The modern study of Alzheimer’s disease relies heavily on population-level data. Large cohorts, national registries, and longitudinal aging studies have provided invaluable insights into how dementia develops and progresses. Yet within these datasets, certain groups remain quietly absent. Transgender and gender-diverse individuals rarely appear as identifiable populations in dementia research, not because they are unaffected by neurodegenerative disease, but because the systems that collect health data have historically not recorded gender diversity [1]. This absence is subtle but meaningful. When a population is not visible in research data, its health trajectories remain largely unexplored. As a result, the scientific narrative of cognitive aging may unintentionally overlook experiences that shape brain health across the lifespan [2].

In recent years, a small but growing body of research has begun to examine dementia risk within transgender populations. Analyses of health records and behavioral risk datasets suggest that transgender adults may experience higher prevalence of several modifiable risk factors associated with Alzheimer’s disease and related dementias [3]. Cardiovascular disease, depression, chronic psychosocial stress, and barriers to preventive healthcare appear more frequently within transgender communities. These factors are well known contributors to cognitive decline and neurodegeneration in the general population [3]. At present, the available evidence indicates that the biological mechanisms underlying Alzheimer’s disease remain consistent across populations. Amyloid accumulation, tau pathology, and synaptic degeneration follow established pathways regardless of gender identity [4].

If the neuropathology is shared, the question becomes one of lived experience. The concept of minority stress offers a framework for understanding how long-term social conditions may influence neurological health. Transgender individuals often navigate environments shaped by stigma, discrimination, and limited access to affirming healthcare services [5]. Exposure to chronic social stress can have measurable physiological consequences. Persistent activation of stress pathways, including dysregulation of cortisol and inflammatory signaling, has been linked to structural and functional changes in brain regions central to memory and cognition [5]. Over the course of decades, these physiological responses may interact with metabolic and cardiovascular risk factors to influence susceptibility to neurodegenerative disease [4].

Healthcare access also plays a significant role in shaping long-term brain health. Studies have documented that transgender individuals frequently encounter barriers when seeking medical care, ranging from lack of provider knowledge to negative clinical experiences [3]. When preventive care is delayed or avoided, conditions such as hypertension, diabetes, and depression may remain inadequately treated. Each of these conditions is independently associated with increased risk of cognitive decline [2]. Reports from older transgender adults suggest that experiences of discrimination in healthcare settings are associated with greater levels of subjective cognitive decline, a symptom that often precedes measurable impairment in dementia [7].

Public discussions about transgender health frequently center on gender-affirming hormone therapy. However, current research has not demonstrated a clear link between hormone therapy and increased dementia risk [3]. The limited data available suggest that broader determinants such as cardiovascular health, mental health, and access to care likely play a more influential role in shaping cognitive outcomes [3]. Nevertheless, the long-term neurological effects of gender-affirming therapies remain an important area for future investigation, particularly as increasing numbers of individuals receive such treatments earlier in life [4].

Despite growing interest in health equity, the intersection between transgender health and dementia remains underrepresented in scientific literature. Few longitudinal studies have been designed to examine cognitive aging in transgender populations, and many national datasets still lack standardized measures of gender identity [2]. Recognizing this gap, international health organizations have emphasized the importance of inclusive health data systems capable of capturing diverse gender identities [6]. Without such data, researchers cannot accurately estimate dementia prevalence or identify protective factors within gender-diverse communities [2].

Future research should aim to integrate gender identity variables into large epidemiological studies and national health registries. This step alone would allow researchers to observe cognitive aging patterns across previously overlooked populations [2]. Longitudinal studies focusing specifically on transgender aging may provide valuable insight into how psychosocial stress, endocrine factors, and cardiovascular health interact to influence neurodegenerative processes [3]. Collaborative research bridging neuroscience, endocrinology, and social epidemiology may also reveal how environmental experiences shape the biological pathways of dementia [4]. Importantly, expanding this area of research has the potential to deepen our understanding of brain aging more broadly. Studying how social conditions affect neurological resilience could offer insights relevant far beyond any single population.

The story of Alzheimer’s disease is still being written. Each new dataset adds detail to our understanding of how memory fades and why some brains prove more resilient than others. But for that story to be complete, the populations represented in research must reflect the diversity of the world in which aging occurs. Transgender individuals have long lived at the margins of health research. Bringing their experiences into the study of cognitive aging does more than correct an omission. It opens a new window into how biology, society, and lived experience together shape the aging brain.