Brain Imaging Study Paused After LGBTQ+ Advocates Complain

Criticism from LGBTQ+ organizations has put a halt, at least temporarily, to enrollment in a University of California Los Angeles study seeking to examine the neurobiological underpinnings of gender dysphoria.

Gender Justice LA and the California LGBTQ Health and Human Services Network released a joint statement, citing major ethical concerns about the research endeavor at UCLA's Semel Institute for Neuroscience & Human Behavior, led by psychiatrist Jamie Feusner, MD.

Feusner told MedPage Today that he has asked UCLA's Institutional Review Board (IRB) to "re-review our entire protocol to ensure that it meets all ethics and safety standards."

He said his team is "actively engaged with members of the LGBTQ community" to help inform potential adjustments to study protocols. It wasn't clear whether the entire study is on hold or just enrollment of new participants.

Ezak Perez, executive director of Gender Justice LA, said in the statement that the "research design unapologetically aims to cause mental health distress to trigger 'dysphoria' to an already marginalized and vulnerable community."

The advocacy groups said that researchers from the Semel Institute reached out to members of the TGI (transgender, gender non-conforming, and intersex) community of Southern California to take part in a meeting that would help the researchers further develop the study's design. When community members expressed concerns during this meeting and realized the study was already underway with approval from the IRB, leaders from Gender Justice LA and the California LGBTQ Health and Human Services Network wrote a letter to UCLA's Office of the Human Research Protection Program.

"The researchers are falsely advertising this study without clarity about the expectations of participants and without consideration of the need for direct access to mental health after care," wrote Perez and Dannie Cesena, program manager of LGBTQ Health and Human Services Network.

The call for participants on the Semel Institute's website states that researchers were looking for transgender, nonbinary, and cisgender adults between the ages of 18 and 40 to complete an assessment and one or more MRI scans.

Participants would also be "photographed from the neck down while wearing a unitard," a point of contention cited by Perez in his statement. The enrollment announcement also noted that participants who experience discomfort during this process could withdraw from the study at any point.

Researchers also required that participants not be on any psychiatric medications, and that trans and nonbinary participants could not already be on hormone therapy or have had gender-affirming surgery. The UCLA Semel Institute website said participants would be paid $110 to $210 and travel expenses would be subsidized.

The study in question would use the "body morph'" test, designed by Feusner and fellow researchers in 2015. During the test, transgender and cisgender participants are photographed from various angles in a nude-colored, full-body unitard. After faces, hands, and feet are cropped from the images, photographs of participants' bodies are morphed with pictures of different bodies from a variety of angles, amounting to the production of 62 unique images per participant.

In an emailed statement to MedPage Today, Feusner and co-researcher Ivanka Savic-Berglund, MD, PhD -- also an adjunct professor of neurology at UCLA -- wrote that at the time that Feusner created the "body morph" test, "experiences of body-self incongruence were not easily understood. The test uses images to estimate the degree of alignment between individuals' body perception and their gender-specific self-identity."

In their letter to UCLA, Perez and Cesena strongly objected to the idea that such brain imaging -- capturing the neurological response of gender dysphoria -- could provide any scientific data that could "help" trans people in the future.

"It is suggestive of a search for medical 'cure,' which can open the door for more gatekeeping and restrictive policies and practices in relation to access to gender-affirming care," the letter stated.

Feusner and Savic-Berglund, however, explained that "by demonstrating that body-self incongruence was linked to brain structure and function, we aimed to help provide a biological basis and increase empathy for the life stories of transgender individuals. From the beginning, the aim was to help increase acceptance of transgender individuals."

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