Traumatic brain injury (TBI) affects millions of individuals each year and is a leading cause of death and disability worldwide. TBI is heterogeneous and outcome is influenced by a combination of factors that include injury location, severity, genetics, and environmental factors. More recently, sex as a biological variable has been incorporated into TBI research, although there is conflicting literature regarding clinical outcomes in males versus females after TBI. We review the current clinical literature investigating sex differences after TBI. We focus our discussion on differences within contemporary gender categories to suggest that binary categories of male and female are not sufficient to guide clinical decisions for neurotrauma. Some studies have considered physiological variables that influence sex such as hormone cycles and stages in males and females pre- and post-TBI. These data suggest that there are phasic differences within male populations and within female populations that influence an individual's outcome after TBI. Finally, we discuss the impact of gender identity and expression on outcome after TBI and highlight the lack of neurotrauma research that includes non-binary individuals. Social constructs regarding gender impact an individual's vulnerability to violence and consequent TBI, including the successful reintegration to society after TBI. We call for incorporation of gender beyond the binary in TBI education, research, and clinical care. Precision medicine necessarily must progress beyond the binary to treat individuals after TBI.

中文翻译：

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超越二元：性别和性别对创伤性脑损伤后结果的影响。

创伤性脑损伤 (TBI) 每年影响数百万人，是全球死亡和残疾的主要原因。TBI 是异质性的，结果受多种因素的影响，包括损伤部位、严重程度、遗传和环境因素。最近，性别作为一个生物学变量已被纳入 TBI 研究，尽管关于 TBI 后男性与女性的临床结果存在相互矛盾的文献。我们回顾了当前调查 TBI 后性别差异的临床文献。我们将讨论重点放在当代性别类别内的差异上，以表明男性和女性的二元类别不足以指导神经创伤的临床决策。一些研究考虑了影响性别的生理变量，例如 TBI 前后男性和女性的激素周期和阶段。这些数据表明，男性人群和女性人群中存在影响个体 TBI 后结果的相位差异。最后，我们讨论了性别认同和表达对 TBI 后结果的影响，并强调缺乏包括非二元个体在内的神经创伤研究。关于性别的社会建构会影响个人对暴力和随之而来的 TBI 的脆弱性，包括 TBI 后成功重新融入社会。我们呼吁在 TBI 教育、研究和临床护理中将性别纳入二元之外。精准医学必须超越二元论来治疗 TBI 后的个体。