As a University of Guelph neuroscientist who studies sex-based differences in the brain, Dr. Melissa Perreault is always thinking about biological sex.

portrait of woman
Dr. Melissa Perreault

After attending an international conference where panellists discussed sex and gender inclusivity in brain research, the Ontario Veterinary College neuroscience professor began to think more broadly about how the sex and gender binaries impacted her own work.

A Métis woman, Perreault understands how marginalized groups have historically been studied and represented by folks who do not identify as part of them. She wanted to draw attention to the lack of gender inclusivity in clinical neuroscience research – specifically transgender and gender non-conforming people – but understood it wasn’t a project she could do alone.

“I felt like I had a background to transfer my knowledge to a group whose well-being interested me,” she said. “But by no means would I have attempted to do it without people who have lived experience.”

Enter Caitlin Nolan, a cisgender woman and lesbian who is a PhD student in the Department of Biomedical Sciences. Nolan told her adviser Perreault she was interested in studying schizophrenia, a major part of the professor’s research program.

With Dr. Troy Roepke, a non-binary, gay professor in the Department of Animal Sciences at Rutgers University, Noland and Perreault wrote Beyond the Binary: Gender Inclusivity in Schizophrenia Research published in Biological Psychiatry.

“I could not have done this without Caitlin taking the lead and without the guidance of Dr. Roepke,” Perreault said.

Schizophrenia and stress

Schizophrenia is a severe neuropsychiatric disorder that leads people to misinterpret reality. Hallucinations, delusions and disordered thinking and behaviour impair one’s ability to function. People living with schizophrenia who receive treatment early are often able to get their symptoms under control, but the illness does require lifelong treatment.

There is no exact known cause of schizophrenia. It develops from a mix of genetic susceptibility factors and environmental factors; one significant contributor is stress.

Schizophrenia is expressed differently in cisgender men and women, the authors write, but research has failed to consider gender beyond the socially constructed binary of male and female.

That needs to change, Perreault said, pointing out that schizophrenia occurs up to nine times more in trans and gender non-conforming people. They already experience higher rates of anxiety, depression, suicide, homelessness, violence and substance use and are exposed to ongoing prejudice and discrimination.

Misgendering, being denied access to gendered spaces like washrooms, negative portrayals in the media and transitioning are all examples of stressors experienced by trans and gender non-conforming people.

In Canada, the first country to provide census data on this demographic, one in every 300 people aged 15 or older identifies as trans or non-binary.

Schizophrenia and gender dysphoria

“More people than ever are starting to think about how research is done in marginalized communities,” said Perreault. “Further, we are really beginning to acknowledge how important diversity and inclusion is in academics, so there is no reason why we can’t be diverse and inclusive in our research approaches.”

Traditionally, schizophrenia symptoms have been known to surface in men in their late teens and early 20s and in women in their late 20s to early 30s.

People experiencing gender dysphoria – the discomfort or distress one has because their biological sex does not match their gender identity – can also develop at a young age.

“This can result in a delay of treatment for either condition for fear of misdiagnosis,” Perreault said.

Improving mental health care

Ultimately, Perreault sees more gender-inclusive research as the path to improving health care. Everyone deserves to have an equal standard of care, she said. Personalized approaches to medicine must include cultural awareness and respect for one’s identity. “When you don’t have that as a health practitioner or a researcher, there’s no trust.”

Moving beyond the gender binary to think about the brain not in a static state of one gender or the other but as part of a continuum of gender is vital, Perreault said. “If we embrace this type of research, it will give us a lot more knowledge not only about schizophrenia but how the brain fundamentally works across genders.”

Following the paper’s conclusion, each researcher wrote a positionality statement explaining how they identify, reinforcing the importance of representation. Perreault said the abundance of positive feedback received during the peer review process leaves her hopeful that academia is beginning to shift toward inclusion in an organic way.

The authors’ recommendations include more training and education for researchers, as well as the inclusion of trans and gender non-conforming people in research.

This study was supported by the Canadian Institutes of Health Research and the National Institute of Mental Health in Maryland.


Dr. Melissa Perreault