Gender-related psychological and behavioural correlates of pubertal timing in a national sample of Swiss adolescents

Gonadotropin-releasing hormone analogs treatment in girls with central precocious puberty and early fast puberty

BACKGROUND

Gonadotropin-releasing hormone analog (GnRHa) is the standard treatment for children with central precocious puberty (CPP). We assessed efficacy and safety of GnRHa treatment in girls with CPP and early fast puberty (EFP).

METHODS

This retrospective observational study included anthropometric, clinical and laboratory data retrieved from medical files of girls with CPP or EFP, treated with GnRHa and followed at a tertiary endocrine clinic during 2007-2021.

RESULTS

For both CPP (n = 144) and EFP (n = 231) groups, mean height-SDS at GnRHa initiation and termination and at the last follow-up visit was greater than mid-parental height-SDS (P < 0.001). Only among girls with EFP, mean BMI-SDS was higher at treatment termination than initiation (P = 0.025). Median ages at menarche of the CPP and EFP groups were 11.8 and 12.0 years. Menstrual irregularities were reported in 20.3% of girls with CPP and in 18.7% of those with EFP. Adverse effects to treatment were reported in 3.5% and 3.9% of girls with CPP and EFP, respectively.

CONCLUSIONS

In this large cohort, GnRHa treatment in girls with EFP was effective without significant adverse effects as in those with CPP. A randomized controlled trial is required to examine the psychological impact of GnRHa treatment of variant early puberty.

IMPACT STATEMENT

Gonadotropin-releasing hormone analog (GnRHa) is the standard treatment for central precocious puberty (CPP). We assessed efficacy and safety of GnRHa treatment in girls with early fast puberty (EFP), characterized by pubertal signs between ages 8-9 years with fast pubertal signs advancement and accelerated growth and bone maturation and in girls with CPP. We found in this large cohort that GnRHa treatment in girls with EFP was effective and safe as in those with CPP. A prospective randomized controlled trial is required to examine the psychological impact of GnRHa treatment of variant early puberty.

Pubertal progression and its relationship to psychological and behavioral outcomes among adolescent boys

Variations in pubertal timing and tempo have relevance to psychosocial development. Accounting for pubertal timing, tempo, and psychosocial development simultaneously in a model remains challenging. This study aimed to document the typology of pubertal development in a cohort of Taiwanese adolescent boys and then to examine how the associations between psychosocial variables across time vary by the patterns of pubertal development. A group of adolescent boys (n = 1,368) reported pubertal signs and psychosocial variables for 3 years since seventh grade. The growth mixture model revealed three major classes of pubertal transition: average pubertal growth, late-onset with rapid catch-up, and late-onset with slow catch-up. In a cross-lagged panel model, the multigroup analysis found the regression coefficients mostly invariant across all three classes, except those between deviant behavior and subsequent changes in depressive symptoms that were significantly positive only in the late-onset with slow catch-up group. Adolescent boys in this group were estimated to have the highest marginal level of depressive symptoms and deviant behavior in ninth grade among the three classes. Our study highlights the heterogeneity in boys' pubertal development and the role of the pubertal development pattern in their psychosocial development.

An Approach to the Patient With Delayed Puberty

Pediatric endocrinologists often evaluate and treat youth with delayed puberty. Stereotypically, these patients are 14-year-old young men who present due to lack of pubertal development. Concerns about stature are often present, arising from gradual shifts to lower height percentiles on the population-based, cross-sectional curves. Fathers and/or mothers may have also experienced later than average pubertal onset. In this review, we will discuss a practical clinical approach to the evaluation and management of youth with delayed puberty, including the differential diagnosis and key aspects of evaluation and management informed by recent review of the existing literature. We will also discuss scenarios that pose additional clinical challenges, including: (1) the young woman whose case poses questions regarding how presentation and approach differs for females vs males; (2) the 14-year-old female or 16-year-old young man who highlight the need to reconsider the most likely diagnoses, including whether idiopathic delayed puberty can still be considered constitutional delay of growth and puberty at such late ages; and finally (3) the 12- to 13-year-old whose presentation raises questions about whether age cutoffs for the diagnosis and treatment of delayed puberty should be adjusted downward to coincide with the earlier onset of puberty in the general population.

Adolescents' Use of Sexually Explicit Internet Material Over the Course of 2019-2020 in the Context of the COVID-19 Pandemic: A Three-wave Panel Study

Recently, sexual health scholars have expressed concerns regarding adolescents' use of sexually explicit internet materials (SEIM) during the COVID-19 pandemic. Therefore, using latent growth curve modeling, the current study explored adolescents' changes in the frequency of SEIM use before, during, and after a strict lockdown period was established in Belgium. Attention was given to individual differences (i.e., gender, gender identity, sexual orientation, pubertal timing, and sensation seeking). A three-wave panel study over a 15-month period among 522 adolescents was used (M_age = 15.36, SD = 1.51, 67.1% girls). In general, SEIM use did not significantly increase over a 15-month period in the context of the COVID-19 pandemic. Only gender predicted a change in SEIM use frequencies with girls showing a greater, increasing change of SEIM use than boys. When addressing why adolescents used SEIM during a strict lockdown period, sexual arousal, stress, and boredom regulation motivations emerged as the most prevalent motivations. Loneliness regulation was the least prominent motivation. Individual differences were found regarding the gratifications sought according to adolescents' gender, pubertal timing, and sensation seeking. The findings offer a response to sexual scholars' worries in terms of adolescents' SEIM use during the COVID-19 pandemic.

Exposures during the prepuberty period and future offspring's health: evidence from human cohort studies†

Emerging evidence suggests that exposures in prepuberty, particularly in fathers-to-be, may impact the phenotype of future offspring. Analyses of the RHINESSA cohort find that offspring of father’s exposed to tobacco smoking or overweight that started in prepuberty demonstrate poorer respiratory health in terms of more asthma and lower lung function. A role of prepuberty onset smoking for offspring fat mass is suggested in the RHINESSA and ALSPAC cohorts, and historic studies suggest that ancestral nutrition during prepuberty plays a role for grand-offspring’s health and morbidity. Support for causal relationships between ancestral exposures and (grand-)offspring’s health in humans has been enhanced by advancements in statistical analyses that optimize the gain while accounting for the many complexities and deficiencies in human multigeneration data. The biological mechanisms underlying such observations have been explored in experimental models. A role of sperm small RNA in the transmission of paternal exposures to offspring phenotypes has been established, and chemical exposures and overweight have been shown to influence epigenetic programming in germ cells. For example, exposure of adolescent male mice to smoking led to differences in offspring weight and alterations in small RNAs in the spermatozoa of the exposed fathers. It is plausible that male prepuberty may be a time window of particular susceptibility, given the extensive epigenetic reprogramming taking place in the spermatocyte precursors at this age. In conclusion, epidemiological studies in humans, mechanistic research, and biological plausibility, all support the notion that exposures in the prepuberty of males may influence the phenotype of future offspring.

Are We Losing the Most Relevant Cases First? Selective Dropout in Two Longitudinal Studies of Adolescent Pornography Use

In longitudinal studies of pornography use, selective loss of participants who may be more vulnerable to the effects of pornography than their peers is a serious concern. To explore the potential for such selective dropout, we used data from two independent large-scale panel studies of adolescents' pornography use. Of the three types of attrition-early attrition, later attrition, and gaps in participation-only the first was substantially higher among more vulnerable adolescents, compared with other participants. Panel type (online vs. classroom-based) moderated only the association between vulnerability and participation gaps, which was significant in the classroom-based but not the online panel. Overall, this study's findings point to the importance of delaying selective dropout by developing a comprehensive plan of action, for which we offer some guidelines.

