Pubertal Status at the Time of Fertility Preservation in Transgender Girls.

BACKGROUND: Puberty blockade and gender-affirming hormone therapy can impair fertility. Counseling on fertility preservation is important before initiation of therapy. Our study aimed to assess Tanner staging and the presence of virilizing secondary sex characteristics at the time of sperm collection and correlate the viability of sperm with the Tanner staging and degree of virilization. METHODS: A retrospective chart review of 23 transgender girls referred to pediatric urology at our academic pediatric transgender clinic for fertility preservation counseling was performed. At the initial visit before treatment, pubertal staging along with the assessment of virilizing secondary characteristics was performed. The semen analyses were evaluated for volume, sperm concentration, total sperm count, motility, and total motile count. RESULTS: Of the first 23 transgender girls evaluated and counseled, 8 transgender females successfully produced a sperm sample for cryopreservation. The average testicular volume was 18.5 ml and ranged from 12 ml to 20 ml. The median semen parameters were at or above the 2021 World Health Organization threshold. The 8 transgender females who successfully underwent fertility preservation presented with at least 1 secondary sex characteristic. In 1 subject with Tanner stage 3 pubic hair development and a testicular volume of 12 ml, only voice change was reported. Facial hair and laryngeal prominence were not present on examination. CONCLUSION: More than a third of our patients who accepted a referral to pediatric urology agreed to produce a sperm sample for cryopreservation. All of these patients successfully preserved sperm. With counseling and early referral to pediatric urology, a high percentage of fertility preservation in transgender girls was achieved.

Using School-Based Health Programs to Prevent Human Trafficking: The Mount Sinai Experience.

This article describes how school-based health centers can serve as human trafficking prevention sites. Setting: School-based health centers are available to all students attending a school and are often located in schools whose students have risk factors associated with human trafficking: those with a history of running away from home; unstable housing or homelessness; a history of childhood maltreatment or substance use; LGBTQ-identification; physical or developmental disabilities, including students who have Individualized Education Programs and need special education; gang involvement; and/or a history of involvement in child welfare or the juvenile justice system. The Mount Sinai Adolescent Health Center provides a model of the types of service school clinics can offer, including integrated medical, sexual, and reproductive health, health education, and behavioral and mental health. Activities: Identifying young people with risk factors and addressing those factors in our clinics in a timely way can disrupt the progression to human trafficking. In addition, if young people who are trafficked are attending schools that have a clinic, their health needs, such as care for sexually transmitted infections and mental health issues, can be addressed on-site. Lastly, some people go to school to recruit students for human trafficking. By raising awareness and addressing human trafficking in the school, students can become aware of this issue and perhaps gain the ability to ask for help if they are approached or know of other students being recruited by a trafficker. Implications: The location of easily-accessible, adolescent-friendly, trafficking-aware services in schools can prevent, identify and intervene in human trafficking.

Featured counter trafficking program: Mount Sinai Adolescent Health Center.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Mount Sinai Adolescent Health Center, a US-based health system dedicated to serving adolescents, some of whom are survivors of sex trafficking or at risk for sexual exploitation.

Use of Copper Intrauterine Device in Transgender Male Adolescents.

Transgender men need contraception if engaging in intercourse with a cis-gender male partner. The copper IUD is an effective, non-hormonal contraceptive well suited for trans-males even while utilizing gender affirming hormone therapy. A gender-neutral medical facility with well-trained and sensitive staff is the ideal setting to provide such contraceptive care.

Sexual minority youth.

This article provides an overview of the medical and mental health needs of the lesbian, gay, bisexual, and transgender (LGBT) youth population. Information is reviewed regarding both primary medical care and the special health risks that these youth face. Providers are introduced to the concept that societal and internalized homophobia lead directly to certain health disparities, including substance use, school and family rejection, depression, and increased sexually transmitted infection acquisition. This article familiarizes the primary care practitioner with the health care needs of the LGBT population and the research behind the various recommendations for caring for these youth.

Cross-gender hormone therapy in adolescents.

Many transgender youth experience significant amounts of emotional distress regarding the incongruence between their internal gender identity and their physical body. Cross-gender hormonal medical treatments, as managed by a multidisciplinary medical/mental health team, assist patients in transitioning to their desired gender by aligning the physical body to match the gender identity. The World Professional Association for Transgender Health Standards of Care and the Endocrine Society's Clinical Practice Guidelines provide a basic road map for practitioners. Expectations of the youth and the concerns of the family must be addressed and the youth psychologically supported during the transition period. Issues around future fertility should be explored as well. The goal of this article is to introduce the general pediatrician to cross-gender hormone treatments, their management, monitoring laboratory tests and clinical effects, and the issues surrounding their use in adolescents.

Prevalence of sexually transmitted infections in at-risk adolescent females at a comprehensive, stand-alone adolescent health center in New York City.

BACKGROUND: Sexually transmitted infections (STIs) are common among adolescents, and multiple STIs over one's lifetime can increase health risks. Few studies have assessed lifetime STI prevalence. This study evaluates minority, underserved adolescents' self-reported lifetime STI history and objective STI rates. METHODS: Lifetime STI rates of female patients at an urban adolescent health center were obtained from self-administered questionnaires. Additionally, STI test results were retrieved from electronic medical records. RESULTS: Patients reported a high lifetime prevalence of STIs. By comparing self-report and objective data, underreporting was identified for chlamydia, gonorrhea, and herpes. CONCLUSIONS: STI rates in at-risk adolescent females are higher than in the general population and remain elevated over time. Lifetime STI reports could expand our understanding of sexual health and should be further studied. Underreporting, which may increase health risks and hinder health care delivery, requires further investigation. Improvements in STI screening and prevention targeting at-risk populations are warranted.

A review of gay, lesbian, bisexual, and transgender youth issues for the pediatrician.

CME EDUCATIONAL OBJECTIVES: 1.Review common gay, lesbian, bisexual, and transgender (GLBT) terminology and discuss sexual constructs as they are currently understood.2.Determine the prevalence of GLBT youth and identify health disparities in the GLBT population.3.Provide strategies to develop an accepting atmosphere for GLBT youth in the pediatric practice, including the maintenance of ongoing health and appropriate screening for at-risk behaviors. Gay, lesbian, bisexual, and transgendered individuals have always been present in human society.1,2 References to same-sex couples and activity have been noted as far back as 600 B.C. on ancient Japanese and Chinese pottery. Ancient Greek and Roman art is full of depictions of same-sex couples; some scholars believe that Alexander the Great was gay.3.

Preventive misconception and adolescents' knowledge about HIV vaccine trials.

OBJECTIVE: Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. METHODS: As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16-19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants' understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. RESULTS: Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. CONCLUSIONS: Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials.