Connect with us


Suppressing puberty safe for child questioning gender, study says



Suppressing puberty in a child who’s questioning their gender identity might seem extreme, but the therapy is relatively safe and could significantly lower their risk of suicide, a new study reports.

Adolescents who wanted and received puberty suppression were 60 percent less likely to have considered suicide within the past year and 30 percent less likely to consider suicide throughout life, according to findings published in the February issue of Pediatrics.

Balancing potential risks

“This study is the first to show that access to pubertal suppression for transgender youth is associated with lower odds of suicidality,” said lead researcher Dr. Jack Turban, a resident psychiatrist at Massachusetts General Hospital in Boston and McLean Hospital in Belmont, Mass.

Puberty suppression is reversible, relying on medications that tell the brain to stop releasing the gender-related hormones that set off sexual maturity, he said.

“This allows transgender youth more time to decide what they want to do next in terms of their gender affirmation,” Turban said. “If they ultimately decide they want to undergo their endogenous puberty, the medication can be stopped and puberty resumes itself.”

The most notable long-term health risks associated with puberty suppression are impaired future fertility and low bone density that could slightly increase risk of broken bones, said Dr. John Lantos, senior author of an ethics analysis that accompanies the suicide risk study.

“Figuring out the best approach to a child or a teenager with gender dysphoria is difficult, because it requires balancing the risks of medical treatment with the psychological benefits that go with gender-affirming therapy,” said Lantos, director of pediatric bioethics at Children’s Mercy Hospital in Kansas City, Mo. “In many cases, we don’t have good long-term outcome data on either the risks or the benefits. We’re trying to make our best guesses.”

As many as four out of 10 transgender adults have attempted suicide, researchers said in background notes.

Questioning starts early

While children might question their gender identity at a young age, their anguish tends to increase as they near puberty, Lantos said.

“Once puberty starts, the stakes are raised because puberty unleashes all these bodily changes that people don’t want and are psychologically distressing,” he said.

Turban’s team surveyed more than 20,600 transgender adults, aged 18 to 36, asking questions about their use of puberty suppression and their mental health.

About 17 percent said they had wanted puberty suppression, but only 2.5 percent received hormone-blockers, the researchers found.

Those who received the treatment had a significantly lower risk of suicidal thoughts, after adjusting for other variables including the level of family support they received, the survey found.

“Many transgender youth have intense dysphoria as their bodies start to develop in a way that does not match who they know themselves to be,” Turban said. “Pubertal suppression pauses those changes to allow youth more time to decide what to do next.”

One child’s personal story

In their accompanying analysis, Lantos and his colleagues discuss the case of a 15-year-old who was born male but has displayed gender-diverse behaviors since preschool.

“Children often have a clear sense of their gender identity as young as 3 or 4 years old,” said senior study author Dr. Alex Keuroghlian, director of the Massachusetts General Hospital Psychiatry Gender Identity Program. “However, no medical intervention occurs for younger children, and the best practice is to provide psychological and social affirmation until very early puberty.”

The child, called “EF” in the paper, presented as male at school but identified and dressed as a girl at home. But neither felt quite right, the researchers said. EF began to identify as agender — neither boy nor girl. EF preferred being referred to by gender-neutral pronouns “they” and “them.”

The onset of puberty at 11 increased EF’s anxiety, as they became concerned about their voice deepening and body hair appearing. The preteen started puberty-suppression treatment at age 12.

“What made this case more complex than that typical case is that after several years, doctors said OK, we’ve delayed puberty for long enough now, which gender do you want to be?” Lantos said. “The patient said neither. I’m perfectly happy like this. Keep me on puberty-blocking drugs.”

EF’s bone density has fallen to very low levels compared to other people, and it can be expected to continue falling, the researchers noted. Gender-based hormones like testosterone and estrogen play an important role in maintaining bone health.

