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Wang Z, Mao Q, Yuan Y, Wang C, Wei H. Shuangshi Tonglin Capsule treats benign prostatic hyperplasia through the ROS/NLRP3 signaling pathway. Int Urol Nephrol 2024; 56:1259-1271. [PMID: 38036804 PMCID: PMC10923981 DOI: 10.1007/s11255-023-03874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/07/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To explore the effects of the SSTL on BPH and clarify the therapeutic mechanisms. METHODS Animal model of BPH was established by castration and subcutaneous injection of TP into SD rats; rats were orally administered SSTL for 28 days while modeling. Detection of PI, LI and RI in rats, to observe histopathological changes and collagen deposition in the prostate tissue. Detects levels of sex hormones and inflammatory factors in serum and tissues of rats, the test kit detects levels of lipid peroxides and antioxidants in serum and tissues. Fluorescent staining analysis of tissue ROS; the expression of NLRP3 inflammatory vesicles was observed by immunohistochemistry; Western blotting detected the expression of NOX4, NOX2, NLRP3 inflammatory vesicles, ASC, Cleaved Caspase-1, Caspase-1, IL-1β. RESULTS After SSTL capsule treatment, the PI and RI of the rats decrease. HE and Masson staining showed that SSTL ameliorated the pathological damage and reduced collagen deposition in the prostate tissue of BPH rats; ELISA results showed that SSTL was able to reduce T, DHT, TNF-α, IL-1β levels in BPH rats. The test kit showed that SSTL made the levels of MDA, CAT and GSH-Px in the serum and prostate tissue of rats and increased the activity of SOD. The results of ROS fluorescence showed that the ROS level was reduced in SSTL group; Western blotting showed that SSTL could cause down-regulation of NOX4, NOX2, NLRP3, ASC, Cleaved Caspase-1, IL-1β protein expression. CONCLUSION SSTL can reduce the PI and RI in BPH rats, it can also inhibit the level of sex hormones and inflammatory factors in BPH rats, which thereby reducing the histopathological damage of prostate gland in BPH rats, and can treat BPH in rats through ROS/NLRP3 pathway.
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Affiliation(s)
- Ziqiang Wang
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - Qian Mao
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - Yong Yuan
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - Chuan Wang
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - Hao Wei
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China.
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Dignam JP, Sharma S, Stasinopoulos I, MacLean MR. Pulmonary arterial hypertension: Sex matters. Br J Pharmacol 2024; 181:938-966. [PMID: 37939796 DOI: 10.1111/bph.16277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a complex disease of multifactorial origin. While registries have demonstrated that women are more susceptible to the disease, females with PAH have superior right ventricle (RV) function and a better prognosis than their male counterparts, a phenomenon referred to as the 'estrogen paradox'. Numerous pre-clinical studies have investigated the involvement of sex hormones in PAH pathobiology, often with conflicting results. However, recent advances suggest that abnormal estrogen synthesis, metabolism and signalling underpin the sexual dimorphism of this disease. Other sex hormones, such as progesterone, testosterone and dehydroepiandrosterone may also play a role. Several non-hormonal factor including sex chromosomes and epigenetics have also been implicated. Though the underlying pathophysiological mechanisms are complex, several compounds that modulate sex hormones levels and signalling are under investigation in PAH patients. Further elucidation of the estrogen paradox will set the stage for the identification of additional therapeutic targets for this disease.
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Affiliation(s)
- Joshua P Dignam
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Smriti Sharma
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Ioannis Stasinopoulos
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Margaret R MacLean
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
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Carvalho V, Colonna I, Curia G, Ferretti MT, Arabia G, Molnar MJ, Lebedeva ER, Moro E, de Visser M, Bui E. Sex steroid hormones and epilepsy: Effects of hormonal replacement therapy on seizure frequency of postmenopausal women with epilepsy-A systematic review. Eur J Neurol 2023; 30:2884-2898. [PMID: 37326003 DOI: 10.1111/ene.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE Hormonal replacement therapy (HRT) is used for symptomatic treatment of menopause. Some evidence suggests a proconvulsant effect of estrogen and an anticonvulsant role of progesterone. Thus, the use of exogenous sex steroid hormones might influence the course of epilepsy in peri- and postmenopausal women with epilepsy (WWE). We conducted a systematic review on the impact of HRT on the frequency of seizures of WWE. METHODS PubMed and Scopus were searched for articles published from inception until August 2022. Abstracts from the past 5 years from the European Academy of Neurology and European Epilepsy Congresses were also reviewed. Article reference lists were screened, and relevant articles were retrieved for consultation. Interventional and observational studies on WWE and animal models of estrogen deficiency were included. Critical appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-E tool. RESULTS Of 497 articles screened, 13 studies were included, including three human studies. One cross-sectional study showed a decrease in seizure frequency in WWE using combined HRT, a case-control study showed an increase in comparison with controls, and a randomized clinical trial found a dose-dependent increase in seizure frequency in women with focal epilepsy taking combined HRT. Ten studies addressing the impact of HRT in rat models were also included, which showed conflicting results. CONCLUSIONS There is scarce evidence of the impact of HRT in WWE. Further studies should evaluate the harmful potential, and prospective registries are needed for monitoring this population.
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Affiliation(s)
- Vanessa Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisbon, Portugal
- Instituto de Medicina Molecular Professor João Lobo Antunes, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Isabella Colonna
- Complex Operative Unit of Neurology, "F. Ferrari" Hospital, Casarano, Italy
| | - Giulia Curia
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Gennarina Arabia
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Elena R Lebedeva
- Department of Neurology, Ural State Medical University, International Medical Center "Europe-Asia" Yekaterinburg, Yekaterinburg, Russia
| | - Elena Moro
- CHU Grenoble Alpes, Division of Neurology, Movement Disorders Unit, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble, France
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Esther Bui
- Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Reinisch W, Hellstrom W, Dolhain RJEM, Sikka S, Westhovens R, Mehta R, Ritter T, Seidler U, Golovchenko O, Simanenkov V, Garmish O, Jeka S, Moravcová R, Rajendran V, Le Brun FO, Arterburn S, Watkins TR, Besuyen R, Vanderschueren D. Effects of filgotinib on semen parameters and sex hormones in male patients with inflammatory diseases: results from the phase 2, randomised, double-blind, placebo-controlled MANTA and MANTA-RAy studies. Ann Rheum Dis 2023; 82:1049-1058. [PMID: 37137672 PMCID: PMC10359529 DOI: 10.1136/ard-2023-224017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The phase 2 MANTA and MANTA-RAy studies aimed to determine if the oral Janus kinase 1 preferential inhibitor filgotinib affects semen parameters and sex hormones in men with inflammatory diseases. METHODS MANTA (NCT03201445) and MANTA-RAy (NCT03926195) included men (21-65 years) with active inflammatory bowel disease (IBD) and rheumatic diseases (rheumatoid arthritis, spondyloarthritis or psoriatic arthritis), respectively. Eligible participants had semen parameters in the normal range per the WHO definition. In each study, participants were randomised 1:1 to receive once-daily, double-blind filgotinib 200 mg or placebo for 13 weeks for pooled analysis of the primary endpoint (proportion of participants with a ≥50% decrease from baseline in sperm concentration at week 13). Participants who met the primary endpoint were monitored over an additional 52 weeks for 'reversibility'. Secondary endpoints included change from baseline to week 13 in: sperm concentration, total motility, normal morphology, total count and ejaculate volume. Sex hormones (luteinising hormone, follicle stimulating hormone, inhibin B and total testosterone) and reversibility were exploratory endpoints. RESULTS Across both studies, 631 patients were screened, and 248 were randomised to filgotinib 200 mg or placebo. Baseline demographics and characteristics were similar within indications between treatment groups. Numerically similar proportions of filgotinib-treated versus placebo-treated patients met the primary endpoint (8/120 (6.7%) vs 10/120 (8.3%)), Δ-1.7% (95% CI -9.3% to 5.8%)). There were no clinically relevant changes from baseline to week 13 in semen parameters or sex hormones, or patterns of reversibility between treatment groups. Filgotinib was well tolerated, with no new safety events. CONCLUSIONS Results suggest that once daily filgotinib 200 mg for 13 weeks has no measurable impact on semen parameters or sex hormones in men with active IBD or inflammatory rheumatic diseases.
