Timing of Puberty Suppression and Surgical Options for Transgender Youth

2021 ◽  
pp. 83-90
Author(s):  
Tim C. van de Grift ◽  
Zosha J. van Gelder ◽  
Margriet G. Mullender ◽  
Thomas D. Steensma ◽  
Annelou L.C. de Vries ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Transgender Women ◽  
Breast Development ◽  
Sex Characteristics ◽  
Long Term Effects ◽  
Endocrine Society ◽  
Puberty Suppression ◽  
Surgical Options ◽  
Transgender Men

OBJECTIVES Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitted or less invasive after PS. In transgender women, the mean penile length was significantly shorter in the PS groups compared with controls (by 4.8 cm [Tanner 2/3] and 2.1 cm [Tanner 4/5]). As a result, the likelihood of undergoing intestinal vaginoplasty was increased (odds ratio = 84 [Tanner 2/3]; odds ratio = 9.8 [Tanner 4/5]). CONCLUSIONS PS reduces the development of sex characteristics in transgender adolescents. As a result, transgender men may not need to undergo mastectomy, whereas transgender women may require an alternative to penile inversion vaginoplasty. These surgical implications should inform decision-making when initiating PS.

Second-Generation Consequences of Small-for-Dates Birth

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 343-347
Author(s):  
Mark A. Klebanoff ◽  
Olav Meirik ◽  
Heinz W. Berendes
Keyword(s):  
Confidence Interval ◽  
Birth Outcomes ◽  
Odds Ratio ◽  
Intrauterine Growth Retardation ◽  
Long Term Effects ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Reported Study ◽  
Increase In Risk

This is the first reported study of birth outcomes of a group of women whose own birth weights and gestational ages had been previously recorded. Births occurring from 1972 to 1983 among 1154 Swedish women, born from 1955 to 1965, were studied. Women who were themselves small for gestational age (SGA) at birth were at increased risk of giving birth to a SGA infant (odds ratio = 2.21, 95% confidence interval = 1.41, 3.48). Women who had been SGA had an even greater increase in risk of giving birth to a preterm infant (odds ratio = 2.96, 95% confidence interval = 1.47, 5.94). Women who were preterm at birth were not at increased risk of giving birth to either preterm (odds ratio = 0.65, 95% confidence interval = 0.15, 2.74) or SGA (odds ratio 1.21, 95% confidence interval = 0.62, 2.38) infants. It is concluded that the long-term effects of intrauterine growth retardation may extend to the next generation; women who had been SGA should be considered at increased risk to give birth to both growth-retarded and preterm infants.

scholarly journals Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up

2019 ◽  
Vol 47 (1) ◽  
pp. 37-46
Author(s):  
Mary E. Costanza ◽  
Roger Luckmann ◽  
Christine Frisard ◽  
Mary Jo White ◽  
Caroline Cranos
Keyword(s):  
Confidence Interval ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Telephone Counseling ◽  
Long Term Effects ◽  
Time Points ◽  
Reminder Call ◽  
Screening Mammograms

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

scholarly journals Long-term effects of prenatal exposure to earthquake on adult schizophrenia

2019 ◽  
Vol 215 (6) ◽  
pp. 730-735 ◽  
Author(s):  
Chao Guo ◽  
Ping He ◽  
Xinming Song ◽  
Xiaoying Zheng
Keyword(s):  
Prenatal Exposure ◽  
Odds Ratio ◽  
Maternal Stress ◽  
First Trimester ◽  
Sample Survey ◽  
Long Term Effects ◽  
Birth Cohorts ◽  
Tangshan Earthquake ◽  
Major Disaster

