Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes

Abstract Introduction In large community-based studies of puberty, Tanner staging by a clinician is often not possible. We compared self-rated Tanner staging and other subjective ratings of pubertal development with serum hormone levels measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to reassess the utility of self-rated pubertal stage using highly sensitive and specific hormone analysis. Methods Adolescents and their parents enrolled in the Adolescent Rural Cohort study of Hormones and health, Education, environments and Relationships (ARCHER) answered annual survey questions on pubertal development. Annually, adolescents provided blood samples for serum testosterone and estradiol measured by LC-MS/MS. Results Longitudinally, self-rated Tanner stage was positively associated with serum testosterone and estradiol levels in both sexes. Confirmation by adolescent and parent that puberty had commenced was associated with higher gonadal hormone levels in both sexes. Parent and adolescent responses demonstrated ‘fair’ to ‘moderate’ agreement. Conclusions Over a 3-year follow-up, self-rated Tanner staging and simple questions regarding pubertal onset and development are positively associated with adolescent gonadal hormone concentrations in serum measured by mass spectrometry. Thus, self-report of puberty stage still has a role in large community-based studies where physical examination is not feasible.

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Bumpy and Smoother Pathways of Puberty Hormone Change: A Novel Way to Define Gonadal Hormone Trajectories in Adolescents

Journal of the Endocrine Society ◽

10.1210/jendso/bvz014 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Katharine S Steinbeck ◽

Frances L Garden ◽

Hoi Lun Cheng ◽

Georgina M Luscombe ◽

David J Handelsman

Keyword(s):

Serum Testosterone ◽

Tanner Stage ◽

Self Report ◽

Quadratic Growth ◽

Gonadal Hormone ◽

Baseline Serum ◽

Growth Mixture ◽

Class 1 ◽

Hormone Effects ◽

Regional Community

Abstract Context The study of gonadal hormone effects on adolescent wellbeing has been limited by logistical challenges. Urine hormone profiling offers new opportunities to understand the health and behavioral implications of puberty hormones. Objective To characterize pubertal change in urinary testosterone and estradiol among male and female adolescents, respectively. Design Three-year prospective cohort study. Setting Australian regional community. Participants 282 (163 male) normally developing adolescents aged 11.8 ± 1.0 years at baseline. Main outcome measure Quarterly urine measurements of testosterone and estradiol (mass spectrometry); annual anthropometric assessment and Tanner stage (TS) self-report. Results Two-class sigmoidal and quadratic growth mixture models (centered on age at TS3) were identified as best-fit for describing testosterone (male) and estradiol (female) change. Classes 1 (male: 63%; female: 82%) and 2 (male: 37%; female: 18%) were respectively named the “stable” and “unstable” trajectories, characterized by different standard deviation of quarterly hormone change and magnitude of hormone peaks and troughs (all P < 0.001). Compared with class 1 (stable), class 2 males were taller at baseline (154 vs 151 cm), reported earlier and faster TS progression (P < 0.01), and showed higher serum testosterone levels at baseline and 3 years (P ≤ 0.01). Class 2 females exhibited smaller height and weight gains over the 3 years and had higher baseline serum estradiol (249 vs 98 pmol/L; P = 0.002) than class 1. Conclusions Adolescents showed 2 distinct urinary gonadal hormone trajectories, characterized by stability of change over time, which were not associated with consistent anthropometric differences. Results provide a methodology for studying gonadal hormone impacts on other aspects of biopsychosocial wellbeing. Identification of potential “at-risk” hormone groups would be important for planning supportive interventions.

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Urinary and salivary endocrine measurements to complement Tanner staging in studies of pubertal development

PLoS ONE ◽

10.1371/journal.pone.0251598 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251598

Author(s):

Mandy Goldberg ◽

Anna J. Ciesielski Jones ◽

John A. McGrath ◽

Christie Barker-Cummings ◽

Deborah S. Cousins ◽

...

