Development Of Secondary Sexual Characteristics Research Articles

Dynamics of anthropometric indicators in girls within the pubertal period of ontogenesis

The harmony of the organism development in different periods of ontogenesis, and especially puberty, determines the future fate of women in both medical and social aspects. The aim of the research was to study the total and partial body sizes in girls of pubertal period of ontogenesis. We surveyed 128 schoolgirls of 5-8 grades. We evaluated the stages of development of secondary sexual characteristics by hair growth in the axilla and pubis, the development of the mammary glands and age of onset of the first menstruation. According to G.G. Avtandilov’s classification, all girls were divided into three groups – prepubertal (preceding the appearance of pubic hair), pubertal (puberty before menarche) and postpubertal period (fixed and completed pubertal maturation). The group of pubertal girls consisted of 106 schoolgirls, who were divided into groups according to calendar age: 13-year-old (n=29), 12-year-old (n=30), 11-year-old (n=24) and 10-year-old (n=23). Anthropometric survey was conducted according to the scheme of V.V. Bunak and contained the definition of total (length and body weight) and partial (longitudinal, transverse and anterior-posterior) dimensions. The analysis of the obtained results was performed in the license package Statistica 5.5 using non-parametric methods of evaluation of indicators. In our study, it was found that anthropometric indicators characterize the physical development, the level of its harmony and morphofunctional maturity of girls within the pubertal period of ontogenesis. We found a progressive age dynamics of total and partial body size in girls of this age period. The periods of the most intensive growth within the pubertal period of ontogenesis of total and partial sizes of a body are established. At the end of puberty there is the most intense age increase in body length: a rapid increase in body weight begins at the age of 12, the most intense processes of longitudinal growth of the torso and lower extremities in girls are observed from 11 years. Most of the transverse dimensions within the pubertal period of ontogenesis have a pronounced progressive age dynamic. Lower thoracic size, interspinous distance, and external conjugate did not differ statistically significantly between girls of different ages during puberty.

Laparoscopic Davydov Procedure for Creation of Neovagina in MRKH Syndrome

Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a condition in which there is an absence of the uterus and the upper part (2/3) of the vagina. Women with MRKH syndrome show normal development of secondary sexual characteristics and a normal 46, XX karyotype. MRKH syndrome is a common cause of primary amenorrhea. Ultrasonography examination confirms kidneys, presence of the ovaries, and absence of uterus. Treatment should include a multidisciplinary approach to create a functional vagina. One of the procedures is laparoscopic Davydov vaginoplasty.
 Aim: To report MRKH syndrome case treated with laparoscopic Davydov vaginoplasty.
 Method: Ms. A, 21 years old, P0A0, came to FER clinic Moh. Hoesin Hospital Palembang with complaint, never had menstruation, the patient admitted her breast, and her pubic had growth. She wants to get married in the next six months. From the US result, there was non visualized uterus, genital band (+), and both ovaries within normal limit ~ MRKH Syndrome. Karyotype Examination: 46, XX. Patient was diagnosed with primary amenorrhea caused by MRKH syndrome and was planned for neovagina (Davydov Procedure).
 Result: A woman 21-year-old, P0A0, was diagnosed with primary amenorrhea caused by MRKH syndrome. The Davydov procedure was done to create a neovagina. Intraoperative, after protrusion of the wood mold as a marker shown, an incision is made to the left and right side so that the mold penetrates the abdominal cavity, then the mold is pulled into the vaginal canal slowly. The anterior and posterior peritoneal layers are drawn into the vaginal canal. The anterior and posterior peritoneal layers were withdrawn with an ovum clamp and then interrupted suture. The anterior and posterior peritoneal layers were sutured in a circular method to form a vaginal cuff. The vaginal wall is sutured (interrupted) to hold mold fixed.
 Conclusion: MRKH syndrome is a disorder that occurs in females and mainly affects the reproductive system. This condition causes the vagina and the uterus to be underdeveloped or even absent at birth. Patients with diagnosed MRKH syndrome require interdisciplinary care. Davydov procedure is a laparoscopically-assisted technique, which has an advantage over traditional approaches. It has shorter operating time, lower intraoperative complications, shorter hospital stay, and no external scars. Postoperatively, sexual function is similar to women without gynecological disorders.