Childhood adversity, pubertal timing and self-harm: a longitudinal cohort study

BACKGROUND

The occurrence of early childhood adversity is strongly linked to later self-harm, but there is poor understanding of how this distal risk factor might influence later behaviours. One possible mechanism is through an earlier onset of puberty in children exposed to adversity, since early puberty is associated with an increased risk of adolescent self-harm. We investigated whether early pubertal timing mediates the association between childhood adversity and later self-harm.

METHODS

Participants were 6698 young people from a UK population-based birth cohort (ALSPAC). We measured exposure to nine types of adversity from 0 to 9 years old, and self-harm when participants were aged 16 and 21 years. Pubertal timing measures were age at peak height velocity (aPHV - males and females) and age at menarche (AAM). We used generalised structural equation modelling for analyses.

RESULTS

For every additional type of adversity; participants had an average 12-14% increased risk of self-harm by 16. Relative risk (RR) estimates were stronger for direct effects when outcomes were self-harm with suicidal intent. There was no evidence that earlier pubertal timing mediated the association between adversity and self-harm [indirect effect RR 1.00, 95% confidence interval (CI) 1.00-1.00 for aPHV and RR 1.00, 95% CI 1.00-1.01 for AAM].

CONCLUSIONS

A cumulative measure of exposure to multiple types of adversity does not confer an increased risk of self-harm via early pubertal timing, however both childhood adversity and early puberty are risk factors for later self-harm. Research identifying mechanisms underlying the link between childhood adversity and later self-harm is needed to inform interventions.

Exploring the Interaction Effects of Gender Contentedness and Pubertal Timing on Adolescent Longitudinal Psychological and Behavioral Health Outcomes

Background: Off-time pubertal timing (PT) and non-conforming gender identity have been reported to predict adverse health and well-being in adolescents. However, the joint effects of these two factors are less addressed. We aimed to investigate the main and interaction effects of gender identity, proxied by perceived gender contentedness (GC), and PT on longitudinal adolescent psychological and behavioral outcomes. Methods: Data (N = 1806, Mage = 13.3 ± 0.5 years) come from the Taiwan Youth Project, which prospectively followed a longitudinal cohort of Taiwanese junior high school students from 2000 (wave 1) to 2009 (wave 9). GC was self-reported at waves 1 and 9 in a binary response, and thus 4 GC trajectories were created. PT was defined using the Pubertal Developmental Scale, which mainly measured physical changes in puberty. Multiple linear regression analyses with gender stratification were applied to examine the effects of the GC trajectory and its interaction with PT on the outcomes. Results: A total of 1,562 subjects (86.5%) remained consistently satisfied with their gender, while the GC of 226 subjects (12.6%) changed at some point. Regression analyses found that males with gender dissatisfaction at wave 9 were likely to engage in delinquent behavior, and females in this group were more likely to have lower self-esteem, as compared to those with consistent GC. The interaction effect between the GC trajectory and PT appeared to be associated with smoking and drinking only at wave 1. Conclusions: These findings indicate that healthcare professionals should concentrate on gender non-conforming individuals at early adolescence, navigating them toward a healthy adulthood.

The Association of Childhood Sexual Abuse With Non-Paraphilic and Paraphilic Sexual Behaviors Among Adolescents Who Have Sexually Offended

A history of childhood sexual victimization (CSV) is one of the most commonly examined factors in research on male adolescent sexual offending. Although CSV has been extensively researched in relation to the onset and maintenance of adolescent sexual offending, few studies have investigated the association of CSV with domains of adolescent sexuality outside of sexual offending. Understanding how CSV may be associated with the non-paraphilic, and paraphilic, sexual behaviors of adolescent males who commit sexual offenses has important implications for promoting healthy sexuality among this population. In a sample of 162 male adolescents (M age = 15.2 years, SD = 1.3) adjudicated for a sexual offense, we tested the association of CSV with a range of non-paraphilic (e.g., age of first consensual sex) and paraphilic (e.g., use of paraphilic pornography) sexual behavior variables. The results indicated CSV was associated with greater engagement in risky non-paraphilic sexual behaviors, as well as paraphilic sexual behaviors. CSV was also associated with specific offense characteristics, replicating previous research findings. The current study is a first step toward understanding the broader sexual context of adolescents who commit sexual offenses.

Pubertal timing and self-harm: a prospective cohort analysis of males and females

AIMS

Early puberty is associated with an increased risk of self-harm in adolescent females but results for males are inconsistent. This may be due to the use of subjective measures of pubertal timing, which may be biased. There is also limited evidence for the persistence of pubertal timing effects beyond adolescence, particularly in males. The primary aim of the current study was therefore to examine the association between pubertal timing and self-harm in both sexes during adolescence and young adulthood, using an objective measure of pubertal timing (age at peak height velocity; aPHV). A secondary aim was to examine whether this association differs for self-harm with v. without suicidal intent.

METHODS

The sample (n = 5369, 47% male) was drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort study. Mixed-effects growth curve models were used to calculate aPHV. Lifetime history of self-harm was self-reported at age 16 and 21 years, and associated suicidal intent was examined at age 16 years. Associations were estimated using multivariable logistic regression adjusted for a range of confounders. Missing data were imputed using Multiple Imputation by Chained Equations.

RESULTS

Later aPHV was associated with a reduced risk of self-harm at 16 years in both sexes (females: adjusted per-year increase in aPHV OR 0.85; 95% CI 0.75-0.96; males: OR 0.72; 95% CI 0.59-0.88). Associations were similar for self-harm with and without suicidal intent. There was some evidence of an association by age 21 years in females (adjusted per-year increase in aPHV OR 0.91; 95% CI 0.80-1.04), although the findings did not reach conventional levels of significance. There was no evidence of an association by age 21 years in males (adjusted per-year increase in aPHV OR 0.99; 95% CI 0.74-1.31).

CONCLUSIONS

Earlier developing adolescents represent a group at increased risk of self-harm. This increased risk attenuates as adolescents transition into adulthood, particularly in males. Future research is needed to identify the modifiable mechanisms underlying the association between pubertal timing and self-harm risk in order to develop interventions to reduce self-harm in adolescence.

Adult height after gonadotropin-releasing hormone agonist treatment in girls with early puberty: A meta-analysis

OBJECTIVE

This analysis of previously published reports was performed to examine the effects of gonadotropin-releasing hormone (GnRH) agonist treatment on adult height and the factors associated with adult height outcomes.

CONTEXT

GnRH agonists are first-line agents in the treatment of precocious puberty. However, studies regarding the treatment effect on subjects with early puberty have reported inconsistent results.

DESIGN

A total of 14 studies identified from a search of electronic databases (AMED, EMBASE, MEDLINE and RISS) were included. Controlled studies with girls who developed puberty before 10 years of age and measurements of the adult heights of the subjects were selected. Studies using only long-acting GnRH agonists to suppress puberty were included. Adult height, duration of the treatment, age at the start of treatment and bone age advancement were analysed.