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Affiliation(s)
- Walter Reinisch
- Medical University of Vienna, Department of Internal Medicine III, Division Gastroenterology & Hepatology, Vienna, Austria
| | - Wayne Hellstrom
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suresh Sikka
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - René Westhovens
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | | | | | - Ursula Seidler
- Department of Gastroenterology, Hannover Medical School, Hannover, Germany
| | - Oleksandr Golovchenko
- Medical Clinical Investigational Center of Medical Center Health Clinic LLC, Vinnytsia, Ukraine
| | - Vladimir Simanenkov
- State Budgetary Healthcare Institution "City Hospital #26", Saint-Petersburg, Russian Federation
| | - Olena Garmish
- National Scientific Center M.D. Strazhesko Institute of Cardiology, Kyiv, Ukraine
| | - Sławomir Jeka
- Clinic of Rheumatology and Systemic Connective Tissue Disorders, J. Biziel University Hospital No. 2, Bydgoszcz, Poland
| | - Radka Moravcová
- Department of Rheumatology, First Faculty of Medicine, Charles University and Rheumatology Institute, Prague, Czech Republic
| | | | | | | | | | | | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
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Homma K, Liu K, Niimi Y, Fukuda S, Hirasawa Y, Baljinnyam T, Bazhanov N, Nawgiri R, Muthukumarana P, Lucas R, Prough D, Enkhbaatar P. GENDER-RELATED VARIATIONS IN PATHOPHYSIOLOGICAL RESPONSES TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS PNEUMONIA AND SEPSIS. Shock 2023; 59:810-819. [PMID: 36870071 DOI: 10.1097/shk.0000000000002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
ABSTRACT In preclinical studies, the protective effects of female sex hormones and the immunosuppressive effects of male sex hormones were demonstrated. However, gender-related differences in multiorgan failure and mortality in clinical trials have not been consistently explained. This study aims to investigate gender-related differences in the development and progression of sepsis using a clinically relevant ovine model of sepsis. Adult Merino male (n=7) and female (n=7) sheep were surgically prepared with multiple catheters before the study. To induce sepsis, bronchoscopy instilled methicillin-resistant Staphylococcus aureus into sheep's lungs. The time from the bacterial inoculation until the modified Quick Sequential Organ Failure Assessment (q-SOFA) score became positive was measured and analyzed primarily. We also compared the SOFA score between these male and female sheep over time. Survival, hemodynamic changes, the severity of pulmonary dysfunction, and microvascular hyperpermeability were also compared. The time from the onset of bacterial inoculation to the positive q-SOFA in male sheep was significantly shorter than in female sheep. Mortality was not different between these sheep (14% vs. 14%). There were no significant differences in hemodynamic changes and pulmonary function between the two groups at any time point. Similar changes in hematocrit, urine output, and fluid balance were observed between females and males. The present data indicate that the onset of multiple organ failure and progression of sepsis is faster in male sheep than in female sheep, even though the severity of cardiopulmonary function is comparable over time. Further studies are warranted to validate the above results.
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Affiliation(s)
- Kento Homma
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Keibun Liu
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Yosuke Niimi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Satoshi Fukuda
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | | | | | - Nikolay Bazhanov
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | | | - Rudolf Lucas
- Vascular Biology Center, Division of Pulmonary Critical Care Medicine, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Donald Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
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6
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Harris E. Gender-Affirming Hormones and Youth Well-being. JAMA 2023; 329:458. [PMID: 36696146 DOI: 10.1001/jama.2023.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Chen D, Berona J, Chan YM, Ehrensaft D, Garofalo R, Hidalgo MA, Rosenthal SM, Tishelman AC, Olson-Kennedy J. Psychosocial Functioning in Transgender Youth after 2 Years of Hormones. N Engl J Med 2023; 388:240-250. [PMID: 36652355 PMCID: PMC10081536 DOI: 10.1056/nejmoa2206297] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Limited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol). METHODS We characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory-II, the Revised Children's Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome. RESULTS A total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants. CONCLUSIONS In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.).
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Affiliation(s)
- Diane Chen
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Johnny Berona
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Yee-Ming Chan
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Diane Ehrensaft
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Robert Garofalo
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Marco A Hidalgo
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Stephen M Rosenthal
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Amy C Tishelman
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
| | - Johanna Olson-Kennedy
- From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California
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Jaafar S, Torres-Leguizamon M, Duplessy C, Stambolis-Ruhstorfer M. Hormonothérapie injectable et réduction des risques : pratiques, difficultés, santé des personnes trans en France. Sante Publique 2023; 34:109-122. [PMID: 37336724 DOI: 10.3917/spub.hs2.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Hormone therapy (HT) adherence practices among trans people are poorly studied. For a large proportion of these people, HT is administered parenterally. The unavailability of certain treatments in France, combined with poor institutional care, keeps injectors away from the health care system and encourages potentially risky injection practices. Following a significant increase in the number of trans people in its active list, the association Safe, coordinator of the remote harm reduction system in France, conducted a cross-sectional descriptive study from December 2020 to February 2021 using an anonymous self-administered online questionnaire. PURPOSE OF RESEARCH The objective is to better understand the profile of trans people who inject their HT and their injection practices. RESULTS We observed that a significant proportion of trans injectors do not benefit from professional support, either to obtain treatment or to carry out the injection. This situation can lead to certain misuses of medical supplies, such as needle sharing or reuse, which present significant health risks. This is especially true for injectors whose treatment is not legally available and who obtain it through parallel markets. This study also underlines the importance of self-support associations to accompany transition. CONCLUSIONS We therefore propose that a harm reduction policy adapted to the practices of trans people be implemented in order to better support this population and avoid the emergence of major health problems such as HIV infection.
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Reyes-Angel J, Kaviany P, Rastogi D, Forno E. Obesity-related asthma in children and adolescents. Lancet Child Adolesc Health 2022; 6:713-724. [PMID: 35988550 DOI: 10.1016/s2352-4642(22)00185-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 05/23/2023]
Abstract
There is substantial epidemiological and experimental evidence of an obesity-related asthma phenotype. Compared to children of healthy weight, children with obesity are at higher risk of asthma. Children with obesity who have asthma have greater severity and poorer control of their asthma symptoms, more frequent asthma exacerbations, and overall lower asthma-related quality of life than children with asthma who have a healthy weight. In this Review, we examine some of the latest evidence on the characteristics of this phenotype and its main underlying mechanisms, including genetics and genomics, changes in airway mechanics and lung function, sex hormone differences, alterations in immune responses, systemic and airway inflammation, metabolic dysregulation, and modifications in the microbiome. We also review current recommendations for the treatment of these children, including in the management of their asthma, and current evidence for weight loss interventions. We then discuss initial evidence for potential novel therapeutic approaches, such as dietary modifications and supplements, antidiabetic medications, and statins. Finally, we identify knowledge gaps and future directions to improve our understanding of asthma in children with obesity, and to improve outcomes in these susceptible children. We highlight important needs, such as designing paediatric-specific studies, implementing large multicentric trials with standardised interventions and outcomes, and including racial and ethnic groups along with other under-represented populations that are particularly affected by obesity and asthma.
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Affiliation(s)
- Jessica Reyes-Angel
- Division of Pulmonary Medicine and Pediatric Asthma Center, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Parisa Kaviany
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Erick Forno
- Division of Pulmonary Medicine and Pediatric Asthma Center, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Abstract
Gender dysphoria is a persistent distress about one's assigned gender. Referrals regarding gender dysphoria have recently greatly increased, often of a form that is rapid in onset. The sex ratio has changed, most now being natal females. Mental health issues pre-date the dysphoria in most. Puberty blockers are offered in clinics to help the child avoid puberty. Puberty blockers have known serious side effects, with uncertainty about their long-term use. They do not improve mental health. Without medication, most will desist from the dysphoria in time. Yet over 90% of those treated with puberty blockers progress to cross-sex hormones and often surgery, with irreversible consequences. The brain is biologically and socially immature in childhood and unlikely to understand the long-term consequences of treatment. The prevailing culture to affirm the dysphoria is critically reviewed. It is concluded that children are unable to consent to the use of puberty blockers.
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Viuff MH, Just J, Brun S, Dam TV, Hansen M, Melgaard L, Hougaard DM, Lappe M, Gravholt CH. Women With Turner Syndrome Are Both Estrogen and Androgen Deficient: The Impact of Hormone Replacement Therapy. J Clin Endocrinol Metab 2022; 107:1983-1993. [PMID: 35302622 DOI: 10.1210/clinem/dgac167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 01/15/2023]
Abstract
CONTEXT Women with Turner syndrome (TS) suffer from hypergonadotropic hypogonadism, causing a deficit in gonadal hormone secretion. As a consequence, these women are treated with estrogen from the age of 12 years, and later in combination with progesterone. However, androgens have been given less attention. OBJECTIVE To assess sex hormone levels in women with TS, both those treated and those nontreated with hormone replacement therapy (HRT), and investigate the impact of HRT on sex hormone levels. METHODS At Aarhus University Hospital, 99 women with TS were followed 3 times from August 2003 to February 2010. Seventeen were lost during follow-up. Control group 1 consisted of 68 healthy age-matched control women seen once during this period. Control group 2 consisted of 28 young, eumenorrheic women sampled 9 times throughout the same menstrual cycle. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17β-estradiol, estrone sulfate, DHEAS, testosterone, free androgen index, androstenedione, 17-OH progesterone, and sex hormone-binding globulin (SHBG) were analyzed. RESULTS All androgens, 17-OH progesterone, and sex hormone-binding globulin (SHBG) were 30% to 50% lower in TS compared with controls (P < 0.01). FSH, LH, and estrone sulfate were more than doubled in women with TS compared with controls (P < 0.02). Using principal component analysis, we describe a positive correlation between women with TS receiving HRT, elevated levels of SHBG, and decreased levels of androgens. CONCLUSION The sex hormone profile in TS reveals a picture of androgen deficiency, aggravated further by HRT. Conventional HRT does not normalize estradiol levels in TS.