Laparoscopic Davydov Procedure for Creation of Neovagina in MRKH Syndrome

Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a condition in which there is an absence of the uterus and the upper part (2/3) of the vagina. Women with MRKH syndrome show normal development of secondary sexual characteristics and a normal 46, XX karyotype. MRKH syndrome is a common cause of primary amenorrhea. Ultrasonography examination confirms kidneys, presence of the ovaries, and absence of uterus. Treatment should include a multidisciplinary approach to create a functional vagina. One of the procedures is laparoscopic Davydov vaginoplasty.
 Aim: To report MRKH syndrome case treated with laparoscopic Davydov vaginoplasty.
 Method: Ms. A, 21 years old, P0A0, came to FER clinic Moh. Hoesin Hospital Palembang with complaint, never had menstruation, the patient admitted her breast, and her pubic had growth. She wants to get married in the next six months. From the US result, there was non visualized uterus, genital band (+), and both ovaries within normal limit ~ MRKH Syndrome. Karyotype Examination: 46, XX. Patient was diagnosed with primary amenorrhea caused by MRKH syndrome and was planned for neovagina (Davydov Procedure).
 Result: A woman 21-year-old, P0A0, was diagnosed with primary amenorrhea caused by MRKH syndrome. The Davydov procedure was done to create a neovagina. Intraoperative, after protrusion of the wood mold as a marker shown, an incision is made to the left and right side so that the mold penetrates the abdominal cavity, then the mold is pulled into the vaginal canal slowly. The anterior and posterior peritoneal layers are drawn into the vaginal canal. The anterior and posterior peritoneal layers were withdrawn with an ovum clamp and then interrupted suture. The anterior and posterior peritoneal layers were sutured in a circular method to form a vaginal cuff. The vaginal wall is sutured (interrupted) to hold mold fixed.
 Conclusion: MRKH syndrome is a disorder that occurs in females and mainly affects the reproductive system. This condition causes the vagina and the uterus to be underdeveloped or even absent at birth. Patients with diagnosed MRKH syndrome require interdisciplinary care. Davydov procedure is a laparoscopically-assisted technique, which has an advantage over traditional approaches. It has shorter operating time, lower intraoperative complications, shorter hospital stay, and no external scars. Postoperatively, sexual function is similar to women without gynecological disorders.

HYPOPITUITARISM: A CASE REPORT OF OVERLOOKED DIAGNOSIS.

Hypopituitarism, which has a number of causes, is a severe endocrine condition that needs early diagnosis and treatment to prevent serious consequences. We report a 17-year old male seen in outpatient department for lack of development of secondary sexual characters and short stature. Laboratory investigation showed low total tri-iodothyronine (T3) , low total thyroxine (T4) and slightly elevated thyroid stimulating hormone (TSH) , low basal cortisol, and normal prolactin level. The patient also had low total testosterone, low LH, and FSH values. Magnetic resonance imaging (MRI) of the pituitary revealed a hypoplastic anterior pituitary with ectopic posterior pituitary. This case highlights the notable absence of recognizing the clinical presentation of hypopituitarism which at times is nonspecic and often progress insidiously before a diagnosis is made. The case calls attention to importance of thorough history taking, attention, and observation in making a new diagnosis that has the potential to alter a patient's health care and quality of life.

Frequency of iodine deficiency disorders among children living in the iodine deficiency region

Introduction. Currently, only a small number of countries have a stable iodine adequacy, about a third of the world’s population lives in areas with some iodine deficiency. Because children have an increased risk of adverse effects in response to iodine deficiency, it is important to assess the health of these children. Aim. To investigate the frequency of iodine deficiency in children from the iodine deficiency region. Methods. The research was conducted during expeditions to various geographical areas of Northern Bukovyna (Chernivtsi region, Ukraine). 1,973 school-age children were examined (measurement of anthropometric indicators, assessment of cognitive, physical and sexual development, ultrasonography of the thyroid gland (TG), ovaries and testicles, determination of hormonal status and iodine in urine). Results. Of 1,973 children, 53.7% (1060) had thyroid abnormalities. The frequency of goiter in the mountain zone – 59.8%. In 12.3% of children there was a tendency to increase of TSH. The median ioduria in children from mountainous areas corresponds to moderate iodine deficiency. Children from mountainous areas have various disorders: 38.5% disharmonious physical development, a third low intellectual development, disorders of the order of appearance and development of secondary sexual characteristics in the examined children. Conclusion. The results of the study show the negative impact of iodine deficiency on the body of children. It is necessary to continue monitoring of ioduria and children’s health and implement preventive measures.

