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Micangeli G, Profeta G, Colloridi F, Pirro F, Tarani F, Ferraguti G, Spaziani M, Isidori AM, Menghi M, Fiore M, Tarani L. The role of the pediatrician in the management of the child and adolescent with gender dysphoria. Ital J Pediatr 2023; 49:71. [PMID: 37316904 DOI: 10.1186/s13052-023-01466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/01/2023] [Indexed: 06/16/2023] Open
Abstract
Gender dysphoria is a clinical condition characterized by significant distress due to the discordance between biological sex and gender identity. Currently, gender dysphoria is also found more frequently in children and adolescents, thanks to greater social sensibleness and new therapeutic possibilities. In fact, it is estimated that the prevalence of gender dysphoria in pediatric age is between 0.5% and 2% based on the statistics of the various countries. Therefore, the pediatrician cannot fail to update himself on these issues and above all should be the reference figure in the management of these patients. Even if the patient must be directed to a referral center and be followed up by a multidisciplinary team, the treating pediatrician will care to coordinate the clinical and therapeutic framework. The aim of the present report is therefore to integrate literature data with our clinical experience to propose a new clinical approach in which the pediatrician should be the reference in the care of these patients, directing them towards the best therapeutic approach and staying in contact with the specialists of the referral center.
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Affiliation(s)
- Ginevra Micangeli
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Profeta
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | | | - Federica Pirro
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Michela Menghi
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy.
| | - Luigi Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.
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Rodriguez-Carrillo A, Remy S, D'Cruz SC, Salamanca-Fernandez E, Gil F, Olmedo P, Mustieles V, Vela-Soria F, Baken K, Olea N, Smagulova F, Fernandez MF, Freire C. Kisspeptin as potential biomarker of environmental chemical mixture effect on reproductive hormone profile: A pilot study in adolescent males. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 868:161668. [PMID: 36657687 DOI: 10.1016/j.scitotenv.2023.161668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Kisspeptin has been proposed as an effect biomarker to understand the mechanisms by which some environmental chemicals adversely affect the human reproductive system. OBJECTIVE To ascertain whether kisspeptin serum protein and DNA methylation levels are associated with exposure to several environmental chemicals (individually and as a mixture) and serum reproductive hormone levels in adolescent males. METHODS Three phenols (bisphenol A [BPA], methyl-paraben [MPB], and benzophenone-3 [BP3]); two toxic metals (arsenic and cadmium); and four metabolites of non-persistent pesticides, including insecticides (2-isopropyl-6-methyl-4-pyrimidinol [IMPy], malathion diacid [MDA], and dimethylcyclopropane carboxylic acid [DCCA]) and fungicides (ethylene thiourea [ETU]) were measured in first-morning urine samples of 133 adolescent males aged 15-17 years from the INMA-Granada cohort. In blood samples collected on the same day, KISS1 gene DNA methylation was measured at four CpGs from the Exon IV, as well as serum levels of kiss54 protein, total testosterone (T), estradiol (E2), sex hormone binding-globulin, dehydroepiandrosterone sulfate, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Multiple linear regression and mixture (quantile g-computation) models were fit. RESULTS Urinary MDA and DCCA concentrations were associated with higher kiss54 levels [% change (95%CI) for each log-unit increase in concentration = 2.90 (0.32;5.56), and 1.93 (0.45,3.43), respectively]; IMPy with lower DNA methylation percentage at CpG1 and total CpGs [% change (95%CI) = -1.15 (-1.96;-0.33): -0.89 (-1.73;-0.01), respectively]; and BP3 and DCCA with lower total CpGs methylation [-0.53 (-1.04;-0.01) and - 0.69 (-1.37;-0.01), respectively]. The pesticide mixture and the whole chemical mixture were associated with higher kiss54 [% change (95%CI) = 9.09 (3.29;15.21) and 11.61 (3.96;19.82), respectively] and lower methylation levels at several CpGs. Additionally, serum kiss54 in the third tertile was associated with higher LH levels [% change (95%CI) = 28.69 (3.75-59.63)], and third-tertile CpG1, CpG2, and total CpG methylation percentages were associated with lower FSH and E2. CONCLUSION The findings of the present study and the negative correlation between serum kiss54 levels and KISS1 DNA methylation percentages suggested that kisspeptin may be a promising effect biomarker.
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Affiliation(s)
- Andrea Rodriguez-Carrillo
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain.
| | - Sylvie Remy
- Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Shereen Cynthia D'Cruz
- Univ Rennes, EHESP, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Elena Salamanca-Fernandez
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Fernando Gil
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Vicente Mustieles
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Fernando Vela-Soria
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Kirsten Baken
- Unit Health, VITO, Flemish Institute for Technological Research, 2400 Mol, Belgium
| | - Nicolás Olea
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Fátima Smagulova
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Mariana F Fernandez
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain.
| | - Carmen Freire
- Biomedical Research Center (CIBM), University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
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Real AG, Fontanari AMV, Costa AB, Soll BMB, Bristot G, de Oliveira LF, Kamphorst AM, Schneider MA, Lobato MIR. Gender dysphoria: prejudice from childhood to adulthood, but no impact on inflammation. A cross-sectional controlled study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 43:37-46. [PMID: 33681906 PMCID: PMC7932037 DOI: 10.47626/2237-6089-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5). METHODS Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay. RESULTS Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine. CONCLUSIONS These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
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Affiliation(s)
- André Gonzales Real
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Anna Martha Vaitses Fontanari
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Angelo Brandelli Costa
- Departamento de PsicologiaPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartamento de Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
| | - Bianca Machado Borba Soll
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Giovana Bristot
- INCT Translacional em MedicinaHospital de Clinicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, INCT Translacional em Medicina, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em BioquímicaUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Bioquímica, UFRGS, Porto Alegre, RS, Brazil.
| | - Larissa Fagundes de Oliveira
- INCT Translacional em MedicinaHospital de Clinicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, INCT Translacional em Medicina, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
| | - Ana Maria Kamphorst
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Maiko Abel Schneider
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Maria Inês Rodrigues Lobato
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
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