Pubic Hair Development Research Articles

Effects of Early Life Adversity on Pubertal Timing and Tempo in Black and White Girls: The National Growth and Health Study.

Although exposure to abuse in early life predicts earlier pubertal timing, especially for girls, it is unclear if this association generalizes to nonabuse stressors. In addition, the impact of race on the stress-maturation association remains unknown. To address these issues, we examined whether race moderates the effects of early adversity on pubertal timing and tempo using a longitudinal study design. In a cohort of 9- and 10-year-old Black and White girls, pubertal (areolar and pubic hair) maturation was assessed annually for 7 years. In adulthood, 368 participants (186 Black, 182 White) reported on abuse and nonabuse stressors they experienced from ages 0 to 12 years. Early life abuse was associated with earlier pubertal timing, as indexed by younger age at menarche (b = -0.22, p = .005, 95% confidence interval [CI] = -0.39 to -0.06) and greater pubic hair development (b = 0.11, p = .003, 95% CI = 0.04 to 0.18), in addition to slower pubertal tempo, as indexed by slower rate of pubic hair (b = -0.03, p < .001, 95% CI = -0.05 to -0.01) and areolar (b = -0.02, p = .02, 95% CI = -0.03 to -0.003) development. These associations were not found for nonabuse adversity. Black girls with early life abuse had greater pubic hair development (b = 0.23, p < .001, 95% CI = 0.12 to 0.35) and were slower in pubic hair tempo (b = -0.07, p < .001, 95% CI = -0.09 to -0.04) than their White counterparts. Screening for early life abuse may help address health disparities related to earlier pubertal timing.

Maternal pre-pregnancy body mass index, gestational weight gain, and pubertal timing in daughters: A systematic review and meta-analysis of cohort studies.

The timing of daughter's puberty onset is constantly earlier. It is still unclear about the maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) as important prenatal factors that may affect offspring's onset of puberty. Thus, we evaluated the association among maternal pre-pregnancy BMI, GWG, and daughters' early pubertal development based on the existing literature. Literature review was conducted in different databases, including Web of Science, Pubmed, Wiley, ScienceDirect, Web of Science, and Chinese National Knowledge Infrastructure databases up to June 2021. We selected random effects model or fixed effects model for meta-analysis according to the I2 statistics value to obtain the summary measurement. A total of 12 cohort studies were included. Compared to maternal pre-pregnancy normal weight, maternal pre-pregnancy overall overweight/obesity (RR = 1.24; 95% CI 1.17 to 1.32), obesity (RR = 1.35; 95% CI 1.23 to 1.48), and overweight (RR = 1.17; 95% CI 1.09 to 1.26) were significantly associated with the increased risk of earlier timing of pubertal onset in daughters. Daughters born of mothers with pre-pregnancy overall overweight/obesity, obesity, and overweight had earlier pubertal onset compared to those born of mothers with normal weight ([mean difference = -3.03, 95% CI: -3.97 to -2.10], [mean difference = -3.50, 95% CI: -5.38 to -1.62], and [mean difference = -2.89, 95% CI: -4.07 to -1.71], respectively). The effects were also significant in the assessed three milestones (menarche, breast development, and pubic hair development). Maternal excessive GWG increased the risk of early pubertal timing in daughters (RR = 1.19; 95% CI 1.09 to 1.30).

A CASE REPORT ON ANDROGEN INSENSITIVITY SYNDROME

Androgen Insensitivity Syndrome is an X linked disorder resulting in normal masculinization of external genitalia due to loss of function mutation in AR gene. Case Report : A 18 year old female presented with C/O not attaining menarche. Patient gives a history of lack of development of pubic and axillary hair. No history of abnormal breast development,cyclical abdominal pain or excessive weight gain. No relevant family history. O/E No palpable swellings in abdomen or bilateral inguinal region. External genitalia appear like a normal female external genitalia. The patient's karyotyping was done and it is of male genotype. The patient is diagnosed as Complete AIS as the phenotype is female and genetically male. The patient is managed by laparoscopic B/L orchidectomy with B/L deep ring closure.

