Translational models of fear have greatly informed our understanding of PTSD and its underlying fear circuitry. One of the most replicated findings in the field is the two-fold higher PTSD incidence in females compared to males. While sociocultural factors play a role, the most robust biological influencers to date are gonadal hormones, such as estradiol and progesterone, which fluctuate across the menstrual cycle. Among studies that account for these hormones, most do so in isolation or collect both and only report one. Variation in study findings suggests that the ratio between these two hormones (the P/E ratio) may be an important and missing variable to further understand gonadal hormone influences on fear. Here we review cross-species examinations of fear and PTSD, within the contexts of estradiol and progesterone as well as P/E ratios that were calculated based on extant literature. We then provide recommendations for best practices in assay methods and reporting to improve research on the P/E ratio in fear and PTSD. Ultimately, greater understanding of this important variable will advance efforts to characterize gonadal hormone influences on fear learning processes in humans and animals.

Purpose Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults’ psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. Methods We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18–100) residing in 45 US states and the District of Columbia (DC). Results Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. Conclusion Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia’s multifaceted nature and negative mental health consequences. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-023-02482-4.

Background: Relative to cisgender adolescents, transgender adolescents experience greater interpersonal trauma, depression, and suicidality. Structural transphobia (societal conditions constraining transgender people’s rights/wellbeing) may exacerbate associations between trauma and poor mental health for this group. Indeed, a recent study found more severe suicidality in trauma-exposed transgender adults from states with more transphobic policies. To date, this line of research has rarely examined transgender adolescents nor considered structural anti-transgender attitudes.Method: We used national survey data (5,188 transgender adolescents; 22 states) to explore the interaction of trauma and state-level transphobia (explicit anti-transgender attitudes) on mental health. Factor analysis was used to create a state-level transphobia measure. Latent class analysis identified transgender adolescents exposed to low (0-2; mostly bullying; 70%) vs. high (>2; mostly physical assault; 30%) numbers of traumas. To explore interaction effects, we created categories representing trauma class and low vs. high transphobia representing 4 groups: 31% low trauma/low transphobia, 16% low trauma/high transphobia, 37% high trauma/low transphobia, and 16% high trauma/high transphobia. Regressions examined associations between group membership and depression and suicidality.Results/Discussion: Relative to the low trauma/low transphobia group, transgender adolescents in high trauma groups were more likely to consider (ORs=2.8 & 2.4) or plan (ORs=2.9 & 3.4) suicide (ps<.001), and those in all other groups were more likely to report depression (ORs=1.3-2.8, ps<.001). The highest odds for depression and suicidality were found in the high trauma/high transphobia group. Results suggest that structural transphobia confers additional risk for trauma-exposed transgender adolescents, who may benefit from multilevel interventions addressing both interpersonal and structural stigma.

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