Neuroscientist Kale Edmiston is no stranger to the intersection of neuroscience, gender identity, and society. He's a postdoctoral fellow at the University of Pittsburgh who uses neuroimaging to get snapshots of brain anatomy and function in different types of people, such as those with anxiety, bipolar disorder, or autism. Currently, he's trying to understand whether folks with anxiety have different brain activity when viewing social or emotional images.

But beyond his research, Edmiston is a longstanding and outspoken proponent for the trans community, specifically their mental health needs. During his PhD at Vanderbilt, he co-founded the trans buddy program, a patient support and advocacy network for trans individuals. He doesn't conduct research on gender identity, but follows and comments on this type of work quite often through the lens of both a scientist and a trans person, critical of the thought that neuroscience is the study of brains without being the study of how we treat the people that have them.

Edmiston is a scientist with an incredibly unique perspective on the intersection of neuroscience and gender identity. Voices like his deserve much more attention. Here is Edmiston, in his own words.

Ashley Juavinett: You have a super unique viewpoint as a neuroscientist and a trans person. As you know, there's a burgeoning subfield of neuroscience where folks are trying to understand whether there are brain signatures of gender identity. Did you ever think, “I’m the person who should do this type of research”?

Kale Edmiston: I did try and do some research related to transgender identity, and I’ve had a very difficult time getting work like this published, primarily because editors and reviewers are really entrenched in the current paradigm. We have this recursive loop where there are very few trans perspectives that are allowed in the field, and the people that control the perspectives that are out there aren’t transgender. I’ve taken a step away, but who knows what the future holds.

What is this‘current paradigm’ that you’re referring to? And how would you change it?

The main thing is the acceptance that there is some prenatal anomaly that causes a mismatch between sex organ development and brain development. There are a whole lot of leaps that are made to support that – if there was evidence that came forward, great. But I’m a scientist and I evaluate the evidence as it comes in. The quality of the evidence now isn’t great.

I actually have some unpublished work filed away with preliminary data I’ve collected. For instance, I did a study that looked at how a lecture about the neurobiological basis of sexuality and gender identity affected homophobic and transphobic attitudes. I found that it basically just served to polarize people’s pre-existing beliefs. At the time, when I submitted it to journals, they considered it a niche thing, saying, “We don’t really publish on transgender topics.” And trans journals all focus on the biological explanations of being trans. So there wasn’t really a good home for it.

That study was a few years ago. At this point, I’m not sure if it would be worth re-visiting it, since so much has changed, post Caitlyn Jenner.

It would be really interesting to do a pre-Jenner, post-Jenner comparison about attitudes…

Hah, yeah.

So, do biological explanations mean anything to you personally?

It’s never been important to me – for some trans people it is. To my mind, whether it’s the third interstitial nucleus of the hypothalamus, or my spleen, I don’t care. No one else should either, really. In terms of how we’re treated, it shouldn’t matter.

As human beings, we should take each other at our word, and we should haven’t to prove that we’re really a certain gender in order to be treated like a person. I should be treated like a person no matter what.

Completely agree. You mentioned that some people find biological explanations of gender identity useful — in what context do you think it might be?

We’re a diverse community and a lot of people understand their gender in really different ways. For some people, the idea that they should have been born xyz gender, with proof in their brain and through some developmental process — that can be really powerful. That’s just not how I understand my gender.

At the end of the day, I also am still a scientist. So there is a part of me that is curious and wants to know. Although I’m not curious about the biological cause, I’m curious about the contributions of depression to studies of trans individuals that have already been published.

Does this type of research into biological explanations have any role in activism or policy making?

If we look at social movements, it’s been activists who have made the difference.

It hasn’t exactly been neurobiologists.

Hah, no. A biological argument isn’t going to sway someone who is determined to hate you.

And you brought up policy — how does this get implemented in terms of policy? Does it become a test that we use to determine who gets access to hormones and surgery? Because trans people have a ton of trauma related to denial of access to those interventions, and there is a really long history of gatekeeping. There is this idea that there is a doctor who knows if you’re trans better that you do. That’s really damaging.

We should be working on the stigma, and I don’t think these studies do that.

So, what research should we be doing?

There are so many open and unstudied questions: what does it mean to be a transgender person in the world, and how does that change through development and environment? Our community has high rates of PTSD, anxiety, and more, and to date none of the work has considered any of those factors. In my opinion, it’s because the work hasn’t included any transgender people.

There are all of these issues: experiences with discrimination, internalizing transphobic messages, fear of future discriminatory experiences. All of those factors effect how trans individuals perceive the world.

Wow, yeah. And there is definitely research on this in other spheres, like how poor coal mining communities pass down depression and anxiety throughout generations, or how the tsunami in Japan had lasting effects on mental health.

The trans community is similarly impoverished, like the communities in those studies. We are disproportionately living in poverty, dealing with really high rates of depression. All of these experiences manifest in the brain.

My ideal experiment is to conduct a neuroimaging study with really thorough psychiatric and trauma histories, and to also include a group of cisgender people who are matched for depression/anxiety, in addition to a healthy group. A sample of trans people with no history of depression or anxiety is just not representative of the community, and that has to be accounted for.

At this point in my career I do visual neuroscience – I’m not trying to write an R01 that does a study to answer this question. But I would love to push for people to do that.