Pubertal Development among HIV-Infected Children aged 8-18 Years in Dar es Salaam, Tanzania: A Cross Sectional Study

Background Pubertal development can be impaired among children living with HIV. This can lead to a psychosocial burden and subsequent negative self-image, social withdrawal and declining academic performance. Objective To assess timing of pubertal development of HIV infected children aged 8-18 years in Dar es Salaam, Tanzania. Methods This was a hospital-based cross-section study conducted at Amana and Mwananyamala, Care and Treatment Centres (CTC) in Dar es Salaam, Tanzania. A structured questionnaire was used to collect information on demographic and clinical characteristics. Participants were regarded to have entered puberty if they were at Tanner stage 2 or more for either breast (female) or genital (male) development and Tanner stage 2 or more for pubic hair development in both sexes. Data was analysed using STATA version 10 statistical packages. Puberty development of study participants was compared to their peers in a database of health children and adolescents attending schools in Dar es Salaam, Tanzania. Descriptive statistics were summarised as median (interquartile range), mean (standard deviation) for continuous variable and proportions for categorical variables. Differences in various groups was tested using Student t- test (means), Mann-Whitney U test (median) and chi square test (Proportions) and p value of < 0.05 was considered significant. Results A total of 330 HIV infected children were recruited, out of these 183 (55.4 %) were females. The median age of the study populations was 12.0 years (IQR 11-15). Median duration on ART at the time of the study was 48 months (IQR 30-62). Majority were in WHO stage III and had CD4 cell count above 500cells/µl. The median age at menarche for HIV infected adolescents was 15 years (IQR 14-16). HIV infected females and males had no significant age difference at baseline but attained puberty one or two years later than their HIV negative peers. Conclusion HIV infected children have delayed sexual maturation compared to their HIV negative peers. We recommend that as part of physical examination of an adolescent, sexual maturation to be emphasized and those identified to have delayed onset to be followed up and offered appropriate counselling.

Primary Amenorrhea with Mayer-Rokitansky-Kuster-Hauser Syndrome

BACKGROUND: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare disorder described as aplasia or hypoplasia of uterus and vagina due to an early arrest in the development of Mullerian ducts. The etiology of MRKH syndrome remains uncertain: Although at the beginning, it was mentioned that this syndrome was the result of sporadic abnormalities. It has recently been assumed the genetic background is the cause of the increasing number of familial cases. CASE REPORT: A 29-year-old female patient presented with amenorrhea. She also has normal pubic and axillary hair and breast development. Routine investigations were normal. Genitalia inspection shows that pubic hair was well developed, labia majora and vagina were seen. Inspeculo show that vaginal wall was smooth, but portio was not seen. Vaginal examination result: The uterus was unpalpable, both adnexa were normal, parametrium was laxed, and Douglas pouch was not protruded. Rectal examination shows that uterus and both adnexa were difficult to identify. Transvaginal sonography revealed absence of uterus, both ovaries within normal. Transvaginal sonography diagnosed a uterine aplasia. With this, the provisional diagnosis made as primary amenorrhea due to suspected MRKH syndrome, the patient was referred for follicle-stimulating hormone, estradiol, testosterone, and prolactin levels by enzyme-linked immunosorbent assay examination and the result was within normal limit followed by genetic karyotyping and the result was normal 46, XX. CONCLUSIONS: We report a 29-year-old woman with primary amenorrhea. From our examination, the patient was diagnosed with MRKH syndrome. Uterus transplant is an alternative for that woman to treat amenorrhea and possibility to get pregnant.

