Neuropsychological Functioning in Transgender Adults: Evidence from a University-Based Gender Identity Clinic in...

Neurocognitive functioning in transgender adults remains understudied and is predominantly derived from Western samples, often treated as universally applicable. Evidence from non-Western contexts is limited, despite the potential influence of structural stigma and minority stress on cognition and research participation. Türkiye represents a sociopolitical setting where transgender individuals face significant barriers to healthcare and research. To date, no study has systematically examined the neuropsychological profile of transgender adults in Türkiye using a four-group design.

This retrospective, cross-sectional study was conducted at a multidisciplinary university-based gender identity clinic. Eighty-one adults were included: transgender women (n = 14), transgender men (n = 39), cisgender women (n = 13), and cisgender men (n = 15), with cisgender groups matched for age and education. Participants completed a standardized neuropsychological battery assessing visuospatial abilities, executive functions/processing speed, working memory, and verbal fluency. Group differences were analyzed using nonparametric methods, with additional aggregated transgender-cisgender comparisons.

Group differences were observed in visuospatial functioning (Judgment of Line Orientation, Rey-Osterrieth Complex Figure; all p ≤ 0.05) and executive control (Trail Making Test Part B, p = 0.048; B-A difference, p = 0.014). Group-level differences were domain-specific: both transgender groups scored below both cisgender groups on the visuospatial measures, whereas the ordering on executive-control measures differed, and distributions overlapped substantially throughout. Processing speed, working memory, and verbal fluency did not differ significantly (p > 0.05). No clear association between hormone therapy status and performance was detected in this small sample.

The observed distributions were domain-specific and substantially overlapping, and should not be interpreted as indicating correspondence between cognitive performance and either gender identity or sex assigned at birth. Differences were domain-specific, with substantial overlap across groups. Findings support a context-sensitive, non-pathologizing interpretation emphasizing sociocultural factors rather than inherent deficits. Longitudinal and cross-cultural studies incorporating psychosocial variables are needed.