research conducted on cisgender individuals, studies on TGD populations must consider distal and proximal stressors like discrimination and internalized stigma. Improved measurement tools that capture the full range of minority stressors are essential for reliable research findings. By incorporating these unique considerations, future research can contribute to a more accurate and comprehensive understanding of TGD health, ultimately leading to better health outcomes for this medically underserved and growing population.

Why is this topic important? 

This topic is important because the growing population of TGD individuals deserve and require proper and accurate healthcare services which stem from properly conducting research to accurately depict their physiological capacities. Researchers cannot conduct studies on this population in the same way as they do cisgender people as there are unique factors to consider when properly assessing the TGD population. The minority stress that they experience contributes to their cardiovascular capacities and therefore cannot be neglected when doing research on the TGD population.

Behind the Science: The Bidirectional Relationship of Behaviour and Stress

Authors: Romina Garcia de leon and Shayda Swann, Women’s Health Blog Coordinators | Interviewee: Dr. Annie Duchesne, Ph.D., University of Northern British Columbia

Published: Nov 17th, 2023

Can you give us a brief explanation of your research? 

I’m particularly interested in understanding how variations in hormones influence or regulate our behaviour, but also how our behaviour may regulate our hormonal processes. 

Over the years, I’ve been interested in understanding how contexts such as stressful situations might be influencing ovarian hormones (estrogens and progesterone). There’s a lot of interplay between the stress and endocrine systems. They often tend to regulate the same or similar affective and cognitive processes, but they’re often studied independently. I have a lot of interest in understanding the two systems together, and I’ve developed various approaches. 

The first approach involves measuring hormone levels and exposing people to different tasks. The second approach is to use observational studies where we take advantage of already accessible databases to try to answer these questions. These studies allow us to add a bit more complexity, given the larger sample sizes.

Studying this interplay is also relevant when we’re interested in questions of sex and gender. The sociocultural constructions of sex-related traits is a central dimension of gender. These constructions inform the way in which people are expected to behave in general and with respect to sex-related traits and situations. And often, our gendered constructions transform sex-related phenomena into specific sources of stress. So I do believe there’s a lot of relevance in studying the handover between stress and the gonadal system, particularly when interested in understanding the ramifications of sex and gender. 

How did you get into the field of women’s health? 

My undergraduate degree was in molecular biology. From these studies, the question that remained was how do people adapt to their environments. My first foray into this question was through conducting research on materno-fetal physiology within Dr. Julie Lafond’s laboratory. Specifically, understanding the metabolic physiology of the placenta. At that time Dr. Lafond’s laboratory was interested in how maternal variation in lipidic and toxicological profiles could influence fetal development through placental physiology. This research experience allowed me to realize the central role that the endocrine system plays in communicating what’s going on in the environment and adaptively relaying this information to all other physiological systems so that the organism is best prepared for a variety of upcoming situations. 

During my Master’s degree, I channelled my interest in endocrinology, development and adaptation to investigate the development of the biobehavioural stress processes. Fascinated by Michael Meaney’s research – which transformed our neurobiological understanding of the interplay between the environment, maternal behaviour and the development of the hormonal stress response, I went to work with Dr. Ron Sullivan who was one of the few researchers who looked at the sex difference in the role that maternal behaviour could have in the development of the stress responses. There, I discovered that variation in the environment can differently impact male and female rats, but also realized how we systematically excluded female animals from most behavioural neuroscience research. I continued to research the interplay between stress and sex-related variables during my PhD which I conducted in humans under the supervision of Dr. Jens Pruessner where I studied the interplay between stress and the menstrual cycle on affective processes. Finally, during my postdoctoral research, I continued to investigate neurobehavioural underpinnings of reproductive phenomena by investigating the cognitive correlates of menopause-related endocrine changes in Dr. Gillian Einstein’s lab. Findings from this project support that the type of menopause, in particular whether you have had a spontaneous or surgical menopause moderates the neurocognitive correlates related to menopause.

Could you highlight some of your most important findings or highlights from your research?

One central idea is that the relationship between hormones and behaviour is context-contingent. For instance, during my PhD, I demonstrated that the relationship between cortisol levels and participants’ reported levels of stress changed completely depending on which menstrual cycle they were in. These are crucial findings! Once you have recognized that how hormones can influence brain and behaviour is contingent on context, the second important question is what are the contextual dimensions that are relevant?  

What has been an increasingly important field of investigation in behavioural neuroendocrinology, particularly about women’s health, is the use of feminist theory and feminist research to articulate and operationalize aspects of women’s experiences as relevant contextual dimensions, to then investigate how that particular context may moderate the interplay between hormones, brain and behaviour.  

For example, the menstrual cycle is best characterized as a biosocial phenomenon. Seminal work by feminist scholars has demonstrated how sociocultural attributions about women’s bodies inform how menstruating people feel and behave when menstruating, for example, feeling pressured to conceal one’s menstruation. By understanding women’s endocrine phenomenon as biosocial, relevant, yet often overlooked, contextual dimensions can be incorporated into our understanding of the neuroendocrine underpinnings of reproductive phenomena such as the menstrual cycle.    

Such an approach allows for the necessary resolution to advance bio-behavioural understandings of women’s health that avoids biological essentialist biases and prevents the belief that women are determined by their sex-related biology.

What impact do you hope to see with your work 10 years from now?

I hope I continue to complexify and nuance my understanding and investigation on behavioural neuroendocrinology, stress and reproductive phenomena. I wish that my ideas allow for a more refined and inclusive perspective. We all come to our object of study from a specific perspective or standpoint and therefore carry biases. I hope that more researchers within women’s health and behavioural neuroendocrinology (including myself here!) continue to critically engage and self-reflect on their own biases as well as the ones carried by their fields of research. 

I hope that approaching reproductive phenomena as biosocially entangled becomes more of the norm than the exception in biobehavioural research particularly concerning sex and gender. More generally, I hope that culture is no longer pinpointed against nature but rather that an organism’s biology, culture and environment are embraced as constitutive, dynamic and interdependent. 

Lastly, I hope for a continued diversification of the research in behavioural neuroendocrinology and women’s health. This includes but is not restricted to, who is conducting the research, the geographical locations from where the research is being conducted, the participants being included in the research, and the questions, methods and epistemologies used to advance understanding. 

If you’re interested in joining the NeuroGenderings Book Club, check it out here. 

Check out more of Dr. Duchense’s work here and here. 

If you’re interested in more about the processes and impact of racism and whiteness within the Canadian academic context, check out this collective.