BackgroundMaternal exposure to major stressors during pregnancy has been found to increase the risk of neurodevelopmental, cognitive and psychiatric disorders in the offspring. However, the association between prenatal exposure to earthquake and the risk of adult schizophrenia has yet to be examined.AimsTo explore the potential long-term effects of prenatal exposure to maternal stress on the risk of schizophrenia in adulthood, using the Great Tangshan Earthquake in 1976 as a natural experiment.MethodWe obtained data from the Second China National Sample Survey on Disability, and analysed 94 410 Chinese individuals born between 1975 and 1979. We obtained difference-in-differences estimates of the earthquake effects on schizophrenia by exploiting temporal variation in the timing of earthquake exposure across four birth cohorts born between 1975 and 1979, along with geographical variation in earthquake severity at the prefecture level. Schizophrenia was ascertained by psychiatrists using the ICD-10 classification. Earthquake severity was measured by seismic intensity.ResultsEarthquake cohort who experienced prenatal exposure to felt earthquake had higher risk of schizophrenia (odds ratio, 3.38; 95% CI 1.43–8.00) compared with the unexposed reference cohort. After specifying the timing of exposure by the trimester of pregnancy, prenatal exposure to felt earthquake during the first trimester of pregnancy increased the risk of adulthood schizophrenia significantly (odds ratio, 7.45; 95% CI 2.83–19.59).ConclusionsPrenatal (particularly early pregnancy) exposure to maternal stress after a major disaster substantially affects the mental health of Chinese adults.

scholarly journals Municipal Residence Level of Long-Term PM10 Exposure Associated with Obesity among Young Adults in Seoul, Korea

2020 ◽  
Vol 17 (19) ◽  
pp. 6981
Author(s):  
Jayeun Kim ◽  
Kyuhyun Yoon
Keyword(s):  
Young Adults ◽  
Odds Ratio ◽  
Residential Area ◽  
Individual Characteristics ◽  
Long Term Effects ◽  
Specific Effects ◽  
Study Population ◽  
The Relationship ◽  
Pm10 Exposure

Background: long-term effects of ambient pollutants used to be defined in cohort studies using biomarkers. Health effects on young adults from long-term exposure to particulate matters (PM) in residential ambiance have received less attention. Methods: using the data of population-representative aged 19–29 in Seoul, the relationship between obesity and PM10 levels of the living district was examined. We defined obesity as Body Mass Index (BMI) 25 kg/m2 and more. Survey logistic regression was conducted according to individual residence periods in the current municipality. Individual characteristics were adjusted overall and were age-specific; aged 19–24 and 25–29. Results: study population was 3655 (1680 (46%) men and 1933 aged 19–24 (52.9%)) individuals. Relationship between length of residence in municipalities with a greater level of PM10 from 2001–2005 and obesity was increased over the residing period; 10 years ≤ (odds ratio (OR) 1.071, 95% confidence interval (CI) 0.969–1.185), 15 years ≤ (1.120, 1.006–1.247), and 20 years ≤ (1.158, 1.034–1.297) in aged 19–29. Age-specific effects showed slight differences. Conclusions: Although PM10 levels are currently decreasing, higher levels of PM10 exposure in the residential area during the earlier lifetime may contribute to obesity increase among young adults.

scholarly journals Transgender patients: considerations for routine gynecologic care and cancer screening

2020 ◽  
Vol 30 (12) ◽  
pp. 1990-1996
Author(s):  
Trinidad Labanca ◽  
Ivan Mañero ◽  
Marcelo Pannunzio
Keyword(s):  
Cancer Screening ◽  
Reproductive Tract ◽  
Hormone Treatment ◽  
Transgender Women ◽  
Cancer Risk Assessment ◽  
Bilateral Mastectomy ◽  
Long Term Effects ◽  
Transgender People ◽  
Personalized Cancer ◽  
Transgender Men

In the last several years, demand for transgender care from gynecologists has increased significantly. Transgender people comprise a diverse group who do not identify with the sex they were assigned at birth. Worldwide, it is estimated that 25 million people identify as transgender. Some undergo hormonal and/or surgical treatment aiming to feminize or masculinize their bodies. Cross-sex hormone treatment for transgender women—individuals assigned as male at birth who identify themselves as women—includes exogenous estrogen and/or progestin administration in combination with anti-androgens, whereas testosterone is used for transgender men—individuals whose natal sex is women but identify themselves as men. Although it is usually rare, hormone-sensitive malignancies may arise, and long-term effects remain unknown. In addition, reconstructive surgeries may include breast augmentation and vaginoplasty (creation of a vagina) for transgender women, and chest masculinization surgery (bilateral mastectomy) and metoidioplasty (lengthening of the clitoris to create a microphallus) or phalloplasty (creation of a phallus) for transgender men. Evidence relating to breast and reproductive tract cancers in the trans population is limited and insufficient to estimate cancer prevalence, and recommendations for screening and preventive care depend on the patients’ hormonal and surgical status. Even less information exists regarding the sub-set of individuals with genetic predisposition for these malignancies. In this review, we aimed to summarize current recommendations for gynecologists and gynecologic oncologists regarding cancer screening and personalized cancer-risk assessment in transgender people.