Особенности полового развития девушек с общим и генитальным инфантилизмом в раннем репродуктивном периоде

Purpose — study of the severity of secondary sexual characteristics in girls with general and genital infantilism in the early reproductive period. Materials and methods. 150 girls with general and genital infantilism were examined. All examined girls underwent clinical, functional, hormonal, biochemical, radiological, genetic and laboratory tests. The average age of girls was 19.56±0.13 (17–22) years. The average weight of the examined was within 55.37±1.56 (32–98) kg, height 1.57±0.13 (1.36–1.71) m. The body-mass index was 22.5±0.48 (15–48). The severity of secondary sexual characteristics was assessed according the J. Tanner scale. Results and conclusions. It was found that adolescents with general infantilism (hypogonadotropic hypogonadism) have a significant delay in the development of secondary sexual characteristics against the background of mild hirsutism (р<0.05). In Patients with genital infantilism (hypergonadotropic hypogonadism), significant axillary and suprapubic hair growth at the background of poor development of the mammary glands was noted. Also the moderate degree of hirsutism was confirmed. With normogonadotropic hypogonadism, the development of secondary sexual characteristics corresponds to similar indicators of practically healthy girls. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: general infantilism, genital infantilism, hypogonadotropic hypogonadism, normogonadotropic hypogonadism, hypergonadotropic hypogonadism, hirsutism.

44. Abnormal Uterine Bleeding during Pubertal Induction with Transdermal Estrogen in Turner Syndrome: Experience from a Large Turner Syndrome Center

<h3>Background</h3> More than 80% of girls with Turner syndrome (TS) experience primary ovarian failure prior to the onset of menarche. Hormone replacement therapy (HRT) is recommended to start between 11-12 years of age, followed by titration to adult dosing over 18-24 months. Current guidelines recommend that HRT starts with transdermal estradiol, followed by the addition of oral progesterone once breakthrough bleeding occurs or after 18-24 months of unopposed estrogen therapy, whichever occurs first. In our TS population, several individuals have experienced abnormal uterine bleeding (AUB) while undergoing pubertal induction with transdermal estradiol. The objective of this study was to identify risk factors associated with and evaluate the management practices of AUB during pubertal induction among females with TS. <h3>Methods</h3> A retrospective case series of 45 TS females seen between January 2007 and June 2019 . Among these, 64% (n=29) served as controls and 55% (n=16) experienced AUB. <h3>Results</h3> Several risk factors for the development of AUB were identified: frequency of progestin cycling less than monthly (56.5% for cases vs. 0% for control), prolonged duration of unopposed estrogen (median of 21 months for cases vs. 17 months for controls), low dose (<200 mg) of progestin (50% of cases vs. 13.5% of control), and noncompliance with HRT (18.8%). Of the patients who experienced AUB, 3 received an additional 10 day course of progestins, 7 were treated by increasing their progestin dose, 6 were switched to another method of HRT (e.g. IUD or OCP), 6 increased cycling frequency to monthly, 4 required hospitalization, 2 required iron supplementation, and 2 required a transfusion with blood products. <h3>Conclusions</h3> Based on our experience, we recommend the following to prevent AUB during pubertal induction with transdermal estrogen in TS girls: 1) Cycle with progestins monthly, 2) Introduce progestins at the onset of breakthrough bleeding or at 18 months, whichever occurs first, 3) Use progestin dosing at the upper end of the recommended range (e.g. 200 mg for micronized progesterone) 4) Counsel all patients regarding the risk of AUB, 5) Monitor all patients regularly during pubertal induction, 6) Monitor with heightened surveillance those patients who show rapid development of secondary sex characteristics on low dose estrogen.