RESULTS

The mean age of the subjects ranged from 6.3 to 9.0 years. The meta-analysis showed a pooled mean difference in adult height of 3.2 cm and a 95% confidence interval of 1.3-5.1 cm. The height difference between the treated subjects and controls was significantly associated with the duration of treatment (P = .005) rather than the age at the start of treatment (P = .084) or the difference between bone age and chronological age (P = .427).

CONCLUSIONS

Administration of GnRH agonists in girls who develop early puberty and demonstrate advanced bone age may be effective for increasing adult height, especially if a sufficiently long treatment duration can be achieved.

Psychosexual effects resulting from delayed, incomplete, or absent puberty

Puberty is a remarkable period of postnatal development culminating in reproductive capacity. Biological changes of puberty are accompanied by social and emotional changes including psychosexual development. Developmental changes of adolescence are influenced by numerous biological, psychological and social influences. Work to date has identified associations between disrupted puberty (i.e. delayed, incomplete or absent) and psychosexual development. This brief review summarizes our current understanding of the psychosexual effects of delayed puberty and congenital hypogonadotropic hypogonadism (Kallmann syndrome). The importance of psychosocial support and transitional care is highlighted and future directions are discussed.

Usefulness and utilization of treatment elements from the Transdiagnostic Sleep and Circadian Intervention for adolescents with an evening circadian preference

OBJECTIVE

Existing research has demonstrated that patient ratings of usefulness and ratings of utilization of treatment elements are associated with treatment outcome. Few studies have examined this relationship among adolescents and with an extended follow-up. This study examined the extent to which elements of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) were rated by youth as useful and utilized 6-months and 12-months after treatment.

METHOD

Participants were 64 adolescents with an evening circadian preference who were given TranS-C as a part of their participation in a NICHD-funded study. At 6-month and 12-month follow-up, they completed the Usefulness Scale, the Utilization Scale, a 7-day sleep diary assessing total sleep time (TST) and bedtime, and the Children's Morningness-Eveningness Preference Scale (CMEP).

RESULTS

On average, adolescents rated treatment elements as moderately useful and they utilized the treatment elements occasionally. Ratings of usefulness were associated with TST at 6-month follow-up, but not with bedtime or CMEP. Ratings of utilization were associated with a change in bedtime from 6-month to 12-month follow-up, but not with TST or CMEP. Ratings of usefulness and utilization were associated with selected treatment outcome measures at both follow-ups.

CONCLUSIONS

These findings have implications for understanding mechanisms of change following treatment.

Exploring the mediating and moderating roles of body-related concerns and social interactions on the association between early puberty and psychological distress in young adult women

OBJECTIVE

To explore the mechanisms through which early puberty is associated with psychological distress in women aged 18-25. This cross-sectional study aims to investigate whether body-related concerns and social interactions moderate or mediate this association.

METHODS

Participants were compared on measures evaluating psychological distress, body image dysphoria, bulimic symptomatology and negative intimacy with best friend according to three pubertal timing groups: (1) "very early" puberty (menarche at 9 years old or less), (2) "early" puberty (menarche at 10 years old), and (3) "on-time" puberty (menarche between 11 and 13 years old). Forward stepwise multiple regressions and multiple mediation analysis were successively performed to see whether body-related concerns and peer interactions mediate or moderate the relationship between premature puberty and psychological distress.

RESULTS

Controlling for age and ethnicity, results indicated (1) that women who began puberty "very early" had significantly higher levels of psychological distress than their "on-time" counterparts; (2) the association found between very early puberty and psychological distress was mediated by body image dysphoria and negative intimacy with best friend and was moderated by bulimic symptomatology. No mediational effect was found in women whose puberty was "early".

CONCLUSION

These findings highlight the importance of using more than one group of early pubertal timing and the role of body and intimacy concerns in the explanation of psychological distress in women. Intervention strategies addressing the increased risk of psychological distress in women who begin puberty very early should target their body image and ability to form intimate friendships.

Associations between adolescents' use of sexually explicit material and risky sexual behavior: A longitudinal assessment

The unprecedented accessibility and affordability of online sexually explicit material (SEM) has facilitated widespread use among adolescents and growing concerns over adverse reproductive health outcomes. Although SEM-induced risky sexual behavior is among key concerns, there is a paucity of longitudinal research addressing this issue. This study aimed to assess the longitudinal association between frequency of SEM use and risky sexual behavior among adolescents in two independent 5-wave panel samples of Croatian adolescents (n = 368; n = 247). The indicators of risky sexual behavior were: (1) not using a condom at most recent sexual intercourse, and (2) reporting two or more sexual partners. Multilevel logistic regression analysis with a lagged component was used to explore the associations of interest. Controlling for sociodemographic characteristics, pubertal timing and sensation seeking, frequency of SEM use was not associated with the two indicators of sexual risk taking. This study’s findings are relevant for health and educational experts, but also for concerned parents.

Blood lead levels and timing of male sexual maturity: A longitudinal study of Russian boys

BACKGROUND

Higher blood lead levels (BLLs) have been linked to neurologic deficits and impaired growth, but few studies have evaluated their association with timing of sexual maturity or pubertal progression in boys.

METHODS

In a longitudinal cohort of Russian boys enrolled at age 8-9 and followed to adulthood, BLLs were measured at study entry, and pubertal staging (genitalia and pubic hair) and testicular volume (TV) measurements were obtained annually. We used interval-censored regression models to estimate differences between boys with higher BLL (≥5 μg/dL) and lower BLL in mean ages at sexual maturity (genitalia stage 5, pubic hair stage 5, or TV ≥ 20 mL) and duration of pubertal progression (onset to maturity), adjusting for potential confounders. Mediation analyses were conducted to quantify the percent of lead's effect attributable to its association with reduced somatic growth.

RESULTS

Among 481 evaluable boys, 28% had BLL ≥ 5 μg/dL. Adjusted mean ages at sexual maturity were 14.7 years for genitalia, 16.1 for pubic hair, and 13.9 for TV. In adjusted models, boys with BLLs ≥5 μg/dL had later maturity than those with lower levels by 4-5 months depending on pubertal indicator. In mediation analyses, height and body mass index at age 11 accounted for 40-71% of the shift in age at maturity for boys with higher compared to lower BLLs. Higher BLLs were not associated with pace of pubertal progression.

CONCLUSIONS

Higher lead levels were associated with later attainment of sexual maturity in males, but not with the duration of pubertal progression. A high proportion of the delay in sexual maturity for boys with higher as compared to lower BLL was shown to be attributable to mediating effects of BLL on reduced growth.

Psychological Aspects of Congenital Hypogonadotropic Hypogonadism

Congenital hypogonadotropic hypogonadism/Kallmann syndrome (CHH/KS) is a rare, treatable form of infertility. Like other rare disease patients, individuals with CHH/KS frequently experience feelings of isolation, shame, and alienation. Unlike many rare diseases, CHH/KS is not life threatening and effective treatments are available. Nevertheless, it remains a profoundly life-altering condition with psychosocial distress on a par with untreatable or life-limiting disease. Patients with CHH/KS frequently express lasting adverse psychological, emotional, social, and psychosexual effects resulting from disrupted puberty. They also frequently experience a "diagnostic odyssey," characterized by distressing and convoluted medical referral pathways, lack-of-information, misinformation, and sometimes-incorrect diagnoses. Unnecessary delays in diagnosis and treatment-initiation can significantly contribute to poor body image and self-esteem. Such experiences can erode confidence and trust in medical professionals as well as undermine long-term adherence to treatment-with negative sequelae on health and wellbeing. This review provides a summary of the psychological aspects of CHH/KS and outlines an approach to comprehensive care that spans medical management as well as appropriate attention, care and referrals to peer-to-peer support and mental health services to ameliorate the psychological aspects of CHH/KS.