scholarly journals Long-term effects of previous oxandrolone treatment in adult women with Turner syndrome

2013 ◽  
Vol 168 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Kim Freriks ◽  
Theo C J Sas ◽  
Maaike A F Traas ◽  
Romana T Netea-Maier ◽  
Martin den Heijer ◽  
...  
Keyword(s):  
Body Composition ◽  
Adult Height ◽  
Breast Development ◽  
Breast Size ◽  
Long Term Effects ◽  
Follow Up Study ◽  
Height Gain ◽  
Mean Time

ObjectiveShort stature is a prominent feature of Turner syndrome (TS), which is partially overcome by GH treatment. We have previously reported the results of a trial on the effect of oxandrolone (Ox) in girls with TS. Ox in a dose of 0.03 mg/kg per day (Ox 0.03) significantly increased adult height gain, whereas Ox mg/kg per day (0.06) did not, at the cost of deceleration of breast development and mild virilization. The aim of this follow-up study in adult participants of the pediatric trial was to investigate the long-term effects of previous Ox treatment.Design and methodsDuring the previous randomized controlled trial, 133 girls were treated with GH combined with placebo (Pl), Ox 0.03, or Ox 0.06 from 8 years of age and estrogen from 12 years. Sixty-eight women (Pl,n=23; Ox 0.03,n=27; and Ox 0.06,n=18) participated in the double-blind follow-up study (mean age, 24.0 years; mean time since stopping GH, 8.7 years; and mean time of Ox/Pl use, 4.9 years). We assessed height, body proportions, breast size, virilization, and body composition.ResultsHeight gain (final minus predicted adult height) was maintained at follow-up (Ox 0.03 10.2±4.9 cm, Ox 0.06 9.7±4.4 cm vs Pl 8.0±4.6 cm). Breast size, Tanner breast stage, and body composition were not different between groups. Ox-treated women reported more subjective virilization and had a lower voice frequency.ConclusionOx 0.03 mg/kg per day has a beneficial effect on adult height gain in TS patients. Despite previously reported deceleration of breast development during Ox 0.03 treatment, adult breast size is not affected. Mild virilization persists in only a small minority of patients. The long-term evaluation indicates that Ox 0.03 treatment is effective and safe.

scholarly journals Forever young? The ethics of ongoing puberty suppression for non-binary adults

2020 ◽  
Vol 46 (11) ◽  
pp. 743-752 ◽  
Author(s):  
Lauren Notini ◽  
Brian D Earp ◽  
Lynn Gillam ◽  
Rosalind J McDougall ◽  
Julian Savulescu ◽  
...  
Keyword(s):  
Well Being ◽  
Sex Characteristics ◽  
The Novel ◽  
Goals Of Medicine ◽  
Specific Patient ◽  
Secondary Sex Characteristics ◽  
Puberty Suppression ◽  
Long Term Follow Up ◽  
Potential Benefits

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.

scholarly journals Long-Term Effects of Placental Growth on Overweight and Body Composition

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Johan G. Eriksson ◽  
Jill Gelow ◽  
Kent L. Thornburg ◽  
Clive Osmond ◽  
Markku Laakso ◽  
...  
Keyword(s):  
Body Composition ◽  
Surface Area ◽  
Body Fat ◽  
Odds Ratio ◽  
Adult Life ◽  
Nutrient Supply ◽  
Body Fat Percentage ◽  
Long Term Effects ◽  
Fat Percentage