6-Month Subcutaneous Leuprolide Acetate Effectively Suppresses Clinical Signs of Puberty in Children With Central Precocious Puberty

Objective: Gonadotropin-releasing hormone (GnRH) agonists, such as intramuscular leuprolide acetate, triptorelin and the subcutaneous histrelin implant, are standard treatment for central precocious puberty (CPP). Implants require surgery and sometimes anesthesia, while frequent intramuscular injections can be painful. A shift to longer acting-formulations and subcutaneous injections has been proposed for the treatment of CPP. Therapies with convenient administration, prolonged duration of action and favorable safety profile may be beneficial, improving patient adherence. 87% of subjects achieved stimulated LH suppression to <4 IU/L by Week (W) 24 in a Phase III trial evaluating the efficacy and safety of the first6-month subcutaneous injectable in situ gel leuprolide acetate for CPP. We present secondary analyses of bone age (BA) advancement, weight, BMI, and pubertal maturation from this trial. Methods: 62 children (60 girls, 2 boys) with CPP (naïve to treatment) received 2 doses of 45 mg subcutaneous leuprolide acetate at 24-week intervals, constituting the intent-to-treat population. Radiographs of the left hand and wrist were used to determine BA using the Greulich and Pyle method. BA was assessed by a blinded central reader. Rate of BA advancement was determined by the ratio of BA to chronological age (CA, BA/CA). Pubertal maturation was categorized with the Tanner staging system using breast development, external genitalia, and pubic hair. Safety outcomes were measured. Results: Mean age at onset of treatment was 7.5 ± 0.9 (SD) (range 4-9) years. BA/CA consistently declined throughout treatment, from 1.4 ± 0.2 at baseline, to 1.3 ± 0.1 at W24 and 1.3 ± 0.1 at W48. Although mean weight increased 8.7% from screening to W24 (34.8 kg vs 37.7 kg) and 16.9% from screening to W48 (40.4 kg), mean BMI remained stable throughout the study. The proportion of girls with early breast Tanner stage development (stage 1 and 2) increased from 9% at baseline to 37% at W48. The proportion of girls with late breast Tanner stage development (stage 4 and 5) decreased from 18% at baseline to 5% at W48. Both boys regressed from Tanner stage 3 to stage 2 for external genitalia development by W48. Tanner staging for pubic hair development remained stable for approximately 80% and decreased for 7% of children by W48. 52/53 treatment emergent adverse events were mild or moderate. Conclusions: 6-month 45 mg subcutaneous leuprolide acetate is a promising treatment for CPP. It effectively suppressed LH, suppressed clinical signs of pubertal maturation and demonstrated a good safety profile. It also has the beneficial features of subcutaneous administration, small injection volumeand twice a year dosing. This may be a welcome addition to the armamentarium given the proposed shift in CPP therapies towards longer-acting formulations and subcutaneous injections.

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.

Girls' Pubertal Timing and Tempo and Mental Health: A Longitudinal Examination in an Ethnically Diverse Sample

PurposeEarlier timing and faster tempo of puberty have been linked to adolescents' poor mental health. Previous research rarely adjusted for childhood mental health, did not use physical examination to assess puberty, and excluded Latinas and Asian Americans. This study addressed these limitations. MethodsWe followed 822 girls, recruited at ages 6-8, for 8 years. Breast and pubic hair development and anxiety and depressive symptoms were assessed prospectively and repeatedly. Structural equation models tested whether pubertal timing and tempo were associated with adolescent mental health symptoms and whether associations varied by ethnicity. Models were adjusted for childhood mental health symptoms, body mass index, and family income. ResultsEarlier breast development was associated with higher depressive symptoms among whites (β = −.19; p < .01) and higher anxiety symptoms among Latinas (β = −.26; p < .05), but lower depressive symptoms among Asians (β = .24, p < .05). Later pubic hair development (b = .24; p < .05) and faster pubic hair tempo (β = .26; p < .01) were associated with higher anxiety symptoms among Latinas. Faster pubic hair tempo was associated with lower depressive symptoms among Asians (β = −.34; p < .05). Tempo of breast development showed no associations. ConclusionsFindings confirmed that earlier breast development was associated with higher mental health symptoms for Latina and white girls but was protective among Asians. Results for pubic hair and pubertal tempo were inconsistent, requiring future examination. While targeted interventions to prevent mental health problems among early-maturing girls are critical, there is variability among who might benefit most.

