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Henry BW, Cruz CD, Goulet RW, Nolan BT, Locke C, Padmanabhan V, Moravek MB, Shikanov A, Killian ML. Bone quality following peripubertal growth in a mouse model of transmasculine gender-affirming hormone therapy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.12.08.570840. [PMID: 38106067 PMCID: PMC10723410 DOI: 10.1101/2023.12.08.570840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
During peri-puberty, bone growth and the attainment peak bone mass is driven predominantly by sex steroids. This is important when treating transgender and gender diverse youth, who have become increasingly present at pediatric clinics. Analogues of gonadotropin-releasing hormone (GnRH) are commonly prescribed to transgender and gender diverse youth prior to starting gender-affirming hormone therapy (GAHT). However, the impact of GnRH agonists on long bones with the addition of GAHT is relatively unknown. To explore this, we developed a trans-masculine model by introducing either GnRHa or vehicle treatment to female-born mice at a pre-pubertal age. This treatment was followed by male GAHT (testosterone, T) or control treatment three weeks later. Six weeks after T therapy, bone quality was compared between four treatment groups: Control (vehicle only), GnRHa-only, GnRHa + T, and T-only. Bone length/size, bone shape, mechanical properties, and trabecular morphology were modulated by GAHT. Independent of GnRHa administration, mice treated with T had shorter femurs, larger trabecular volume and increased trabecular number, higher trabecular bone mineral density, and wider superstructures on the surface of bone (e.g., third trochanters) when compared to control or GnRHa-only mice. In conclusion, prolonged treatment of GnRHa with subsequent GAHT treatment directly affect the composition, parameters, and morphology of the developing long bone. These findings provide insight to help guide clinical approaches to care for transgender and gender diverse youth.
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Affiliation(s)
- Brandon W Henry
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Cynthia Dela Cruz
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Robert W Goulet
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Bonnie T Nolan
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Conor Locke
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Vasantha Padmanabhan
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Megan L Killian
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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2
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Dubois V, Ciancia S, Doms S, El Kharraz S, Sommers V, Kim NR, David K, Van Dijck J, Valle-Tenney R, Maes C, Antonio L, Decallonne B, Carmeliet G, Claessens F, Cools M, Vanderschueren D. Testosterone Restores Body Composition, Bone Mass, and Bone Strength Following Early Puberty Suppression in a Mouse Model Mimicking the Clinical Strategy in Trans Boys. J Bone Miner Res 2023; 38:1497-1508. [PMID: 37222072 DOI: 10.1002/jbmr.4832] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023]
Abstract
Transgender youth increasingly present at pediatric gender services. Some of them receive long-term puberty suppression with gonadotropin-releasing hormone analogues (GnRHa) before starting gender-affirming hormones (GAH). The impact of GnRHa use started in early puberty on bone composition and bone mass accrual is unexplored. It is furthermore unclear whether subsequent GAH fully restore GnRHa effects and whether the timing of GAH introduction matters. To answer these questions, we developed a mouse model mimicking the clinical strategy applied in trans boys. Prepubertal 4-week-old female mice were treated with GnRHa alone or with GnRHa supplemented with testosterone (T) from 6 weeks (early puberty) or 8 weeks (late puberty) onward. Outcomes were analyzed at 16 weeks and compared with untreated mice of both sexes. GnRHa markedly increased total body fat mass, decreased lean body mass, and had a modest negative impact on grip strength. Both early and late T administration shaped body composition to adult male levels, whereas grip strength was restored to female values. GnRHa-treated animals showed lower trabecular bone volume and reduced cortical bone mass and strength. These changes were reversed by T to female levels (cortical bone mass and strength) irrespective of the time of administration or even fully up to adult male control values (trabecular parameters) in case of earlier T start. The lower bone mass in GnRHa-treated mice was associated with increased bone marrow adiposity, also reversed by T. In conclusion, prolonged GnRHa use started in prepubertal female mice modifies body composition toward more fat and less lean mass and impairs bone mass acquisition and strength. Subsequent T administration counteracts GnRHa impact on these parameters, shaping body composition and trabecular parameters to male values while restoring cortical bone architecture and strength up to female but not male control levels. These findings could help guide clinical strategies in transgender care. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Vanessa Dubois
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
- Basic and Translational Endocrinology (BaTE), Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Stefanie Doms
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Sarah El Kharraz
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Vera Sommers
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Na Ri Kim
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Karel David
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Jolien Van Dijck
- Laboratory of Skeletal Cell Biology and Physiology (SCEBP), Skeletal Biology and Engineering Research Center (SBE), Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Roger Valle-Tenney
- Laboratory of Skeletal Cell Biology and Physiology (SCEBP), Skeletal Biology and Engineering Research Center (SBE), Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christa Maes
- Laboratory of Skeletal Cell Biology and Physiology (SCEBP), Skeletal Biology and Engineering Research Center (SBE), Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Leen Antonio