Gonadotropin-releasing hormone (GnRH) deficiency under treatment: psychological and sexual functioning impacts

OBJECTIVE

GnRH (gonadotropin releasing hormone) is a crucial hormone for sexual development, puberty, and fertility, and its deficiency leads to hypogonadotropic hypogonadism (HH), which causes abnormal secondary sexual development and infertility. The combination of the lack of sense of smell, i.e., anosmia, and HH is a type of GnRH deficiency known as Kallmann syndrome, which affects both men and women. The impact of Kallmann syndrome can be very severe and causes a variety of psychological problems in patients. The aim of the present study was to investigate psychopathology, sexuality, and personality characteristics in patients with GnRH deficiency under hormonal replacement therapy.

DESIGN

A total of 38 patients with GnRH deficiency aged 30.6 ± 10.44 years and 38 healthy matched for age individuals participated in the study and completed a series of questionnaires concerning sexual functioning, ego defense mechanisms, quality of life, personality characteristics, as well as anxiety and depression.

RESULTS

After adjustment for anxiety and depression, no difference in sexuality parameters were reported between men with and without GnRH deficiency, while women with GnRH deficiency had significantly lower sexual desire compared to controls. Concerning quality of life, satisfaction with general health was significantly lower in patients compared to controls, even after adjusting for sex. Furthermore, patients with GnRH deficiency indicated markedly less anxiety and a trend for less depression compared to controls. Finally, defense styles, ego-strength, and hostility did not differ between GnRH deficiency patients and controls.

CONCLUSIONS

Our study is the first to investigate psychological and sexual functioning impacts in patients with GnRH deficiency under hormonal replacement therapy. However, larger studies are needed so as to add further empirical evidence.

The Use of Sexually Explicit Material and Its Relationship to Adolescent Sexual Activity

PURPOSE

There is growing concern that sexually explicit material (SEM) may influence young people's sexual activity. The present study aimed to assess the longitudinal association between frequency of SEM use and adolescent sexual debut.

METHOD

The present study used two independent panel samples of Croatian adolescents (with four and five data collection waves, respectively). We employed discrete-time event history approach and propensity matching score analysis to explore the target association.

RESULTS

A consistent lack of significant association between SEM use and sexual debut was observed among male adolescents. Among female adolescents, the findings were inconclusive. We also found some evidence for the role of timing of first exposure to SEM.

CONCLUSIONS

Our findings are relevant for educational and adolescent health specialists, as well as concerned parents. Considering that this study focused on middle adolescence, future research should address a potential link between SEM use and early sexual debut.

Longitudinal Effects of Self-Report Pubertal Timing and Menarcheal Age on Adolescent Psychological and Behavioral Outcomes in Female Youths from Northern Taiwan

BACKGROUND

Early puberty is linked to adverse developmental outcomes in adolescents in Western societies. However, little is known about this relationship in an East Asian context. In addition, whether the impact of subjective pubertal timing (PT) and menarcheal age (MA) on adolescent psychosocial development persists into early adulthood remains unclear and is worthy of investigation.

METHODS

A subset of data was retrieved from the Taiwan Youth Project, which recruited and followed a longitudinal cohort of 7^th- and 9^th-grade female Taiwanese students from 2000 to 2007. Subjective PT was defined using the Pubertal Developmental Scale (PDS), which mainly measures pubertal changes. MA was recalled by participants themselves. Various psychological and behavioral factors were recorded and measured until the age of 20, including the use of alcohol and cigarettes, psychological well-being, sexual activity, and socially problematic behaviors. A χ² test for linear-by-linear association and one-way analysis of variance followed by multivariate regression models were used to dissect the differential effects of PT and MA in the association with the outcome variables.

RESULTS

In total, 1545 female participants with an average age of 14.5 (±1.1) years were deemed valid for analysis. Among them, 257 (16.6%) participants perceived themselves as having early PT, defined as more than 1 standard deviation above the mean PDS score, and 82 (5.3%) had early MA (occurring before the 4^th grade). In univariate analysis, participants with early PT had higher rates of smoking and sexual activity, and MA was not related to their psychobehavioral outcomes. After multivariate adjustment, only late PT was significantly correlated with lower amounts of cigarette smoking and sexual activity before the age of 20.

CONCLUSION

Conceptual and actual pubertal developments may be differentially associated with psychobehavioral outcomes among young Taiwanese girls. Clinical attention should be given to adolescent self-perception of sexual maturation and developmental guidance provided accordingly.

Adult height after spontaneous pubertal growth or GnRH analog treatment in girls with early puberty: a meta-analysis

Early puberty (EP) has been defined as the onset of puberty in the low-normal range; it may be a cause for concern regarding a possible impairment of adult height (AH). This paper meta-analysed data on AH after spontaneous growth or after gonadotropin-releasing hormone (GnRH) analog treatment in girls with EP. A computerized literature search was conducted from 1980 to June 30, 2016. Only published studies in English were considered. Eight papers were selected (483 cases). In untreated girls (n = 300), predicted adult height (PAH) at start of follow-up (-0.559 SDS (95%CI -1.110 to 0.001); P = 0.050) was close to mid-parental height (MPH) (-0.557 SDS (95%CI -0.736 to -0.419); P < 0.0001) and AH (-0.663 SDS (95%CI -0.803 to -0.524); P < 0.0001). In GnRH analog treated girls (n = 183), PAH before the start of treatment was slightly reduced (-0.939 SDS (95%CI -1.401 to -0.477; P < 0.0001) vs MPH (-0.678 SDS (95%CI -0.942 to -0.414); P < 0.0000), but AH (-0.604 SDS (95%CI -0.877 to -0.338); P < 0.0000) was close to MPH.

CONCLUSION

Present meta-analysis indicates that girls with EP spontaneously reach their MPH and that GnRH analog treatment does not widely change growth outcome. Differences among the selected studies for definition of EP, inclusion criteria, treatment duration, age at discontinuation of therapy, definition of AH may affect results. What is Known: • Early puberty represents a main cause of consultation in paediatric endocrinology offices due to concerns of both practitioners and parents. • Treatment with GnRH analogs is sometimes attempted with the aim to improve adult height. What is New: • Untreated and GnRH analog treated girls with early puberty reached similar adult height. • Adult height was consistent with mid-parental height in both untreated and GnRH analog treated girls with early puberty.

Age at first birth and cardiovascular risk factors in the 1958 British birth cohort

BACKGROUND

To assess relationships between age at first birth and cardiovascular risk factors in a large longitudinal study of men and women. By assessing associations for both genders, we were able to investigate biological versus social and behavioural explanations from early life through to adulthood.

METHODS

Multiply-imputed data on more than 7600 men and women of a British birth cohort study (National Child Development Study, 1958 British birth cohort) were used. Cardiovascular risk factors at age 44/45 years included body mass index, waist:hip ratio, blood pressure (systolic and diastolic), cholesterol (total, low and high-density lipoprotein), triglycerides, glycated haemoglobin, C reactive protein, von Willebrand factor and fibrinogen. Age at first birth was categorised as <20 years, 20-24 years, 25-29 years, 30-34 years or >34 years.

