Abstract
BACKGROUND: Minority groups including transgender persons are frequently subjected to social rejection and ostracism, leading to minority stress. This stress may lead to a variety of adverse mental and physical health outcomes. Yet, the impact of this stress on underlying psychophysiology in transgender people has not been tested experimentally. METHODS: Using the "first impressions paradigm" this study examined psychophysiological feedback to experimentally-induced social rejection in hormone-naïve transgender people (37 trans men (TM) and 27 trans women (TW)) and cisgender comparisons (30 cis men (CM) and 36 cis women (CW)). Participants received positive and negative social evaluations (based on their own photograph) while eye movements (i.e., gaze behavior and pupil dilation) were recorded. All participants filled out questionnaires regarding mental health (e.g., depression, anxiety, resilience) before the task, and prior to commencing gender-affirming hormone treatment (T0) (GAHT) in trans people, and again after 6-10 months (T1). RESULTS: Trans people gazed more towards the feedback word relative to cis comparisons. Also, CW gazed more to the evaluator than any of the other three groups. No differences in pupil dilation emerged. Interestingly, gaze data at T0 predicted anxiety (TW & CW), resilience (TW & CW), and self-esteem (both trans groups) at T1. CONCLUSIONS: The findings indicate heightened attention to feedback in trans people as well as heightened attention to the evaluator in CW during a social evaluation task. Lastly, gaze duration is linked with mental health outcomes more than half year later for TM, TW, and CW.