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Book Details
Abstract
Offering current guidelines on the relatively new practice of puberty suppression for gender-dysphoric adolescents, Pubertal Suppression in Transgender Youth provides a succinct, easy-to-digest overview of this timely topic. This concise, clinically-focused resource by Dr. Courtney Finlayson covers all relevant topics, from a brief history of medical care of transgender youth to emerging developments in the field.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Pubertal Suppression in Transgender Youth | i | ||
| Pubertal Suppression in Transgender Youth | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Contents | vii | ||
| 1 - History of Care of Transgender Youth | 1 | ||
| DEDICATION | 4 | ||
| REFERENCES | 4 | ||
| 2 - Models of Care and Current Guidelines for Care of Transgender Individuals | 5 | ||
| GENDER-AFFIRMING CARE | 5 | ||
| MULTIDISCIPLINARY CARE | 6 | ||
| PRACTICE GUIDELINES | 6 | ||
| MENTAL HEALTHCARE | 6 | ||
| MEDICAL CARE | 8 | ||
| ADJUNCTIVE SERVICES | 9 | ||
| BARRIERS TO CARE | 10 | ||
| SUMMARY | 11 | ||
| REFERENCES | 11 | ||
| 3 - Puberty | 13 | ||
| PHYSICAL CHANGES ASSOCIATED WITH PUBERTY | 13 | ||
| Female Changes | 13 | ||
| Male Changes | 15 | ||
| Age at Onset | 15 | ||
| Growth Spurt | 16 | ||
| Changes in Body Composition | 16 | ||
| Other Changes of Puberty | 16 | ||
| PHYSIOLOGY OF PUBERTY | 16 | ||
| Endocrine Changes From Fetal Life to Puberty | 16 | ||
| Changes at Birth and the Mini Puberty of INFANCY | 17 | ||
| The Juvenile Pause or the Mid-Childhood Nadir of Gonadotropin Secretion | 17 | ||
| Peripubertal Gonadotropin Increase | 17 | ||
| Sex Steroid Secretion | 18 | ||
| Gonadotropin-Releasing Hormone Stimulation | 18 | ||
| Leptin and Puberty | 19 | ||
| Ovulation and Menarche | 19 | ||
| Adrenarche | 20 | ||
| DELAYED PUBERTY OR ABSENT PUBERTY (SEXUAL INFANTILISM) | 20 | ||
| Constitutional Delay in Growth and Adolescence | 20 | ||
| Hypogonadotropic Hypogonadism | 20 | ||
| Central nervous system disorders | 20 | ||
| Other acquired central nervous system disorders | 20 | ||
| Developmental defects | 21 | ||
| Radiation therapy | 21 | ||
| Isolated gonadotropin deficiency | 21 | ||
| Idiopathic hypopituitary dwarfism (growth hormone deficiency in the absence of defined anatomic or organic defects) | 21 | ||
| Miscellaneous disorders | 21 | ||
| Chronic disease and malnutrition | 21 | ||
| Anorexia nervosa | 21 | ||
| Increased physical activity | 22 | ||
| Hypothyroidism | 22 | ||
| Hypergonadotropic Hypogonadism | 22 | ||
| PRECOCIOUS PUBERTY (SEXUAL PRECOCITY) | 22 | ||
| Central (Complete or True) Precocious Puberty | 22 | ||
| Idiopathic central (complete or true) isosexual precociious puberty | 22 | ||
| Genetic causes of central precocious puberty | 22 | ||
| Peripheral or Incomplete Isosexual Precocious Puberty | 23 | ||