RESULTS

Being younger than 20 years of age at time of first birth was associated with an adverse cardiovascular profile by mid-life. Conversely, older parents had a lower cardiovascular risk as captured by lower body mass index, waist:hip ratio, blood pressure, high and low-density lipoprotein cholesterol, triglycerides, glycated haemoglobin, C reactive protein and fibrinogen. The relationship between age at first birth and cardiovascular risk factors was graded. Few differences between men and women were observed. Associations were largely unchanged after adjustment for early life factors but were partially mediated through adult social and behavioural factors.

CONCLUSIONS

Age at first birth is inversely associated with differences in cardiovascular risk factors in mid-life in a large prospective birth cohort. Our results potentially suggest a social and behavioural rather than a biological explanation.

The effect of first nocturnal ejaculation timing on risk and sexual behaviors of Korean male adolescents

PURPOSE

This study evaluated the effect of first nocturnal ejaculation timing on risk and sexual behaviors of Korean male adolescents.

METHODS

We analyzed data from the 10th edition of the Korea Youth Risk Behavior Web-based survey that was conducted with male high school adolescents in grades 10-12. The survey included 17,907 adolescents, and 10,326 responded their experience of first nocturnal ejaculation. Of these, 595 had their first nocturnal ejaculation in ≤grade 4 ("early puberty") and 9,731 had their first nocturnal ejaculation in ≥grade 5 ("normal puberty"). We analyzed differences between these 2 groups in risk and sexual behaviors.

RESULTS

Early first nocturnal ejaculation showed a positive association with sexual intercourse (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.56-4.17), sexual debut at elementary school age (OR, 7.45; 95% CI, 5.00-11.10), and having had a sexually transmitted disease (OR, 6.60; 95% CI, 3.94-11.08). After a multiple logistic regression to adjust for socio-demographic variables, early first nocturnal ejaculation was still positively associated with sexual intercourse (OR, 2.73; 95% CI, 2.03-3.69), sexual debut at elementary school age (OR, 5.96; 95% CI, 3.47-10.22), and having had a sexually transmitted disease (OR, 5.17; 95% CI, 2.52-10.20). Early first nocturnal ejaculation was positively associated with alcohol consumption, smoking, and substance use. However, this was not statistically significant after adjusting for several socio-demographic variables.

CONCLUSION

There is a positive association between early nocturnal ejaculation and sexual behaviors in male adolescents. Proactive education about sexual behaviors is required for adolescents who reach sexual maturity early.

Increasing incidence of premature thelarche in the Central Region of Denmark - Challenges in differentiating girls less than 7 years of age with premature thelarche from girls with precocious puberty in real-life practice

Background

Premature thelarche (PT) seems to be increasing and it is difficult to differentiate its early stages from precocious puberty (PP). Clinical and biochemical parameters are warranted to differentiate the two diagnoses.

Methods

One hundred ninety-one girls aged 0.5–7 years were included. Diagnoses were validated and the girls were categorized to the groups PP (n = 27) and PT (n = 164). Anthropometry, Tanner stages, ethnicity, bone age, and biochemistry, were recorded. Conventional variables for diagnosing PP were compared between the groups at time of referral to identify parameters predictive for the diagnosis.

Results

The referral rate of PT increased from 1998–2013. Girls with PT and PP differed with regards to age at referral, body mass index standard deviation scores (BMISDS), ethnicity, bone age advancement, basal luteinizing hormone (LH), gonadotropin releasing hormone (GnRH) stimulated LH and follicle stimulating hormone (FSH), basal and stimulated LH/FSH ratio, and sex-hormone binding globulin (SHBG). Apart from SHBG there was considerable overlap of the variables between the PT and the PP groups.

Conclusions

First, the incidence of PT appears to increase. Second, SHBG was the variable which best discriminated PT from PP. Third, stimulated LH in 1–3 years old girls with PT is similar to stimulated LH in 5–7 years old girls with PP. Age, BMISDS, ethnicity, bone age, stimulated gonadotropins and LH/FSH and SHBG are all useful variables for differentiating PP from PT. However normative data for stimulated LH and FSH in the age group 0.5–7 years are warranted.

Associations of Sexual Subjectivity with Global and Sexual Well-Being: A New Measure for Young Males and Comparison to Females

Sexual subjectivity refers to multiple aspects of sexual self-perceptions, including sexual body-esteem, perceptions of efficacy and entitlement to sexual desire and pleasure, and sexual self-reflection (Horne & Zimmer-Gembeck, 2006). Previous research on sexual subjectivity has shown that it is elevated in young women who report better global well-being and have more sexual experience. However, research has not focused on young men. Thus, two studies were conducted to develop a new measure to assess young men's sexual subjectivity (Study 1, N = 304 men) and to examine associations of sexual subjectivity with general and sexual well-being among young men and women (Study 2, N = 208 men and 214 women). In Study 1, five elements of men's sexual subjectivity were found, which paralleled the elements found in previous research with young women. In Study 2, sexual subjectivity, especially two elements of sexual body-esteem and self-efficacy in achieving pleasure, was significantly associated with enhanced global and sexual well-being in both men and women. Gender did not moderate these associations, supporting sexual subjectivity as an aspect of sexual health in all young adults. As anticipated, men reported greater entitlement to self-pleasure and self-efficacy in achieving pleasure, but women reported greater entitlement to pleasure with partners. Women's feelings of less efficacy but more entitlement to pleasure with partners suggest that feelings of entitlement may not be consistent with their experiences. Future research with young men and women will be important for understanding sexual health and development during late adolescence and early adulthood.

A Longitudinal Study of Sexual Entitlement and Self-Efficacy among Young Women and Men: Gender Differences and Associations with Age and Sexual Experience

Many scholars have called for an increased focus on positive aspects of sexual health and sexuality. Using a longitudinal design with two assessments, we investigated patterns of entitlement to sexual partner pleasure and self-efficacy to achieve sexual pleasure among 295 young men and women aged 17-25 years attending one Australian university. We also tested whether entitlement and efficacy differed by gender, and hypothesized that entitlement and efficacy would be higher in older participants and those with more sexual experience. A sense of entitlement to sexual partner pleasure increased significantly over the year of the study, whereas, on average, there was no change in self-efficacy over time. At Time 1 (T1), young women reported more entitlement than young men. Age was positively associated with T1 entitlement, and experience with a wider range of partnered sexual behaviors was concurrently associated with more entitlement and efficacy and was also associated with increased entitlement to partner pleasure and increased self-efficacy in achieving sexual pleasure at T2 relative to T1. A group with the least amount of sexual experience was particularly low in entitlement and efficacy when compared to groups with a history of coital experience. There was no evidence that any association differed between young men and young women. Limitations of the study include a sample of predominantly middle class, Caucasian students at one university and the possibility that students more interested in sex and relationships, and with more sexual experience, chose to participate.

The relation between internet use and overweight among adolescents: a longitudinal study in Switzerland

OBJECTIVE

This longitudinal study aimed to investigate the characteristics and predictive risk factors of overweight among adolescents. The hypothesis was that baseline overweight predicted most overweight over time compared to other factors, especially excessive internet use.

SUBJECTS

A sample of 621 youths were followed from age 14 (T0 Spring 2012) to age 16 (T1 Spring 2014) in Switzerland. Participants were divided into two groups according to their weight at the final assessment: overweight and non-overweight. At T0, participants reported demographic, health, substance use and internet use data. A logistic regression was performed to assess the explanatory variables of overweight at T1. Data are presented as adjusted odds ratios (aORs) with 95% confidence interval.