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Affiliation(s)
- Mette Hansen Viuff
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Jesper Just
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Tine Vrist Dam
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Mette Hansen
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Lars Melgaard
- Danish Center for Neonatal Screening, Clinical Mass Spectrometry, Statens Serum Institut, 2300 Copenhagen, Denmark
| | - David M Hougaard
- Danish Center for Neonatal Screening, Clinical Mass Spectrometry, Statens Serum Institut, 2300 Copenhagen, Denmark
| | - Michael Lappe
- CONNECT, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
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Nordenström A, Ahmed SF, van den Akker E, Blair J, Bonomi M, Brachet C, Broersen LHA, Claahsen-van der Grinten HL, Dessens AB, Gawlik A, Gravholt CH, Juul A, Krausz C, Raivio T, Smyth A, Touraine P, Vitali D, Dekkers OM. Pubertal induction and transition to adult sex hormone replacement in patients with congenital pituitary or gonadal reproductive hormone deficiency: an Endo-ERN clinical practice guideline. Eur J Endocrinol 2022; 186:G9-G49. [PMID: 35353710 PMCID: PMC9066594 DOI: 10.1530/eje-22-0073] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
An Endo-European Reference Network guideline initiative was launched including 16 clinicians experienced in endocrinology, pediatric and adult and 2 patient representatives. The guideline was endorsed by the European Society for Pediatric Endocrinology, the European Society for Endocrinology and the European Academy of Andrology. The aim was to create practice guidelines for clinical assessment and puberty induction in individuals with congenital pituitary or gonadal hormone deficiency. A systematic literature search was conducted, and the evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. If the evidence was insufficient or lacking, then the conclusions were based on expert opinion. The guideline includes recommendations for puberty induction with oestrogen or testosterone. Publications on the induction of puberty with follicle-stimulation hormone and human chorionic gonadotrophin in hypogonadotropic hypogonadism are reviewed. Specific issues in individuals with Klinefelter syndrome or androgen insensitivity syndrome are considered. The expert panel recommends that pubertal induction or sex hormone replacement to sustain puberty should be cared for by a multidisciplinary team. Children with a known condition should be followed from the age of 8 years for girls and 9 years for boys. Puberty induction should be individualised but considered at 11 years in girls and 12 years in boys. Psychological aspects of puberty and fertility issues are especially important to address in individuals with sex development disorders or congenital pituitary deficiencies. The transition of these young adults highlights the importance of a multidisciplinary approach, to discuss both medical issues and social and psychological issues that arise in the context of these chronic conditions.
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Affiliation(s)
- A Nordenström
- Pediatric Endocrinology, Department of Women’s and Children’s Health Karolinska Institutet, and Department of Pediatric Endocrinology and Inborn Errors of Metabolism, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Correspondence should be addressed to A Nordenström;
| | - S F Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - E van den Akker
- Division of Pediatric Endocrinology and Obesity Center CGG, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Blair
- Department of Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
| | - M Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - C Brachet
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants HUDERF, Université Libre de Bruxelles, Bruxelles, Belgium
| | - L H A Broersen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Childrens Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Sophia Children’s Hospital Erasmus Medical Center, Rotterdam, Netherlands
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - A Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - C H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - A Juul
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Research and Research Training Centre for Endocrine Disruption in Male Reproduction and Child Health (EDMaRC) and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C Krausz
- Department of Biochemical, Experimental and Clinical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - T Raivio
- New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital, and Research Program Unit, Faculty of Medicine, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - A Smyth
- Turner Syndrome Support Society in the UK, ePAG ENDO-ERN, UK
| | - P Touraine
- Department of Endocrinology and Reproductive Medicine, Pitié Salpêtriere Hospital, Paris, France
- Sorbonne Université Médecine and Center for Endocrine Rare Disorders of Growth and Development and Center for Rare Gynecological Disorders, Paris, France
| | - D Vitali
- SOD ITALIA APS – Italian Patient Organization for Septo Optic Dysplasia and Other Neuroendocrine Disorders – ePAG ENDO-ERN, Rome, Italy
| | - O M Dekkers
- Department of Clinical Epidemiology, LUMC Leiden, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Fisher AD, Senofonte G, Cocchetti C, Guercio G, Lingiardi V, Meriggiola MC, Mosconi M, Motta G, Ristori J, Speranza AM, Pierdominici M, Maggi M, Corona G, Lombardo F. SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people. J Endocrinol Invest 2022; 45:657-673. [PMID: 34677807 DOI: 10.1007/s40618-021-01694-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/10/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.
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Affiliation(s)
- A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Senofonte
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, 00185, Rome, Italy
| | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Guercio
- Studio Legale Avv. Giovanni Guercio, Via Antonio Mordini, 14, 00195, Rome, Italy
| | - V Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185, Roma, Italy
| | - M C Meriggiola
- Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - M Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - A M Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185, Roma, Italy
| | - M Pierdominici
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl, Bologna, Italy
| | - F Lombardo
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, 00185, Rome, Italy.
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Lang E, Abdou H, Edwards J, Patel N, Morrison JJ. State-of-the-Art Review: Sex Hormone Therapy in Trauma-Hemorrhage. Shock 2022; 57:317-326. [PMID: 34618728 DOI: 10.1097/shk.0000000000001871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Trauma-hemorrhage is the leading cause of prehospital and early in-hospital deaths, while also significantly contributing to the later development of multisystem organ dysfunction/failure and sepsis. Common and advanced resuscitative methods would potentially demonstrate benefits in the prehospital setting; however, they face a variety of barriers to application and implementation. Thus, a dialogue around a novel adjunct has arisen, sex hormone therapy. Proposed candidates include estradiol and its derivatives, metoclopramide hydrochloride/prolactin, dehydroepiandrosterone, and flutamide; with each having demonstrated a range of salutary effects in several animal model studies. Several retrospective analyses have observed a gender-based dimorphism in mortality following trauma-hemorrhage, thus suggesting that estrogens contribute to this pattern. Trauma-hemorrhage animal models have shown estrogens offer protective effects to the cardiovascular, pulmonary, hepatic, gastrointestinal, and immune systems. Additionally, a series of survival studies utilizing 17α-ethinylestradiol-3-sulfate, a potent, water-soluble synthetic estrogen, have demonstrated a significant survival benefit and beneficial effects on cardiovascular function. This review presents the findings of retrospective clinical studies, preclinical animal studies, and discusses how and why 17α-ethinylestradiol-3-sulfate should be considered for investigation within a prospective clinical trial.
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Affiliation(s)
- Eric Lang
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
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Cesur E, Yüksel Ş, Başar K, Kaptan S. Clinical Follow-up of Two Adolescents Diagnosed with Gender Dysphoria. Turk Psikiyatri Derg 2022; 33:214-219. [PMID: 36148573 DOI: 10.5080/u26795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rapid physical, psychological and sexual changes in adolescents due to the developmental process differentiate the approach to adolescents with gender dysphoria (GD) from the approach to adults. In this article, two adolescents who applied for GD and followed up for a long time are presented. The first case was assigned male at birth and defined herself as female. At the age of fifteen, a gonadotropin-releasing hormone analog was started for puberty suppression, and sex hormone was started in the follow-up. The second case's assigned sex was female and defined himself as male. At the age of sixteen years and six months, puberty suppressive treatment was started, followed by sex hormones. Both cases were able to continue their psychosocial development without any problems after the psychiatric and physical treatments they could reach on time. Although GD in adolescents cannot be resolved with puberty suppression alone, it creates time to resolve the acute problems and to search for appropriate treatment approaches in the future. Puberty suppression partially relieves and prevents the exacerbation of the dysphoria experienced by the youth diagnosed as GD, and creates time to search appropriate treatment approaches in the follow-up. Through these two cases, it is aimed to introduce the gender affirmation processes of adolescents with GD, to discuss the medical interventions in adolescence and the psychosocial effects of the process on individuals. Keywords: Gender dysphoria, gender incongruence, adolescence, gender affirmation process, puberty supression, puberty blockers.
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16
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Myfembree for fibroid-associated heavy menstrual bleeding. Med Lett Drugs Ther 2021; 63:121-3. [PMID: 34550666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Glintborg D, T'Sjoen G, Ravn P, Andersen MS. MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people. Eur J Endocrinol 2021; 185:R49-R63. [PMID: 34081614 DOI: 10.1530/eje-21-0059] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023]
Abstract
Transgender women are assigned male at birth but identified as women. The incidence of gender dysphoria is estimated to be around 1% of the population. Gender dysphoria may be associated with depression and low quality of life, which in most cases improves during gender-affirming hormonal treatment (GAHT). Feminizing hormonal treatment for transgender women or gender non-binary people typically includes natural estrogen (estradiol). Additional testosterone-blocking treatment is often needed to ensure the suppression of the pituitary-gonadal axis and may include cyproterone acetate, a gonadotropin-releasing hormone agonist (GnRH-a), or spironolactone. The health risks of cyproterone acetate as anti-androgen treatment are debated and randomized protocols with other anti-androgen treatments are requested. Orchiectomy is performed in some transgender women after various duration of GAHT. Currently, natural progesterone is not recommended as part of GAHT due to limited knowledge on the balance between risks and benefits. In the present article, we discuss evidence regarding established and upcoming feminizing treatment for adult transgender women or gender non-binary people seeking feminization. Data on study populations with transgender women are put into a wider context of literature regarding the effects of sex steroid hormones in cisgender study populations. Relevant follow-up and monitoring during feminizing treatment is debated. The review has a special focus on the pharmacotherapy of feminizing hormonal therapy.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Pernille Ravn
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Damen L, Grootjen LN, Donze SH, de Graaff LCG, van der Velden JAEM, Hokken-Koelega ACS. Bone mineral density during 3 years of growth hormone in previously GH-treated young adults with PWS. Eur J Endocrinol 2021; 184:773-782. [PMID: 33769952 DOI: 10.1530/eje-20-1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In children with Prader-Willi syndrome (PWS), growth hormone (GH) treatment has positive effects on bone mineral density (BMD). Two 1-year studies did not show a difference between GH or placebo on BMD in young adults with PWS. However, there are no studies investigating BMD during longer-term GH treatment in young adults with PWS. DESIGN Open-label, a prospective study in 43 young adults with PWS. METHODS BMD of the total body (BMDTBSDS) and lumbar spine (BMADLSSDS) measured by DXA. RESULTS In the total group, estimated mean (95% CI) of BMDTB remained similar during 3 years of GH, being -0.76 (-1.11 to -0.41) SDS at start and -0.90 (-1.27 to -0.54) SDS after 3 years (P = 0.11), as did BMADLS, being -0.36 (-0.72 to 0.01) SDS and -0.46 (-0.77 to -0.16) SDS, respectively (P = 0.16). In men, there was a significant decrease in BMDTBSDS during 3 years of GH, while BMADLSSDS remained similar. In women, both BMDTBSDS and BMADLSSDS remained similar. BMDTBSDS was associated with female sex, lean body mass and age. The majority of patients received sex steroid replacement therapy (SSRT). CONCLUSIONS During 3 years of combined GH and SSRT treatment, BMD remained stable in the normal range in young adults with PWS. However, men showed a decline in BMDTBSDS, probably due to insufficient SSRT. We recommended to continue GH treatment in young adults with PWS and to start SSRT during adolescence unless puberty progresses normally.