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Brigitte Decallonne
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Carmeliet
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
| | - Frank Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism (Chrometa), KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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3
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Micangeli G, Profeta G, Colloridi F, Pirro F, Tarani F, Ferraguti G, Spaziani M, Isidori AM, Menghi M, Fiore M, Tarani L. The role of the pediatrician in the management of the child and adolescent with gender dysphoria. Ital J Pediatr 2023; 49:71. [PMID: 37316904 DOI: 10.1186/s13052-023-01466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/01/2023] [Indexed: 06/16/2023] Open
Abstract
Gender dysphoria is a clinical condition characterized by significant distress due to the discordance between biological sex and gender identity. Currently, gender dysphoria is also found more frequently in children and adolescents, thanks to greater social sensibleness and new therapeutic possibilities. In fact, it is estimated that the prevalence of gender dysphoria in pediatric age is between 0.5% and 2% based on the statistics of the various countries. Therefore, the pediatrician cannot fail to update himself on these issues and above all should be the reference figure in the management of these patients. Even if the patient must be directed to a referral center and be followed up by a multidisciplinary team, the treating pediatrician will care to coordinate the clinical and therapeutic framework. The aim of the present report is therefore to integrate literature data with our clinical experience to propose a new clinical approach in which the pediatrician should be the reference in the care of these patients, directing them towards the best therapeutic approach and staying in contact with the specialists of the referral center.
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Affiliation(s)
- Ginevra Micangeli
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Profeta
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | | | - Federica Pirro
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Michela Menghi
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy.
| | - Luigi Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.
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Mason A, Crowe E, Haragan B, Smith S, Kyriakou A. Gender Dysphoria in Young People: A Model of Chronic Stress. Horm Res Paediatr 2023; 96:54-65. [PMID: 34673639 DOI: 10.1159/000520361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gender dysphoria (GD) refers to the distress that may accompany gender incongruence, often heightened at the onset of puberty, with the development of secondary sex characteristics. Children and adolescents may be especially vulnerable to severe stressors, including GD, with potentially irreversible effects if these exposures occur during critical periods of development and brain maturation. SUMMARY We describe the evidence for GD as a chronic stressor, drawing parallels to other established models of stress, activating both innate psychological and biological stress responses. As well as being an inherently distressing experience, a person who experiences GD may also experience minority stress. Minority stress has been demonstrated in young people who experience GD with higher rates of social rejection and internalized stigma and shame. The biological stress response in young people with GD is illustrated through the activation of the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and pro-inflammatory response. The number of young people who report experiencing GD has increased exponentially worldwide in the past decade, demanding a change in the clinic infrastructure. Paediatric endocrinologists and specialists in mental health work together to both support psychosocial well-being and offer individualized treatment to align the phenotype with gender identity with the aim of alleviating the distress of GD. Medical interventions may include puberty suppression and gender-affirming hormones. Ongoing monitoring is required prior to initiation and during treatment to ensure that the goals of treatment are being achieved.
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Affiliation(s)
- Avril Mason
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
| | - Eimear Crowe
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Beccy Haragan
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Simon Smith
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.,Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
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5
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Bargiacchi A. [Transgender care in the USA, advances and setbacks, and how it impacts Europe]. Med Sci (Paris) 2023; 39:146-150. [PMID: 36799750 DOI: 10.1051/medsci/2023014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
What is happening in the United States in terms of support for trans people, as in other areas, is regularly observed and a source of inspiration at the international level; the recent political turmoil around affirmative trans care in some States, especially for minors, has a tremendous impact in Europe, being regularly used by the "camps" that argue today on this issue. However, the political context and the organization of the health and health insurance system color this support in a very specific way in the United States, and omitting these aspects or simplifying them is a source of erroneous interpretations and misinformation. Understanding these determinants is essential to define what belongs to the medical field, and to put back at the center of the discussions the interest of the people concerned, the principles of beneficence, non-maleficence and equity. In this article, we will therefore discuss the organization of care and recommendations for good practice, but also, from "non-scientific" articles and references, the political and social climate and its impact on trans health and care, including in Europe.