RESULTS

The 2-year evolution showed a net BMI increase of 4.8%. Overweight adolescents were significantly more likely to be male, to live in an urban area, to be on a diet and to report using the internet more than 2 h per day on weekends at T0. However, with the addition of baseline overweight, only the excessive use of internet on weekends remained as an explanatory variable. An adolescent who was already overweight at T0 had a more than 20-fold risk (aOR 21.04) of being overweight 2 years later. Moreover, among adolescents becoming overweight between T0 and T1, internet use did not show any significant effect.

CONCLUSION

The risk of being overweight is mostly influenced by weight status at baseline compared to excessive internet use. Thus, our results do not confirm the negative effect of internet on healthier activities. Internet use could at most reinforce an already existing risk of being overweight.

Strain and sex differences in puberty onset and the effects of THC administration on weight gain and brain volumes

The use of recreational marijuana is widespread and frequently begins and persists through adolescence. Some research has shown negative consequences of adolescent marijuana use, but this is not seen across studies, and certain factors, like genetic background and sex, may influence the results. It is critical to identify which characteristics predispose an individual to be susceptible to the negative consequences of chronic exposure to marijuana in adolescence on brain health and behavior. To this end, using males and females of two strains of rats, Long-Evans hooded (LER) and Wistar (WR) rats, we explored whether these anatomically and behaviorally dimorphic strains demonstrated differences in puberty onset and strain-specific effects of adolescent exposure to Δ9-tetrahydrocannabinol (THC), the main psychoactive component of marijuana. Daily 5 mg/kg treatment began on the day of puberty onset and continued for 14 days. Of particular interest were metrics of growth and volumetric estimates of brain areas involved in cognition that contain high densities of cannabinoid receptors, including the hippocampus and its subregions, the amygdala, and the frontal cortex. Brain volumetrics were analyzed immediately following the treatment period. LER and WR females started puberty at different ages, but no strain differences were observed in brain volumes. THC decreased weight gain throughout the treatment period for all groups. Only the hippocampus and some of its subregions were affected by THC, and increased volumes with THC administration was observed exclusively in females, regardless of strain. Long-term treatment of THC did not affect all individuals equally, and females displayed evidence of increased sensitivity to the effects of THC, and by extension, marijuana. Identifying differences in adolescent physiology of WR and LER rats could help determine the cause for strain and sex differences in brain and behavior of adults and help to refine the use of animal models in marijuana research.

Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study

Early puberty timing is associated with higher risks for type 2 diabetes (T2D) and cardiovascular disease in women and therefore represents a potential target for early preventive interventions. We characterised the range of diseases and other adverse health outcomes associated with early or late puberty timing in men and women in the very large UK Biobank study. Recalled puberty timing and past/current diseases were self-reported by questionnaire. We limited analyses to individuals of White ethnicity (250,037 women; 197,714 men) and to disease outcomes with at least 500 cases (~0·2% prevalence) and we applied stringent correction for multiple testing (corrected threshold P < 7.48 × 10^–5). In models adjusted for socioeconomic position and adiposity/body composition variables, both in women and men separately, earlier puberty timing was associated with higher risks for angina, hypertension and T2D. Furthermore, compared to the median/average group, earlier or later puberty timing in women or men was associated with higher risks for 48 adverse outcomes, across a range of cancers, cardio-metabolic, gynaecological/obstetric, gastrointestinal, musculoskeletal, and neuro-cognitive categories. Notably, both early and late menarche were associated with higher risks for early natural menopause in women. Puberty timing in both men and women appears to have a profound impact on later health.

Maturity-associated variation in physical activity and health-related quality of life in British adolescent girls: moderating effects of peer acceptance

BACKGROUND

Using a Biocultural Model of Maturity-Associated Variance in physical activity (PA) as a conceptual framework, the main and interactive effects of biological maturity status and perceived peer acceptance on PA and health-related quality of life (HRQoL) in adolescent girls were examined.

METHODS

Three hundred forty-two female British students in years 7 to 9 (13.2±0.83 years) participated in the study. All participants completed the PA Questionnaire for Adolescents and KIDSCREEN-10, a measure of HRQoL. Self-reported perceptions of peer acceptance were measured by items from the National Longitudinal Study of Adolescent Health.Maturity status was estimated as the percentage of predicted adult (mature) height attained at the time of observation.

RESULTS

Analysis of covariance suggested an influence of peer acceptance on maturity-associated differences in PA, but not on HRQoL. Girls early and "on time" in maturation with higher perceptions of peer acceptance reported greater involvement in PA than girls early and "on time" in maturation with lower perceptions of peer acceptance. A reverse association was observed for late-maturing girls.

CONCLUSIONS

Peer acceptance is an important moderator of maturity-associated variation in PA.

Transitions in body and behavior: a meta-analytic study on the relationship between pubertal development and adolescent sexual behavior

The present meta-analysis studies the relations of pubertal timing and status with sexual behavior and sexual risk behavior among youth aged 10.5-22.4 years. We included biological sex, age, and ethnicity as potential moderators. Four databases were searched for studies (published between 1980 and 2012) on the relation between pubertal timing or status and sexual behavior. The outcomes were (1) sexual intercourse; (2) combined sexual behavior; and (3) risky sexual behavior. Earlier pubertal timing or more advanced pubertal status was related to earlier and more sexual behavior, and earlier pubertal timing was related to more risky sexual behavior. Further, the links between (1) pubertal status and combined sexual behavior and (2) pubertal timing and sexual intercourse status, combined sexual behavior, and risky sexual behavior were stronger for girls than boys. Most links between pubertal status, timing, and sexual behavior and sexual risk behavior were stronger for younger adolescents. Moderation by ethnicity did not yield consistent results. There was significant variation in results among studies that was not fully explained by differences in biological sex, age, and ethnicity. Future research is needed to identify moderators that explain the variation in effects and to design sexual health interventions for young adolescents.

Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: a mixed methods study

Introduction

Congenital hypogonadotropic hypogonadism (CHH) is a rare, genetic, reproductive endocrine disorder characterized by absent puberty and infertility. Limited information is available on the psychosocial impact of CHH and psychosexual development in these patients.

Aim

The aim of this study was to determine the impact of CHH on psychosexual development in men on long-term treatment.

Methods

A sequential mixed methods explanatory design was used. First, an online survey (quantitative) was used to quantify the frequency of psychosexual problems among CHH men. Second, patient focus groups (qualitative) were conducted to explore survey findings in detail and develop a working model to guide potential nursing and interdisciplinary interventions.

Main Outcome Measures

Patient characteristics, frequency of body shame, difficulty with intimate relationships, and never having been sexually active were assessed. Additionally, we collected subjective patient-reported outcomes regarding the impact of CHH on psychological/emotional well-being, intimate relationships, and sexual activity.

Results

A total of 101 CHH men on long-term treatment (>1 year) were included for the analysis of the online survey (mean age 37 ± 11 years, range 19–66, median 36). Half (52/101, 51%) of the men had been seen at a specialized academic center and 37/101 (37%) reported having had fertility-inducing treatment. A high percentage of CHH men experience psychosexual problems including difficulty with intimate relationships (70%) and body image concerns/body shame (94/101, 93%), and the percentage of men never having been sexually active is five times the rate in a reference group (26% vs. 5.4%, P < 0.001). Focus groups revealed persisting body shame and low self-esteem despite long-term treatment that has lasting impact on psychosexual functioning.