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Affiliation(s)
- Layla Damen
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, the Netherlands
| | - Lionne N Grootjen
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, the Netherlands
| | - Stephany H Donze
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, the Netherlands
| | - Laura C G de Graaff
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, the Netherlands
- Internal Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Janielle A E M van der Velden
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, the Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Academic Center for Rare Growth Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, the Netherlands
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Hidalgo-Mora JJ, Tarín JJ, Cano A. Ovarian steroids and cancer: news on the breast, questions on the reproductive tract. Gynecol Endocrinol 2021; 37:383-384. [PMID: 33825589 DOI: 10.1080/09513590.2021.1904871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Juan J Hidalgo-Mora
- Research Unit on Women's Health-Institute of Health Research, INCLIVA, Valencia, Spain
| | - Juan J Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Valencia, Spain
| | - Antonio Cano
- Research Unit on Women's Health-Institute of Health Research, INCLIVA, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
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20
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Stangl TA, Wiepjes CM, Defreyne J, Conemans E, D Fisher A, Schreiner T, T'Sjoen G, den Heijer M. Is there a need for liver enzyme monitoring in people using gender-affirming hormone therapy? Eur J Endocrinol 2021; 184:513-520. [PMID: 33524005 DOI: 10.1530/eje-20-1064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Individuals with gender dysphoria can receive gender-affirming hormone therapy. Different guidelines mention a severe risk of liver injury within the first months after the start of treatment with anabolic androgenic steroids, anti-androgens, and oral contraceptives, which is potentially fatal. OBJECTIVE The incidence of liver injury in a transgender population using gender-affirming hormone therapy. DESIGN Multicentre prospective study with 1933 transgender individuals, who started with hormone therapy between 2010 and 2020. METHODS The following parameters were analysed before hormone therapy, after 3 months, and after 12 months of hormone therapy: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Both male and female reference values were considered. Liver injury was defined as either an elevation of 2× upper limit of normal (ULN) of ALP, 3× ULN of ALT, or 3× ULN of AST. RESULTS 889 transgender women and 1044 transgender men were included in the analysis. The incidence of liver injury within 12 months after the start of hormone therapy, without attribution to alcohol abuse, medical history, or comedication was 0.1 and 0.0%. in transgender women according to female and male reference intervals respectively, and 0.6 and 0.4% in transgender men (female and male reference intervals). CONCLUSION The incidence of liver injury is found to be very low. We, therefore, conclude that liver enzyme monitoring within the frame of the risk of liver injury due to hormone therapy is not necessary for a transgender population.
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Affiliation(s)
- Theresa A Stangl
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chantal M Wiepjes
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Justine Defreyne
- Department of Endocrinology, Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Elfi Conemans
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alessandra D Fisher
- Department of Experimental, Clinical and Biomedical Sciences, Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy
| | - Thomas Schreiner
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Guy T'Sjoen
- Department of Endocrinology, Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Martin den Heijer
- Department of Internal Medicine, Division of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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21
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Pappas II, Craig WY, Spratt LV, Spratt DI. Efficacy of Sex Steroid Therapy Without Progestin or GnRH Agonist for Gonadal Suppression in Adult Transgender Patients. J Clin Endocrinol Metab 2021; 106:e1290-e1300. [PMID: 33247919 DOI: 10.1210/clinem/dgaa884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Indexed: 02/04/2023]
Abstract
CONTEXT Testosterone (T) or estradiol (E2) are administered to suppress gonadal function in female-to-male (FTM) and male-to-female (MTF) transgender patients. How often sex steroids cause adequate suppression without GnRH agonist (GnRHa) or progestin therapy has not been reported. OBJECTIVES (1) To determine how often T and E2 therapy alone can effectively suppress gonadal function in MTF and FTM transgender patients, and (2) to determine the frequency and range of serum E2 levels above the normal male range in FTM patients receiving T therapy. DESIGN Retrospective cohort study. SETTING Outpatient reproductive endocrinology clinic at an academic medical center. PATIENTS A total of 65 FTM and 33 MTF patients were included who were > 18 years of age and not receiving progestin or GnRHa therapy. INTERVENTION Female-to-male patients were receiving T through injections or gel. Male-to-female patients were receiving oral or subcutaneous E2. MAIN OUTCOME MEASUREMENTS In FTM patients the indicator of ovary suppression was amenorrhea. In MTF patients, the indicator of testes suppression was T levels <50 ng/dL. RESULTS Median serum total T level for FTM patients was 712 ng/dL (range, 370-1164 ng/dL). On T therapy alone, 90.8% of patients achieved amenorrhea and 49.2% of patients had serum E2 levels above the normal range for women. For MTF patients, the median serum E2 level was 129.2 pg/mL (range, 75-197 pg/mL). On E2 therapy alone, 84.8% of MTF patients had adequate suppression of testicular function. CONCLUSIONS Testosterone and E2 therapy are usually effective without progestin or GnRHa therapy to suppress gonadal function in transgender patients. Progestin and/or GnRHa therapy should only be initiated in those patients who do not have adequate gonadal suppression on optimized doses of T or E2 alone.
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Affiliation(s)
- India I Pappas
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Maine Medical Center, Portland, Maine, USA
| | - Wendy Y Craig
- Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Lindsey V Spratt
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Maine Medical Center, Portland, Maine, USA
| | - Daniel I Spratt
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Maine Medical Center, Portland, Maine, USA
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22
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Shepherd R, Cheung AS, Pang K, Saffery R, Novakovic B. Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics. Front Immunol 2021; 11:604000. [PMID: 33584674 PMCID: PMC7873844 DOI: 10.3389/fimmu.2020.604000] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Sexual dimorphism refers to differences between biological sexes that extend beyond sexual characteristics. In humans, sexual dimorphism in the immune response has been well demonstrated, with females exhibiting lower infection rates than males for a variety of bacterial, viral, and parasitic pathogens. There is also a substantially increased incidence of autoimmune disease in females compared to males. Together, these trends indicate that females have a heightened immune reactogenicity to both self and non-self-molecular patterns. However, the molecular mechanisms driving the sexually dimorphic immune response are not fully understood. The female sex hormones estrogen and progesterone, as well as the male androgens, such as testosterone, elicit direct effects on the function and inflammatory capacity of immune cells. Several studies have identified a sex-specific transcriptome and methylome, independent of the well-described phenomenon of X-chromosome inactivation, suggesting that sexual dimorphism also occurs at the epigenetic level. Moreover, distinct alterations to the transcriptome and epigenetic landscape occur in synchrony with periods of hormonal change, such as puberty, pregnancy, menopause, and exogenous hormone therapy. These changes are also mirrored by changes in immune cell function. This review will outline the evidence for sex hormones and pregnancy-associated hormones as drivers of epigenetic change, and how this may contribute to the sexual dimorphism. Determining the effects of sex hormones on innate immune function is important for understanding sexually dimorphic autoimmune diseases, sex-specific responses to pathogens and vaccines, and how innate immunity is altered during periods of hormonal change (endogenous or exogenous).
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Affiliation(s)
- Rebecca Shepherd
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Ken Pang
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Brain and Mitochondrial Research, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Richard Saffery
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Boris Novakovic
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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23
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Hansen AB, Wøjdemann D, Renault CH, Pedersen AT, Main KM, Raket LL, Jensen RB, Juul A. DIAGNOSIS OF ENDOCRINE DISEASE: Sex steroid action in adolescence: too much, too little; too early, too late. Eur J Endocrinol 2021; 184:R17-R28. [PMID: 33112274 DOI: 10.1530/eje-20-0545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022]
Abstract
This review aims to cover the subject of sex steroid action in adolescence. It will include situations with too little sex steroid action, as seen in for example, Turners syndrome and androgen insensitivity issues, too much sex steroid action as seen in adolescent PCOS, CAH and gynecomastia, too late sex steroid action as seen in constitutional delay of growth and puberty and too early sex steroid action as seen in precocious puberty. This review will cover the etiology, the signs and symptoms which the clinician should be attentive to, important differential diagnoses to know and be able to distinguish, long-term health and social consequences of these hormonal disorders and the course of action with regards to medical treatment in the pediatric endocrinological department and for the general practitioner. This review also covers situations with exogenous sex steroid application for therapeutic purposes in the adolescent and young adult. This includes gender-affirming therapy in the transgender child and hormone treatment of tall statured children. It gives some background information of the cause of treatment, the patient's motivation for medicating (or self-medicating), long-term consequences of exogenous sex steroid treatment and clinical outcome of this treatment.