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Affiliation(s)
- Anne Bargiacchi
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert Debré, Paris, France
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6
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« La médecine face à la transidentité de genre chez les enfants et les adolescents ». Med Sci (Paris) 2022; 38:934-935. [PMID: 36448901 DOI: 10.1051/medsci/2022145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
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- 16 rue Bonaparte - 75006 Paris
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7
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Fiot É, Lebrun C, Delcour C, Rogez C, Cohen A, Martinerie L. Accompagnement des transidentiteés chez l’enfant et l’adolescent(e). Med Sci (Paris) 2022; 38:897-904. [DOI: 10.1051/medsci/2022150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Depuis la création de consultations dédiées en 2014, les enfants et adolescent(e)s transgenres peuvent être accompagnés en France par des équipes pluridisciplinaires. L’accompagnement personnalisé qui s’y est développé s’appuie sur des recommandations internationales, reposant elles-mêmes sur des études scientifiques qui ont démontré l’impact bénéfique d’un tel accompagnement à court et moyen termes. De nombreuses questions persistent néanmoins, à la fois médicales, en particulier sur les effets à long terme des traitements ou l’impact sur la fertilité, mais aussi éthiques. L’accumulation de données au long cours permettra d’apporter à ces jeunes et à leur famille les informations les plus éclairées possibles.
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8
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Moreno-Bencardino C, Zuluaga L, Perez J, Cespedes C, Forero C, Fernandez N. Gender Dysphoria in the Pediatric Population: Initial Experience of a Transdisciplinary Group. Rev Urol 2021. [DOI: 10.1055/s-0041-1730327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Introduction Although there is an increasing experience in the management of transgender individuals, this has not been thoroughly explored in children. The need to establish a comprehensive and transdisciplinary management is of critical importance. In order to solve this issue, we want to report the results of a cohort of individuals with gender dysphoria (GD) seen by our transdisciplinary group from a social and clinical and health access perspective.
Methods A 10-year retrospective case series of all patients that had been seen by our transdisciplinary team was reviewed. The main demographic characteristics were described, as well as impact variables in terms of diagnosis and treatment of these individuals. A social description of each individual was described. Frequency, distribution, and central tendency measures were evaluated for data presentation. IBM SPSS Statistics for Windows, version 24.0 (IBM Corp, Armonk, NY) software was used.
Results Four cases of GD were included. Three had male to female dysphoria and one female to male. The median reported age of GD awareness was 6 years old (between 4 and 8 years old), and the median time between GD awareness and the 1st medical evaluation was 7 years for all individuals. The median age at gender role expression was 12 years old (between 10 and 14 years old). All patients had already assumed their experienced gender role before the 1st evaluation by our group. The median age at the 1st evaluation by our group was 13 years old (between 10 and 16 years old); three of the patients were evaluated after initiation of puberty. In the present study, individuals with GD demonstrated having health care access barriers for their transition process. Referral times are high, and individuals with GD are cared after pubertal development, which is related to suboptimal outcomes. The spectrum of GD is broad, and management must be individualized according to expectations.
Conclusion Individuals with GD face multiple access barriers that limit their possibility of being seen by a transdisciplinary team. This reflects in longer waiting times that negatively impact medical management. Gender dysphoria is a wide spectrum, and individuals should be evaluated individually by a transdisciplinary team.
