Effect of Hormones on Frequency of Headache and Brain Structure and Function in Puberty

MTF youth who will begin estrogen clinically will be enrolled in the study and will be seen twice, once before starting estrogen and then one year after beginning estrogen. Cisgender males (male sex, male gender identity) will also be enrolled as a control group and will be seen once at the beginning of the study and then once a year later. The researchers will track how often youth have headaches during this time to see if it is different between groups. In a subset of the youth enrolled, an MRI will be completed to also look at brain structure and function.

Inclusion criteria

For MTF youth (cases):

• Identify as MTF
• Age 11-20 years at the time of enrollment
• Plan to start estrogen clinically in < 6 months

For cisgender male youth (controls):

• Identify as cisgender male
• Age 9-20 years at the time of enrollment
• No diagnosis of Klinefelter Syndrome (XXY)

Exclusion criteria

• Cognitive, or psychiatric impairment resulting in inability to tolerate the study procedures not including depression or anxiety
• Known history of stroke, multiple sclerosis, or other serious neurologic condition

• MRI-specific exclusion criteria (Weight > 500 lbs, claustrophobia, metal in body)