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Affiliation(s)
- A B Hansen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D Wøjdemann
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - C H Renault
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A T Pedersen
- Department of Gynecology and Fertility Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - K M Main
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L L Raket
- H. Lundbeck A/S, Valby, Hovedstaden, Denmark
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - R B Jensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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24
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Viuff MH, Stochholm K, Lin A, Berglund A, Juul S, Gravholt CH. Cancer occurrence in Turner syndrome and the effect of sex hormone substitution therapy. Eur J Endocrinol 2021; 184:79-88. [PMID: 33112259 DOI: 10.1530/eje-20-0702] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although the overall risk of cancer is not increased in Turner syndrome, the pattern of cancer occurrence differs from the general population. We aim to describe the cancer morbidity pattern in Turner syndrome and evaluate the effect of long-term hormone replacement therapy (HRT). DESIGN Nationwide epidemiological study. METHODS 1156 females with Turner syndrome diagnosed during 1960-2014, were linked with data from the Danish National Patient Registry. Statistics Denmark randomly identified 115 578 female controls. Stratified Cox regression was used to analyze cancer morbidity, mortality and effect of HRT. RESULTS Overall risk of cancer was not elevated (hazard ratio 1.04 (95% CI: 0.80-1.36)). The risk of skin cancer and benign skin neoplasms was two-fold increased, while the risk of breast cancer was decreased (hazard ratio 0.4 (0.2-0.9)). Turner syndrome (45,X) had a two- to five-fold increased risk of benign CNS tumors, colon and rectal cancers, benign skin neoplasms and skin cancer. Turner syndrome women with a 45,X/46,XX karyotype had an increased risk of tongue cancer. HRT had no impact on the risk of any cancer investigated in this study. CONCLUSIONS The lack of one X chromosome might play a role in skin neoplasms, CNS tumors, colon and rectal cancers. The risk of breast cancer is lower than in the general population. Long-term HRT during the premenopausal age range seems not to exert a cancerous effect in Turner syndrome. Increased vigilance concerning specific types of cancer in Tuner syndrome harboring a 45,X karyotype is needed.
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Affiliation(s)
- Mette Hansen Viuff
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Angela Lin
- Medical Genetics Unit, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Agnethe Berglund
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University, Aarhus, Denmark
| | - Svend Juul
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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25
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Abstract
CONTEXT Menopause, the permanent cessation of menses, reflects oocyte depletion and loss of gonadal steroids. It is preceded by a transition state, the perimenopause, which is characterized by the gradual loss of oocytes, altered responsiveness to gonadal steroid feedback, wide hormonal fluctuations, and irregular menstrual patterns. The goal of this mini-review is to discuss the basic pathophysiology of the menopausal transition and the hormonal and nonhormonal management of clinicopathology attributed to it. EVIDENCE ACQUISITION A Medline search of epidemiologic, population-based studies, and studies of reproductive physiology was conducted. A total of 758 publications were screened. EVIDENCE SYNTHESIS The reproductive hormonal milieu of the menopausal transition precipitates bothersome vasomotor symptoms, mood disruption, temporary cognitive dysfunction, genitourinary symptoms, and other disease processes that reduce the quality of life of affected women. The endocrine tumult of the menopause transition also exposes racial and socioeconomic disparities in the onset, severity, and frequency of symptoms. Hormone therapy (HT) treatment can be effective for perimenopausal symptoms but its use has been stymied by concerns about health risks observed in postmenopausal HT users who are older than 60 and/or women who have been postmenopausal for greater than 10 years. CONCLUSIONS The menopause transition is a disruptive process that can last for over a decade and causes symptoms in a majority of women. It is important for clinicians to recognize early signs and symptoms of the transition and be prepared to offer treatment to mitigate these symptoms. Many safe and effective options, including HT, are available.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Cassandra Roeca
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Sidor E, Dżugan M. Drone Brood Homogenate as Natural Remedy for Treating Health Care Problem: A Scientific and Practical Approach. Molecules 2020; 25:molecules25235699. [PMID: 33287191 PMCID: PMC7730673 DOI: 10.3390/molecules25235699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
Drone brood homogenate is a little-known bee product used in folk medicine to treat various health problems. It is a very nutritious milky substance with high content of nutrients: proteins, lipids, fatty acids, carbohydrates, vitamins (A, B, E and D), and minerals. Moreover, when collected on early stage of larvae development, it is, most of all, rich source of sex hormone (testosterone, progesterone and estradiol). Some beekeepers consider drone brood as a waste product, although in some countries they use it to fight Varroa. Meanwhile, in many scientific reports a curative effect of bee drone homogenate in treating urgent global health problems have been confirmed, including ovarian dysfunction in women and male infertility, thyroid and immunity disorders, as well as malnutrition in children. A few dietary supplements based on drone brood are available online. Many patents relating to drone brood-based dietary supplements have been filed in Russia, but their prevalence in EU countries is still limited. Further research is needed to fully recognize the pharmacological activity and increase the use of drone brood.
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27
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Pilgrim D, Entwistle K. GnRHa ('Puberty Blockers') and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression. New Bioeth 2020; 26:224-237. [PMID: 32715988 DOI: 10.1080/20502877.2020.1796257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone analogues (GnRHas) and cross sex hormones to children and adolescents respectively. We place those clinical concerns in a wider societal context and invite consideration of two further relevant ethical domains: competing rights-based claims about male and female personhood; and freedom of expression about those claims. When reflecting on the assessment and medicalization of children and adolescents presenting at gender clinics, the matters of informed consent and iatrogenic risk should be the most pressing for clinicians. However, this is not just a matter of medical ethics, it also implies the need for a full ethical debate on competing notions of personhood and the defence of freedom of expression about transgender and its implications within contemporary democracies.
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Affiliation(s)
- David Pilgrim
- Department of Psychology, University of Southampton, Southampton, UK
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28
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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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Doknic M, Gasic V, Stojanovic M, Pavlovic S, Marinkovic S, Miljic D, Pekic S, Manojlovic-Gacic E, Damjanovic D, Soldatovic I, Petakov M. Hypopituitarism in five PROP1 mutation siblings: long-lasting natural course and the effects of growth hormone replacement introduction in middle adulthood. Pituitary 2020; 23:400-408. [PMID: 32415500 DOI: 10.1007/s11102-020-01049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Twenty years after the first description of combined hypopituitarism (CPHD) caused by PROP1 mutations, the phenotype of affected subjects is still challenging for clinicians. These patients suffer from pituitary hormone deficits ranging from IGHD to panhypopituitarism. ACTH deficiency usually develops later in life. Pituitary size is variable. PROP1 mutation is the most frequent in familial congenital hypopituitarism (CH). Reports on initiation of hormonal replacement including growth hormone (GH) in adults with CH are scarce. We identified 5 adult siblings with CPHD due to PROP1 mutation (301-302delAG), aged 36-51 years (4 females), never treated for hormone deficiencies. They presented with short stature (SD from - 3.7 to - 4.7), infantile sexual characteristic, moderate abdominal obesity and low bone mineral density in 3 of them. Complete hypopituituitarism was confirmed in three siblings, while two remaining demonstrated GH, TSH, FSH and LH deficiencies. Required hormonal replacement including rhGH was initiated in all patients. After several months necessity for hydrocortisone replacement developed in all patients. After 2 years of continual replacement therapy, BMD and body composition (measured by DXA-dual X-ray absorptiometry) improved in all subjects, most prominently in two younger females and the male sibling. Besides rhGH therapy, these three patients have received sex hormones contributing to the favorable effect. The male sibling was diagnosed with brain glioblastoma two years following complete hormonal replacement. This report provides important experience regarding hormonal replacement, particularly rhGH treatment, in adults with long-term untreated CH. Beneficial effect of such therapy are widely acknowledged, yet these subjects could be susceptible to certain risks of hormonal treatment initiated in adulthood. Careful and continual clinical follow-up is thus strongly advised.
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Affiliation(s)
- Mirjana Doknic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotic 13, 11000, Belgrade, Serbia.
- Faculty of Medicine, University Belgrade, Belgrade, Serbia.
| | - Vladimir Gasic
- Institute of Molecular Genetics and Genetic Engineering, University Belgrade, Belgrade, Serbia
| | - Marko Stojanovic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotic 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University Belgrade, Belgrade, Serbia
| | - Snezana Marinkovic
- Special Hospital for Thyroid Gland and Metabolism Diseases, Zlatibor, Serbia
| | - Dragana Miljic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotic 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | - Sandra Pekic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotic 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | | | - Dusan Damjanovic
- Center for Radiology Imaging - Magnetic Resonance and Gamma Knife, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatics, Belgrade, Serbia
- Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | - Milan Petakov
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotic 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University Belgrade, Belgrade, Serbia
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Parikh TP, Malik M, Britten J, Aly JM, Pilgrim J, Catherino WH. Steroid hormones and hormone antagonists regulate the neural marker neurotrimin in uterine leiomyoma. Fertil Steril 2020; 113:176-186. [PMID: 32033718 DOI: 10.1016/j.fertnstert.2019.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To characterize the role of steroid hormone and antihormone exposure on neurotrimin (NTM) expression in human leiomyoma and myometrial tissue and cells. DESIGN Laboratory study of placebo and ulipristal acetate (UPA)-treated patient tissue. In vitro assessment of immortalized myometrial and leiomyoma cell lines after hormone and antihormone exposure. SETTING Academic research center. PATIENT(S) Not applicable. INTERVENTIONS(S) Exposure of leiomyoma cell lines to 17β-E2, medroxyprogesterone acetate (MPA), UPA, and fulvestrant. MAIN OUTCOME MEASURE(S) Messenger RNA expression quantified with the use of RNASeq analysis and quantitative real-time polymerase chain reaction (qRT-PCR). Protein levels quantified by means of Western blot analysis. Immunohistochemistry (IHC) on placebo- and UPA-treated patient uterine tissue specimens. RESULT(S) Expression of NTM in human uterine leiomyoma specimens according to RNASeq was increased compared with myometrium (5.22 ± 0.57-fold), which was confirmed with the use of qRT-PCR (1.95 ± 0.05). Furthermore, NTM protein was elevated in leiomyoma tissue compared with matched myometrium (2.799 ± 0.575). IHC revealed increased staining intensity in leiomyoma surgical specimens compared with matched myometrium of placebo patients. Western blot analysis in immortalized leiomyoma cell lines demonstrated an up-regulation of NTM protein expression (2.4 ± 0.04). Treatment of leiomyoma cell lines with 17β-E2 yielded a 1.98 ± 0.11-fold increase in NTM protein expression; however, treatment with fulvestrant showed no significant change compared with control. Leiomyoma cell lines demonstrated a 1.91 ± 0.97-fold increase in NTM protein expression after progesterone treatment. RNASeq analysis demonstrated a reduced expression in patient leiomyoma after UPA treatment (0.75 ± 0.14). Treatment of leiomyoma cells with UPA demonstrated a reduced total NTM protein amount (0.54 ± 0.31) in patients, which was confirmed with the use of IHC (UPA10 147.2 ± 9.40, UPA20 182.8 ± 8.98). In vitro studies with UPA treatment revealed a concentration-dependent effect that supported these findings. CONCLUSION(S) NTM, a neural cell adhesion molecule, is increased in leiomyoma compared with myometrium in patient tissue and in vitro models after estrogen and progesterone treatment. Down-regulation of expression occurs after UPA treatment, but not after fulvestrant exposure. CLINICAL TRIAL REGISTRATION NUMBER NCT00290251.