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Affiliation(s)
- Camila Moreno-Bencardino
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
| | - Laura Zuluaga
- Urology Department, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, D.C, Colombia
| | - Jaime Perez
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
- Urology Department, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, D.C, Colombia
| | - Camila Cespedes
- Pediatric Endocrinology Division, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, D.C, Colombia
| | - Catalina Forero
- Pediatric Endocrinology Division, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, D.C, Colombia
| | - Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
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McCallion S, Smith S, Kyle H, Shaikh MG, Wilkinson G, Kyriakou A. An appraisal of current service delivery and future models of care for young people with gender dysphoria. Eur J Pediatr 2021; 180:2969-2976. [PMID: 33855617 DOI: 10.1007/s00431-021-04075-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
The clinical needs of young people with gender dysphoria (GD) have outpaced the capacity of health services to provide appropriate care. The study aimed to explore the interface of Paediatric Endocrinology and young people with GD, detailing the clinical characteristics and the clinical care provided, in order to inform future service development. Medical records of all young people with GD (n=91, 59 (65%) birth-assigned females and 32 (35%) birth-assigned males) referred to Paediatric Endocrinology during 2011-2019 for puberty suppression were reviewed. Median age at initial assessment was 14.6 years (range 8.8-17.6 years). There was a threefold increase from 2016 (n=22) to 2019 (n=73). Mental health disorders were present in 34 (37%) and autistic spectrum disorder in 21 (23%), while 54 (59%) had at least one comorbidity. Sixty-four (70%) young people fulfilled the criteria for consideration of fertility preservation, with 6 (9%) of them preserving their gametes. Seventy-nine (87%) young people commenced treatment with gonadotrophin-releasing hormone analogue, at a median age of 14.8 years (range 9.7-18.0 years). Six (8%) of those discontinued treatment, following a median duration of 6 months (range 6-18 months). Forty-one young people commenced gender-affirming hormones. One (2%) of those who started gender-affirming hormones discontinued treatment.Conclusions: We have witnessed increasing numbers of young people with GD attending Paediatric Endocrinology, with an over-representation of comorbidities, necessitating provision of an individualised approach to treatment. Addressing young people's acceptability of fertility services and ongoing close collaboration between endocrinology and mental health professionals require innovative models of multidisciplinary care. What is Known: • A worldwide increase in presentation of gender dysphoria has been mirrored in our service, with majority assigned female at birth and post-pubertal. • An over-representation of comorbidities exists, notably mental health disorders and autistic spectrum disorder. What is New: • Coordination of interprofessional care to meet complex needs, at an individual level, while improving efficiency of working, at a systemic level, can be met by the development of specialist centres. • The reasons for low uptake of fertility services demand further exploration.
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Affiliation(s)
- Stephanie McCallion
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Simon Smith
- Young People's Gender Service, Sandyford Services, 2-6 Sandyford Place, Glasgow, G3 7NB, UK
| | - Heather Kyle
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - M Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Gordon Wilkinson
- Young People's Gender Service, Sandyford Services, 2-6 Sandyford Place, Glasgow, G3 7NB, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
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10
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Gilani M, Wallach P, Kyriakou A. Levels of physical activity and barriers to sport participation in young people with gender dysphoria. J Pediatr Endocrinol Metab 2021; 34:747-753. [PMID: 33818040 DOI: 10.1515/jpem-2021-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the levels of physical activity (PA) in young people with gender dysphoria (GD) and help identify factors which deter participation. METHODS Fifty-six young people who attended paediatric endocrinology because of GD, June to October 2019, and were on treatment with gonadotrophin-releasing hormone (GnRH) analogue were approached to participate in a survey. RESULTS A total of 55 young people (98%) responded to the survey. Thirty-eight (69%) participated in PA for >1 h/week. Thirty-two (58%) reported high motivation level for exercise. Those had median age of 15.9 years (10.7, 18.7) at the time of survey, and 13.6 years (9.7, 17.6) at start of GnRH analogue compared to 16.7 years (13.9, 18.5) (p, 0.047) and 15.4 years (11.2, 18.0) (p, 0.009) of the 23 (42%) who reported low motivation. Forty-one (74.5%) reported barriers when accessing PA, such as not being as good as others (75%), revealing sports clothing (73%) and not satisfied with body image (47%). Those were older (16.4 years [10.9, 18.7] vs. 14.7 years [10.7, 18.4] [p, 0.011]) at the time of survey and at start of GnRH analogue (14.9 years [9.7, 18.0] vs. 12.5 years [10.6, 15.2] [p, 0.0001]) than those 14 (25.5%) who reported facing no barriers. Twelve (85.7%) of those reporting no barriers stated high motivation levels compared to 20 (48.8%) of those reporting barriers (p, 0.026). CONCLUSIONS Strategies aimed at improving participation are twofold: first to improve motivation, especially in post-pubertal young people, and secondly to achieve societal change to help eliminate barriers.
