Women compared with men work harder for small rewards.

In cost-benefit decision-making, women and men often show different trade-offs. However, surprisingly little is known about sex differences in instrumental tasks, where physical effort is exerted to gain rewards. To this end, we tested 81 individuals (47 women) with an effort allocation task, where participants had to repeatedly press a button to collect food and money tokens. We analyzed the motivational phases of invigoration and effort maintenance with varying reward magnitude, difficulty, and reward type. Whereas women and men did not differ in invigoration, we found that women showed higher effort maintenance as well as higher subjective wanting and exertion ratings for small rewards compared with men. Notably, men increased their effort more than women for higher rewards to match women's levels of performance. Crucially, we found no sex differences depending on reward type or difficulty, indicating that sex differences were specific to the encoding of the magnitude of benefits, not costs. To summarize, women exerted higher physical effort for small rewards, which corresponded with an elevated subjective value in women compared with men. Therefore, sex differences in perceived reward magnitude may contribute to differential behavioral preferences highlighting the potential of cost-benefit decision-making to provide insights about potential mechanisms.

No Differences in Value-Based Decision-Making Due to Use of Oral Contraceptives.

Fluctuating ovarian hormones have been shown to affect decision-making processes in women. While emerging evidence suggests effects of endogenous ovarian hormones such as estradiol and progesterone on value-based decision-making in women, the impact of exogenous synthetic hormones, as in most oral contraceptives, is not clear. In a between-subjects design, we assessed measures of value-based decision-making in three groups of women aged 18 to 29 years, during (1) active oral contraceptive intake (N = 22), (2) the early follicular phase of the natural menstrual cycle (N = 20), and (3) the periovulatory phase of the natural menstrual cycle (N = 20). Estradiol, progesterone, testosterone, and sex-hormone binding globulin levels were assessed in all groups via blood samples. We used a test battery which measured different facets of value-based decision-making: delay discounting, risk-aversion, risk-seeking, and loss aversion. While hormonal levels did show the expected patterns for the three groups, there were no differences in value-based decision-making parameters. Consequently, Bayes factors showed conclusive evidence in support of the null hypothesis. We conclude that women on oral contraceptives show no differences in value-based decision-making compared to the early follicular and periovulatory natural menstrual cycle phases.

Male or Female? - Influence of Gender Role and Sexual Attraction on Sex Categorization of Faces.

The categorization of dominant facial features, such as sex, is a highly relevant function for social interaction. It has been found that attributes of the perceiver, such as their biological sex, influence the perception of sexually dimorphic facial features with women showing higher recognition performance for female faces than men. However, evidence on how aspects closely related to biological sex influence face sex categorization are scarce. Using a previously validated set of sex-morphed facial images (morphed from male to female and vice versa), we aimed to investigate the influence of the participant's gender role identification and sexual orientation on face sex categorization, besides their biological sex. Image ratings, questionnaire data on gender role identification and sexual orientation were collected from 67 adults (34 females). Contrary to previous literature, biological sex per se was not significantly associated with image ratings. However, an influence of participant sexual attraction and gender role identity became apparent: participants identifying with male gender attributes and showing attraction toward females perceived masculinized female faces as more male and femininized male faces as more female when compared to participants identifying with female gender attributes and attraction toward males. Considering that we found these effects in a predominantly cisgender and heterosexual sample, investigation of face sex perception in individuals identifying with a gender different from their assigned sex (i.e., transgender people) might provide further insights into how assigned sex and gender identity are related.

Healthcare for Trans*gender People in Germany: Gaps, Challenges, and Perspectives.

People whose gender does not correspond to the binary gender system, i.e., trans∗gender people, face two main problems when it comes to healthcare in Germany: (1) They often suffer from general psychiatric comorbidities as well as specific and significant mental distress due to gender dysphoria, and (2) the German healthcare system lacks sufficiently educated and clinically experienced medical personnel who are able to provide specialized healthcare. Aside from transition, it often is extremely difficult for trans∗gender people to get access to and be integrated into the medical system. Stigmatization and pathologization in treatment are widespread, as are long waiting times for specialized healthcare providers who are often only accessible to those trans∗gender people willing to travel long distances. Frequently, trans∗gender people face further difficulties and barriers after transition, as some healthcare professionals fail to provide suitable care (e.g., gynecological consultation for transmen). The ICD-11 German Modification (ICD-11-GM), which should be routinely used by 2022, implements a depathologization of trans∗gender people in the medical system. This paper compares the issues related to health and healthcare of trans∗gender people in Germany with those in other European countries. We review the care offered by specialized centers with regard to treatment of and support for trans∗gender people. We conclude with specific proposals that may contribute to establish an improved, up-to-date, gender-sensitive healthcare system.

