OBJECTIVES: To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. METHODS: Data gathered on 97 consecutive patients <21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. RESULTS: Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). CONCLUSIONS: After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.
US methods of testicular volume measurement are more accurate and precise than orchidometry. The formula L x W x H x 0.71 provides a superior estimate of testicular volume and should be used in clinical practice.
Tubularized incised plate urethroplasty has become the preferred technique of primary and repeat hypospadias repair at our institution. The technique has few complications as well as proved success and versatility that continues to expand its applicability and popularity.
Studies in the streptozotocin rat model for diabetes mellitus suggest that sexual dysfunction in these animals may result from diabetes-induced alterations of the neuroendocrine-reproductive tract axis. Our investigation was performed to better define the effects of diabetes on the neuroendocrine sex accessory organ axis in the male rat. Rats were rendered diabetic, and were either left untreated or treated with insulin, testosterone or both. Diabetes resulted in decreased body and reproductive organ weights, as well as diminished sperm counts and motility and prostatic acid phosphatase. Seminal fructose was increased. A significant decrease in serum LH, FSH and testosterone was noted. Insulin treatment of the diabetic rats restored serum gonadotropins, reproductive organ weight, sperm counts and motility, and seminal fructose to control levels. Prostatic weight and prostatic acid phosphatase levels remained abnormal. Testosterone restored the above mentioned parameters to control levels, with the exception of LH. Treatment with insulin and testosterone had a synergistic effect on spermatogenesis. A GnRH stimulation test demonstrated that pituitaries of diabetic animals had a blunted response, with diminished LH and FSH secretion. In the diabetic animal, there are both pituitary and testicular abnormalities which may be responsible for reproductive dysfunction.
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