Obesity is programmed in utero and small babies generally have small placentas. In some circumstances, an undernourished fetus can expand its placental surface to extract more nutrients. We hypothesize that this results in an imbalanced nutrient supply to the fetus leading to obesity. To determine whether placental size determines overweight and body composition, we studied 2003 subjects in adult life. Associations between placental surface area and indices of overweight were restricted to people who carried the Pro12Pro genotype of thePPARγ2gene. For every 1 SD increase in placental surface area, the odds ratio for overweight was 1.37 (95% CI 1.10 to 1.71;P=0.005). Expansion of the placental surface in compensation for fetal undernutrition increases the risk of overweight and a higher body fat percentage in people carrying the Pro12Pro genotype. We suggest that similar underlying multifactorial mechanisms affect the development of obesity in general.

Ovarian Dysfunction in Fetally Irradiated Beagles

1977 ◽  
Vol 35 ◽  
pp. 658-659
Author(s):  
T. M. Seed ◽  
M. H. Sanderson ◽  
D. L. Gutzeit ◽  
T. E. Fritz ◽  
D. V. Tolle ◽  
...  
Keyword(s):  
Gamma Rays ◽  
Low Dose ◽  
Long Term Effects ◽  
Ovarian Dysfunction ◽  
Dose Rates ◽  
Highly Sensitive ◽  
Microscopic Evaluation ◽  
Ovarian Pathology ◽  
Normal Offspring

The developing mammalian fetus is thought to be highly sensitive to ionizing radiation. However, dose, dose-rate relationships are not well established, especially the long term effects of protracted, low-dose exposure. A previous report (1) has indicated that bred beagle bitches exposed to daily doses of 5 to 35 R 60Co gamma rays throughout gestation can produce viable, seemingly normal offspring. Puppies irradiated in utero are distinguishable from controls only by their smaller size, dental abnormalities, and, in adulthood, by their inability to bear young.We report here our preliminary microscopic evaluation of ovarian pathology in young pups continuously irradiated throughout gestation at daily (22 h/day) dose rates of either 0.4, 1.0, 2.5, or 5.0 R/day of gamma rays from an attenuated 60Co source. Pups from non-irradiated bitches served as controls. Experimental animals were evaluated clinically and hematologically (control + 5.0 R/day pups) at regular intervals.

Ultrastructural investigations of MDL 19,660-induced effects on the canine platelet and megakaryocyte

1990 ◽  
Vol 48 (3) ◽  
pp. 374-375
Author(s):  
D.E. Loudy ◽  
J. Sprinkle-Cavallo ◽  
J.T. Yarrington ◽  
F.Y. Thompson ◽  
J.P. Gibson
Keyword(s):  
Antidepressant Drug ◽  
Beagle Dogs ◽  
Long Term Effects ◽  
Short Term ◽  
Platelet Counts ◽  
Toxicological Studies ◽  
Induced Aggregation ◽  
Internal Architecture

Previous short term toxicological studies of one to two weeks duration have demonstrated that MDL 19,660 (5-(4-chlorophenyl)-2,4-dihydro-2,4-dimethyl-3Hl, 2,4-triazole-3-thione), an antidepressant drug, causes a dose-related thrombocytopenia in dogs. Platelet counts started to decline after two days of dosing with 30 mg/kg/day and continued to decrease to their lowest levels by 5-7 days. The loss in platelets was primarily of the small discoid subpopulation. In vitro studies have also indicated that MDL 19,660: does not spontaneously aggregate canine platelets and has moderate antiaggregating properties by inhibiting ADP-induced aggregation. The objectives of the present investigation of MDL 19,660 were to evaluate ultrastructurally long term effects on platelet internal architecture and changes in subpopulations of platelets and megakaryocytes.Nine male and nine female beagle dogs were divided equally into three groups and were administered orally 0, 15, or 30 mg/kg/day of MDL 19,660 for three months. Compared to a control platelet range of 353,000- 452,000/μl, a doserelated thrombocytopenia reached a maximum severity of an average of 135,000/μl for the 15 mg/kg/day dogs after two weeks and 81,000/μl for the 30 mg/kg/day dogs after one week.

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