59. Tamoxifen for Puberty Induction and Bone Mineral Density Protection in a Gender Non Binary Patient With 46, XY Complete Gonadal Dysgenesis: A Case Report

<h3>Background</h3> 46XY complete gonadal dysgenesis patients present with primary amenorrhea and delayed puberty. There is an increased risk of gonadoblastoma and often undergo surgical resection. Following diagnosis, sex hormone replacement therapy is started for puberty induction. Tamoxifen prevents loss of bone mineral density in postmenopausal women and has been used to treat gynecomastia in prepubertal males. We present a case of a nonbinary patient with 46XY complete gonadal dysgenesis where typical sex hormone replacement therapy would be incongruent with the patient's gender identity and instead, tamoxifen was used for puberty induction and bone health protection. <h3>Case</h3> A 15 year old patient with autism and ADHD presented with primary amenorrhea. Breast development occurred 1.5 years prior without development of pubic or axillary hair. They had previously identified as gender neutral. They had an elevated FSH (51mIU/mL), elevated LH (16mIU/mL), low estradiol (<2.5pg/mL), low testosterone (10ng/dL), and karyotype 46XY SRY+ of unknown molecular etiology. Sonography showed a prepubertal uterus (4.5 × 0.5 × 2.5cm) and intraabdominal gonads. The workup was suggestive of 46XY complete gonadal dysgenesis. DEXA scan showed decreased bone mineral density for chronologic age (Z score -2.3, whole body BMD:0.71 g/cm2). They were counseled regarding the risk of gonadoblastoma in intraabdominal gonads and elected to undergo a laparoscopic gonadectomy. They expressed concerns about sex hormone replacement and did not wish to develop secondary sex characteristics that would be incongruent with their nonbinary identity. A selective estrogen receptor modulator (tamoxifen) was started for bone health protection without the development of secondary sex characteristics. At 4 months, their height had increased 2cm and had a reduction in breast tissue. At 1 year, their height had increased 5cm and the increase in growth velocity showed pubertal induction. Repeat ultrasound demonstrated a uterus size of 6 × 1.3 × 2.2 cm and a non-visualized endometrial stripe. DEXA showed improvement (Z score -2.2, whole body BMD:0.81 g/cm2). Tamoxifen was titrated up to a goal dose of 15-20mg daily. Mental health and psychosocial adaptation was regularly screened following the DSD-TRN protocol. The patient has not had any menstrual bleeding, continues on the tamoxifen, and plans to undergo a hysterectomy at the age of 18. <h3>Comments</h3> Following gonadectomy in patients with 46XY complete gonadal dysgenesis, hormone replacement therapy is imperative for overall heath, puberty induction, and bone health. In patients who require sex hormone replacement but whose gender is not consistent with a male or female gender identity, a selective estrogen receptor modulator can be used.

Diagnosis and management of precocious sexual maturation: an updated review.

The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. It is classified as central precocious puberty when premature maturation of the hypothalamic-pituitary-gonadal axis occurs, and as peripheral precocious puberty when there is excessive secretion of sex hormones, independent of gonadotropin secretion. Precocious sexual maturation is more common in girls, generally central precocious puberty of idiopathic origin. In boys, it tends to be linked to central nervous system abnormalities. Clinical evaluation should include a detailed history and physical examination, including anthropometric measurements, calculation of growth velocity, and evaluation of secondary sexual characteristics. The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. Hormonal assessment and imaging are required for diagnosis and identification of the etiology. Genetic testing should be considered if there is a family history of precocious puberty or other clinical features suggestive of a genetic syndrome. Long-acting gonadotropin-releasing hormone analogs are the standard of care for central precocious puberty management, while peripheral precocious puberty management depends on the etiology.Conclusion: The aim of this review is to address the epidemiology, etiology, clinical assessment, and management of precocious sexual maturation. What is Known: • The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. • Long-acting gonadotropin-releasing hormone agonist (GnRHa) is the standard of care for CPP management, and adequate hormone suppression results in the stabilization of pubertal progression, a decline in growth velocity, and a decrease in bone age advancement. What is New: • Most cases of precocious sexual maturation are gonadotropin-dependent and currently assumed to be idiopathic, but mutations in genes involved in pubertal development have been identified, such as MKRN3 and DLK1. • A different preparation of long-acting GnRHa is now available: 6-month subcutaneous injection.

