Consecutive lynestrenol and cross-sex hormone treatment in biological female adolescents with gender dysphoria: a retrospective analysis.

BACKGROUND: Prior to the start of cross-sex hormone therapy (CSH), androgenic progestins are often used to induce amenorrhea in female to male (FtM) pubertal adolescents with gender dysphoria (GD). The aim of this single-center study is to report changes in anthropometry, side effects, safety parameters, and hormone levels in a relatively large cohort of FtM adolescents with a diagnosis of GD at Tanner stage B4 or further, who were treated with lynestrenol (Orgametril®) monotherapy and in combination with testosterone esters (Sustanon®). METHODS: A retrospective analysis of clinical and biochemical data obtained during at least 6 months of hormonal treatment in FtM adolescents followed at our adolescent gender clinic since 2010 (n = 45) was conducted. McNemar's test to analyze reported side effects over time was performed. A paired Student's t test or a Wilcoxon signed-ranks test was performed, as appropriate, on anthropometric and biochemical data. For biochemical analyses, all statistical tests were done in comparison with baseline parameters. Patients who were using oral contraceptives (OC) at intake were excluded if a Mann-Whitney U test indicated influence of OC. RESULTS: Metrorrhagia and acne were most pronounced during the first months of monotherapy and combination therapy respectively and decreased thereafter. Headaches, hot flushes, and fatigue were the most reported side effects. Over the course of treatment, an increase in musculature, hemoglobin, hematocrit, creatinine, and liver enzymes was seen, progressively sliding into male reference ranges. Lipid metabolism shifted to an unfavorable high-density lipoprotein (HDL)/low-density lipoprotein (LDL) ratio; glucose metabolism was not affected. Sex hormone-binding globulin (SHBG), total testosterone, and estradiol levels decreased, and free testosterone slightly increased during monotherapy; total and free testosterone increased significantly during combination therapy. Gonadotropins were only fully suppressed during combination therapy. Anti-Müllerian hormone (AMH) remained stable throughout the treatment. Changes occurred in the first 6 months of treatment and remained mostly stable thereafter. CONCLUSIONS: Treatment of FtM gender dysphoric adolescents with lynestrenol monotherapy and in combination with testosterone esters is effective, safe, and inexpensive; however, suppression of gonadotropins is incomplete. Regular blood controls allow screening for unphysiological changes in safety parameters or hormonal levels and for medication abuse.

Gender identity disorder in twins: a review of the case report literature.

INTRODUCTION: The etiology of gender identity disorder (GID) remains largely unknown. In recent literature, increased attention has been attributed to possible biological factors in addition to psychological variables. AIM: To review the current literature on case studies of twins concordant or discordant for GID. METHODS: A systematic, comprehensive literature review. RESULTS: Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same-sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P=0.005). Of the seven opposite-sex twins, all were discordant for GID. CONCLUSIONS: These findings suggest a role for genetic factors in the development of GID.

Early detection of psychological problems in a population of children with enuresis: construction and validation of the Short Screening Instrument for Psychological Problems in Enuresis.

PURPOSE: The current study focuses on the construction and validation of the Short Screening Instrument for Psychological Problems in Enuresis, for emotional problems and symptoms of attention deficit hyperactivity disorder, in a population of children with enuresis. MATERIALS AND METHODS: In phase I factor analyses were performed on 31 items of the Internalizing scale of the Child Behavior Checklist and on 18 items of the Attention Deficit Disorder scale of the Disruptive Behavior Disorders Rating Scale to select the most discriminating items. The question format and cutoff score for referral were determined by maximization of correctly classified patients, with the full Child Behavior Checklist and Disruptive Behavior Disorders Rating Scale as standards. In phase II 109 children with enuresis (76 males and 33 females, mean age 8.5 years, SD 2.4) admitted to a tertiary care university hospital entered the validation study. The parents completed the Short Screening Instrument for Psychological Problems in Enuresis and the original questionnaires, ie Child Behavior Checklist and Disruptive Behavior Disorders Rating Scale. RESULTS: Seven items (factor loading greater than 0.65) were selected for "emotional problems," 3 (greater than 0.80) for "attention problems" and 3 (greater than 0.75) for "hyperactivity/impulsivity problems." Full screening was indicated when at least 2 problem behaviors occurred at least "sometimes" for Child Behavior Checklist items or "frequently" for Disruptive Behavior Disorders Rating Scale items. Validation of the Short Screening Instrument for Psychological Problems in Enuresis revealed good accuracy for all subscales (approximately 88%), excellent specificity (0.91 to 0.99) and low to fair sensitivity (0.29 to 0.75). CONCLUSIONS: The Short Screening Instrument for Psychological Problems in Enuresis meets its goal because it leads to time efficient and early detection of problems of emotion, attention and hyperactivity/impulsivity. The implementation of this short questionnaire can contribute to better followup of medical treatment.