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Baxendale S. The impact of suppressing puberty on neuropsychological function: A review. Acta Paediatr 2024; 113:1156-1167. [PMID: 38334046 DOI: 10.1111/apa.17150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
AIM Concerns have been raised regarding the impact of medications that interrupt puberty, given the magnitude and complexity of changes that occur in brain function and structure during this sensitive window of neurodevelopment. This review examines the literature on the impact of pubertal suppression on cognitive and behavioural function in animals and humans. METHODS All studies reporting cognitive impacts of treatment with GnRH agonists/antagonists for pubertal suppression in animals or humans were sought via a systematic search strategy across the PubMed, Embase, Web of Science and PsycINFO databases. RESULTS Sixteen studies were identified. In mammals, the neuropsychological impacts of puberty blockers are complex and often sex specific (n = 11 studies). There is no evidence that cognitive effects are fully reversible following discontinuation of treatment. No human studies have systematically explored the impact of these treatments on neuropsychological function with an adequate baseline and follow-up. There is some evidence of a detrimental impact of pubertal suppression on IQ in children. CONCLUSION Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function associated with puberty blockers. The impact of puberal suppression on measures of neuropsychological function is an urgent research priority.
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Cohn J. Some Limitations of "Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist's View". JOURNAL OF SEX & MARITAL THERAPY 2022:1-17. [PMID: 36565052 DOI: 10.1080/0092623x.2022.2160396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
There is significant disagreement about how to support trans-identified or gender-dysphoric young people. Different experts and expert bodies make strikingly different recommendations based upon the same (limited) evidence. The US-originating "gender-affirmative" model emphasizes social transition and medical intervention, while some other countries, in response to evidence reviews of medical intervention outcomes, have adopted psychological interventions as the first line of treatment. A proposed model of gender-affirming care, comprising only medical intervention for "eligible" youth, is described in Rosenthal (2021). Determining eligibility for these medical interventions is challenging and engenders considerable disagreement among experts, neither of which is mentioned. The review also claims without support that medical interventions have been shown to clearly benefit mental health, and leaves out significant risks and less invasive alternatives. The unreliability of outcome studies and the corresponding uncertainties as to how gender dysphoria develops and responds to treatment are also unreported.
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Affiliation(s)
- J Cohn
- Society for Evidence-based Gender Medicine (SEGM), Twin Falls, ID, USA
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Zhang Y, Lu S, Yang Y, Wang Z, Wang B, Zhang B, Yu J, Lu W, Pan M, Zhao J, Guo S, Cheng J, Chen X, Hong K, Li G, Yu Z. The diversity of gut microbiota in type 2 diabetes with or without cognitive impairment. Aging Clin Exp Res 2021; 33:589-601. [PMID: 32301029 DOI: 10.1007/s40520-020-01553-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diabetes is associated with a high risk of developing cognitive impairment, but the underlying mechanism remains unclear. Recent studies have found that gut microbiota may be involved in the progression of diabetes-associated cognitive impairment. AIMS To analyze the diversity of gut microbiota in type 2 diabetes with or without cognitive impairment METHODS: 16S rRNA sequencing was used to detect the gut microbiota composition in 154 type 2 diabetes (T2DM) subjects RESULTS: Among 154 elderly T2DM participants included in our study, 73 with normal and 81 with impaired cognition. Lower levels of hemoglobin and HDL were observed in subjects with cognitive impairment. Patients with cognitive impairment had a lower abundance of Tenericutes. Comparison at the genus level revealed that T2DM patients with cognitive impairment had a decreased abundance of Bifidobacterium and unranked-RF39 and an increased abundance of Peptococcus and unranked-Leuconostocaceae. Additionally, the relative abundance of Veillonella and Pediococcus were decreased in subjects with cognitive impairment. Furthermore, the relative abundance of 7 sub-functions was significantly changed in the group with cognitive impairment. Calcium signaling pathways and the Renin-angiotensin system were upregulated in the cognitive impairment group while GnRH signaling, Fc gamma R-mediated phagocytosis, endocytosis, isoflavonoid biosynthesis, and cytochrome P450 were deregulated. CONCLUSION Bifidobacterium may be associated with cognition in T2DM. Calcium signaling and renin-angiotensin system were shown to be associated with diabetes-associated cognitive impairment through gut microbiota.
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Affiliation(s)
- Yunyun Zhang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Shourong Lu
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Ying Yang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Zhuo Wang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Bin Wang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Bingshan Zhang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Jie Yu
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Wenwei Lu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, China
| | - Mingluo Pan
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, China
| | - Shenghua Guo
- Department of Medicine, Wuxi Xin'an Community Health Service Center, Wuxi, 214135, China
| | - Jin Cheng
- Department of Medicine, Wuxi Xin'an Community Health Service Center, Wuxi, 214135, China
| | - Xiaorong Chen
- Department of Medicine, Wuxi Xin'an Community Health Service Center, Wuxi, 214135, China
| | - Kan Hong
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China.
| | - Gang Li
- Department of Neurology, Nanjing Medical University Affiliated Shanghai East Hospital, Shanghai, 200123, China.
| | - Zhiming Yu
- Department of Cardiovascular, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China.
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Kyriakou A, Nicolaides NC, Skordis N. Current approach to the clinical care of adolescents with gender dysphoria. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:165-175. [PMID: 32191677 PMCID: PMC7569586 DOI: 10.23750/abm.v91i1.9244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 01/29/2023]
Abstract
Over the last decade, we have witnessed a significant rise in the number of transgender young people seeking endocrine treatment, of which clinical service and gender dysphoria terminology have attempted to keep pace both in matching demand and better describing the condition. Although helpful guidelines for pubertal suppression and gender affirming hormones have been developed, uncertainties remain regarding treatment and monitoring during treatment, often because the clinical needs of the transgender population have outpaced medical expertise and training. Recently, multidisciplinary team work has evolved due to the increasing complexity of diagnostic and treatment decision-making and has been instrumental in creating a unique service with input from a range of specialists. In this article, the current approach in clinical management of adolescents with gender dysphoria is reviewed, with focus on the endocrine aspect of care in children and adolescents. Questions on what defines optimal clinical care of children and adolescents with gender dysphoria remain and should be the focus of future research. (www.actabiomedica.it)
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Affiliation(s)
- Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.
| | - Nicolas C Nicolaides
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Greece; Division of Endocrinology, Metabolism and Diabetes, First Department of Paediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Nicos Skordis
- Division of Paediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus; School of Medicine, University of Nicosia, Nicosia, Cyprus .
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