Tribal cultures all across Africa recognize numerous gender identities, which Europeans tried to wipe out. The Indigenous cultures of North America recognized a third gender far before European colonialism, and still do to this day. The Gala, a middle gender priest class of the Sumerian empire, existed over 4,500 years ago. In cultures worldwide, for as long as human civilization has existed, there have been people whose experience of their gender identity do not align with the Anglo-European concepts of binary sex based on genital structure. I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.Denoting or relating to a person whose sense of personal identity and gender does not correspond with their sex assigned at birth. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. This study was approved by the institutional review board of the Medical University of Vienna (EK Nr.: 1104/2016). The details of the IRB/oversight body that provided approval or exemption for the research described are given below: I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Manfred Klöbl and Murray Bruce Reed are recipients of a DOC Fellowship of the Austrian Academy of Sciences. This research was funded as whole or in part by the Austrian Science Fund (FWF), a Brain and Behavior Research Foundation (formerly NARSAD) Young Investigator grant (23741, PI: Marie Spies), the Medical Imaging Cluster of the Medical University of Vienna, and by the grant "Interdisciplinary translational brain research cluster (ITHC) with highfield MR" from the Federal Ministry of Science, Research and Economy (BMWFW), Austria. She further spoke at a workshop organized by Eli Lilly. Marie Spies received travel grants from Janssen, AOP Orphan Pharmaceuticals Lecture Honoraria: Heel, Janssen and Austroplant. He is a shareholder of the start-up company BM Health GmbH since 2019. He received investigator-initiated research funding from Siemens Healthcare regarding clinical research using PET/MR. Rupert Lanzenberger received travel grants and/or conference speaker honoraria within the last three years from Bruker BioSpin MR and Heel, and has served as a consultant for Ono Pharmaceutical. Future investigations longer into transition might resolve the discrepancy on behavioral and neuronal levels. We show that correlates of sexual arousal in transgender individuals might change in direction of the chosen gender. This prominent role of lesbian stimuli might be explained by their differential responses in cis women and men. Activation of the ventral striatum supported our hypothesis only for lesbian scenes in trans women. The hypothesized changes in response patterns could indeed be observed in the behavioral responses to the single but not the differentiation between stimulus categories with the strongest results for trans men and lesbian scenes. Utilizing a Bayesian framework allowed us to incorporate behavioral findings in cisgender individuals of different sexual orientations. To this aim, trans women and men as well as age-matched cisgender controls rated visual stimuli showing heterosexual, lesbian or gay intercourse for subjective sexual arousal. Using functional magnetic resonance imaging, we investigated whether the neuronal and behavioral patterns of sexual arousal in transgender individuals moved from the given (before) to their chosen gender after 4.5 months of hormone therapy. In transgender individuals sexual orientation occasionally changes before or during transition, which may involve gender-affirming hormone therapy. Both experienced gender and sex hormones have a relation to sexual preferences, arousal in response to erotic stimuli, and thus sexual orientation. While the concept of sexual orientation is more clearly defined in cisgender, this is less so in transgender individuals.
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