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Affiliation(s)
- Toral P Parikh
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Minnie Malik
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joy Britten
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jasmine M Aly
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Justin Pilgrim
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - William H Catherino
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Conklin SE, Knezevic CE. Advancements in the gold standard: Measuring steroid sex hormones by mass spectrometry. Clin Biochem 2020; 82:21-32. [PMID: 32209333 DOI: 10.1016/j.clinbiochem.2020.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
Sex hormones, such as testosterone and estrogens, play an essential role in regulating physiological and reproductive development throughout the lifetime of the individual. Although variation in levels of these hormones are observed throughout the distinct stages in life, significant deviations from reference ranges can result in detrimental effects to the individual. Alterations, by either an increase or decrease, in hormone levels are associated with physiological changes, decreased reproductive capabilities, and increased risk for diseases. Hormone therapies (HTs) and assisted reproductive technologies (ARTs) are commonly used to address these factors. In addition to these treatments, gender-affirming therapies, an iteration of HTs, are also a prominent treatment for transgender individuals. Considering that the effectiveness of these treatments relies on achieving therapeutic hormone levels, monitoring of hormones has served as a way of assessing therapeutic efficay. The need for reliable methods to achieve this task has led to great advancements in methods for evaluating hormone concentrations in biological matrices. Although immunoassays are the more widely used method, mass spectrometry (MS)-based methods have proven to be more sensitive, specific, and reliable. Advances in MS technology and its applications for therapeutic hormone monitoring have been significant, hence integration of these methods in the clinical setting is desired. Here, we provide a general overview of HT and ART, and the immunoassay and MS-based methods currently utilized for monitoring sex hormones. Additionally, we highlight recent advances in MS-based methods and discuss future applications and considerations for MS-based hormone assays.
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Affiliation(s)
- Steven E Conklin
- Department of Pathology, The Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed B1020, Baltimore, MD 21287, USA.
| | - Claire E Knezevic
- Department of Pathology, The Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed B1020, Baltimore, MD 21287, USA.
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Atwood CS, Ekstein SF. Human versus non-human sex steroid use in hormone replacement therapies part 1: Preclinical data. Mol Cell Endocrinol 2019; 480:12-35. [PMID: 30308266 DOI: 10.1016/j.mce.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 03/12/2018] [Accepted: 10/04/2018] [Indexed: 11/24/2022]
Abstract
Prior to 2002, hormone replacement therapy (HRT) was considered to be an important component of postmenopausal healthcare. This was based on a plethora of basic, epidemiological and clinical studies demonstrating the health benefits of supplementation with human sex steroids. However, adverse findings from the Women's Health Initiative (WHI) studies that examined the 2 major forms of HRT in use in the US at that time - Premarin (conjugated equine estrogens; CEE) and Prempro (CEE + medroxyprogesterone acetate; MPA), cast a shadow over the use of any form of HRT. Here we review the biochemical and physiological differences between the non-human WHI study hormones - CEE and MPA, and their respective human counterparts 17β-estradiol (E2) and progesterone (P4). Preclinical data from the last 30 years demonstrate clear differences between human and non-human sex steroids on numerous molecular, physiological and functional parameters in brain, heart and reproductive tissue. In contrast to CEE supplementation, which is not always detrimental although certainly not as optimal as E2 supplementation, MPA is clearly not equivalent to P4, having detrimental effects on cognitive, cardiac and reproductive function. Moreover, unlike P4, MPA is clearly antagonistic of the positive effects of E2 and CEE on tissue function. These data indicate that minor chemical changes to human sex steroids result in physiologically distinct actions that are not optimal for tissue health and functioning.
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Affiliation(s)
- Craig S Atwood
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, USA; Geriatric Research, Education and Clinical Center, Veterans Administration Hospital, Madison, WI, 53705, USA; School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, 6027, WA, Australia.
| | - Samuel F Ekstein
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, USA
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Hammarstrand C, Ragnarsson O, Bengtsson O, Bryngelsson IL, Johannsson G, Olsson DS. Comorbidities in patients with non-functioning pituitary adenoma: influence of long-term growth hormone replacement. Eur J Endocrinol 2018; 179:229-237. [PMID: 30299891 DOI: 10.1530/eje-18-0370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with hypopituitarism have an increased mortality. The aim of this study was to investigate comorbidities including cerebral infarction, type 2 diabetes mellitus (T2DM) and malignant tumors in patients with non-functioning pituitary adenomas (NFPA) with and without growth hormone replacement therapy (GHRT). METHODS Observational cohort study in patients with NFPA within the western region of Sweden. Subjects were identified through the National Patient Registry and followed between 1987 and 2014. Patient records were reviewed and standardized incidence ratios (SIRs) with 95% CIs for comorbidities were calculated. RESULTS In total, 426 patients were included, 206 with GHRT and 219 without. Median (range) follow-up time for patients with and without GHRT was 12.2 (0–24) and 8.2 (0–27) years, respectively. Mean ± s.d. BMI was 28.5 ± 4.5 and 26.5 ± 4.4 for patients with and without GHRT, respectively (P < 0.001). Incidence of cerebral infarction was increased (SIR: 1.39; 95% CI: 1.03–1.84; P = 0.032), with no difference between patients with and without GHRT. SIR for T2DM in patients not receiving GHRT was increased (1.65; 1.06–2.46; P = 0.018), whereas the incidence in patients receiving GHRT was not (0.99; 0.55–1.63; P = 0.99). The incidence of malignant tumors was not increased, either in patients with or without GHRT. CONCLUSION The incidence of cerebral infarction is increased in patients with NFPA irrespective of GHRT. Patients without GHRT had an increased risk of T2DM, whereas patients with GHRT had a normal incidence of T2DM, despite having higher BMI. Incidence of malignant tumors was not increased. Thus, long-term GHRT seems to be safe regarding risk of comorbidities.
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Affiliation(s)
- Casper Hammarstrand
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Olivia Bengtsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
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Abstract
Management of patients with hypogonadism is dependent on the underlying cause. Whilst functional hypogonadism presenting as delayed puberty in adolescence is relatively common, permanent hypogonadism presenting in infancy or adolescence is unusual. The main differential diagnoses of delayed puberty include self-limited delayed puberty (DP), idiopathic hypogonadotropic hypogonadism (IHH) and hypergonadotropic hypogonadism. Treatment of self-limited DP involves expectant observation or short courses of low dose sex steroid supplementation. More complex and involved management is required in permanent hypogonadism to achieve both development of secondary sexual characteristics and to maximize the potential for fertility. This review will cover the options for management involving sex steroid or gonadotropin therapy, with discussion of benefits, limitations and specific considerations of the different treatment options.
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Affiliation(s)
- Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK.
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK.
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Mancini I, Rotilio A, Coati I, Seracchioli R, Martelli V, Meriggiola MC. Presentation of a meningioma in a transwoman after nine years of cyproterone acetate and estradiol intake: case report and literature review. Gynecol Endocrinol 2018; 34:456-459. [PMID: 29105524 DOI: 10.1080/09513590.2017.1395839] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The administration of cyproterone acetate (CPA) and estradiol is a common regimen used by male-to-female transsexuals (transwoman) to adjust their body to their gender identity. Major adverse events are uncommon in these subjects in spite of long-term, high dose cross-sex steroid treatments. We describe the occurrence of a meningioma in a transwoman treated with estrogens and CPA over a period of nine years. The meningioma was revealed during a magnetic resonance imaging (MRI) scan performed as follow-up of a previous surgery for ganglioglioma. CPA intake was discontinued and tumor resection was performed. Histological diagnosis confirmed a strong progesterone receptor-positive and slight estrogen positive meningioma. After surgery, the patient continued her treatment with leuprorelina acetate and estradiol. At one-year follow-up, the MRI scan reveals no recurrence of the tumor. This is the ninth case in literature of a meningioma in a transwoman treated with estrogens and CPA, confirming a possible association between female sex steroids and meningioma. Although there is no still strong evidence of an association between meningioma and CPA, this report may suggest use of alternative treatment for transwomen. This report highlights the importance to record all the cases of meningiomas in high dose CPA-users, in order to improve data.