Prevalence of precocious puberty among Chinese children: a school population-based study.

To investigate the prevalence of precocious puberty in school-based population in Zhongshan, Guangdong, China. We recruited a total of 4058 students in grades 1-3 using a multistage stratified cluster random sampling method in a population-based cross-sectional study. We evaluated height, weight, and development of breast and pubic hair in girls, breast development was evaluated by inspection and palpation combined with ultrasound detection for overweight and obese girls, and testicular volume and development of pubic hair in boys. We estimated overall, sex-, age, and district-specific prevalence of precocious puberty and examined the association between prevalence of precocious puberty and body mass index (BMI). The unadjusted and adjusted prevalence of precocious puberty by Tanner stage was 4.74% (girls:8.78%, boys:2.58%) and 6.19% (girls:11.47%, boys:3.26%), respectively. In both urban and suburban areas, the prevalence of precocious puberty was higher in the overweight and obese group than in the normal-weight group (p < 0.05). The prevalence of precocious puberty among overweight (27.94%) and obese (48.00%) girls was higher than that of normal-weight girls (8.73%) (p value for trend < 0.05). In boys, the prevalence of precocious puberty in the obese (6.78%) group was higher than that in the normal-weight (2.86%) group (p < 0.05). The prevalence of precocious puberty was high in China. Overweight and obesity was related to precocious puberty, but this correlation had gender differences and may be affected by other environmental factors.

Dealing with adolescent not a child’s play

Adolescents are one-third of the country’s population and dealing with adolescents is not a child’s play. According to the WHO, around 1.2 billion people, or 1 in 6 of the world’s population, are adolescents aged 10–19. Adolescence is the second growth spurt of life and poses lots of challenges for the adolescent, parents, and caregivers. It marks a transition characterized by physical, emotional, and social changes. It is one of the most crucial and challenging periods of life with peak intelligence and stamina. The physical changes that herald adolescence are – the development of breasts, axillary and pubic hair, and first menstrual periods for girls and deepening of voice and broadening of shoulders for boys, which are the most striking markers of this stage. Developing brains bring new cognitive skills that enhance their reasoning ability and abstract thinking but these changes occur few years later than the physical development which brings in challenges for the adolescents and their caregivers. Adolescents develop cognitively, physically, socially, and emotionally. It prepares them to experiment with new behaviors. There is a high chance of adolescents getting into smoking, alcohol, and drug abuse. Changing sexuality predisposes for early unprotected and premarital sex. Some of the reasons for high- risk behavior in adolescents includes Living in increasingly sexualized societies, impact of media, rapid growth of cities, and breakdown of traditional family structure. HEADSS criteria are the best way to assess the characteristics of an adolescent (1) H – Home, (2) E - Education and employment, (3) A – Activity, (4) D – Drugs, (5) S – Sexuality, (6) S – Suicide/depression. Adolescents (20%) are important asset to our nation. Pediatricians with a little training can deal with the adolescent in a comfortable way.

Longitudinal Associations of Pubertal Timing and Tempo With Adolescent Mental Health and Risk Behavior Initiation in Urban South Africa

