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Cirrincione LR, Huang KJ, Sequeira GM. Clinical pharmacology in adolescent transgender medicine. Br J Clin Pharmacol 2024; 90:2387-2397. [PMID: 39187392 DOI: 10.1111/bcp.16213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/28/2024] Open
Abstract
Adolescent transgender medicine is a growing clinical field. Gender-affirming medications for transgender youth may include gonadotropin-releasing hormone (GnRH) agonists, gender-affirming hormones or both. To evaluate the potential effects of GnRH agonists (puberty suppression) on pharmacokinetic processes for transgender youth, we searched PubMed from inception to May 2024 for publications on the effects of GnRH agonists on drug absorption, distribution, metabolism or excretion for transgender adolescents or effects on hormones (including gonadotropins, adrenal androgens, sex steroids) that are associated with changes in drug metabolism during puberty in the general adolescent population. No publications discussed the effects of GnRH agonist treatment on pharmacokinetic processes for adolescent transgender people. Sixteen publications observed marked decreases in gonadotropins and sex steroids for both adolescent transgender men and adolescent transgender women and slight effects on adrenal androgens. During GnRH agonist treatment, changes in body composition and body shape were greater for adolescent transgender people than for cisgender adolescent people. Further research is needed to better understand the effects of GnRH agonists on drug metabolism and other pharmacokinetic processes for transgender adolescents receiving GnRH agonists and other gender-affirming medications.
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Affiliation(s)
| | - Kai J Huang
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gina M Sequeira
- Seattle Children's Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Kahn NF, Asante PG, Coker TR, Kidd KM, Christakis DA, Richardson LP, Sequeira GM. Demographic Differences in Gender Dysphoria Diagnosis and Access to Gender-Affirming Care Among Adolescents. LGBT Health 2024; 11:348-358. [PMID: 38190267 DOI: 10.1089/lgbt.2023.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Purpose: The goal of this article was to identify demographic differences in receipt of gender dysphoria (GD) diagnosis and access to gender-affirming care (GAC) among adolescents whose gender identity and/or pronouns differed from their sex assigned at birth. Methods: Data were from 2444 patients who were 13-17 years old and had a documented gender identity and/or pronouns that differed from their sex assigned at birth in the electronic health record. Adjusted logistic regression models explored associations between demographic characteristics (sex assigned at birth, gender identity, race and ethnicity, language, insurance type, rural status) and presence of GD diagnosis and having accessed GAC. Results: The average predicted probability (Pr) of having received a GD diagnosis was 0.62 (95% confidence interval [CI] = 0.60-0.63) and of having accessed GAC was 0.48 (95% CI = 0.46-0.50). Various significant demographic differences emerged. Notably, Black/African American youth were the least likely to have received a GD diagnosis (Pr = 0.43, 95% CI = 0.33-0.54) and accessed GAC (Pr = 0.32, 95% CI = 0.22-0.43). Although there were no significant differences in GD diagnosis by insurance type, youth using Medicaid, other government insurance, or self-pay/charity care were less likely to have accessed GAC compared with youth using commercial/private insurance. Conclusion: Results indicate significant differences in both receipt of GD diagnosis and accessing GAC by various demographic characteristics, particularly among Black/African American youth. Identification of these differences provides an opportunity to further understand potential barriers and promote more equitable access to GAC among adolescents who desire this care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Peter G Asante
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Dimitri A Christakis
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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Dhar CP, Dixon SV, Michelson C. Protecting Graduate Medical Education and Gender-Diverse Youth. J Grad Med Educ 2024; 16:264-266. [PMID: 38882415 PMCID: PMC11173016 DOI: 10.4300/jgme-d-23-00910.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Affiliation(s)
- Cherie Priya Dhar
- is Program Director, Adolescent Medicine Fellowship, Ann and Robert H. Lurie Children's Hospital of Chicago, and Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shamieka Virella Dixon
- is Division Chief, Adolescent Medicine, Vice Chair, Diversity, Equity & Inclusion, Medical Director, Center for Gender Health, and Clinical Assistant Professor of Pediatrics, Atrium Health's Levine Children's Hospital, Wake Forest School of Medicine, Charlotte, North Carolina, USA; and
| | - Catherine Michelson
