Here is a paragraph-based synthesis of the information from Table 4 in the article “What has sex

got to do with it? The role of hormones in the transgender brain” by Nguyen et al. (2019):

Van Goozen et al. (2019) investigated the behavioral and cognitive changes in transgender
individuals after receiving gender-affirming hormone therapy (GAHT). In their study, 35 female-
to-male (FTM) participants received three months of androgen therapy, while 15 male-to-female
(MTF) participants received three months of estrogen and anti-androgen therapy. The results
showed that FTMs experienced an increase in aggression, anger proneness, sexual arousability,
and motivation, but also a decline in verbal fluency. In contrast, MTFs exhibited reduced
aggression and sexual interest, but an improvement in verbal fluency. These behavioral and
cognitive patterns were measured through various tools, including anger proneness
questionnaires, sex role inventories, and several tests for spatial and verbal fluency, such as card
rotation and sentence production tasks.

In a cross-sectional study, Miles et al. (2019) compared 29 MTFs receiving estrogen therapy
with 30 untreated MTFs. Estrogen-treated participants scored higher on the Paired Associate
Learning subtest, suggesting a potential benefit of hormone therapy for verbal memory.
However, no significant differences were observed in mental rotation, controlled associations, or
vocabulary.

Gómez-Gil et al. (2009) found that androgen-treated FTMs outperformed untreated FTMs on
several visual memory measures, including the Visual Paired Associates and Rey-Osterrieth
Complex Figure Test. These findings suggest that testosterone might improve visuospatial
memory

Longitudinal research highlights the plasticity of the brain in response to GAHT. Hulshoff Pol et
al. (2006) reported that after four months of estrogen and anti-androgen therapy, MTFs
experienced decreased total brain volume and increased ventricle size—shifting toward female
proportions. Conversely, FTMs on testosterone exhibited increases in total brain and
hypothalamic volumes.

Haraldsen et al. (2019) conducted a longitudinal study assessing 30 FTMs and 22 MTFs at three
time points: 8–12 weeks before, 3 months after, and 12 months after GAHT. Their results
indicated no significant differences in cognitive performance between cisgender male and female
controls (MCs and FCs) and the transgender groups.
Van Goozen et al. (2000) also examined visuospatial ability in 19 FTMs and 22 MTFs, both pre-
and post-GAHT, and compared them with cisgender male and female controls. They used tests
such as the Verbal Reasoning Test, Line Orientation Test, and multiple 3D Rotated Figures
tasks. Results revealed a significant linear increase in performance from FCs to FTMs to MTFs
to MCs, reflecting a sex-based gradient (with biologically male individuals scoring higher).
Despite this pattern supporting the organizational effects of early hormone exposure on cognitive
ability, 14 weeks of GAHT showed no evidence of activating effects. That is, hormone treatment
did not produce acute cognitive changes in visuospatial abilities during the study period.

Paap and Haraldsen (2019) examined arithmetic skills before and after 12 months of GAHT and
found no significant differences between groups or over time.

Slabbekoorn et al. (1999) used seven sex-biased tests and observed that testosterone therapy
improved spatial ability (especially 3D rotation tasks) in FTMs after 1.5 years, without
negatively impacting verbal fluency. In contrast, estrogen therapy in MTFs had no clear
enhancing effect, nor did it cause verbal performance to deteriorate. Notably, MTFs retained
their spatial performance even after stopping hormone treatment, indicating potential
organizational effects of testosterone exposure before transition.

Van Goozen et al. (2002) found that three months of testosterone treatment improved
visuospatial abilities and verbal fluency in FTMs, specifically in tests such as Rotated Figures
and Word Production.

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longer analysis.

Here’s a paragraph-style summary of Table 3: GAHT effects on neuronal activation (fMRI) from
the article What has sex got to do with it? by Nguyen et al. (2019):

In cross-sectional fMRI studies, Carrillo et al. (2010) found that FTMs on GAHT showed no
specific cerebral activation pattern during mental rotation tasks. However, MTFs on GAHT
demonstrated a distinct pattern of activation compared to MCs and FCs, specifically in the
parietal and orbital prefrontal cortices. Interestingly, the degree of cerebral activation in MTFs
negatively correlated with the duration of hormone therapy, particularly in the parietal, occipital,
and temporal regions. Schöning et al. (2010) similarly noted that GAHT had minimal influence
on the brain activation pattern during mental rotation tasks. Both treated and untreated MTFs
employed more verbal strategies during the task and exhibited greater temporo-occipital
activation than MCs.
In longitudinal studies, Sommer et al. (2008) found that GAHT appeared to influence cerebral
activation during language and mental rotation tasks. Specifically, activation during language
tasks increased after three months of GAHT and was associated with higher post-treatment
estradiol levels. However, activation during mental rotation tasks was more closely linked to
post-GAHT testosterone levels. Spies et al. (2016) assessed resting-state functional connectivity
and found that, pre-GAHT, MTFs displayed increased rsFC in areas such as the supramarginal
gyrus—a region involved in empathy. However, changes in this network were more likely due to
emotional adaptation during gender transition than the direct effects of GAHT. Lastly, Nota et al.
(2017) observed that functional connectivity patterns across the DMN, SN, and WMN remained
largely unchanged after 4 months of GAHT in both MTFs and FTMs. Notably, cisgender males
showed stronger functional connectivity in the right caudate nucleus, while hormone therapy and
sex steroid levels in transgender individuals had no significant impact on functional connectivity.

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Here is a paragraph-style summary of Table 2: GAHT Effects on Brain Structure (Structural

In cross-sectional studies, Mueller et al. (2017) found that the neuroanatomical volumes of the
amygdala, putamen, and corpus callosum in MTFs differed from FCs but not from MCs. This
suggests that certain brain structures in transgender women remain more aligned with their natal
sex. Additionally, FTMs and FCs showed differences in the medial temporal lobe, nucleus
accumbens, and third ventricle. Spizzirri et al. (2018) observed that MTFs—both naïve and
treated—showed bilateral reductions in gray matter compared to cisgender individuals,
particularly in the posterior-superior frontal cortex.

Zubiaurre-Elorza et al. (2014) confirmed that testosterone increased cortical thickness in FTMs
and that these increases correlated with both testosterone levels and changes in the parieto-
temporo-occipital regions. Estrogen therapy in MTFs, by contrast, decreased subcortical volume
and hippocampal thickness.

Seiger et al. (2016) found that gray matter reductions in MTFs were likely driven by reduced
estrogen and increased progesterone.
Burke et al. (2017) noted significant changes in structural and functional connectivity in FTMs,
including increased insular and superior cortical thickness and higher fractional anisotropy in
white matter tracts.

Lastly, Kranz et al. (2018) demonstrated that FTMs showed reduced mean diffusivity in lateral
hypothalamic regions following testosterone treatment. These reductions correlated with
increases in free androgen index and bioavailable testosterone.

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theoretical framework.