Risk factors for Alzheimer’s disease ‘significantly higher’ in transgender, non-binary population

Key points:

• Alzheimer’s disease is the most common form of dementia

• The recently published findings are the first global study investigating risk factors in transgender and non-binary people for developing Alzheimer’s disease later in life

• ‘Risk factors’ are lifestyle traits which may heighten the likelihood of dementia onset

Transgender men, transgender women and non-binary populations were found to have significantly more ‘risk factors’ for developing Alzheimer’s disease later in life, relative to their cisgender male and female counterparts, as noted in a recently published research study.

The study, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, found risk factors commonly associated with the onset of Alzheimer’s disease, such as depression, kidney problems and diminished physical activity varied far more between gender than sex.

Dr Brooke Brady, lead author of the study and interdisciplinary research fellow at the School of Psychology and Ageing Futures Institute at the University of New South Wales Sydney, said the recently published study addressed the “long overlooked” experiences of transgender and gender-diverse people, in both health research and policy.

“When it comes to dementia and Alzheimer’s disease risk, it appears there are some modifiable risk factors impacting transgender and gender-diverse people that may not have been considered,” Dr Brady said.

Several limitations are acknowledged in the study, such as the role of societal stigma and discrimination against gender diverse individuals, race, age education and the difference between mid-life and late-life Alzheimer’s disease development.

“It’s vital we’re considering sex differences separately from gender differences because, as the findings of this study illustrate, they may have a different relationship to dementia and Alzheimer’s disease risk across the lifespan,” Dr Brady said.

‘Sex’ refers to biological status as male, female, or another variation of sex characteristics, whereas ‘gender’ is a dynamic social construct.

Transgender or non-binary people may have lived experiences of ‘gender dysphoria,’ commonly thought of as being ‘born in the wrong body.’ ‘Cisgender’ people — those whose gender aligns with their sex — make up the vast majority of the population.

The study also found that the level of risk for Alzheimer’s disease changes over the course of a person’s life, according to the sex assigned at birth. While males had higher overall risk in middle-age, this pattern reversed in old age when females reported higher overall risk.

Data from the analysis assessed 955 transgender and gender-diverse participants from a 2019 surveillance survey in the United States, who were age-matched with a cisgender sample group. Dr Brady said further research is needed to collect data for an Australian dementia study to compare to the new analysis.

“We would also love to understand how this compares to dementia risk in Australia and other countries, but we need to develop strong local and global datasets,” Dr Brady added.

“In doing so, I hope we can dramatically grow the evidence base and dramatically shrink the health disparities impacting trans and non-binary adults in dementia risk.”

Depression rates by gender and sex:

• Non-binary adults — 49.8 percent
• Transgender men — 39.8 percent
• Transgender women — 30.7 percent
• Cisgender women — 23.6 percent
• Cisgender men — 13.8 percent

Kidney problem rates by gender and sex:

• Non-binary adults — eight percent
• Cisgender women — 1.3 percent
• Cisgender men — 0.9 percent

Physical inactivity rates by gender and sex:

• Non-binary adults — 35.6 percent
• Cisgender women — 23.9 percent
• Cisgender men — 23.2 percent
• Transgender men — 5.8 percent
• Transgender women — 5.6 percent

Heart attack rates by gender and sex:

• Non-binary adults — six percent
• Transgender men — 5.8 percent
• Transgender women — 5.6 percent

“These disparities in modifiable risk factors like higher rates of depression and kidney disorders are significant and may drive a higher risk of later-life Alzheimer’s disease for transgender and non-binary adults,” Dr Brady said.