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Calcaterra V, Tornese G, Zuccotti G, Staiano A, Cherubini V, Gaudino R, Fazzi EM, Barbi E, Chiarelli F, Corsello G, Esposito SMR, Ferrara P, Iughetti L, Laforgia N, Maghnie M, Marseglia G, Perilongo G, Pettoello-Mantovani M, Ruggieri M, Russo G, Salerno M, Striano P, Valerio G, Wasniewska M. Adolescent gender dysphoria management: position paper from the Italian Academy of Pediatrics, the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, the Italian Society of Adolescent Medicine and the Italian Society of Child and Adolescent Neuropsychiatry. Ital J Pediatr 2024; 50:73. [PMID: 38637868 PMCID: PMC11025175 DOI: 10.1186/s13052-024-01644-7] [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: 02/28/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND In response to the imperative need for standardized support for adolescent Gender Dysphoria (GD), the Italian Academy of Pediatrics, in collaboration with the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, Italian Society of Adolescent Medicine and Italian Society of Child and Adolescent Neuropsychiatry is drafting a position paper. The purpose of this paper is to convey the author's opinion on the topic, offering foundational information on potential aspects of gender-affirming care and emphasizing the care and protection of children and adolescents with GD. MAIN BODY Recognizing that adolescents may choose interventions based on their unique needs and goals and understanding that every individual within this group has a distinct trajectory, it is crucial to ensure that each one is welcomed and supported. The approach to managing individuals with GD is a multi-stage process involving a multidisciplinary team throughout all phases. Decisions regarding treatment should be reached collaboratively by healthcare professionals and the family, while considering the unique needs and circumstances of the individual and be guided by scientific evidence rather than biases or ideologies. Politicians and high court judges should address discrimination based on gender identity in legislation and support service development that aligns with the needs of young people. It is essential to establish accredited multidisciplinary centers equipped with the requisite skills and experience to effectively manage adolescents with GD, thereby ensuring the delivery of high-quality care. CONCLUSION Maintaining an evidence-based approach is essential to safeguard the well-being of transgender and gender diverse adolescents.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Department, Buzzi Children's Hospital, Milano, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gianluca Tornese
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milano, Italy.
- Department of Biomedical and Clinical Sciences, University of Milan, Via GB Grassi, n.74, Milano, 20157, Italy.
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University Federico II of Naples, Naples, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria delle Marche, Ospedali Riuniti di Ancona, "G. Salesi Hospital", Ancona, Italy
| | - Rossella Gaudino
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elisa Maria Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Giovanni Corsello
- Division of Pediatrics, "A.R.N.A.S." Civic Hospital, Di Cristina Benfratelli, University of Palermo, Palermo, Italy
| | - Susanna Maria Roberta Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Pietro Ferrara
- Department of Medicine and Surgery, Università Campus Bio-Medico, Roma, Italy
- Operative Research Unit of Pediatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Lorenzo Iughetti
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Laforgia
- Section of Neonatology and Neonatal Intensive Care Unit, Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | - Mohamad Maghnie
- IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Gianluigi Marseglia
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pediatric Unit, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giorgio Perilongo
- Department of Rare Diseases, University Hospital of Padua, Padua, Italy
- Division of Pediatrics, Department of Woman's & Child's Health, University Hospital of Padua, Padua, Italy
| | | | - Martino Ruggieri
- Unit of Pediatric Clinic, Centre for Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences, Paediatric Endocrinology Unit, University "Federico II", Naples, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giuliana Valerio
- Department of Medical, Movement and Wellbeing studies, University of Napoli "Parthenope", Napoli, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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Köllner MG, Braun S, Schöttner H, Dlugash G, Bettac M, Steib S. Relationships of the Ulna-to-fibula Ratio to Baseline and Reactive Steroid Hormone Levels: An Exploratory Study. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022. [DOI: 10.1007/s40750-022-00204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Objective
Organizational hormone effects on the human brain and behavior are often retrospectively assessed via morphological markers of prenatal (e.g., 2D:4D digit ratio) or pubertal (e.g., facial width-to-height ratio, fWHR) hormone exposure. It has been argued that markers should relate to circulating hormones particularly in challenging, dominance/status-relevant situations. However, meta-analytic research indicates that fWHR, a frequently used pubertal marker, is neither reliably sex-dimorphic nor related to steroid hormones. This casts doubt on fWHR’s validity for reflecting hormone levels. Ulna-to-fibula ratio (UFR), an alternative, long-bone-length-based pubertal marker, is sex-dimorphic and associated with dominance motivation. However, its hormonal associations were never tested before. We therefore explored UFR’s relationships to baseline and reactive hormone levels.
