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PainSHINENCT05787470

State of Hormones Impact Nociceptive Expression

An observational study of Pain and Gender Identity, run by University of Alabama at Birmingham at 1 site in United States.

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Sites and contacts
Official record
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Trial summary

The Investigators have recently published on differences in pain sensitivity measures between cis and trans individuals in the local area. The investigators observed the anticipated differences in pain sensitivity between CM and CW (CW > CM), but found that the TW were phenotypically similar to CW in all measures. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
Pain, Gender Identity
What is being tested?
Quantative sensory testing and Blood Draw
How many people
120 participants
Where
1 siteUnited States
Study dates
1 Mar 2023to 31 Jul 2027
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Study population will be chosen from the general public within the Birmingham as well as participants recruited through the Birmingham Aids Outreach (BAO), Magic City Acceptance Center (MCAC) and the Transgender Advocates Knowledgeable Empowering (TAKE).

Who may be able to join

  • self-identification as one of the above gender identities
  • understanding of verbal and written English.
  • participants that have been on/off hormone treatment for at least 6 months

Who cannot join

  • pain in at least 3/7 days/week for the past 3 months
  • HIV positive diagnosis
  • cardiovascular or pulmonary disease
  • regular use of opioid pain medications
  • uncontrolled hypertension (i.e. SBP/DBP of > 150/95)
  • current illness accompanied by fever (body temperature >38 °C)
  • prostatectomy, hysterectomy or oophorectomy
  • hospitalization due to psychiatric illness within the last 6 months.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Tammie Quinn, BA contact

(205) 934-8743

tquinn@uab.edu

United States1 site, 1 recruiting
  • University of Alabama at Birmingham

    Birmingham, Alabama, 35294

    Tammie Quinn, BA, (205) 934-8743, tquinn@uab.edu

    Recruiting

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About this study

The Investigators have recently published on differences in pain sensitivity measures between cis and trans individuals in the local area. The investigators observed the anticipated differences in pain sensitivity between CM and CW (CW > CM), but found that the TW were phenotypically similar to CW in all measures. However, the investigators did not assess hormone level, nor did the investigators recruit TM participants. Here, with the assistance of two local community group stakeholders the investigators will recruit the following groups: CM, CW, TM+T (currently taking exogenous testosterone), TW+E (exogenous estradiol), TM, and TW (n=20/group). The investigators will use quantitative sensory testing to assess sensitivity to cold, pressure, and heat via standardized protocols. Blood samples will be taken for assessment of stress and reproductive hormone levels, immune cell populations and stimulated cytokine release. Finally, questionnaires will measure pain state, quality of life (QOL), voice QOL, body image, appearance, self-reported health, masculinity/femininity, community connectedness, gender role, sleep, depression, social support, adverse childhood experiences and stigma.

Read the detailed description

Aim 1: To determine the impact of gender identity, genetic sex and hormone status on pain sensitivity.

Hypotheses: CM, TM and TM+T will have higher thresholds and lower sensitivity across the majority of pain tests when compared to CW, TW, and TW+E. Gender identity will influence pain sensitivity.

Aim 2: To examine social and psychological factors that contribute to pain sensitivity in our groups.

Hypotheses: Trans individuals will have pain sensitivity scores that align with their identified gender and will not be related to hormone levels or genetic sex. Stress, sleep quality, depression, social support and perceived discrimination will affect pain sensitivity measures.

Aim 3: To quantify differences in immune cell populations and activity between our groups.

Hypotheses: Hormone levels will be directly related to immune cell populations. CM, TW and TM+T will have increased frequencies of NK and CD8+ cells than CW, TM and TW+E. The presence of estradiol will be positively correlated with stimulated cytokine release in T cells.

Inclusion criteria will include:

  1. self-identification as one of the above gender identities; 2) age between 18-65; 3) understanding of verbal and written English. There will be considerable heterogeneity within the trans population with respect to gender/sexual expression. Whereas the investigators feel that these factors are important to consider, in order to enhance recruitment and inclusion, the investigators will focus on self-reported gender identity and note other variables of interest. With respect to hormone use, only participants that have been on/off hormone treatment for at least 6 months will be eligible. In both cases, this allow for stabilization of hormone levels and reduced variability. At this time the investigators will restrict our recruitment to self-identified trans and cisgender participants, but recognize that very little research exists on non-binary or genderfluid groups.

Exclusion criteria will be the following:

  1. pain in at least 3/7 days/week for the past 3 months; 2) HIV positive diagnosis; 3) cardiovascular or pulmonary disease; 4) regular use of opioid pain medications; 5) uncontrolled hypertension (i.e. SBP/DBP of > 150/95); 6) current illness accompanied by fever (body temperature >38 °C); 7) active use of oral contraceptives; 8) prostatectomy, hysterectomy or oophorectomy; 9) hospitalization due to psychiatric illness within the last 6 months. The investigators acknowledge that the rates of HIV are higher in the South and in gender minority populations 46, but our investigation of immune cell reactivity (Aim 3) necessitates this exclusion.

This study will consist of a single visit which will include the following:

Blood Draw: A small amount of blood (2 tsp) will be drawn by a trained and certified nurse. The investigators will be analyzing this blood to determine the participants' levels of oxidative stress. (5 minutes)

Questionnaires: The investigators will be administering a number of questionnaires to assess various aspects related to quality of life, experiences of stigma, depression and social support. These are standard measures for this type of study and will provide necessary information about factors that may influence pain sensitivity. (40 minutes)

Body Measurements: Body weight and height will be measured. The investigators will also be measuring the participants' blood pressure. (5 minutes)

Pain Testing: This will consist of a number of sensitivity tests. (70 minutes)

  • Pressure: The investigators will use a handheld probe that has a small rubber tip. This will produce a pressure sensation and the pressure pain threshold will be obtained.
  • Heat: Heat pain sensitivity will be tested with a thermal sensory testing machine used widely in clinical settings. This machine has a small square piece that is used to apply heat to the skin. The amount of heat is controlled by a computer. One or more of the following types of heat stimuli will be delivered: 1) a slowly increasing heat stimulus; 2) a series of 5 heat pulses. These heat pulses will be repeated at different temperatures.
  • Cold: Cold sensitivity will be assessed with the cold pressor task. The hand is placed into cold water (4-10 C) for up to 60 seconds. With the fingers splayed, the participant is asked for their pain ratings at 30 and 60 seconds.
  • Combined pressure and cold: The investigators will use a handheld device with a small rubber tip to apply pressure. As soon as pain is reported, the pressure will be removed. Next, the hand will be immersed into cold water. After 20 seconds, the pressure stimulator will again be applied.
Being tested
Quantative sensory testing, Blood Draw
Medical subject headings
Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Quantative sensory testingBehavioural

    Also called QST

    All participants will undergo quantitative sensory testing for assessment of endogenous pain modulation using painful heat, mechanical, and cold stimuli in a laboratory session lasting approximately 1 hour.

  • Blood DrawDiagnostic test

    Also called Venipuncture

    Sample of blood will be taken.

Study groups in NCT05787470
Study groupRoleWhat they receive
Cis ManPerson assigned male at birth and whose gender identity is man.
Receives: Behavioral: Quantative sensory testing; Diagnostic Test: Blood Draw
Cis WomanPerson assigned female at birth and whose gender identity is woman.
Receives: Behavioral: Quantative sensory testing; Diagnostic Test: Blood Draw
Transgender ManPerson assigned female at birth and whose gender identity is man.
Receives: Behavioral: Quantative sensory testing; Diagnostic Test: Blood Draw
Transgender WomanPerson assigned male at birth and whose gender identity is woman.
Receives: Behavioral: Quantative sensory testing; Diagnostic Test: Blood Draw
Transgender Man plus TestosteronePerson assigned female at birth and whose gender identity is man and are currently on testosterone replacement.
Receives: Behavioral: Quantative sensory testing; Diagnostic Test: Blood Draw
Transgender Woman plus EstrogenPerson assigned male at birth and whose gender identity is woman and are currently on estrogen replacement.
Receives: Behavioral: Quantative sensory testing; Diagnostic Test: Blood Draw

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Experimental Heat Pain Thresholds

    Heat pain thresholds will be taken with a slowing increasing temperature probe. The temperature at which pain is first detected over repeated tests will be the heat pain threshold.

    Measured: Baseline

  2. Experimental Pressure Pain Thresholds

    Pressure pain thresholds will be assessed by algometer. The average kPa of force at which the participant detects the pressure as painful will be the threshold.