PurposeIn high-income countries, early and rapid pubertal development is consistently associated with poor adjustment and increased risk behavior in adolescence. This study contributes to the meager knowledge of these associations in lower income countries. MethodsWe used longitudinal data from 1,784 urban black South Africans in the Birth to Twenty Plus cohort. We used regression analyses to assess associations between age at menarche and latent classes of pubertal timing and tempo and adolescent internalizing and externalizing emotional and behavioral problems, eating attitudes, and patterns of health risk behavior initiation. ResultsRelatively earlier and faster pubertal timing and tempo were associated with increased health risk behavior initiation (e.g., adjusted odds ratio [95% confidence interval] high- vs. low-risk pattern = 5.7 [1.7, 19.06] for male genital development; adjusted odds ratio = 3.45 [1.13, 10.49] for female breast development). Among males, earlier and faster pubertal timing and tempo were associated with increased externalizing problems in early adolescence and increased oppositional defiant problems in midadolescence, whereas later and slower pubertal timing and tempo were associated with decreases. Among females, earlier and faster pubertal timing and tempo were associated with increased internalizing and externalizing problems in midadolescence and increased dieting behaviors in early and late adolescence (β [95% confidence interval] = 2.51 [.87, 4.15] for pubic hair development), whereas later and slower pubertal timing and tempo were associated with decreases. ConclusionsIn this urban South African cohort, relatively earlier and faster pubertal development was detrimental to mental health and risk behavior activity, whereas later and slower maturation was somewhat protective.

Normative values of handgrip strength in adolescents according to chronological age and sexual maturation

Aim: Handgrip strength is considered an important health indicator. It is extremely important to establish normative values so that the handgrip strength is correctly interpreted in adolescents. The present study aims to establish normative values of handgrip strength (HGS) for adolescents, according to chronological age and sexual maturation. Methods: Data from three large projects carried out in Florianopolis and São José, Santa Catarina were used, corresponding to a sample of 2,637 adolescents aged 14 to 19 years old of both sexes (1,428 girls). The HGS of the right and left hands was measured by a manual dynamometer, and total HGS being defined by the sum of the left hand and the right-hand strength. Sexual maturation was determined by the development of pubic hair. The percentiles 3, 10, 15, 25, 50, 75, 85, 90, and 97 were calculated for the right, left, and total HGS. The percentile ranges < p15 (low), p15-p85 (normal) and > p85 (high) were used. ANOVA and Kruskal-Wallis tests were applied. Results: In boys, the mean total HGS ranged from 67.5 ± 16.5 to 86.9 ± 21.8 (p < 0.001) and 74.3 ± 17.5 to 82.2 ± 17.8 (p < 0.001) for age and sexual maturation, respectively, while in girls the mean HGS total ranged from 48.8 ± 11.3 to 56.4 ± 16.0 (p = 0.127) and 47.8 ± 10.6 to 54.3 ± 12.3 (p < 0.001). Conclusion: Reference values established by the percentile score, can be used to identify adolescents with better athletic condition and can be useful for prescribing exercises.

Clinicohormonal Parameters as a Primary Step to Differentiate Normosmic Idiopathic Hypogonadotropic Hypogonadism and Kallmann Syndrome in a Tertiary Care Hospital in Eastern India

Introduction: Idiopathic hypogonadotropic hypogonadism is a rare gonadal dysgenesis in which puberty does not take place naturally. It occurs due to insufficient pulsatile secretion of Gonadotrophin-Releasing Hormone (GnRH) and the resulting Follicle-Stimulating Hormone (FSH) and Luteinising Hormone (LH) deficiency leads to absence of or delayed sexual maturation. Kallmann syndrome is an uncommon genetic disorder characterised by hypogonadotropic hypogonadism associated with anosmia or hyposmia. When anosmia is absent, the same is referred as normosmic Idiopathic Hypogonadotropic hypogonadism (nIHH). Aim: To find out the significant differences between Kallmann syndrome and nIHH based on clinical features and biochemical assessment as a primary measure to initiate the treatment early. Materials and Methods: This hospital based cross-sectional observational cohort study was conducted in Department of Endocrinology, Nilratan Sircar Medical College and Hospital, Kolkata, India. The study was done on 55 cases of IHH presenting to the department with delayed secondary sexual characteristics. Results: Out of these 55 cases, 45 (81.8%) were of nIHH and only 10 (18.2%) cases were of Kallmann Syndrome. It was found that both the conditions show male predominance. Smell abnormalities were present only in Kallmann group. The level of serum testosterone was significantly higher (p&lt;0.05) in nIHH subjects (mean-35.59 ng/dL) than patients with Kallmann Syndrome (mean-14.90 ng/dL). Patients with Kallmann syndrome showed significantly reduced pubic and axillary hair development and absence of gonadal development. Conclusion: Absence of puberty with anosmia/hyposmia with low serum FSH and LH, drastically reduced serum testosterone, are factors that point towards the diagnosis of Kallmann syndrome even in absence of genetic study, which is helpful for initiation of hormone replacement therapy for treatment.