| Peripheral or incomplete isosexual precocious puberty in genotypic females | 23 | ||
| Variations of Puberty | 23 | ||
| Premature thelarche | 23 | ||
| Premature adrenarche | 23 | ||
| FURTHER READING | 23 | ||
| 4 - GnRH Analogs (Mechanism, Past Studies, Drug Options, Use in Precocious Puberty, Use in Gender-Nonconforming Youth) | 25 | ||
| HISTORICAL PERSPECTIVE | 25 | ||
| PHYSIOLOGY AND MECHANISM OF ACTION | 26 | ||
| USE IN CENTRAL PRECOCIOUS PUBERTY | 26 | ||
| OUTCOMES IN CENTRAL PRECOCIOUS PUBERTY | 27 | ||
| USE IN GENDER-NONCONFORMING YOUTH | 28 | ||
| OPTIONS FOR TREATMENT | 29 | ||
| OUTCOMES IN GENDER-NONCONFORMING YOUTH | 29 | ||
| CHALLENGES IN CARE | 30 | ||
| CONCLUSION | 30 | ||
| REFERENCES | 31 | ||
| 5 - Rationale for the Initiation, Use, and Monitoring of GnRHa in Gender Non-conforming Youth | 33 | ||
| INTRODUCTION | 33 | ||
| RATIONALE | 33 | ||
| INITIATION | 34 | ||
| MONITORING | 35 | ||
| Clinical Monitoring | 36 | ||
| Hormone Monitoring | 36 | ||
| Radiographic Monitoring | 37 | ||
| CONCLUSION | 38 | ||
| REFERENCES | 38 | ||
| 6 - Psychosocial Considerations in Pubertal Suppression Treatment | 41 | ||
| INTRODUCTION | 41 | ||
| POSSIBLE EFFECTS OF GONADOTROPIN-RELEASING HORMONE ANALOGUES ON GENDER IDENTITY AND/OR SEXUALITY DEVELOPMENT | 41 | ||
| UNKNOWN NEUROCOGNITIVE SEQUELAE OF PUBERTAL SUPPRESSION TREATMENT | 43 | ||
| PSYCHOSOCIAL IMPLICATIONS OF KNOWN MEDICAL SIDE EFFECTS OF GONADOTROPIN-RELEASING HORMONE ANALOGUE TREATMENT | 44 | ||
| Fertility Considerations | 44 | ||
| Sexual Function Considerations | 44 | ||
| FAMILY FACTORS | 45 | ||
| CONCLUSION | 45 | ||
| REFERENCES | 46 | ||
| 7 - Medical Side Effects of GnRH Agonists | 49 | ||
| BONE HEALTH | 49 | ||
| BRAIN | 50 | ||
| FERTILITY | 51 | ||
| BODY MASS INDEX AND BODY COMPOSITION | 51 | ||
| SUMMARY | 51 | ||
| REFERENCES | 51 | ||
| 8 - Surgical Side Effects of GnRHa | 53 | ||
| INTRODUCTION | 53 | ||
| GOALS OF SURGERY | 53 | ||
| TIMING OF SURGERY | 54 | ||
| SURGICAL CONSIDERATIONS FOR INDIVIDUALS ON GNRHA | 54 | ||
| Surgery for Transwomen on Gonadotrophin-Releasing Hormone Agonists | 54 | ||
| Vaginoplasty | 54 | ||
| Feminizing procedures | 55 | ||
| Other feminizing procedures | 56 | ||
| Surgery for Transmen on GnRHa | 56 | ||
| Chest surgery | 56 | ||
| Masculinizing genital surgery | 57 | ||
| AREAS OF UNCERTAINTY | 59 | ||
| CONCLUSION | 60 | ||
| REFERENCES | 60 | ||
| 9 - Fertility Preservation: Considerations for Gender-Diverse Youth | 63 | ||
| RISK OF INFERTILITY DUE TO HORMONAL THERAPIES | 63 | ||
| FERTILITY PRESERVATION OPTIONS IN BIRTH-ASSIGNED MALES | 64 | ||
| FERTILITY PRESERVATION OPTIONS IN BIRTH-ASSIGNED FEMALES | 64 | ||
| ATTITUDES TOWARD FP AND OTHER PSYCHOLOGICAL CONSIDERATIONS | 65 | ||
| ETHICAL CONSIDERATIONS | 66 | ||
| FINANCIAL CONSIDERATIONS | 67 | ||
| FUTURE DIRECTIONS | 68 | ||
| CONCLUSIONS | 68 | ||