- is Program Director, Pediatric Residency, Ann and Robert H. Lurie Children's Hospital of Chicago, and Associate Professor of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Trinh MH, Quint M, Coon D, Bhasin S, Tocci B, Reisner SL. Transgender Patients Report Lower Satisfaction with Care Received than Cisgender Patients Receiving Care in an Academic Medical Care System. LGBT Health 2024; 11:202-209. [PMID: 38100315 DOI: 10.1089/lgbt.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Purpose: Transgender and gender diverse (TGD) patients experience challenges in health care settings, including stigma, lack of culturally competent providers, and suboptimal gender-affirming care. However, differences in patient satisfaction between TGD patients compared with cisgender patients have been inadequately studied. This study aimed to assess such differences in patient satisfaction with care received in a large academic medical care system in Boston, Massachusetts. Methods: Routine patient satisfaction surveys were fielded from January to December 2021 and were summarized. Logistic regression models compared low net promoter scores (NPS; ≤6) between gender identity groups (cisgender women, transmasculine and nonbinary/genderqueer people assigned female at birth [AFAB], transfeminine and nonbinary/genderqueer people assigned male at birth) relative to cisgender men, adjusting for age, race, ethnicity, education, inpatient/outpatient service delivery, and distance from medical center. Results: Of 94,810 patients, 246 (0.3%) were TGD and 94,549 (99.7%) were cisgender. The mean age was 58.3 years (standard deviation = 16.6). Of the total sample, 17.0% of patients were people of color, 6.6% were Hispanic/Latinx, 48.6% were college graduates, and 2.6% had received inpatient care. In general, patient satisfaction with health care received was lower for TGD patients than for cisgender patients (7.3% vs. 4.5% reporting low NPS; adjusted odds ratio [aOR] = 1.14; 95% confidence interval [CI] = 0.70-1.85). Transmasculine and nonbinary/genderqueer patients AFAB had elevated odds of low NPS compared with cisgender men (8.8% vs. 3.6%; aOR = 1.71; 95% CI = 1.02-2.89). Conclusion: Future research is warranted to better understand factors driving lower ratings among TGD patients. Health care quality improvement efforts are needed to address gender identity inequities in care.
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Affiliation(s)
- Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Devin Coon
- Center for Transgender Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shalender Bhasin
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Transgender Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin Tocci
- Office of Patient Experience, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Transgender Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, and Brigham and Women's Hospital, Boston, Massachusetts, USA
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Kim R, Choo S, Lee H, Eom YJ, Yi H, Kim R, Kim SS. Does discrimination prevent transgender and gender diverse people from seeking healthcare?: A nationwide cohort study in South Korea. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:283-294. [PMID: 38681498 PMCID: PMC11044721 DOI: 10.1080/26895269.2023.2215750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Introduction Using Asia's first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea. Methods We analyzed a two-wave (2020-2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transition-related healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD. Results Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21-2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD. Conclusion In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination.
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Affiliation(s)
- Ranyeong Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sungsub Choo
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyemin Lee
- Healthcare Policy Team, Jeju Institute of Public Health & Health Policy, Jeju, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, Republic of Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Curtis A, Swaringen S, Janssen A. Complex Psychiatric Histories and Transgender and Gender Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:731-745. [PMID: 37739631 DOI: 10.1016/j.chc.2023.05.011] [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] [Indexed: 09/24/2023]
Abstract
Transgender and gender diverse (TGD) individuals face higher rates of stressors driving disproportionate health risks. Although psychiatric conditions are important to consider in the context of greater health-promoting efforts for TGD youth, any mental health concerns may or may not be related to gender identity or associated dysphoria. Nevertheless, it is essential to consider the impact of complex mental health factors on decisional capacity and gender care discussions. Psychiatric care of TGD youth includes stratifying risk factors through a minority stress lens, balancing acute needs with patient and caregiver priorities, and bolstering resilience using affirming care principles.