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Affiliation(s)
| | - Antonino Rotilio
- b Department of Surgery , Operative Unit of Neurosurgery, Hospital of Padua , Padua , Italy
| | - Irene Coati
- c Department of Medicine (DIMED) , Surgical Pathology Unit, University of Padua , Padua , Italy
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de Blok CJM, Klaver M, Wiepjes CM, Nota NM, Heijboer AC, Fisher AD, Schreiner T, T'Sjoen G, den Heijer M. Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study. J Clin Endocrinol Metab 2018; 103:532-538. [PMID: 29165635 DOI: 10.1210/jc.2017-01927] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/15/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT Breast development is a key feature of feminization and therefore important to transwomen (male-to-female transgender persons). It is not exactly known when breast development starts after initiating cross-sex hormone therapy (CHT) and how much growth may be expected. OBJECTIVE To investigate breast development in transwomen during their first year of CHT and whether clinical or laboratory parameters predict breast development. DESIGN This study was performed as part of the European Network for the Investigation of Gender Incongruence, which is a prospective multicenter cohort study. SETTING Gender clinics in Amsterdam, Ghent, and Florence. PARTICIPANTS Transwomen who completed the first year of CHT (n = 229). INTERVENTION CHT. MAIN OUTCOME MEASURES Breast development in centimeter and cup size. RESULTS The median age of the included transwomen was 28 years (range, 18 to 69). Mean breast-chest difference increased to 7.9 ± 3.1 cm after 1 year of CHT, mainly resulting in less than an AAA cup size (48.7%). Main breast development occurred in the first 6 months of therapy. Serum estradiol levels did not predict breast development after 1 year of CHT (first quartile, 3.6 cm [95% confidence interval (CI), 2.7 to 4.5], second quartile, 3.2 cm [95% CI, 2.3 to 4.2], third quartile, 4.4 cm [95% CI, 3.5 to 5.3], and fourth quartile, 3.6 cm [95% CI, 2.7 to 4.5]). CONCLUSION This study shows that, after 1 year of CHT, breast development is modest and occurs primarily in the first 6 months. No clinical or laboratory parameters were found that predict breast development.
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Affiliation(s)
- Christel Josefa Maria de Blok
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Maartje Klaver
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Chantal Maria Wiepjes
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Nienke Marije Nota
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke Corine Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, The Netherlands
- Laboratory of Endocrinology, Academic Medical Center, Amsterdam, The Netherlands
| | - Alessandra Daphne Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy
| | - Thomas Schreiner
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Martin den Heijer
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
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Singh-Ospina N, Maraka S, Rodriguez-Gutierrez R, Davidge-Pitts C, Nippoldt TB, Prokop LJ, Murad MH. Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2017; 102:3904-3913. [PMID: 28945851 DOI: 10.1210/jc.2017-01642] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The impact of sex steroids on bone health in transgender individuals is unclear. METHODS A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). RESULTS Thirteen studies evaluating 639 transgender individuals were identified [392 male-to-female (MTF), 247 female-to-male (FTM)]. In FTM individuals and compared with baseline values before initiation of masculinizing hormone therapy, there was no statistically significant difference in the lumbar spine, femoral neck, or total hip bone mineral density (BMD) when assessed at 12 and 24 months. In MTF individuals and compared with baseline values before initiation of feminizing hormone therapy, there was a statistically significant increase in lumbar spine BMD at 12 months (0.04 g/cm2; 95% CI, 0.03 to 0.06 g/cm2) and 24 months (0.06 g/cm2; 95% CI, 0.04 to 0.08 g/cm2). Fracture rates were evaluated in a single cohort of 53 MTF and 53 FTM individuals, with no events at 12 months. The body of evidence is derived mostly from observational studies at moderate risk of bias. CONCLUSION In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.
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Affiliation(s)
- Naykky Singh-Ospina
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida 32610
| | - Spyridoula Maraka
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Caroline Davidge-Pitts
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Todd B Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota 55905
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Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, Murad MH. Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2017; 102:3914-3923. [PMID: 28945852 DOI: 10.1210/jc.2017-01643] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health. METHODS A comprehensive search of several databases up to 7 April 2015 was conducted for studies evaluating the effect of sex steroid use on lipids, myocardial infarction, stroke, venous thromboembolism (VTE), and mortality in transgender individuals. Pairs of reviewers selected and appraised the studies. A random-effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). RESULTS We found 29 eligible studies with moderate risk of bias. In female-to-male (FTM) individuals, sex steroid therapy was associated with statistically significant increases in serum triglyceride (TG) levels at 3 to 6 months and at ≥24 months (21.4 mg/dL; 95% CI: 0.14 to 42.6) and in low-density lipoprotein cholesterol (LDL-C) levels at 12 months and ≥24 months (17.8 mg/dL; 95% CI: 3.5 to 32.1). High-density lipoprotein cholesterol (HDL-C) levels decreased significantly across all follow-up periods (highest at ≥24 months, -8.5 mg/dL; 95% CI: -13.0 to -3.9). In male-to-female (MTF) individuals, serum TG levels were significantly higher at ≥24 months (31.9 mg/dL; 95% CI: 3.9 to 59.9) without any changes in other parameters. Few myocardial infarction, stroke, VTE, and death events were reported (more frequently in MTF individuals). CONCLUSIONS Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.
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Affiliation(s)
- Spyridoula Maraka
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
- Central Arkansas Veterans Health Care System, Little Rock, Arkansas 72205
| | - Naykky Singh Ospina
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida 32610
| | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo León, Monterrey, Mexico 64460
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Todd B Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota 55905
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
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Affiliation(s)
- Asa Radix
- Callen Lorde Community Health Center, New York, New York
| | - Andrew M Davis
- University of Chicago, Section of General Internal Medicine, Chicago, Illinois
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Abstract
BACKGROUND Gender confirming surgery (GCS) represents a new and interdisciplinary urological field of activity. OBJECTIVES Based on more than 20 years of experience, the development of interdisciplinary strategies in the surgical management of male-to-female (MtF) and female-to-male (FtM) transgenders is summarized. MATERIALS AND METHODS The current national and international literature, as well as the surgical experience of the authors in the field of GCS, were evaluated, and aspects relevant for urologists are presented in a comprehensive review. RESULTS Since 1990 more than 1200 primary GCS in MtF transgenders and more than 230 primary GCS in FtM transgenders have been performed in the authors' institutions. Presuming an incidence of at least 1:20,000 for patients with gender dysphoria (GD) in the general population, the overall number of patients is limited. The complex surgical procedures should be realized in an interdisciplinary team, trained and specialized in this field of surgery, given the high rate of complications and secondary procedures with MtF GCS. CONCLUSION Postoperative satisfaction rates of FtM and MtF transgenders at over 80% are satisfactory. During the last few decades, surgical procedures have been widely standardized. In the field of penile reconstruction, the free forearm lap represents the preferred method, while several surgical alternatives arise from the current literature in this field.
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Affiliation(s)
- M Sohn
- Klinik für Urologie, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Deutschland
| | - U M Rieger
- Klinik für Plastische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Deutschland
| | - J Heß
- Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
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Talovic M, Sheikh A, McCleary N, Erkkola M, Kaila M, Virtanen SM, Nwaru BI. Periconception endogenous and exogenous maternal sex steroid hormones and risk of asthma and allergy in offspring: protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e014637. [PMID: 28706087 PMCID: PMC5734299 DOI: 10.1136/bmjopen-2016-014637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Pregnancy is associated with several hormonal changes which influence the developing fetus. Variations in maternal endogenous hormones and prepregnancy use of hormonal preparations have been linked to asthma and allergy in the offspring, but findings are inconsistent. We plan to undertake a systematic review to synthesise the evidence on the association between endogenous and exogenous maternal sex hormones and the risk of asthma and allergy in the offspring. METHODS AND ANALYSIS We will search Medline, Embase, Cochrane Library, Institute of Scientific Information Web of Science, Cumulative Index of Nursing and Allied Health, Scopus, Google Scholar, Allied and Complementary Medicine Database, Global Health, Psychological Information (PsycINFO), Centre for Agriculture and Bioscience (CAB) International and WHO Global Health Library from inception until 2016 to identify relevant studies on the topic. Additional studies will be identified by searching databases of proceedings of international conferences, contacting international experts in the field and searching the references cited in identified studies. We will include analytical epidemiological studies. Two researchers will independently screen identified studies, undertake data extraction and assess risk of bias in eligible studies, while a third reviewer will arbitrate any disagreement. We will use the Effective Public Health Practice Project tool to assess the risk of bias in the studies. We will perform a random-effects meta-analysis to synthesise the evidence. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to rate the strength and quality of the overall evidence with respect to each outcome. ETHICS AND DISSEMINATION Ethical approval is not required since the study is a systematic review of published literature. Our findings will be reported in a peer-reviewed scientific journal. PROSPERO REGISTRATION NUMBER CRD42016048324.
