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Home > News > Josh Babu ’22 researches the effects of gender-affirming care on transgender youth’s long-term health

Josh Babu ’22 researches the effects of gender-affirming care on transgender youth’s long-term health

April 19th, 2022
Thesis book held in front of Nassau Hall

This article is the first installment in a series that explores one of Princeton’s most distinct academic traditions: the requirement of junior and senior independent work for nearly all undergraduate students. As thousands of students conduct and present unique research every year, these Features articles shed light on the inspiration, the outcomes, and everything in between.

For Josh Babu ’22, a pre-med concentrator in the Department of Molecular Biology and Rhodes Scholar, a certificate in Gender and Sexuality Studies (GSS) might not seem like the most obvious choice. Far from it, his studies in the GSS department actually led him to the topic of his senior thesis.

“When I started to focus on GSS a little bit more and look into queer and trans health specifically, that’s when I found a real true passion and felt driven,” Babu explained. “So I would say the GSS certificate program was actually pretty instrumental in my career aspirations.” 

Princeton’s GSS Department enables undergraduate students seeking a certificate in the department to explore the intersection of GSS with interests in their home department, ultimately creating a diverse array of research avenues for student independent work. 

Babu is certainly taking advantage of this opportunity. His experience in the GSS department, he says, guided him to research on gender-affirming healthcare, now the subject of his senior thesis.

This passion led Babu to pursue research on transgender healthcare with clinical support from Princeton and the Rutgers Robert Wood Johnson Medical School. He studies biological markers of stress in transitioning youth, contributing to the literature on the psychological effects of gender-affirming care.

Gender-affirming care, according to the Columbia University Department of Psychiatry, is a model of healthcare that validates patients’ diverse gender identities.

Babu’s research looks at the effect of gender-affirming care on the degradation of telomeres, or protective regions of repetitive sequences at the ends of chromosomes. As telomeres degrade and shorten, they limit the ability of the chromosome to replicate without losing critical DNA, essentially counting down the life of a cell. 

Chronic stress in individuals has been shown to increase the rate of telomere degradation, so telomeres can serve as a biological marker of stress. According to the American Psychological Association, “a number of studies have linked stress with shorter telomeres, a chromosome component that's been associated with cellular aging and risk for heart disease, diabetes and cancer.”

Stress is a particularly important element of transgender medicine, as numerous studies have documented that transgender and nonbinary teenagers experience anxiety, depression, and suicidal ideation at much higher rates than their cisgender counterparts.

Though the research group has not completed their data analysis, Babu explained that he expects “to find an increase in the activity of the protein that regulates telomere extension” among patients who received gender-affirming care. In other words, Babu anticipates results that indicate gender-affirming care prevents accelerated rate of telomere degradation due to stress in trans youth.

“If gender-affirming care can help with that and make [telomere degradation] less severe,” Babu said, “then that’s also really important to know and will help healthcare providers and policymakers make more informed decisions about gender-affirming care for kids specifically.”

 His research goes beyond telomere analysis. With this senior thesis and beyond, he hopes to pave the way for future studies of trans health and to provide a framework for navigating some of the challenges he has faced along the way. 

“My goal is to build a methodology and infrastructure for studying trans health in general. And that means establishing a roadmap for future researchers so that they know how to deal with big institutions and how to apply for grant funding in a way that will make them successful and how to establish credibility as a researcher in the trans community,” Babu said. 

Babu noted that this kind of medical research has not always prioritized the well-being of transgender individuals.

“There’s an extremely unfortunate history of trans people being tested on and treated like lab rats,” Babu said. “And it’s important we combat that.”

Babu’s research is informed by first-hand experience. 

“I’m gay myself, and I have had experiences in healthcare that were subpar at best. And I understand that, especially in the place I grew up, there weren’t a lot of doctors who understood the needs of queer patients,” Babu explained. 

“While that’s less common now, and less common across the United States, it is far more common for physicians not to be familiar with issues dealing with trans patients. So that’s something that I really felt pushed to help improve,” he continued. 

While conducting his research, Babu grappled with his role in the queer community as a cis researcher in the context of historical tensions between gay and trans members of the LGBTQ+ community. 

“There’s something to be said about leaving intellectual work about a community of people to the community itself. With that being said, I do think my experience in the LGBTQ+ community is relevant, but not necessarily parallel at all,” Babu said. 

“In fact, I think the experiences are wildly different in most scenarios,” he continued. “But being a part of the LGBTQ+ community has made me appreciate and understand how important it is to have an alliance across the full spectrum of the queer and trans community.” 

Babu emphasized the importance of direct involvement with the trans kids in his study, so as not to assume he knows what is best for an entire community.

“I sat down with [a transgender youth] and their family and asked them, ‘What kind of research do you want to see? What kind of research do you think will be helpful to you?’ And this was at the very early stages of the study, before we had established a research design or even applied for grants,” he said. 

Applying for these grants eventually became one of Babu’s greatest challenges. Babu recognized that many of the obstacles to his research have come in the form of systemic institutional barriers as opposed to outright rejection of advancing trans health. In particular, he noted the complexity of navigating funding from small nonprofits aimed at LGBTQ+ research versus larger organizations who may consider it less urgent than other biomedical research.

“If you approach individuals at these [large] institutions and propose a study like mine, their initial response might be ‘Oh, that sounds great. That’s very important socially, yes, we support.’ But then when you get down to it, and you actually want to apply for money at the institutional level, they generally don’t put their money where their mouth is,” Babu said.

“That’s just been a general trend in the field of trans health research, but it’s not true across the board. We were able to get funding pretty easily from the NIH [National Institutes of Health], but I think that was a unique case,” he continued.

The support he has received over the course of his thesis work isn’t only financial. 

His advisor Dan Notterman, Professor of the Practice in Molecular Biology and one of few practicing physicians among Princeton’s faculty, has guided him through this process, even though the field of transgender healthcare is largely new to him. Notterman noted that his medical training did not adequately cover gender diversity.

“Physicians my age didn’t have training in gender and sexuality aside from training in disorders of sexual differentiation,” Notterman said.

Notterman stressed the importance of continual learning about gender diversity by reading and allowing other professors at Princeton to shape his biology lectures on these topics. 

“I have to say, though, that it has been mainly my students who teach me this,” Notterman noted, in reference to students like Babu.

As Babu prepares to continue his education in medicine and healthcare policy at the University of Oxford as a Rhodes Scholar, Gillian Hilscher ’23 will build on Babu’s research with Notterman’s guidance in the coming year. Hilscher is also a pre-med concentrator in the Department of Molecular Biology, pursuing certificates in GSS and Neuroscience. 

Hilscher did not originally intend to study GSS. She was first introduced to the field through her first-year Writing Seminar, The Politics of Intimacy, taught by Professor Alexander Davis. Then, in her junior year, Babu presented his senior thesis research to one of Hilscher’s classes, piquing her interest as a way to combine the study of gender and sexuality with her biology focus.

To date, she has outlined her research proposal in her Junior Paper and will work to extend previous research in the field by examining the blood samples of trans youth for changes in gene expression as a result of outside influences, a branch of biology known as epigenetics. Specifically, Hilscher will study DNA methylation and epigenetic age as further biological markers in relation to gender-affirming care. 

“I couldn’t imagine not having this aspect of education [in GSS]. Especially as a pre-med [student], I think that it’s very important to have these perspectives,” Hilscher said. “These are the people you’ll be serving.”

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