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Affiliation(s)
- Amy Curtis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - Shanna Swaringen
- Division of Psychiatry and Behavioral Health, The Ohio State University College of Medicine. Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Aron Janssen
- The Pritzker Department of Psychiatry and Behavioral Health, Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario, Chicago, IL 60611, USA. https://twitter.com/LGBTDoc
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Sequeria GM, Guler J, Reyes V, Asante PG, Kahn N, Anan Y, Bocek K, Kidd K, Christakis D, Pratt W, Richardson LP. Adolescent and Caregiver Perspectives on Receiving Gender-Affirming Care in Primary Care. Pediatrics 2023; 152:e2023062210. [PMID: 37697934 PMCID: PMC10698727 DOI: 10.1542/peds.2023-062210] [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] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Transgender and gender-diverse (TGD) adolescents experience barriers to receiving gender-affirming care. Delivering services in the pediatric primary care setting may help facilitate improved access. With this study, we aimed to explore TGD adolescents' and caregivers' experiences receiving primary care services and their perspectives regarding gender-affirming care delivery in pediatric primary care. METHODS TGD adolescents aged 14 to 17 and caregivers of TGD adolescents currently receiving gender-affirming medical care participated in 1-hour-long, semi-structured, individual, virtual interviews. Each interview was recorded and transcribed. Transcripts were then individually coded, and themes were generated iteratively by using a reflexive thematic analysis framework. Recruitment of each group continued until thematic saturation was reached. RESULTS A total of 33 participants (15 adolescents and 18 caregivers) completed interviews. Adolescent participants (mean age of 15.7 years) predominantly identified as transmasculine or trans male (73%), and caregiver participants were predominantly mothers (83.3%). Four themes were identified, which included (1) barriers, such as microaggressions and poor psychosocial support, (2) benefits, such as existing trusted relationships with primary care providers (PCPs) and convenience, (3) improvement strategies, such as training and interdisciplinary collaboration, and (4) opportunities for integrating primary care and specialty gender-affirming care. CONCLUSIONS TGD adolescents and their caregivers reported previous negative interactions with PCPs; however, some desired to receive gender-affirming care in this setting, citing increased convenience, efficiency, and availability. Participants highlighted an ongoing need for further work to provide resources, education, and training to PCPs and their staff and improve PCP-to-specialist communication and collaboration.
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Affiliation(s)
- Gina M Sequeria
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Jessy Guler
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | | | - Peter G Asante
- University of Washington School of Medicine, Seattle, Washington
| | - Nicole Kahn
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Yomna Anan
- Seattle Children's Hospital, Seattle, Washington
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington
| | - Kacie Kidd
- West Virginia University, Morgantown, West Virginia
| | - Dimitri Christakis
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Wanda Pratt
- University of Washington School of Medicine, Seattle, Washington
| | - Laura P Richardson
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Ford CA. The Journal of Adolescent Health's Editor-In-Chief Annual Reflection: A Year to Embrace Science and Compassion. J Adolesc Health 2023; 73:213-216. [PMID: 37455041 DOI: 10.1016/j.jadohealth.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/18/2023]
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Pflugeisen CM, Boomgaarden A, Denaro AA, Konicek D, Robinson E. Patient Empowerment Among Transgender and Gender Diverse Youth. LGBT Health 2023; 10:429-438. [PMID: 37126404 PMCID: PMC10468556 DOI: 10.1089/lgbt.2022.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.
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Affiliation(s)
| | - Anna Boomgaarden
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Aytch A. Denaro
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Danielle Konicek
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
- School of Social Work & Criminal Justice, University of Washington, Tacoma, Washington, USA
| | - Emily Robinson
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
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Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Breaking Down Barriers to Facilitate Access to Healthcare Among Transgender People. J Adolesc Health 2022; 71:768-769. [PMID: 36403991 DOI: 10.1016/j.jadohealth.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health, and Environmental Sciences University of L'Aquila, L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis ASL Teramo Teramo, Italy; Technical Group for the Coordination of Gender Medicine Regione Abruzzo, Italy
| | - Lina Maria Magnanimi
- Department of Life, Health, and Environmental Sciences University of L'Aquila L'Aquila, Italy
| | - Lia Ginaldi
- Department of Life, Health, and Environmental Sciences University of L'Aquila L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis ASL Teramo Teramo, Italy; Technical Group for the Coordination of Gender Medicine Regione Abruzzo, Italy
| | - Massimo De Martinis
- Department of Life, Health, and Environmental Sciences University of L'Aquila L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis ASL Teramo Teramo, Italy; Technical Group for the Coordination of Gender Medicine Regione Abruzzo, Italy
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