Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person's genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person's desired gender. A mental health professional (MHP) must recommend endocrine treatment and participate in ongoing care throughout the endocrine transition and decision for surgical sex reassignment. The endocrinologist must confirm the diagnostic criteria the MHP used to make these recommendations. Because a diagnosis of transsexualism in a prepubertal child cannot be made with certainty, we do not recommend endocrine treatment of prepubertal children. We recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. We suggest suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks in adult transsexual persons.

These findings highlight the importance of continued cardiometabolic monitoring of IVF-conceived children and might contribute to current knowledge about periconceptional influences and their consequences in later life.

Treatment outcome in transsexuals is expected to be more favourable when puberty is suppressed than when treatment is started after Tanner stage 4 or 5. In the Dutch protocol for the treatment of transsexual adolescents, candidates are considered eligible for the suppression of endogenous puberty when they fulfil the Diagnostic and Statistic Manual of Mental Disorders-IV-RT criteria for gender disorder, have suffered from lifelong extreme gender dysphoria, are psychologically stable and live in a supportive environment. Suppression of puberty should be considered as supporting the diagnostic procedure, but not as the ultimate treatment. If the patient, after extensive exploring of his/her sex reassignment (SR) wish, no longer pursues SR, pubertal suppression can be discontinued. Otherwise, cross-sex hormone treatment can be given at 16 years, if there are no contraindications. Treatment consists of a GnRH analogue (GnRHa) to suppress endogenous gonadal stimulation from B2-3 and G3-4, and prevents development of irreversible sex characteristics of the unwanted sex. From the age of 16 years, cross-sex steroid hormones are added to the GnRHa medication.Preliminary findings suggest that a decrease in height velocity and bone maturation occurs. Body proportions, as measured by sitting height and sitting-height/height ratio, remains in the normal range. Total bone density remains in the same range during the years of puberty suppression, whereas it significantly increases on cross-sex steroid hormone treatment. GnRHa treatment appears to be an important contribution to the clinical management of gender identity disorder in transsexual adolescents.European Journal of Endocrinology 155 S131-S137

Index (WHO-5) is a short self-report instrument that appears suitable for this purpose. This study is the first to assess the reliability and validity of the WHO-5 in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Ninety-one adolescents with type 1 diabetes (aged 13-17 years) from four pediatric clinics completed the WHO-5, along with other psychological measures: the Center for Epidemiologic Studies Depression Scale (CES-D), the Diabetes Family Conflict Scale (DFCS), and the mental health and self-esteem subscales of the Child Health Questionnaire (CHQ-CF87). Confirmatory factor analysis (CFA) and exploratory factor analysis were conducted. Readability, homogeneity, and item-total and inter-item correlations were determined. Concurrent validity was examined by calculating correlation coefficients among all measures. Sensitivity and specificity of the WHO-5 were tested against those for the CES-D using receiver operating characteristic (ROC) curves.RESULTS -CFA confirmed the one-factor structure; Cronbach's ␣ of this 5-item scale was 0.82. The WHO-5 showed a moderate to strong correlation with the CES-D (r ϭ Ϫ0.67), with the mental health (r ϭ 0.60) and self-esteem (r ϭ 0.43) subscales of the CHQ-CF87, and with the DFCS (r ϭ Ϫ0.34), confirming concurrent validity. ROC curve analysis confirmed the WHO-5 cutoff point of Ͻ50 for identification of mild to severe depressive affect (sensitivity 89% and specificity 86%).CONCLUSIONS -The WHO-5 is a brief, patient-friendly measure of positive well-being with good psychometric properties that appears suitable for routine use in adolescents with type 1 diabetes. Diabetes Care 30:2003-2006, 2007D epression appears to be two to three times more prevalent in adolescents with diabetes compared with adolescents in the general population and adversely affects quality of life and diabetes outcomes (1-4). It is therefore recommended that screening for depression be performed routinely in this age-group, but there is no consensus on which measure to use for this purpose (1-3,5). The World Health Organization-Five WellBeing Index (WHO-5) is a short, positively worded instrument designed to assess the level of emotional well-being over a 14-day period. The screening properties of the WHO-5 have been studied in adults with and without diabetes against the Structured Clinical Interview for the Diagnostic and Statistical Manual (DSM)-IV, showing excellent sensitivity (94 -100%) and specificity (78%) (6,7). Given its brevity and focus on positive affect, the WHO-5 may be a suitable instrument to screen for low emotional well-being and depressive affect in adolescents with diabetes. Moreover, as the WHO-5 is a generic measure, it allows for comparison with healthy peers and is available in a multitude of languages. However, only one study so far used the WHO-5 in young men, but no validation data were reported (8). We therefore set out this study to investigate the reliability and validity of the WHO-5 in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS-Partici...