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In this pilot study, we sought to characterize the knowledge about fertility and attitudes about future parenthood in a sample of transgender and gender expansive (TGE) youth attending an academic, universityaffiliated adolescent gender program. Methods: A 22-item cross-sectional survey assessing knowledge of fertility issues and attitudes toward future parenthood was administered to 23 transgender adolescents, 12-22 years of age, who reported gender identity incongruent with birth-assigned sex, and who were seen at our university-affiliated clinic during an 11-month period between October 2016 and August 2017. Knowledge scores and ranked responses on selected topics in fertility and reproduction were evaluated. Results: Participants were well informed overall about fertility topics related to their gender care (mean score of 3.8-0.8 out of 5), but over half of participants lacked specific knowledge regarding basic fertility principles and overestimated the ability of physicians to predict the effects of gender-affirming hormone therapy on fertility. The majority of participants (15/23) preferred nonbiological parenthood in the form of adoption. Participants who ranked future parenthood as unimportant had the greatest concern about becoming a parent (p < 0.05), and over one-third were also concerned about interrupting their gender-affirming hormone therapy to preserve fertility. Conclusion: TGE youth would benefit from fertility-related counseling that both assesses baseline understanding of reproduction and also acknowledges the limitations of current data on gender-affirming hormones and future fertility. Counseling should also be comprehensive and explore both biological and nonbiological forms of parenthood.

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Nearly 380,000 U.S. service members between 2000 and 2017 were, and at least 300,000 athletes annually are, diagnosed with concussion. It is imperative to establish a gold-standard diagnostic test to quickly and accurately diagnose concussion. In this non-randomized, prospective study, we examined the reliability and validity of a novel neurocognitive assessment tool, the Defense Automated Neurobehavioral Assessment (DANA), designed to be a more sensitive, yet efficient, measure of concussion symptomatology. In this study, the DANA Brief version was compared to an established measure of concussion screening, the Military Acute Concussion Evaluation (MACE), in a group of non-concussed service members. DANA Brief subtests demonstrated low to moderate reliability, as measured by intra-class correlation coefficient (ICC; values range: 0.28–0.58), which is comparable to other computerized neurocognitive tests that are widely-implemented to diagnose concussion. Statistically significant associations were found between learning and memory components of the DANA Brief and the diagnostic MACE cognitive test score (DANA Brief subtests: CDD: R 2 = 0.05, p = 0.023; CDS: R 2 = 0.10, p = 0.010). However, a more robust relationship was found between DANA Brief components involving attention and working memory, including immediate memory, and the MACE cognitive test score (DANA Brief subtests: GNG: R 2 = 0.08, p = 0.003; PRO: R 2 = 0.08, p = 0.002). These results provide evidence that the DANA Rapid version, a 5-min assessment self-administered on a hand-held portable device, based on the DANA Brief version, may serve as a clinically useful and improved neurocognitive concussion screen to minimize the time between injury and diagnosis in settings where professional medical evaluation may be unavailable or delayed. The DANA's portability, durability, shorter test time and lack of need for a medical professional to diagnose concussion overcome these critical limitations of the MACE.

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