Methods
We measured ulna and fibula length as well as shoulder/waist/hip circumference of 81 participants (49 women; after exclusions) via anthropometry. Salivary hormone levels (estradiol, testosterone) at baseline and after a gross-motor one-on-one balancing contest were measured via radioimmunoassay.
Results
We replicated UFR’s dimorphism, unrelatedness to height, and correlations to other putative markers of organizational hormone effects. On an exploratory basis, we found UFR to be related to overall baseline testosterone and to competition-induced reactive surges in steroid hormones (estradiol, testosterone) overall and in women.
Conclusions
Our results hint at UFR’s relationship to baseline testosterone and may indicate functional connections between outcomes of pubertal organizational hormone effects and contest-induced steroid reactivity. Pubertal organizational hormone effects may prepare the endocrine system for dominance and status contests. However, the small sample and the exploratory nature of our research demands replication.
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Shirazi TN, Self H, Rosenfield KA, Dawood K, Welling LLM, Cárdenas R, Bailey JM, Balasubramanian R, Delaney A, Breedlove SM, Puts DA. Low Perinatal Androgens Predict Recalled Childhood Gender Nonconformity in Men. Psychol Sci 2022; 33:343-353. [PMID: 35191784 PMCID: PMC8985219 DOI: 10.1177/09567976211036075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The contributions of gonadal hormones to the development of human behavioral sex differences are subjects of intense scientific and social interest. Isolated gonadotropin-releasing-hormone deficiency (IGD) is a rare endocrine disorder that can reveal a possible role of early gonadal hormones. IGD is characterized by low or absent gonadal hormone production after the first trimester of gestation, but external genitalia and hence gender of rearing are concordant with chromosomal and gonadal sex. We investigated recalled childhood gender nonconformity in men (n = 65) and women (n = 32) with IGD and typically developing men (n = 463) and women (n = 1,207). Men with IGD showed elevated childhood gender nonconformity, particularly if they also reported undescended testes at birth, a marker of low perinatal androgens. Women with IGD did not differ from typically developing women. These results indicate that early androgen exposure after the first trimester contributes to male-typical gender-role behaviors in childhood.
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Affiliation(s)
| | - Heather Self
- Department of Anthropology, The
Pennsylvania State University
| | | | - Khytam Dawood
- Department of Psychology, The
Pennsylvania State University
| | | | | | | | | | - Angela Delaney
- Reproductive Physiology and
Pathophysiology Group, National Institutes of Health, Bethesda,
Maryland
| | | | - David A. Puts
- Department of Anthropology, The
Pennsylvania State University,David A. Puts, The Pennsylvania
State University, Department of Anthropology
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Arnocky S, Hodges-Simeon C, Davis AC, Desmarais R, Greenshields A, Liwski R, Quillen EE, Cardenas R, Breedlove SM, Puts D. Heterozygosity of the major histocompatibility complex predicts later self-reported pubertal maturation in men. Sci Rep 2021; 11:19862. [PMID: 34615944 PMCID: PMC8494901 DOI: 10.1038/s41598-021-99334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/23/2021] [Indexed: 12/24/2022] Open
Abstract
Individual variation in the age of pubertal onset is linked to physical and mental health, yet the factors underlying this variation are poorly understood. Life history theory predicts that individuals at higher risk of mortality due to extrinsic causes such as infectious disease should sexually mature and reproduce earlier, whereas those at lower risk can delay puberty and continue to invest resources in somatic growth. We examined relationships between a genetic predictor of infectious disease resistance, heterozygosity of the major histocompatibility complex (MHC), referred to as the human leukocyte antigen (HLA) gene in humans, and self-reported pubertal timing. In a combined sample of men from Canada (n = 137) and the United States (n = 43), MHC heterozygosity predicted later self-reported pubertal development. These findings suggest a genetic trade-off between immunocompetence and sexual maturation in human males.
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Affiliation(s)
| | | | | | | | - Anna Greenshields
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada
| | - Robert Liwski
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada
| | | | | | | | - David Puts
- Pennsylvania State University, State College, USA
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