The role of pelvic ultrasound for the diagnosis and management of central precocious puberty: An update.

Sexual precocity refers to the appearance of physical and hormonal signs of pubertal development at an earlier age. It may be considered as the expression of secondary sexual characteristics prior to the pubertal age in central precocious puberty (CPP), which is gonadotropin-dependent, early maturation of the entire hypothalamic-pituitary-gonadal (HPG) axis occurs, with the full spectrum of physical and hormonal changes of puberty. True precocious puberty in girls must also be distinguished from premature thelarche (PT), usually with breast development before the age of 3 years, and premature pubarche (PA), with the isolated development of pubic hair. These conditions are not usually associated with accelerated growth rate or advancement in bone age. Clinical, laboratory and instrumental evaluations are necessary for the diagnosis. Pelvic ultrasound could serve as a complementary tool for the diagnosis, treatment and follow-up of CPP. The interpretation of clinical, laboratory and strumental data must be performed by an expert pediatric endocrinologist to maximize the diagnostic value in females with pubertal disorders. (www.actabiomedica.it)

In utero and peripubertal metals exposure in relation to reproductive hormones and sexual maturation and progression among boys in Mexico City

BackgroundEndocrine disrupting chemicals (EDCs) such as metals have been reported to alter circulating reproductive hormone concentrations and pubertal development in animals. However, the relationship has rarely been investigated among humans, with the exception of heavy metals, such as Pb and Cd. Our aim was to investigate measures of in utero and peripubertal metal exposure in relation to reproductive hormone concentrations and sexual maturation and progression among boys from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohorts.MethodsOur analysis included 118 pregnant women and their male children from the ELEMENT study. Essential and non-essential metals were measured in urine collected from the mothers during the third trimester of pregnancy and their male children at 8–14 years. Reproductive hormone concentrations [serum testosterone, estradiol, dehydroepiandrosterone sulfate (DHEA-S), inhibin B, and sex hormone-binding globulin (SHBG)] were measured in blood samples from the children at 8–14 years. We also assessed Tanner stages for sexual maturation (genital, pubic hair development, and testicular volume), at two time points (8–14, 10–18 years). We used linear regression to independently examine urinary metal concentrations in relation to each peripubertal reproductive hormones adjusting for child age and BMI. Generalized estimation equations (GEEs) were used to evaluate the association of in utero and peripubertal metal exposures with sexual maturation and progression during follow-up based on Tanner staging and testicular volume.ResultsIn utero and prepubertal concentrations of some urinary metals were associated with increased concentrations of peripubertal reproductive hormones, especially non-essential metal(loid)s As and Cd (in utero), and Ba (peripubertal) as well as essential metal Mo (in utero) in association with testosterone. More advanced pubic hair developmental stage and higher testicular volume at the early teen visit was observed for boys with higher non-essential metal concentrations, including in utero Al and peripubertal Ba, and essential metal Zn concentration (peripubertal). These metals were also associated with slower pubertal progression between the two visits.ConclusionThese findings suggest that male reproductive development may be associated with both essential and non-essential metal exposure during in utero and peripubertal windows.

Common Childhood Viruses and Pubertal Timing: The LEGACY Girls Study.