Keyword(s):

Repeated Measures ◽

Pubertal Development ◽

Tanner Stage ◽

Pubic Hair ◽

Health Study ◽

Final Visit ◽

Tanner Staging ◽

Non Invasive ◽

Stage 1

Background Many studies investigating pubertal development use Tanner staging to assess maturation. Endocrine markers in urine and saliva may provide an objective, sensitive, and non-invasive method for assessing development. Objective Our objective was to examine whether changes in endocrine levels can indicate the onset of pubertal development prior to changes in self-rated Tanner stage. Methods Thirty-five girls and 42 boys aged 7 to 15 years were enrolled in the Growth and Puberty (GAP) study, a longitudinal pilot study conducted from 2007–2009 involving children of women enrolled in the Agricultural Health Study (AHS) in Iowa. We collected saliva and urine samples and assessed pubertal development by self-rated Tanner staging (pubic hair, breast development (girls), genital development (boys)) at three visits over six months. We measured dehydroepiandrosterone (DHEA) in saliva and creatinine-adjusted luteinizing hormone (LH), testosterone, follicle stimulating hormone (FSH), estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) concentrations in first morning urine. We evaluated the relationships over time between Tanner stage and each biomarker using repeated measures analysis. Results Among girls still reporting Tanner breast stage 1 at the final visit, FSH levels increased over the 6-month follow-up period and were no longer lower than higher stage girls at the end of follow-up. We observed a similar pattern for testosterone in boys. By visit 3, boys still reporting Tanner genital stage 1 or pubic hair stage 1 had attained DHEA levels that were comparable to those among boys reporting Tanner stages 2 or 3. Conclusions Increasing concentrations of FSH in girls and DHEA and testosterone in boys over a 6-month period revealed the start of the pubertal process prior to changes in self-rated Tanner stage. Repeated, non-invasive endocrine measures may complement the more subjective assessment of physical markers in studies determining pubertal onset.

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Pubertal assessment: targeted educational intervention for pediatric trainees

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2017-0064 ◽

2017 ◽

Vol 31 (6) ◽

Author(s):

Aditi Khokhar ◽

Sairaman Nagarajan ◽

Yagnaram Ravichandran ◽

Sheila Perez-Colon

Keyword(s):

Educational Intervention ◽

Pubertal Development ◽

Tanner Stage ◽

Clinical Practices ◽

Post Intervention ◽

Tanner Staging ◽

Confidence Levels ◽

Comfort Levels ◽

Pediatric Residency ◽

Baseline Knowledge

Abstract Background Timely and periodic pubertal assessment in children is vital to identify puberty related disorders. Pediatricians need to have working knowledge of puberty time and tempo. Pediatric residency is an important platform to acquire physical examination skills including pubertal assessment. Objective An educational intervention for teaching pubertal assessment was piloted on pediatric residents at our institution. Methods The intervention comprised of interactive lecture series, ID badge size Tanner stage cards and Tanner posters placed in residents’ continuity clinics. Pre-intervention, post-intervention and 3 months post-intervention surveys for participating trainees were administered to determine the effectiveness of the intervention. Attitudes, practices, knowledge scores, and barriers to Tanner staging conduct were analyzed. Results Forty-three residents participated in the intervention. Knowledge scores of PGY1 (5.95 ± 1.6 vs. 7.47 ± 1.4, p < 0.01) improved right after the intervention, as did self-reported clinical practices of all trainees 3 months post- intervention with regards to conducting external genital examination and performing pubertal assessment. Confidence levels of pediatric trainees in conducting pubertal assessment and comfort levels in assessing the need for endocrine referral based on abnormal Tanner staging improved after the intervention, although the effect was not statistically significant. Conclusion Our intervention is a worthwhile technique for teaching pubertal assessment to residents as it is simple to conduct, easily reproducible, provides baseline knowledge needed for recognition of normal pubertal development and puberty related conditions, and instills confidence in residents.

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Self-assessment of pubertal development in a puberty cohort

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0178 ◽

2018 ◽

Vol 31 (7) ◽

pp. 763-772 ◽

Cited By ~ 15

Author(s):

Andreas Ernst ◽

Lea Lykke B. Lauridsen ◽

Nis Brix ◽

Camilla Kjersgaard ◽

Jørn Olsen ◽

...

