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Weidler EM, Ochoa B, van Leeuwen K. Prenatal and postnatal evaluation of differences of sex development: a user's guide for clinicians and families. Curr Opin Pediatr 2024; 36:547-553. [PMID: 39254758 PMCID: PMC11408751 DOI: 10.1097/mop.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PURPOSE OF REVIEW Differences of sex development (DSD) are a group of chromosomal, gonadal, and anatomic conditions that are not often diagnosed during pregnancy. Families and clinicians need diagnostic guidance that supports all aspects of the care from the prenatal to postnatal period. RECENT FINDINGS Noninvasive prenatal screening (NIPS) is obtained by sampling cell-free fetal DNA in the mother's bloodstream in the first trimester. While its primary purpose is to screen for genetic aneuploidies, it is also used to determine the sex of the fetus. When screening ultrasound shows genital anatomy that is discordant with the sex determination by NIPS, a DSD workup is warranted. The use of this relatively new screening tool may result in a higher number of prenatal referrals than in the past. SUMMARY This review summarizes suggested prenatal counseling, neonatal management, and postnatal workup of the most common DSD diagnoses. All of these diagnoses are rare, but the common features that families face are addressed with particular emphasis on psychosocial support and a measured shared decision-making approach.
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Affiliation(s)
- Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital
- Department of Child Health, University of Arizona - College of Medicine, Phoenix, Arizona, USA
| | - Brielle Ochoa
- Division of Pediatric Surgery, Phoenix Children's Hospital
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital
- Department of Child Health, University of Arizona - College of Medicine, Phoenix, Arizona, USA
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Poteat TC, Rich AJ, Jiang H, Wirtz AL, Radix A, Reisner SL, Harris AB, Cannon CM, Lesko CR, Malik M, Williams J, Mayer KH, Streed CG. Cardiovascular Disease Risk Estimation for Transgender and Gender-Diverse Patients: Cross-Sectional Analysis of Baseline Data From the LITE Plus Cohort Study. AJPM FOCUS 2023; 2:100096. [PMID: 37790660 PMCID: PMC10546528 DOI: 10.1016/j.focus.2023.100096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Approximately 2% of the U.S. population identifies as transgender, and transgender people experience disproportionate rates of cardiovascular disease mortality. However, widely used cardiovascular disease risk estimators have not been validated in this population. This study sought to determine the impact on statin therapy recommendations using 3 different approaches to operationalizing sex in the American Health Association/American College of Cardiology Pooled Cohort Equation Risk Estimator. Methods This is a cross-sectional analysis of baseline clinical data from LITE Plus, a prospective cohort study of Black and/or Latina transgender women with HIV. Data were collected from October 2020 to June 2022 and used to calculate Pooled Cohort Equation scores. Results The 102 participants had a mean age of 43 years. A total of 88% were Black, and 18% were Latina. A total of 79% were taking gender-affirming hormones. The average Pooled Cohort Equation risk score was 6% when sex assigned at birth was used and statins would be recommended for the 31% with Pooled Cohort Equation >7.5%. The average risk score was 4%, and 18% met the criteria for statin initiation when current gender was used; the mean risk score was 5%, and 22% met the criteria for statin initiation when current hormone therapy was used. Conclusions Average Pooled Cohort Equation risk scores vary substantially depending on the approach to operationalizing the sex variable, suggesting that widely used cardiovascular risk estimators may be unreliable predictors of cardiovascular disease risk in transgender populations. Collection of sex, gender, and hormone use in longitudinal studies of cardiovascular health is needed to address this important limitation of current risk estimators.
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Affiliation(s)
- Tonia C. Poteat
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ashleigh J. Rich
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Huijun Jiang
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York
| | - Sari L. Reisner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | | | | | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mannat Malik
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Williams
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kenneth H. Mayer
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Infectious Diseases Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Carl G. Streed
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
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Lee PA, Mazur T, Houk CP. DSD/intersex: historical context and current perspectives. J Pediatr Endocrinol Metab 2023; 36:234-241. [PMID: 36630604 DOI: 10.1515/jpem-2022-0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023]
Abstract
Intersex/Disorders/Differences of sex development conditions have been recognized for millennia. An organized approach was adopted in the 1960-70s using the philosophy that gender identity was fluid and malleable. Consequences of this approach were the lack of disclosure, stigmatization, and excessive surgery to "normalize" the genitalia. Often this led to quality of life issues for those patients. There have been many modifications in approach since then to avoid the problems noted. There is consensus on many of these changes (e.g. disclosure) but continued controversy on others (e.g. the benefits of early surgery). This review summarizes the historical context and the current areas of consensus and controversy.
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Affiliation(s)
- Peter A Lee
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Tom Mazur
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York, John R. Oistei Children's Hospital, Buffalo, NY, USA
| | - Christopher P Houk
- Medical College of Georgia, Augusta University Medical Center, Augusta, GA, USA
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