The relationship between body weight and dietary habits with respect to the timing of puberty among saudi children and adolescents.

Objective:The objective is to investigate the timing of pubertal onset as determined by the development of secondary sexual characteristics in relation to body weight and dietary patterns among Saudi females.Methods:Children/adolescents visiting general and endocrinology pediatric clinics in King AbdulAziz University Hospital were invited to participate in this study. Female subjects between the ages of 5 and 20 years were included in this study, and those with syndromic disease, chronic comorbidities, endocrinopathies, organic causes of precocious puberty, positive family history of early pubertal onset, and under chronic medication were excluded from the study. Data were collected through clinical interviews with the consent of the legal guardians, and physical examinations were conducted.Results:A total of 164 females were investigated. The mean age of thelarche, adrenarche, and menarche was 10, 11.3, and 12.2 years, respectively. We found a significant correlation between higher weight standard deviation and an earlier age of both thelarche and adrenarche. In addition, daily consumption of fast foods was significantly associated with an earlier menarchal age. Consumption of nonorganic poultry was linked to early thelarche.Conclusion:Efforts should be directed to increase public and community awareness that fast food consumption, inorganic poultry, and higher body weight are important modifiable factors that lead to an earlier onset of female puberty across different parameters: breast development, adrenarche, and menstruation.

Cytogenetic Study of Patients with Primary Amenorrhea in the Northeast of Iran.

Background & Objective:Primary amenorrhea refers to the absence of menstruation in females of reproductive by age 16 when the development of secondary sexual characteristics is evident (breast development, pubic hair) or by age 14 when there are no secondary sexual characteristics are present. Primary amenorrhea can occur in several quite different reasons. Common hormonal causes of primary amenorrhea include constitutional delay, hypothalamic or pituitary disorders, chronic systemic disease, and primary ovarian insufficiency, some endocrine gland disorders, and other causes. Previous studies suggested that chromosomal abnormality is the second most common cause of amenorrhea. This report aims to measure the prevalence of the chromosomal abnormality in primary amenorrhea (PA) patients in the northeast of Iran.Methods:Chromosomal study was carried out on 200 patients with clinical features. The standard method for culturing peripheral venous blood lymphocyte was to prepare metaphase chromosomes and perform routine GTG band analysis.Results:The results revealed that 71% of PA had normal female karyotype (46,XX) and 29% showed different chromosomal abnormalities. The chromosomal abnormalities can be categorized into seven primary groups with or without mosaicism. 1- The most common karyotype was X chromosome aneuploidy (10.5%, n=21), 2- Male karyotype with or without structural abnormality of Y chromosome (5.5 %, n=11), 3- Mosaicism of turner karyotype and structural anomalies of X chromosome (4%, n=8), 4- Structural anomalies of the X chromosome (3.5%, n=7), 5- Mosaicism of turner karyotype and normal karyotype (3%, n=6), 6- Mosaicism of turner karyotype and male karyotype (1.5%, n=3) and 7- Super female karyotype (1%, n=2).Conclusion:The present study has emphasized that early cytogenetic and timely investigation can be necessary for the evaluation of primary amenorrhea.

Using reproductive technologies to assess the development of secondary sexual characteristics, ovarian senescence and hermaphroditism in the endangered mountain yellow-legged frog Rana muscosa.

Anurans can display a host of intriguing sexual syndromes, including hermaphroditism and sex reversal. Using a multifaceted approach for diagnosing and characterising hermaphroditism in the endangered anuran species Rana mucosa , we tracked changes in female reproductive status using hormone monitoring, ultrasound examinations, individual life history, fertilisation records and post-mortem findings. Seven individuals originally sexed as females developed secondary male sexual characteristics, behaviour and hormone profiles and, in some cases, had testicular tissue despite having previously laid eggs. Our results suggest that reproductive technologies can shed light on life history patterns and reproductive anomalies that may affect endangered anuran survival.