| REFERENCES | 69 | ||
| 10 - Duration of Pubertal Suppression and Initiation of Gender-Affirming Hormone Treatment in Youth | 73 | ||
| PUBERTAL SUPPRESSION AND GENDER-AFFIRMING HORMONE THERAPIES | 74 | ||
| RELEVANT TIME POINTS IN CLINICAL GUIDELINES AND PROTOCOLS | 75 | ||
| The “Dutch Protocol” | 75 | ||
| World Professional Association for Transgender Health | 75 | ||
| University of California San Francisco Primary Care Guidelines | 76 | ||
| Endocrine Society Clinical Practice Guidelines | 76 | ||
| UNRESOLVED QUESTIONS | 77 | ||
| CASE EXAMPLES | 77 | ||
| Case 1: the 9-Year-Old Prepubertal Boy or Girl at Pubertal Stage 1 | 77 | ||
| Case 2: the 11-Year-Old Transgender Boy at Pubertal Stage 2 | 78 | ||
| Case 3: the 11-Year-Old Transgender Girl at Pubertal Stage 2 | 79 | ||
| Case 4: the 15-Year-Old Transgender Boy at Pubertal Stage 4 | 80 | ||
| Case 5: the 15-Year-Old Transgender Girl at Pubertal Stage 4 | 81 | ||
| Case 6: the 17-Year-Old Transgender Boy at Pubertal Stage 5, or the Adult Transgender Man | 81 | ||
| Case 7: the 17-Year-Old Transgender Girl at Pubertal Stage 5, or the Adult Transgender Woman | 81 | ||
| Case 8: The Gender Nonconforming Child in Early Puberty | 82 | ||
| Financial Considerations | 82 | ||
| INITIATION OF GENDER-AFFIRMING HORMONES | 83 | ||
| TESTOSTERONE | 83 | ||
| ESTROGEN | 83 | ||
| CONCLUSIONS | 84 | ||
| REFERENCES | 84 | ||
| 11 - Ethical Considerations of GnRHa Treatment and Consent Process | 87 | ||
| INTRODUCTION | 87 | ||
| PUBERTAL SUPPRESSION | 87 | ||
| BENEFITS OF PUBERTAL SUPPRESSION | 88 | ||
| ETHICAL ISSUES | 88 | ||
| Research | 88 | ||
| Balancing Beneficence and Nonmaleficence | 89 | ||
| Respect for Autonomy: Assent and Consent | 91 | ||
| CONCLUSION | 92 | ||
| REFERENCES | 92 | ||
| 12 - Emerging Developments in Pubertal Suppression for Gender Incongruent/Gender Dysphoric Youth | 95 | ||
| TRIPTORELIN, A NEW GONADOTROPIN-RELEASING HORMONE AGONIST | 95 | ||
| PROLONGED USE OF HISTRELIN ACETATE IMPLANT IN TRANSGENDER YOUTH | 95 | ||
| GONADOTROPIN-RELEASING HORMONE AGONIST USE IN NONBINARY YOUTH | 96 | ||
| GONADOTROPIN-RELEASING HORMONE AND GONADOTROPIN ANTAGONISTS | 96 | ||
| Gonadotropin Antagonists | 96 | ||
| KISSPEPTIN AND NEUROKININ B ANTAGONISTS | 96 | ||
| OXANDROLONE AS AN ALTERNATIVE GENDER-AFFIRMING MASCULINIZING HORMONE | 97 | ||
| LOW-DOSE ESTROGEN AND TESTOSTERONE | 97 | ||
| ANTIANDROGENS AND ANDROGEN RECEPTOR INHIBITORS | 98 | ||
| ANTIANDROGENS | 98 | ||
| CONCLUSION | 98 | ||
| REFERENCES | 98 | ||
| Index | 101 | ||
| A | 101 | ||
| B | 101 | ||
| C | 101 | ||
| D | 101 | ||
| E | 101 | ||
| F | 102 | ||
| G | 102 | ||
| H | 103 | ||
| I | 103 | ||
| J | 103 | ||
| K | 103 | ||
| L | 103 | ||
| M | 103 | ||
| N | 103 | ||
| O | 103 | ||
| P | 103 | ||
| R | 104 | ||
| S | 104 | ||
| T | 104 | ||
| U | 105 | ||
| V | 105 | ||
| W | 105 | ||
| X | 105 | ||
| Z | 105 |