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Affiliation(s)
- Merhunisa Talovic
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Nicola McCleary
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Maijaliisa Erkkola
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Minna Kaila
- Department of Pediatrics, Public Health Medicine, University of Helsinki and Helsinki University Hospital, University of Helsinki, Tampere University Hospital, Helsinki, Finland
| | - Suvi M Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland
- Department of Lifestyle and Participation, Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
- Tampere Centre for Child Health Research, Tampere University Hospital, Tampere, Finland
- Science Centre of Pirkanmaa Hospital District, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Bright I Nwaru
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- School of Health Sciences, University of Tampere, Tampere, Finland
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Abstract
Growth hormone (GH) regulates somatic growth, substrate metabolism and body composition. Sex hormones exert profound effect on the secretion and action of GH. Estrogens stimulate the secretion of GH, but inhibit the action of GH on the liver, an effect that occurs when administered orally. Estrogens suppress GH receptor signaling by stimulating the expression proteins that inhibit cytokine receptor signaling. This effect of estrogens is avoided when physiological doses of estrogens are administered via a non-oral route. Estrogen-like compounds, such as selective estrogen receptor modulators, possess dual properties of inhibiting the secretion as well as the action of GH. In contrast, androgens stimulate GH secretion, driving IGF-1 production. In the periphery, androgens enhance the action of GH. The differential effects of estrogens and androgens influence the dose of GH replacement in patients with hypopituitarism on concomitant treatment with sex steroids. Where possible, a non-oral route of estrogen replacement is recommended for optimizing cost-benefit of GH replacement in women with GH deficiency. Adequate androgen replacement in conjunction with GH replacement is required to achieve the full anabolic effect in men with hypopituitarism.
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Affiliation(s)
- Vita Birzniece
- School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia; Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; School of Medicine, University of New South Wales, NSW 2052, Australia.
| | - Ken K Y Ho
- Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; Centres for Health Research, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD 4102, Australia
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Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev 2017; 39:93-107. [PMID: 28486701 PMCID: PMC5868281 DOI: 10.1093/epirev/mxw003] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022] Open
Abstract
Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.
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Affiliation(s)
- Hayley Braun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Janice Brockman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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Yoshino M. [Psychological Support for Children and Adolescents with Gender Dysphoria -From a Clinical Psychologist's Viewpoint-]. Seishin Shinkeigaku Zasshi 2017; 119:35-41. [PMID: 30629866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper considers what psychological support should be provided for children and ado- lescents with gender dysphoria based on lessons learnt as a member of a comprehensive medi- cal care team for patients with Gender Identity Disorder (GID), and as a school counselor (SC). The characteristics of adult patients with GID and the results of psychological tests, together with the issues and problems these patients experienced in childhood are analyzed. The need to provide care in consideration of their low self-esteem caused by the inconsiderate remarks of others, how to lessen the conflicts arising from the stereo-typed gender images imposed at school, and the capability to face gender dysphoria and build their future are pointed out Based on actual school cases, ideas for the support needed for these children and adolescents with gender dysphoria are presented. This takes a developmental viewpoint of a clinical psychologist who endeavors to provide children and adolescents with a safe place to talk about gender dysphoria problems, and serve as a liaison between the school and home.
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Matikainen N. [Osteoporosis: a clinical perspective]. Duodecim 2016; 132:1051-1058. [PMID: 27400591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Osteoporosis is defined by decreased bone density and microarchitectural deterioration that predispose to fragility fractures. The WHO diagnostic criteria of osteoporosis require bone densitometry but treatment is possible on the basis of high clinical fracture risk and can be assessed by the FRAX risk algorithm. All those subject to fracture risk should be advised about proper basic treatment of osteoporosis, including exercise, prevention of falls, smoking cessation, avoidance of alcohol intake, and dietary or supplemental abundance of calcium and vitamin D. Underlying diseases must be studied after diagnosis of osteoporosis even if treatment is initiated without densitometry. When indicated, specific osteoporosis therapy includes bisphosphonates, denosumab, teriparatide, strontium ranelate or SERMs. In hypogonadism, gonadal steroids may be indicated alone or in addition to a specific treatment. Treatment effect and continuation are assessed after 2 to 5 years.
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Norjavaara E, Ankarberg-Lindgren C, Kriström B. Sex Steroid Replacement Therapy in Female Hypogonadism from Childhood to Young Adulthood. Endocr Dev 2016; 29:198-213. [PMID: 26680580 DOI: 10.1159/000438892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The overall goal of pubertal sex hormone replacement therapy (HRT) in girls is not only about development of secondary sexual characteristics, but also to establish an adult endocrine and metabolic milieu, as well as adult cognitive function. Estradiol (E2) is the first choice for HRT compared to ethinyl estradiol (EE2). E2 is the most potent endogenous estrogen in the circulation, with established levels during spontaneous puberty. Transdermal E2, compared to oral administration, is the first choice to start pubertal HRT. Transdermal application avoids liver exposure to supraphysiologic estrogen concentrations and provides a more physiologic mechanism for hormone delivery. By cutting E2 matrix patches in doses of 0.05-0.07 µg/kg or administrate E2 gel in doses of 0.1 mg/day, serum concentrations of E2 seen in early spontaneous puberty can be obtained. Patches can be removed in the morning and thereby mimic the normal circadian rhythm. For those clinics with access to sensitive E2 determinations methods (extraction followed by radioimmunoassay or mass spectrometry) monitoring the attained E2 serum levels is recommended in order to optimally mimic the levels seen in early puberty as well as growth velocity, breast and uterus development. Mid- and late pubertal HRT is obtained by increased doses of E2, adding cyclic oral or transdermal progestin, as well as testosterone gel over the pubic area if indicated.
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Abstract
This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.
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Affiliation(s)
| | - Emilia Sanabria
- Laboratoire Triangle & INSERM 15 Parvis René Descartes, Ecole normale supérieure de Lyon, Lyon, França,
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48
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Abstract
Male delayed puberty is common, affecting up to 3% of the population. Management of patients with pubertal delay is dependent on the underlying cause. The main differential diagnoses of delayed puberty in males include constitutional delay of growth and puberty (CDGP), idiopathic hypogonadotropic hypogonadism and hypergonadotropic hypogonadism. Treatment of isolated CDGP involves expectant observation or short courses of low-dose sex steroid supplementation. More complex and involved management is required in males with hypogonadism to achieve both development of secondary sexual characteristics and to maximise the potential for fertility. This review will cover the options for management involving androgen or gonadotropin therapy, with discussion of benefits, limitations and specific considerations of the different treatment options.
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49
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Turan N, Heider RAJ, Zaharieva D, Ahmad FU, Barrow DL, Pradilla G. Sex Differences in the Formation of Intracranial Aneurysms and Incidence and Outcome of Subarachnoid Hemorrhage: Review of Experimental and Human Studies. Transl Stroke Res 2015; 7:12-9. [PMID: 26573918 DOI: 10.1007/s12975-015-0434-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 12/26/2022]
Abstract
Intracranial aneurysms are defined as pathological dilatations of cerebral arteries and rupture of intracranial aneurysms leads to subarachnoid hemorrhage (SAH). The goal of this review was to outline the sex differences in the formation and progression of intracranial aneurysms as well as sex-related differences in incidence and outcome of SAH. The literature review was performed using PubMed with a combination of these search terms: "subarachnoid hemorrhage," "incidence," "outcome," "sex," "gender," "male," "female," "experimental," "mice," and "rats." Studies written in English were used. Female sex is thought to be a risk factor for aneurysm formation, especially in postmenopausal age populations, suggesting the potential protective involvement of sex steroids. Female sex is also considered a risk factor for SAH occurrence. Although incidence and mortality are confirmed to be higher in females in most studies, they elucidated no clear differences in the functional outcome among SAH survivors. The effect of gender on the pathophysiology of SAH is not very well understood; nevertheless, the majority of pre-clinical studies suggest a beneficial effect of sex steroids in experimental SAH. Moreover, conflicting results exist on the role and effect of hormone replacement therapies and oral contraceptive pills on the incidence and outcome of human SAH. Sex differences exist in the formation of aneurysms as well as the incidence and mortality of SAH. Potential therapeutic effects of sex steroids have been replicated in many animal studies, but their potential use in the treatment of acute SAH in human populations needs more future study.
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Affiliation(s)
- Nefize Turan
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Rd. NE, Suite B6166, Atlanta, GA, 30322, USA
| | - Robert Allen-James Heider
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Rd. NE, Suite B6166, Atlanta, GA, 30322, USA
| | - Dobromira Zaharieva
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Rd. NE, Suite B6166, Atlanta, GA, 30322, USA
| | - Faiz U Ahmad
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Rd. NE, Suite B6166, Atlanta, GA, 30322, USA
| | - Daniel L Barrow
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Rd. NE, Suite B6166, Atlanta, GA, 30322, USA
| | - Gustavo Pradilla
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Rd. NE, Suite B6166, Atlanta, GA, 30322, USA.
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50
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Abstract
PURPOSE OF REVIEW Transgender individuals display incongruence between their assigned birth sex and their current gender identity, and may identify as male, female, or being elsewhere on the gender spectrum. Gender nonconformity describes an individual whose gender identity, role, or expression is not typical for individuals in a given assigned sex category. This update highlights recent literature pertaining to the psychosocial and medical care of transgender and gender nonconforming (TGN) adolescents with applications for the general practitioner. RECENT FINDINGS The psychological risks and outcomes of TGN adolescents are being more widely recognized. Moreover, there is increasing evidence that social and medical gender transition reduces gender dysphoria, defined as distress that accompanies the incongruence between one's birth sex and identified gender. Unfortunately, lack of education about TGN adolescents in medical training persists. SUMMARY Recent literature highlights increased health risks in TGN adolescents and improved outcomes following gender dysphoria treatment. It is important for clinicians to become familiar with the range of treatment options and referral resources available to TGN adolescents in order to provide optimal and welcoming care to all adolescents.
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Affiliation(s)
- Carly Guss
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA
| | - Daniel Shumer
- Boston Children’s Hospital, Division of Endocrinology, Boston, MA
| | - Sabra L. Katz-Wise
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA
- Harvard Medical School, Department of Pediatrics, Boston, MA
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