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Ewan regularly travels to Ghent, where a team closely monitors his response to hormone therapy. People who transition early in life, for instance, might have different brain characteristics from those who transition later, owing to the way their brains are shaped by societal gender roles or biological factors, such as hormones during puberty. In the examination room in Ghent, a year-old transgender man named Ewan is describing how his facial hair has grown since he last visited the clinic six months ago. And yet transgender women have largely been excluded from studies on prophylactic HIV treatments, or have been erroneously lumped together with men who have sex with men. Sara Reardon Search for this author in:

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Benita Arren wishes that the human body came with instructions.

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The researchers must tread carefully to avoid making things more difficult for a group that is already stigmatized. Researchers debate what kind of differences — if any — exist between male and female brains, and many such studies have been poorly interpreted. There are reasons to believe that high doses of oestrogen could affect how HIV works in the body and stymie common approaches to treating it, but no one has ever looked at the question explicitly.

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He had just launched a study — the first of its kind — that would follow people such as Arren through their transition and for years afterwards.

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