    Measured: Baseline

  3. Experimental Pain Sensitivity

    In the cold pressor task, temporal summation and conditioned pain modulation tasks, the participants will rate any painful sensations on a 0-100 scale. On this scale, 0 refers to "no pain" and 100 refers to "worst pain imaginable". The ratings will be the basis for determining pain sensitivity.

    Measured: Baseline

  4. Temporal Summation

    Pain ratings on repeated stimulation with heat will be used to determine temporal summation by taking the differences in pain ratings between the fifth and first stimulation. Pain will be rated as 0 (no pain at all ) to 100 (worst pain imaginable).

    Measured: Baseline

  5. Conditioned Pain Modulation

    The pressure pain threshold taken alone will be subtracted from the pressure pain threshold obtained while the hand is in cold water as a measure of CPM.

    Measured: Baseline

  6. Sleep quality

    Sleep quality will be assessed using the insomnia severity index. The index will provide a score as follows: 0-7 = No clinically significant insomnia, 8-14 = Subthreshold insomnia, 15-21 = Clinical insomnia (moderate severity), 22-28 = Clinical insomnia (severe)

    Measured: Baseline

  7. Depression

    Depression will be assessed using the CES-D. Items are scored on a 0-3 scale. The possible range is 0-60, with higher scores reflecting greater depressive symptomatology.

    Measured: Baseline

  8. Social Support

    A social support survey will be given to measure the amount of social support experienced by each participant. Each item will be scored, giving a score from 0-100 with higher scores representing greater social support.

    Measured: Baseline

  9. Discrimination

    Perceived discrimination will be measured using the DISC-12. Each of the 35 items is scored from 0-3, giving a total overall score between 0 and 105.

    Measured: Baseline

  10. Hormone levels

    Testosterone and estradiol will be assessed in blood samples.

    Measured: Baseline

  11. Immune cell number

    Blood samples will be assessed for absolute cell population numbers to include Th1, Th1, Th17, effector T, B and NK cells.

    Measured: Baseline

  12. Immune cell cytokine production

    Isolated immune cells (PBMCs) will be simulated and cytokine production measured. IL-4+, IL-17A+, IFNgamma+ cells will be measured as percent of total PBMCs.

    Measured: Baseline

Secondary outcomes (6)
  1. Community connectedness

    All participants will have their perceived connectedness to the LGBTQ+ community assessed. Each of 7 items will be scored on a 3 (strongly agree) to 0 (strongly disagree) scale, resulting in a range of 0-21. Higher scores reflect greater connectedness to the LGBTQ+ community.

    Measured: Baseline

  2. Bodily pain

    The presence of any mild pain will be assessed using the brief pain inventory. Items 3-6 will be scored from 0-10 to assess the severity of pain (40 as the most pain possible). Items 9A-9I will be scored and summated to assess pain interference with 0 reflecting no interference and 90 reflecting complete interference.

    Measured: Baseline

  3. Quality of life metrics

    The SF-36 will be used to assess various aspects of quality of life including mood, activity, energy, general health, and pain. An overall score will be taken with a range of 0-100, with higher scores reflecting higher reported quality of life.

    Measured: Baseline

  4. Body image

    The BIQLI will be sued to assess relative comfort with participants' perceived and experienced body image. The 10-item questionnaire uses a 7-point scoring system from -3 (very negative) to 3 (very positive) to rate statements about body image. Higher scores reflect more positive feelings about body image.

    Measured: Baseline

  5. Gender role expectation of pain

    The GREP will be used to determine how participants feel about their gender role (and others) as it relates to experiencing pain. For each question, the participant indicates on a 10-point scale from "far less" to "far greater" to what extent they agree/disagree with statements.

    Measured: Baseline

  6. Adverse childhood events

    The ACE questionnaire will be sued to determine the presence and number of adverse events experienced by participants.

    Measured: Baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Mar 2023
  2. Study start1 Mar 2023
  3. Primary completion31 Jul 2027 (estimated)
  4. Study completion31 Jul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Prospective
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05787470
Sponsor's protocol ID
IRB-300009452
Other IDs
5R01NR019417
Acronym
SHINE
Status last verified
Jul 2026
First submitted
3 Mar 2023
Last updated
2 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

An observational study of Pain and Gender Identity, run by University of Alabama at Birmingham at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 2 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Tammie Quinn, BA ((205) 934-8743, tquinn@uab.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Experimental Heat Pain Thresholds (time frame: Baseline). The study lists 12 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jul 2026.

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