Earlier pubertal development is only partially explained by childhood body mass index; the role of other factors, such as childhood infections, is less understood. Using data from the LEGACY Girls Study (North America, 2011-2016), we prospectively examined the associations between childhood viral infections (cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) 1, HSV2) and pubertal timing. We measured exposures based on seropositivity in premenarcheal girls (n= 490). Breast and pubic hair development were classified based on mother-reported Tanner Stage (TS) (TS2+ compared with TS1), adjusting for age, body mass index, and sociodemographic factors. The average age at first blood draw was 9.8 years (standard deviation, 1.9 years). The prevalences were 31% CMV+, 37% EBV+, 14% HSV1+, 0.4% HSV2+, and 16% for both CMV+/EBV+ coinfection. CMV+ infection without coinfection was associated with developing breasts an average of 7 months earlier (hazard ratio (HR)= 2.12, 95% confidence interval (CI): 1.32, 3.40). CMV infection without coinfection and HSV1 and/or HSV2 infection were associated with developing pubic hair 9 months later (HR= 0.41, 95% CI: 0.24, 0.71, and HR= 0.42, 95% CI: 0.22, 0.81, respectively). Infection was not associated with menarche. If replicated in larger cohorts with blood collection prior to any breast development, this study supports the hypothesis that childhood infections might play a role in altering pubertal timing.

Early Life Adversity and Pubertal Timing: Implications for Cardiometabolic Health.

To identify early life adversity (ELA) risk factors for earlier pubertal timing, itself a risk factor for poor cardiometabolic health, and to determine whether such ELA-related risk may be mediated by pre-pubertal body mass index (BMI). Subjects included 426 female participants in a prospective birth cohort study, the NICHD Study of Early Child Care and Youth Development. Survival analysis models were fit to examine ELA exposures, representing childhood socioeconomic status (SES), maternal sensitivity, mother-child attachment, and negative life events, along with child health indicators and covariates, in relation to pubertal timing outcomes, including age at menarche and ages at Tanner stage II for breast and pubic hair development. Higher childhood SES emerged as an independent predictor of older age at menarche, showing each one standard deviation increase in childhood SES corresponded to a 1.3% increase in age at menarche (factor change = 1.013; 1.003-1.022; p < .01), but did not predict breast or pubic hair development (ps > .05). In mediation analyses, indirect (mediated) effects of mother-child attachment on the pubertal timing outcomes, via pre-pubertal BMI, were all statistically significant (ps < .05). Higher childhood SES predicted directly, and secure (vs. insecure) mother-child attachment predicted indirectly (via pre-pubertal BMI), later pubertal timing, suggesting these factors may protect girls from earlier pubertal development. By extension, clinical implications are that intervention strategies designed to lessen ELA- and pre-pubertal obesity-related risk may be effective in remediating life course pathways linking ELA, accelerated pubertal development, and cardiometabolic risk.

Prenatal and Peripubertal Exposure to Per- and Polyfluoroalkyl Substances and Pubertal Development in Boys and Girls in the HOME Study

Background/Aim: Per- and polyfluoroalkyl substances (PFAS) exposures in pregnancy and childhood have been associated with lower sex hormones levels in children, but few prospective studies have estimated the effect of PFAS on secondary sex characteristics. We examined the associations of prenatal and peripubertal exposure to PFAS with sexual maturation. Methods: We used data from a prospective pregnancy and birth cohort study in Cincinnati, OH (the HOME Study, enrolled: 2003-2006). We quantified serum concentrations of four PFAS—perfluorooctane sulfonate, perfluorooctanoate (PFOA), perfluorononanoate, and perfluorohexane sulfonate—in mothers at ~16 weeks gestation and their children at age ~12 years (120 girls and 96 boys). At age ~12 years, we collected pubertal data by self-reported Tanner staging of pubic hair growth (boys and girls) and breast growth (girls), as well as age at menarche in girls. We estimated covariate-adjusted associations between PFAS and stages of breast and pubic hair growth (stage 1 to 5) using ordinal regression models. We evaluated age at menarche using Cox proportional-hazard models that account for censored data. Results: Mean age at menarche was 11.6 years; 82% and 97% of boys and girls, respectively, were stage 2+ for pubic hair development; and 96% of girls were stage 2+ for breast growth. We observed that higher peripubertal serum concentrations of all PFAS were associated with later puberty among girls. For example, one IQR increase in PFOA (3.5 ng/mL) was inversely associated with breast (OR=0.47, 95%CI:0.22-0.98) and pubic hair (OR=0.84, 95%CI:0.45-1.58) growth, and age at menarche (HR=0.66, 95%CI:0.37-1.18). We found no clear pattern in males or for prenatal concentrations. Conclusions: These data suggest that higher peripubertal PFAS concentrations may be associated with later pubertal development in girls, but not boys.