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Affiliation(s)
- Misha Gilani
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Peri Wallach
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
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11
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Brik T, Vrouenraets LJJJ, de Vries MC, Hannema SE. Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2611-2618. [PMID: 32152785 PMCID: PMC7497424 DOI: 10.1007/s10508-020-01660-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 05/12/2023]
Abstract
Gonadotropin-releasing hormone analogues (GnRHa) are recommended as initial treatment for adolescents diagnosed with gender dysphoria, providing time to follow gender identity development and consider further treatment wishes without distress caused by unwanted pubertal changes. This has been described as an extended diagnostic phase. However, there are also concerns about the physical, neurocognitive, and psychosocial effects of this treatment. In this retrospective study, we document trajectories after the initiation of GnRHa and explore reasons for extended use and discontinuation of GnRHa. Treatment was considered appropriate in 143 (67%) of the 214 adolescents eligible for GnRHa treatment by virtue of their age/pubertal status, and all started GnRHa (38 transgirls, 105 transboys; median age, 15.0 years [range, 11.1-18.6] and 16.1 years [range, 10.1-17.9]). After a median duration of 0.8 years (0.3-3.8) on GnRHa, 125 (87%) started gender-affirming hormones (GAH). Nine (6%) discontinued GnRHa, five of whom no longer wished gender-affirming treatment. Thirteen had used GnRHa for longer than required by protocol for reasons other than logistics and regularly met with a mental health professional during this time, supporting the use of GnRHa treatment as an extended diagnostic phase. In conclusion, the vast majority who started GnRHa proceeded to GAH, possibly due to eligibility criteria that select those highly likely to pursue further gender-affirming treatment. Due to the observational character of the study, it is not possible to say if GnRHa treatment itself influenced the outcome. Few individuals discontinued GnRHa, and only 3.5% no longer wished gender-affirming treatment.
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Affiliation(s)
- Tessa Brik
- Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Lieke J J J Vrouenraets
- Department of Pediatric and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine C de Vries
- Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sabine E Hannema
- Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Paediatric Endocrinology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands.
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12
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Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020; 19:267-276. [PMID: 32020566 DOI: 10.1007/s42000-020-00174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.
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Affiliation(s)
- Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus.
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Shai Dror
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Avital Mushailov
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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13
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Kyriakou A, Nicolaides NC, Skordis N. Current approach to the clinical care of adolescents with gender dysphoria. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:165-175. [PMID: 32191677 PMCID: PMC7569586 DOI: 10.23750/abm.v91i1.9244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 01/29/2023]
Abstract
Over the last decade, we have witnessed a significant rise in the number of transgender young people seeking endocrine treatment, of which clinical service and gender dysphoria terminology have attempted to keep pace both in matching demand and better describing the condition. Although helpful guidelines for pubertal suppression and gender affirming hormones have been developed, uncertainties remain regarding treatment and monitoring during treatment, often because the clinical needs of the transgender population have outpaced medical expertise and training. Recently, multidisciplinary team work has evolved due to the increasing complexity of diagnostic and treatment decision-making and has been instrumental in creating a unique service with input from a range of specialists. In this article, the current approach in clinical management of adolescents with gender dysphoria is reviewed, with focus on the endocrine aspect of care in children and adolescents. Questions on what defines optimal clinical care of children and adolescents with gender dysphoria remain and should be the focus of future research. (www.actabiomedica.it)
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Affiliation(s)
- Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.
| | - Nicolas C Nicolaides
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Greece; Division of Endocrinology, Metabolism and Diabetes, First Department of Paediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Nicos Skordis
- Division of Paediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus; School of Medicine, University of Nicosia, Nicosia, Cyprus .
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14
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Agana MG, Greydanus DE, Indyk JA, Calles JL, Kushner J, Leibowitz S, Chelvakumar G, Cabral MD. Caring for the transgender adolescent and young adult: Current concepts of an evolving process in the 21st century. Dis Mon 2019; 65:303-356. [DOI: 10.1016/j.disamonth.2019.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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