Keyword(s):

Clinical Examination ◽

Pubertal Development ◽

Tanner Stage ◽

Weighted Kappa ◽

Pubic Hair ◽

Kappa Statistics ◽

Random Errors ◽

Rater Agreement ◽

Self Assessment ◽

Tanner Staging

Abstract Background We evaluated the inter-rater agreement between self-assessed Tanner staging and clinical examination and the intra-individual agreement of self-assessed information on various puberty markers in late adolescents from the longitudinal nationwide Puberty Cohort, a sub-cohort of the Danish National Birth Cohort (DNBC). Methods We invited 715 children from the ongoing Puberty Cohort between June 2016 and January 2017. In total, 366 children (51%) returned an add-on questionnaire identical to the questionnaire used to collect information on puberty markers, including Tanner staging, in the Puberty Cohort. Of these, 197 (54%) also participated in a clinical examination with Tanner staging. We used percentage agreement and weighted kappa statistics to evaluate the inter-rater and intra-individual agreement. Results Due to late entry, more than 75% of children were Tanner stage 4 or above at clinical examination. In girls, the inter-rater agreement for pubic hair and breast staging was 54% and 52%, respectively, yielding weighted kappas of fair strength. In boys, pubic hair and genital staging agreed in 55% and 33%, respectively, corresponding to weighted kappas of fair to moderate strength. Boys tended to underestimate genitalia staging consistently. The intra-individual agreement on Tanner staging was 75–77% in girls and 69% in boys, whereas the intra-individual agreement on axillary hair and acne was above 92%. Conclusions Self-assessment of late stages of pubertal development may be misclassified, leading to random errors in studies of puberty timing. However, self-assessment continues to serve as an important time- and cost-saving tool in large prospective puberty cohorts.

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Sexual function in male lymphoma survivors versus matched controls: Relationship to age, gonadal hormones, and quality of life

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9510 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9510-9510

Author(s):

C. E. Kiserud ◽

L. R. Schover ◽

A. Fossaa ◽

A. A. Dahl ◽

J. H. Loge ◽

...

Keyword(s):

Quality Of Life ◽

Sexual Function ◽

Mental Distress ◽

Gonadal Hormones ◽

Self Report ◽

Gonadal Hormone ◽

Multivariate Linear Regression Analysis ◽

Hormone Levels ◽

Lymphoma Survivors

9510 Background: Sexual function in male lymphoma survivors (LS) was examined and compared to age-matched controls from the general population (CTR). Methods: The study includes 294 LSs, diagnosed 1980–2002, treated at the Norwegian Radium Hospital, ≤50 years at diagnosis, with recent gonadal hormone levels [testosterone (T), SHBG, LH, and FSH]. Sexual function was assessed using the Brief Male Sexual Function Inventory (BSFI) consisting of 11 self-report items covering five domains: sexual drive, erectile function, ejaculatory function, problem assessment and overall satisfaction. Lower scores indicate impaired sexual function. A total BSFI score (T-BSFI) was constructed by summing all items except overall satisfaction. Mean and median scores for the BSFI domains and T-BSFI were compared across age groups (21–39, 40–49, 50–59, 60–69 years at survey), gonadal hormone levels [normal (n=144), elevated FSH only (n=60), low T and/or elevated LH (n=90)], cancer treatment intensity, comorbidity, relationship status, fatigue score, mental distress (HADS) and quality of life (SF-36, mental and physical health components). Multivariate linear regression analysis was performed with T-BSFI as the dependent variable including independent variables significant in univariate analyses. Each LS was matched to two CTRs (n=506). Results: Valid T-BSFI scores were available for 253 LSs (86%). Median age at survey was 48 years, median duration of follow-up 15 years, and 78% were in a committed relationship. LSs aged 40–59 years had significantly lower T-BSFIs compared to their CTRs (p≤0.01). All BSFI domain scores and T-BSFI decreased significantly with ageing. LSs with low T and/or elevated LH had the lowest BSFI domain and T-BSFI scores. Survivors with normal hormone levels had the highest scores. Low T and/or elevated LH (p=0.03), age ≥50 years at survey (p≤ 0.001) and mental distress (p< 0.001) were significantly associated with male sexual dysfunction (T-BSFI) in the multivariate analysis. Conclusions: LSs aged 40–59 years reported poorer sexual function than age-matched CTRs. Impaired sexual function was significantly associated with age ≥ 50 years at survey, having low T and/or elevated LH and being distressed. No significant financial relationships to disclose.

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Can we rely on adolescents to self-assess puberty stage? A systematic review and meta-analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa135 ◽

2020 ◽

Vol 105 (8) ◽

pp. 2846-2856 ◽

Cited By ~ 1

Author(s):

Susan C Campisi ◽

Josée D Marchand ◽

Fahad Javaid Siddiqui ◽

Muhammad Islam ◽

Zulfiqar A Bhutta ◽

...

