Sexual Orientation Modulates Endocrine Stress Reactivity

Abstract

BACKGROUND Biological sex differences and sociocultural gender diversity influence endocrine stress reactivity. Although numerous studies have shown that men typically activate stronger stress responses than women when exposed to laboratory-based psychosocial stressors, it is unclear whether sexual orientation further modulates stress reactivity. Given that lesbian, gay, and bisexual (LGB) individuals frequently report heightened distress secondary to stigma-related stressors, we investigated whether cortisol stress reactivity differs between LGB individuals and heterosexual individuals in response to a well-validated psychosocial stressor. METHODS The study population comprised 87 healthy adults (mean age, 25 years) who were grouped according to their biological sex and their gendered sexual orientation: lesbian/bisexual women (n = 20), heterosexual women (n = 21), gay/bisexual men (n = 26), and heterosexual men (n = 20). Investigators collected 10 salivary cortisol samples throughout a 2-hour afternoon visit involving exposure to the Trier Social Stress Test modified to maximize between-sex differences. RESULTS Relative to heterosexual women, lesbian/bisexual women showed higher cortisol stress reactivity 40 min after exposure to the stressor. In contrast, gay/bisexual men displayed lower overall cortisol concentrations throughout testing compared with heterosexual men. Main findings were significant while adjusting for sex hormones (estradiol-to-progesterone ratio in women and testosterone in men), age, self-esteem, and disclosure status (whether LGB participants had completed their “coming out”). CONCLUSIONS Our results provide novel evidence for gender-based modulation of cortisol stress reactivity based on sexual orientation that goes beyond well-established between-sex differences. This study raises several important avenues for future research related to the physiologic functioning of LGB populations and gender diversity more broadly.

Sexual Orientation Disparities in Pregnancy and Infant Outcomes

“…Given the high rates of discrimination experienced by SMW, it is possible that similar processes contribute to the inequities in birth outcomes observed among bisexual and lesbian women. In addition, research with non-pregnant samples has shown that exposure to stress is associated with higher cortisol stress reactivity among bisexual and lesbian women than heterosexual women (Juster et al, 2015). Thus, it may be that pregnant SMW who experience levels of stress during pregnancy that are similar to their heterosexual peers are more vulnerable to adverse birth outcomes due to differences in physical reactivity to stress.…”

Sexual orientation and diurnal cortisol patterns in a cohort of U.S. young adults

“…Following from this logic, it is possible that young sexual minority adults in the GUTS cohort have developed coping strategies that enhance their ability to manage stigma-related stressors and are reflected in HPA-axis responses that parallel those of their heterosexual peers. Prior research on stress reactivity finding low cortisol response to a laboratory stressor among gay/bisexual men in relation to heterosexual men was also hypothesized to be due to successful adaptation to sexual minority stigma (Juster et al, 2015). That said, the well-documented higher rates of depressive symptoms, PTSD, eating disorder symptoms, substance use, and other health risk indicators found in sexual minority compared to heterosexuals in the GUTS cohort (Austin et al, 2013; Corliss et al, 2010; Roberts et al, 2012, 2013b) raises the question as to whether coping strategies that mitigate dysregulation of the HPA axis or, more particularly, cortisol diurnal rhythms, may be different from strategies that mitigate mental health problems.…”

“…In spite of the large sample size, power limitations are a concern for this analysis, particularly given the relatively small sample of LGB individuals who provided saliva for the study, made even smaller when stratified by sex. Future studies with even larger samples are needed because, as indicated by prior research on stress-related biomarkers (Everett et al, 2014; Juster et al, 2015, 2013) and guided by intersectionality theory (Bauer, 2014), it is critically important to be able to examine the intersection of sexual orientation and gender to improve understanding of physiological stress response. Larger samples and oversampling of transgender participants would also allow for analyses of gendered patterns beyond those seen in cisgender populations.…”

“…One study of LGB and heterosexual adults in Montreal found no significant differences in diurnal cortisol profiles by sexual orientation identity, although within the LGB group, sexual identity disclosure was associated with lower cortisol levels at 30 min after waking (Juster et al, 2013) A study of HPA axis reactivity in this same sample found differences by sexual orientation and gender, such that lesbian/bisexual women had higher cortisol reactivity following exposure to a laboratory stressor than heterosexual women while gay/bisexual men showed lower overall cortisol levels throughout the study than heterosexual men (Juster et al, 2015). In addition, one study examined associations between sexual orientation identity and other stress-related biomarkers in a nationally representative cohort of U.S. young adults (Everett et al, 2014; Hatzenbuehler et al, 2013).…”

A time to be stressed? Time perspectives and cortisol dynamics among healthy adults

“…All communication took place through an intercommunication device. This “panel-out” approach maximizes sex differences in cortisol stress reactivity among heterosexual women that respond even less than men (Andrews et al, 2007; Diener, Emmons, Larsen, & Griffin, 1985; Juster et al, 2014; Juster et al, 2011b; Soler et al, 2012). …”