The Tendency for Adolescent Girls to Feel Comfortable in Communicating About Puberty and Reproductive Health with their Families: A Systematic Review

ackground: There are knowledge problems related to puberty and health problems among adolescent girls so that they cannot be confident in effectively handling changes in their bodies during puberty as well as long-term reproductive health. Purpose: This study aims to systematically review the tendency for adolescent girls to feel comfortable in communicating about puberty and reproductive health with their families. Method: Systematic review is conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The search was conducted through PubMed, Google Scholar, and Science Direct databases on English studies from 2016-2021 published date. Results: Adolescent girls feel free to discuss issues related to puberty such as the development of secondary sex characters, menarche, and menstruation with the mother due to feelings and gender-specific compatibility This is due to stigma and perceived taboos in sociocultural factors. Fluency in communication is also caused by various factors such as knowledge between family and children, the number of families and attitudes and ways of communication of parents. Conclusion: Parental involvement is important in giving knowledge about reproductive health for adolescent girls but must ensure that the family have good knowledge and good ways of communication as well as approaches to overcome barriers in the gender perspective.

Spontaneous puberty in Turner’s syndrome: A case report

Turner syndrome is a pan-ethnic congential disorder caused by the partial or complete absence of one of the X chromosomes in females. Development of secondary sexual characteristics or menarche or spontaneous conception in Turner syndrome requires hormonal replacement therapy. Only a very few cases have been documented with spontaneous menarche with Turner syndrome. In this report, we are presenting a case of Turner syndrome, along with thyroid dysfunction who had spontaneous menarche. Keywords: Spontaneous puberty, Spontaneous menarche, Turner syndrome.

Sexual development and menstrual function in adolescent girls after viral hepatitis

Purpose of the study: to prove the pathological effect of chronic viral hepatitis on sexual development (SD) and menstrual function of adolescent girls by analyzing the secondary sexual characteristics and to determine the features of disorders of menstrual function (DMF) in such patients.Materials and methods. The study involved 150 girls of pubertal age (12–17 years) who were divided into groups: the main group (n = 50) – patients with DMF and SD on the basis of chronic viral hepatitis B and C; comparison group (n = 50) – patients with DMF and SD on the basis of hepatobiliary system diseases (cholecystitis, dyskinesia of the biliary tract); control group (n = 50) – almost healthy girls. All patients underwent clinical analysis of menstrual function, appearance and development of secondary sexual characteristics, clinically determined the degree of SD and SD score calculated.Results. The whole spectrum of DMF in the main and comparison group was revealed. There were more patients with hypomenstrual type of DMF in the main group than in the comparison group: 37 (74%) against 28 (56%) (p &lt;0.05). Patients with juvenile uterine bleedings were almost equally: 8 (16%) in the main and 7 (14%) in the comparison group (p &lt;0.05). There were three times more patients with dysmenorrhea in the comparison group – 15 (30%) girls against 5 (10%) in the main group (p &lt;0.05). The dependence of SD disorders and clinical form of DMF on the time of hepatitis development in the main group was revealed: SD delay and primary amenorrhea were more often with the disease onset in childhood, persistent oligomenorrhea was formed in the prepubertal period, and juvenile uterine bleedings and secondary amenorrhea in the late puberty (p &lt;0.05).Conclusions. This study demonstrated the role of hepatobiliary system diseases in slowing puberty of girls, characterized by disturbance of the secondary sexual characteristics onset, deviation of the SD score. Dependence of DMF on periods of exacerbation of hepatobiliary system diseases was also determined.

Systematic Review: Puberty suppression with GnRH analogues in adolescents with gender incongruity.

Gender incongruence is defined as disharmony between assigned gender and gender identity. Several interventions are liable in this case including genital affirming surgery among other surgical interventions such as harmonization, and also the use of gonadotropin-releasing hormone agonists (GnRHa) for gonadal shielding. This aids in preventing the development of secondary sexual characteristics related to the genetic sex. Systematically review the treatment of gender incongruity with GnRHa analogues. The data source of this research is from Pubmed-Medline and Embase. Articles published between 2009 and 2019 which studied transgender adolescents treated with GnRHa were carefully selected. Were extracted: design, sample size, study context, targeted subjects of intervention, outcome measures, and results. Eleven studies were included. The use of GnRHa seems to be well tolerated by the studied population. When started in pubertal transition, it was associated with a more distinct resemblance to body shape than to the affirmed sex. In addition to preventing the irreversible phenotypic changes that occur in cross-hormonal therapy, the use of GnRHa can equally contribute to the mental health of these adolescents. There are few consistent studies on the use of GnRHa for gender incongruence. As the population of transgender children and adolescents grows, they acquire knowledge and greater access to the various forms and stages of treatment for sex reassignment. The medical community needs to be adequately prepared to better serve this population and offer the safest resources available.