Conclusions

CHH men frequently experience psychosexual problems that pose barriers to intimate relationships and initiating sexual activity. These lingering effects cause significant distress and are not ameliorated by long-term treatment. Psychosexual assessment in CHH men with appropriate psychological support and treatment should be warranted in these patients. Dwyer AA, Quinton R, Pitteloud N, and Morin D. Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: A mixed methods study. Sex Med 2015;3:32–41.

[Age of puberty and western young women sexuality]

The onset of menarche and age of first sexual experience have both lowered over the past century. Does the age of puberty influence the sexuality of the girl/young occidental woman? If so, to what degree? Besides, is the acquisition of reproductive function, regardless of age, a sign of sufficient maturity to engage in sexual activity? Studies show that early puberty, early sex, unprotected sexual intercourse in adolescence and number of sexual partners in early adulthood are closely related. These early sexual experiences could be stimulated by early drug use as well as by depressive disorders. The age of puberty has a real influence on sexuality but this link will be modulated by a number of social behavioral factors and it is not sustainable. The age of puberty is not a good indicator of maturity for teenage sexuality; early maturation and early sexual activity are usually associated with risky behaviors. However, other studies on the subject are required, including a consideration of the issues associated with delayed puberty, a subject virtually absent from the literature.

How evolutionary principles improve the understanding of human health and disease

An appreciation of the fundamental principles of evolutionary biology provides new insights into major diseases and enables an integrated understanding of human biology and medicine. However, there is a lack of awareness of their importance amongst physicians, medical researchers, and educators, all of whom tend to focus on the mechanistic (proximate) basis for disease, excluding consideration of evolutionary (ultimate) reasons. The key principles of evolutionary medicine are that selection acts on fitness, not health or longevity; that our evolutionary history does not cause disease, but rather impacts on our risk of disease in particular environments; and that we are now living in novel environments compared to those in which we evolved. We consider these evolutionary principles in conjunction with population genetics and describe several pathways by which evolutionary processes can affect disease risk. These perspectives provide a more cohesive framework for gaining insights into the determinants of health and disease. Coupled with complementary insights offered by advances in genomic, epigenetic, and developmental biology research, evolutionary perspectives offer an important addition to understanding disease. Further, there are a number of aspects of evolutionary medicine that can add considerably to studies in other domains of contemporary evolutionary studies.

Effects of pubertal timing on alcohol and tobacco use in the early adulthood: A longitudinal cohort study in Taiwan

We aimed to examine the effects of pubertal timing on adolescents' alcohol and tobacco use from late adolescence to young adulthood. In addition, we separately explored associative factors of the use of these substances stratified by pubertal timings. A longitudinal cohort of 7th- and 9th-grade students was recruited in Taiwan. Pubertal timing was classified according to the Pubertal Developmental Scale. Effects of pubertal timing on self-reported drinking and smoking at age 20 were evaluated using generalized estimating equation analysis. Furthermore, we assessed the predictive roles of parental monitoring, parent-child relationships, peer influence, and school adhesion among participants, stratified by pubertal timing using multiple logistic regression analysis. A survey of 2290 participants was analyzed, with 51.2% being female. The smoking rate is 19.2% (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.03-2.00) and the alcohol drinking rate is 41.6% (adjusted OR 1.34, 95% CI 1.07-1.69) for early maturing adolescents as compared to 12.3% and 41.6% respectively for on-time peers. A satisfactory parent-child relationship is a protective factor and strict parental monitoring is a risk factor for future tobacco and alcohol use in logistic regression analyses. Early maturation confers risk for cigarette smoking and alcohol consumption in young adulthood. Health professionals and parents should be advised of the potential associative factors with future substance use among adolescents with different maturation tempo. Emphasis could be placed on promoting positive parenting strategies and intra-familial interactions.

Early pubertal timing as a vulnerability to depression symptoms: differential effects of race and sex

Robust evidence supports that girls and boys who experience early pubertal timing, maturing earlier than one's peers, are vulnerable to developing symptoms of depression. However, it has yet to be clarified whether early pubertal timing confers vulnerability to African American as well as to Caucasian adolescents and whether this vulnerability is specific to depressive symptoms or can be generalized to symptoms of social anxiety. In previous studies, one race or one sex was examined in isolation or sample sizes were too small to examine racial differences. Our longitudinal study consisted of a sample of 223 adolescents (Mage = 12.42, 54.3 % female, 50.2 % African American, and 49.8 % Caucasian). At baseline, depressive symptoms, social anxiety symptoms, and pubertal timing were assessed by self-report. Nine months later, we assessed depressive symptoms, social anxiety symptoms, body esteem, and stressful life events that occurred between baseline and follow-up. Analyses indicated that early pubertal timing interacted with stressful life events to predict increased symptoms of depression, but only for Caucasian girls and African American boys. Results were found to be specific to depressive symptoms and did not generalize to symptoms of social anxiety. Additionally, there was a significant positive indirect effect of pubertal timing on symptoms of depression through body esteem for Caucasian females.

Neurokinin B receptor antagonism decreases luteinising hormone pulse frequency and amplitude and delays puberty onset in the female rat

The neural mechanisms controlling puberty onset remain enigmatic. Humans with loss of function mutations in TAC3 or TACR3, the genes encoding neurokinin B (NKB) or its receptor, neurokinin-3 receptor (NK3R), respectively, present with severe congenital gonadotrophin deficiency and pubertal failure. Animal studies have shown ambiguous actions of NKB-NK3R signalling with respect to controlling puberty onset. The present study aimed to determine the role of endogenous NKB-NK3R signalling in the control of pulsatile luteinising hormone (LH) secretion and the timing of puberty onset, and also whether precocious pubertal onset as a result of an obesogenic diet is similarly regulated by this neuropeptide system. Prepubertal female rats, chronically implanted with i.c.v. cannulae, were administered SB222200, a NK3R antagonist, or artificial cerebrospinal fluid via an osmotic mini-pump for 14 days. SB222200 significantly delayed the onset of vaginal opening and first oestrus (as markers of puberty) compared to controls in both normal and high-fat diet fed animals. Additionally, serial blood sampling, via chronic indwelling cardiac catheters, revealed that the increase in LH pulse frequency was delayed and that the LH pulse amplitude was reduced in response to NK3R antagonism, regardless of dietary status. These data suggest that endogenous NKB-NK3R signalling plays a role in controlling the timing of puberty and the associated acceleration of gonadotrophin-releasing hormone pulse generator frequency in the female rat.

Pros and cons of GnRHa treatment for early puberty in girls

The timing of puberty has considerable biological, psychosocial and long-term health implications. Secular trends in age at pubertal development, the effects of obesity and the potential effects of environmental endocrine disruptors challenge the standard definitions of precocious puberty and the indications for intervention with gonadotropin-releasing hormone agonists (GnRHa) in girls with precocious puberty. GnRHa therapy is effective in improving adult height in patients who present with classic central precocious puberty (at <8 years old), without causing adverse effects on body composition, BMD and reproductive function. However, its benefits in patients with atypical forms of early puberty not driven by luteinising hormone are not well defined. The role of GnRHa in these patients and the potential benefits in terms of later growth, psychosocial functioning and long-term risk of adult diseases that are associated with early menarche, such as breast cancer and the metabolic syndrome, have not been established.