A single dose of escitalopram blunts the neural response in the thalamus and caudate during monetary loss.

Background: Selective serotonin reuptake inhibitors (SSRIs) show acute effects on the neural processes associated with negative affective bias in healthy people and people with depression. However, whether and how SSRIs also affect reward and punishment processing on a similarly rapid time scale remains unclear. Methods: We investigated the effects of an acute and clinically relevant dose (20 mg) of the SSRI escitalopram on brain response during reward and punishment processing in 19 healthy participants. In a doubleblind, placebo-controlled study using functional MRI, participants performed a well-established monetary reward task at 3 time points: at baseline; after receiving placebo or escitalopram; and after receiving placebo or escitalopram following an 8-week washout period. Results: Acute escitalopram administration reduced blood-oxygen-level-dependent (BOLD) response during punishment feedback in the right thalamus (family-wise error corrected [FWE] p = 0.013 at peak level) and the right caudate head (pFWE = 0.011 at peak level) compared to placebo. We did not detect any significant BOLD changes during reward feedback. Limitations: We included only healthy participants, so interpretation of findings are limited to the healthy human brain and require future testing in patient populations. The paradigm we used was based on monetary stimuli, and results may not be generalizable to other forms of reward. Conclusion: Our findings extend theories of rapid SSRI action on the neural processing of rewarding and aversive stimuli and suggest a specific and acute effect of escitalopram in the punishment neurocircuitry.

Influence of ovarian hormones on value-based decision-making systems: Contribution to sexual dimorphisms in mental disorders.

Women and men exhibit differences in behavior when making value-based decisions. Various hypotheses have been proposed to explain these findings, stressing differences in functional lateralization of the brain, functional activation, neurotransmitter involvement and more recently, sex hormones. While a significant interaction of neurotransmitter systems and sex hormones has been shown for both sexes, decision-making in women might be particularly affected by variations of ovarian hormones. In this review we have gathered information from animal and human studies on how ovarian hormones affect decision-making processes in females by interacting with neurotransmitter systems at functionally relevant brain locations and thus modify the computation of decision aspects. We also review previous findings on impaired decision-making in animals and clinical populations with substance use disorder and depression, emphasizing how little we know about the role of ovarian hormones in aberrant decision-making.

Sex hormones and human brain function.

Sex hormones have organizational and activational effects on the human brain and can interact with the neurotransmitter systems. These biologic mechanisms may have a far-reaching impact, with both behavioral consequences and structural as well as functional brain modulation. The impact of cycling hormone levels throughout the menstrual cycle on cognitive and emotion processing has especially received some attention recently. Therefore, the aim of this chapter is to give an overview of findings regarding the effects of estradiol and progesterone, but also testosterone, on functional brain domains comprising cognition, emotion, and reward processing.

Effects of Hormonal Contraceptives on Mood: A Focus on Emotion Recognition and Reactivity, Reward Processing, and Stress Response.

PURPOSE OF REVIEW: We review recent research investigating the relationship of hormonal contraceptives and mood with a focus on relevant underlying mechanisms, such as emotion recognition and reactivity, reward processing, and stress response. RECENT FINDINGS: Adverse effects of hormonal contraceptives (HCs) on mood seem most consistent in women with a history of depressive symptoms and/or previous negative experience with HC-intake. Current evidence supports a negativity bias in emotion recognition and reactivity in HC-users, although inconsistent to some extent. Some data, however, do indicate a trend towards a blunted reward response and a potential dysregulation of the stress response in some HC-users. HC-effects on psychological and neurophysiological mechanisms underlying mood are likely context-dependent. We provide suggestions on how to address some of the contributing factors to this variability in future studies, such as HC-dose, timing, administration-mode, and individual risk. A better understanding of how and when HCs affect mood is critical to provide adequate contraceptive choices to women worldwide.