Clinical manifestation, diagnosis, and treatment of Klinefelter syndrome

Klinefelter syndrome is the most common congenital chromosomal syndrome in men. Clinical manifestations of Klinefelter syndrome vary greatly depending on the level of expression of the added X chromosome, the sensitivity of the androgen receptor, and the testosterone level. On average, the likelihood of a lifetime diagnosis of Klinefelter syndrome patients is less than 40%, and more than 60% of patients are unaware of their condition. Klinefelter syndrome patients in infancy sometimes have speech impairment; however, there are more cases without symptoms. In the early stages of puberty, there are many normal puberty development cases, but after mid-puberty, secondary sexual characteristics stop progressing. In adulthood, it is often diagnosed as a non-obstructive azoospermia disease. After middle-age, an increase in various metabolic disorders due to testosterone reduction appears as the main symptom. Testosterone treatment can promote the development of secondary sexual characteristics from puberty. Diagnosing a patient with Klinefelter syndrome due to infertility in adulthood may cause a psychological shock; therefore, a psychotherapeutic approach is also essential. Klinefelter syndrome is a disease that requires lifelong management, and in most cases the quality of life of patients and their families can be improved with appropriate therapeutic intervention. Because there are many cases without symptoms, it is important to screen suspected patients through active chromosomal testing.

Evaluation of Characteristics of the Dental Maturity in Girls with Precocious Puberty

Precocious puberty (PP) is defined as the early development of secondary sexual characteristics (before the ages of 8 years in girls and 9 years in boys). The aim of this study is to identify characteristics of the dental maturity in girls with PP that discriminate them from normal healthy girls.This study included 99 girls aged 6 - 8 years with PP and 99 girls without past medical history of same chronological age (control group). The study was performed on 198 panoramic radiographs (99 PP girls, 99 control group girls). Demirjian method was used to evaluate the panoramic radiographs and determine dental maturity. Difference in dental maturity score and tooth formation stages between the two groups were analyzed.The PP group showed significant higher maturity score than control group. Among mandibular teeth, mandibular 2nd premolar and 2nd molar were significantly more mature in the PP group than control group. Logistic regression analysis showed that mandibular 2nd molar was only significant predictor for PP girls.

Forever young? The ethics of ongoing puberty suppression for non-binary adults

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way...

Roles of gonad-inhibiting hormone in the protandric simultaneous hermaphrodite peppermint shrimp†.

To date, the molecular mechanisms of the unique gonadal development mode known as protandric simultaneous hermaphroditism (PSH) are unclear in crustaceans. In this study, cDNA of a gonad-inhibiting hormone (Lv-GIH1) was isolated from the PSH peppermint shrimp Lysmata vittata, and its expression was exclusively found in the eyestalk ganglion. Real-time quantitative polymerase chain reaction (qRT-PCR) revealed that the expression of Lv-GIH1 increased during gonadal development of the functional male stages but decreased significantly at subsequent simultaneous hermaphroditism stage. Further in vitro experiment showed that recombinant GIH1 protein (rGIH1) effectively inhibited Vg expression in the cultured hepatopancreas tissues while the short-term injection of GIH1-dsRNA resulted in reduced expression of Lv-GIH1 and upregulated expression of Vg in the hepatopancreas. Moreover, long-term rGIH1 injection led to significantly reduced expression of Lv-Vg, Lv-VgR, and Lv-CFSH1, subdued growth of oocytes, and feathery setae as a secondary sexual characteristic in females. Interestingly, while germ cells in testicular part were suppressed by rGIH1 injection, the expression of Lv-IAGs showed no significant difference; and long-term GIH1-dsRNA injection results were contrary to those of rGIH1 injection. Taken together, the results of this study indicate that Lv-GIH1 is involved in gonadal development and might also participate in controlling secondary sexual characteristic development in L. vittata by inhibiting Lv-CFSH1 expression.