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Pubertal Development ◽

Tanner Stage ◽

Pubic Hair ◽

Cochrane Library ◽

Self Assessment ◽

Pubertal Stage ◽

Tanner Staging ◽

Stage 1

Abstract Context Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings. Objective To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. Data Sources MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. Study Selection Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician–assessment for the 5-stage Tanner scale. Data Extraction We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. Data Synthesis After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups. Conclusions Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. Protocol Registration PROSPERO # CRD42018100205

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Correspondence Between Perceived Pubertal Development and Hormone Levels in 9-10 Year-Olds From the Adolescent Brain Cognitive Development Study

Frontiers in Endocrinology ◽

10.3389/fendo.2020.549928 ◽

2021 ◽

Vol 11 ◽

Author(s):

Megan M. Herting ◽

Kristina A. Uban ◽

Marybel Robledo Gonzalez ◽

Fiona C. Baker ◽

Eric C. Kan ◽

...

Keyword(s):

Cognitive Development ◽

Latent Variables ◽

Pubertal Development ◽

Self Report ◽

Brain Maturation ◽

Latent Factor ◽

Pubertal Maturation ◽

Hormone Levels ◽

Physical Maturation ◽

Physical Features

AimTo examine individual variability between perceived physical features and hormones of pubertal maturation in 9–10-year-old children as a function of sociodemographic characteristics.MethodsCross-sectional metrics of puberty were utilized from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study—a multi-site sample of 9–10 year-olds (n = 11,875)—and included perceived physical features via the pubertal development scale (PDS) and child salivary hormone levels (dehydroepiandrosterone and testosterone in all, and estradiol in females). Multi-level models examined the relationships among sociodemographic measures, physical features, and hormone levels. A group factor analysis (GFA) was implemented to extract latent variables of pubertal maturation that integrated both measures of perceived physical features and hormone levels.ResultsPDS summary scores indicated more males (70%) than females (31%) were prepubertal. Perceived physical features and hormone levels were significantly associated with child’s weight status and income, such that more mature scores were observed among children that were overweight/obese or from households with low-income. Results from the GFA identified two latent factors that described individual differences in pubertal maturation among both females and males, with factor 1 driven by higher hormone levels, and factor 2 driven by perceived physical maturation. The correspondence between latent factor 1 scores (hormones) and latent factor 2 scores (perceived physical maturation) revealed synchronous and asynchronous relationships between hormones and concomitant physical features in this large young adolescent sample.ConclusionsSociodemographic measures were associated with both objective hormone and self-report physical measures of pubertal maturation in a large, diverse sample of 9–10 year-olds. The latent variables of pubertal maturation described a complex interplay between perceived physical changes and hormone levels that hallmark sexual maturation, which future studies can examine in relation to trajectories of brain maturation, risk/resilience to substance use, and other mental health outcomes.

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Foot Length Growth as a Novel Marker of Early Puberty

Clinical Pediatrics ◽

10.1177/0009922819875531 ◽

2019 ◽

Vol 58 (13) ◽

pp. 1429-1435

Author(s):

Ben W. R. Balzer ◽

Hoi Lun Cheng ◽

Frances Garden ◽

Georgina M. Luscombe ◽

Karen T. Paxton ◽

...

Keyword(s):

Growth Parameters ◽

Cost Effective ◽

Serum Testosterone ◽

Tanner Stage ◽

Hormonal Changes ◽

Early Puberty ◽

Serum Hormones ◽

Tanner Staging ◽

Foot Length ◽

Length Changes

Foot growth is part of overall pubertal growth but its relation to other anthropometric and hormonal changes is unclear. Our objective was to determine how foot length changes relate to changes in other growth parameters (height and weight), Tanner stage, and serum hormones. Adolescents (n = 342) were recruited to a 3-year longitudinal cohort study, underwent annual anthropometric assessments (height, weight, and foot length), and provided self-rated Tanner staging. They also provided blood samples that were analyzed using liquid chromatography-tandem mass spectrometry for serum testosterone and estradiol and classified as pre-pubertal or pubertal based on circulating hormone levels. Average annual percent increase in foot length was greater for pre-pubertal adolescents compared with pubertal. Increased foot length was associated with increases in height, weight, Tanner stage, and serum hormones in males and pre-menarcheal females but not post-menarcheal females. Foot length offers a novel, noninvasive, cost-effective, and easily demonstrable marker of early pubertal changes.

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