Prepubertal Internalizing Symptoms and Timing of Puberty Onset in Girls

Stressful environments have been associated with earlier menarche. We hypothesized that anxiety, and possibly other internalizing symptoms, are also associated with earlier puberty in girls. The Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study (2011-2016) included 1,040 girls aged 6-13 years at recruitment whose growth and development were assessed every 6 months. Prepubertal maternal reports of daughter's internalizing symptoms were available for breast onset (n=447), pubic hair onset (n=456), and menarche (n=681). Using Cox proportional hazard regression, we estimated prospective hazard ratios and 95% confidence intervals for the relationship between 1 standard deviation of the percentiles of prepubertal anxiety, depression, and somatization symptoms and the timing of each pubertal outcome. Multivariable models included age, race/ethnicity, study center, maternal education, body mass index percentile, and family history of breast cancer. Additional models included maternal self-reported anxiety. A 1-standard deviation increase in maternally reported anxiety in girls at baseline was associated with earlier subsequent onset of breast (hazard ratio (HR)=1.22, 95% confidence interval (CI): 1.09, 1.36) and pubic hair (HR=1.15, 95% CI: 1.01, 1.30) development, but not menarche (HR=0.94, 95% CI: 0.83, 1.07). The association of anxiety with earlier breast development persisted after adjustment for maternal anxiety. Increased anxiety in young girls may indicate risk for earlier pubertal onset.

Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is characterized by impaired social communication and poor adaptation to change; thus, the onset of puberty may be a pivotal transition. This cross-sectional study measured pubertal timing to examine hypothesized differences for sex (female vs. male) and group (ASD vs. typical development [TD]). Participants included 239 children (137 ASD, 102 TD) between 10 and 13 years. The ASD group included 35 females and 102 males; the TDs included 44 females and 58 males. Pubertal onset measured by genital or pubic stage was investigated with linear regression using main effects of sex and age-by-sex interactions in TD and ASD groups and main effects of diagnosis and diagnosis-by-age interactions in males and females, controlling for body mass index, socioeconomic status, and race. In TD, examination of main effects for genital (penis/breast) stage showed no difference for male and female children (t = 1.33, P = 0.187, rdf = 92); however, there were significant differences in ASD (t = 2.70, P = 0.008, rdf = 121). For diagnosis modeled separately by sex, there was significantly earlier pubertal development in females with ASD (t = 1.97, P = 0.053, rdf = 70, but not males (t = 1.329, P = 0.186, rdf = 143). In addition, analysis of menses revealed females with ASD had significantly earlier onset than TD (t = -2.56, P = 0.018, rdf = 21). Examination of pubic stage revealed expected sex differences for TD (t = 2,674, P = 0.009, rdf = 91) and ASD (t = 3.482, P = 0.001, rdf = 121). Females with ASD evidence advanced pubertal onset relative to ASD males and TD females. Findings underscore the need for enhanced understanding of pubertal development in ASD, as differences may have significant psychological, social, physiological, and developmental consequences. LAY SUMMARY: Children with autism spectrum disorder (ASD) have difficulty with social communication and respond poorly to change, which may include the onset and course of puberty. The study measured the timing of puberty in 239 children (137 ASD and 102 typical development [TD]) between 10 and 13 years based on pubertal stage of genital (breast/penis) and pubic hair development. Females with ASD evidence advanced pubertal onset relative to ASD males and TD females. Findings underscore the need for an enhanced understanding of pubertal development in ASD.