Depression and self-concept in girls with perception of pubertal onset

PURPOSE

Early pubertal timing in girls is associated with psychological and behavioral problems. This study aimed to evaluate the psychological features of girls who perceived breast development beginning by analyzing their depression levels and self-concept.

METHODS

From March 2007 to December 2012, 93 girls were enrolled and assigned to a pre-8 (younger than 8 years, n=43) or post-8 (8 years and older, n=50) group according to the age at onset of perceived breast development, and their height, body weight, body mass index, bone age (BA), Tanner stage, and luteinizing hormone and follicle-stimulating hormone levels were examined. We investigated their psychological state with the Korean Children's Depression Inventory (CDI) and Piers-Harris Children's Self-Concept Scale (PHCSC) to evaluate depression levels and self-concept, respectively.

RESULTS

The pre-8 group had a significantly greater height standard deviation score, (0.5±1.01 vs. 0.11±0.86, P = 0.048) and more advanced BA (2.07±1.02 years vs. 1.40±0.98 years, P = 0.004) compared to the post-8 group. There were no statistically significant intergroup differences for the CDI and PHCSC scores; however, the pre-8 group scored higher than the post-8 group in the physical appearance and attributes domain of the PHCSC (9.93±2.57 vs. 8.52±3.03, P = 0.017).

CONCLUSION

The timing of perceived breast development among girls who thought puberty to begin did not affect depression levels and self-concept. There was no correlation between Tanner stage and depression levels and self-concept despite the perception of pubertal onset. The pre-8 group had a more positive view of their physical appearance than the post-8 group.

Association of adiposity genetic variants with menarche timing in 92,105 women of European descent

Obesity is of global health concern. There are well-described inverse relationships between female pubertal timing and obesity. Recent genome-wide association studies of age at menarche identified several obesity-related variants. Using data from the ReproGen Consortium, we employed meta-analytical techniques to estimate the associations of 95 a priori and recently identified obesity-related (body mass index (weight (kg)/height (m)(2)), waist circumference, and waist:hip ratio) single-nucleotide polymorphisms (SNPs) with age at menarche in 92,116 women of European descent from 38 studies (1970-2010), in order to estimate associations between genetic variants associated with central or overall adiposity and pubertal timing in girls. Investigators in each study performed a separate analysis of associations between the selected SNPs and age at menarche (ages 9-17 years) using linear regression models and adjusting for birth year, site (as appropriate), and population stratification. Heterogeneity of effect-measure estimates was investigated using meta-regression. Six novel associations of body mass index loci with age at menarche were identified, and 11 adiposity loci previously reported to be associated with age at menarche were confirmed, but none of the central adiposity variants individually showed significant associations. These findings suggest complex genetic relationships between menarche and overall obesity, and to a lesser extent central obesity, in normal processes of growth and development.

Puberty and gonadal hormones: role in adolescent-typical behavioral alterations

This article is part of a Special Issue "Puberty and Adolescence". Adolescence is characterized by a variety of behavioral alterations, including elevations in novelty-seeking and experimentation with alcohol and other drugs of abuse. Some adolescent-typical neurobehavioral alterations may depend upon pubertal rises in gonadal hormones, whereas others may be unrelated to puberty. Using a variety of approaches, studies in laboratory animals have not revealed clear relationships between pubertal-related changes and adolescent- or adult-typical behaviors that are not strongly sexually dimorphic. Data reviewed suggest surprisingly modest influences of gonadal hormones on alcohol intake, alcohol preference and novelty-directed behaviors. Gonadectomy in males (but not females) increased ethanol intake in adulthood following surgery either pre-pubertally or in adulthood, with these increases in intake largely reversed by testosterone replacement in adulthood, supporting an activational role of androgens in moderating ethanol intake in males. In contrast, neither pre-pubertal nor adult gonadectomy influenced sensitivity to the social inhibitory or aversive effects of ethanol when indexed via conditioned taste aversions, although gonadectomy at either age altered the microstructure of social behavior of both males and females. Unexpectedly, the pre-pubertal surgical manipulation process itself was found to increase later ethanol intake, decrease sensitivity to ethanol's social inhibitory effects, attenuate novelty-directed behavior and lower social motivation, with gonadal hormones being necessary for these long-lasting effects of early surgical perturbations.

Puberty as a critical risk period for eating disorders: a review of human and animal studies

This article is part of a Special Issue "Puberty and Adolescence". Puberty is one of the most frequently discussed risk periods for the development of eating disorders. Prevailing theories propose environmentally mediated sources of risk arising from the psychosocial effects (e.g., increased body dissatisfaction, decreased self-esteem) of pubertal development in girls. However, recent research highlights the potential role of ovarian hormones in phenotypic and genetic risk for eating disorders during puberty. The goal of this paper is to review data from human and animal studies in support of puberty as a critical risk period for eating disorders and evaluate the evidence for hormonal contributions. Data are consistent in suggesting that both pubertal status and pubertal timing significantly impact risk for most eating disorders in girls, such that advanced pubertal development and early pubertal timing are associated with increased rates of eating disorders and their symptoms in both cross-sectional and longitudinal research. Findings in boys have been much less consistent and suggest a smaller role for puberty in risk for eating disorders in boys. Twin and animal studies indicate that at least part of the female-specific risk is due to genetic factors associated with estrogen activation at puberty. In conclusion, data thus far support a role for puberty in risk for eating disorders and highlight the need for additional human and animal studies of hormonal and genetic risk for eating disorders during puberty.

Current pharmacotherapy of central precocious puberty by GnRH analogs: certainties and uncertainties

INTRODUCTION

GnRH analogs represent the drug of choice for medical treatment of central precocious puberty (CPP). They provided prompt and reversible suppression of reproductive axis and several reports have shown that adult height is preserved in treated children.

AREAS COVERED

This review updates GnRH analog treatment in CPP by a search of the literature published on the topic since 1980.

EXPERT OPINION

Monthly GnRH analogs are currently considered the 'gold standard' for the medical treatment of CPP, since a lot of experience is accumulated on their use in children. Differences in long-term outcome (in terms of adult height) are reported and they may be due to differences in selection criteria, treatment monitoring, criteria to stop of therapy, different biological activity of the various drugs and different genetic background of treated patients; altogether, these items remain poorly evaluated. Psychological indications for treatment and long-term psychological outcome of treated children should be better addressed. Comparative trials among the various GnRH analogs are very scarce. New very long-acting GnRH analogs (quarterly or yearly formulations) may improve compliance with therapy, but longer follow-up studies are needed. Medical treatment of CPP should be close to pediatric endocrinologists or tertiary pediatric endocrinology centers with documented experience in this field.

A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use

AIMS

Experiences linked to poor family functioning and pubertal timing have each been associated with increased risk of substance misuse in adolescence. However, it remains unclear to what extent family functioning and pubertal timing combine to put adolescents at particular risk.

METHOD

A systematic review was planned, undertaken and reported according to the 27 items of the PRISMA statement. Databases World of Knowledge, PsycINFO and PubMed were searched. Fifty-eight papers were retained and are discussed in this review after screening titles, abstracts and full papers against pre-established exclusion criteria.

RESULTS

The combination of off-time pubertal timing and poor parent-adolescent relationship quality has been related to higher levels of substance use. However, this is an under-studied area of research and the evidence is less strong for boys than girls.

CONCLUSIONS

Adolescents experiencing both poor parent-adolescent relationship quality and off-time pubertal timing may represent a high-risk group that can benefit from approaches aimed at reducing risk of substance misuse.