But while EF is at increased risk of fractures, that risk needs to be put into perspective, the researchers said. A 50-year-old man with bone density similar to EF’s has a 0.2 percent to 0.3 percent risk of hip fracture and a 1 percent to 2 percent risk of other fractures within the next decade.

Dr. Joshua Safer, executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York City, explained that “the greatest known risk for puberty suppressants is the risk to bone development. That said, the osteoporosis risk is so small that it has been hard to demonstrate.”

Time to reflect on identity

Safer said he would be “very relaxed” about using puberty blockers in a child who might be transgender, arguing that the medications are a conservative treatment that give kids time to reflect on their identity.

“They have been used in numerous circumstances and appear to be exceedingly safe at least for a couple of years,” he said. “They are easy to discontinue. In the majority of cases, the children using them are transgender after all and use of puberty blockers can mean less surgery later for these children, which is a huge benefit.”
Lantos said parents with a child questioning their gender identity should take the matter seriously and not minimize it. They should discuss it as a family with their doctor, and seek a referral to a center with expertise in gender issues.

“Most children’s hospitals now have gender identity clinics, so as long as people can get to a children’s hospital they usually can find people with this expertise,” he said.

Keuroghlian added that strong family support is a key factor in transgender youths’ mental health.

“Parents of transgender kids ought to connect with local services and programs dedicated to helping families learn to support their child’s gender affirmation at home, at school, and in their community,” he said.

More information
The American Psychiatric Association has more about gender dysphoria.

Copyright 2020 HealthDay. All rights reserved.

Source link


Study: Seizures after vaccination don’t affect child development



Kids who have a fever-related seizure after getting a vaccine won’t have developmental and behavioral problems as a result, according to a new study.

These so-called febrile seizures do not affect children’s development whether they occur after a vaccination or not, the researchers said.

“A febrile seizure can occur following vaccination and understandably can be quite distressing to parents. It can also cause parents to lose confidence in future vaccinations,” said study author Dr. Lucy Deng. She is a pediatrician at the National Center for Immunization Research and Surveillance in Sydney, Australia.

“Now, parents will be relieved to hear that having a febrile seizure following vaccination does not affect the child’s development,” Deng added.

For the study, Deng’s team compared 62 kids who had a fever-related seizure within two weeks of a shot with 70 who had a seizure from another cause and 90 who never had a seizure. All were about 2 years old.

The investigators found no differences in development, thinking skills or behavior among the three groups.

“At a time when there is a global resurgence of measles and new diseases are emerging, our findings are particularly important in reassuring parents and providers on the safety of vaccines,” Deng said in a news release from the American Academy of Neurology.

The report was published online July 1 in the journal Neurology.

More information

To learn more about fever-related seizures, visit the U.S. National Institute of Neurological Disorders and Stroke.

Copyright 2020 HealthDay. All rights reserved.

Source link

Continue Reading


Most MS patients use alternative treatments like marijuana, vitamins or massage



Despite the existence of conventional medications to manage multiple sclerosis (MS) symptoms, a majority of patients also rely on alternative therapies, including vitamins, exercise and marijuana, a new survey suggests.

For the study, researchers at Oregon Health and Science University in Portland asked MS patients if they used “complementary and alternative therapies” — medicines and practices outside of standard medical care.

A majority of just over 1,000 respondents said they used some type of alternative therapy, including marijuana, vitamins, herbs and minerals, plus mind-body therapies like exercise, mindfulness, massage and various diets.

An earlier survey, conducted in 2001, found some people regularly used these therapies — and many found them helpful — but only 7 percent were talking to their doctors about them.

“It was a little bit of a wake-up call to physicians that they need to be more educated about complementary or alternative therapies, and then consider these therapies as part of the overall treatment plan for their patients,” said lead author Dr. Elizabeth Silbermann, a neurology fellow.

MS is a potentially disabling disease that results from the immune system attacking the nervous system and damaging nerves. Symptoms vary, and while some patients eventually lose their ability to walk, others may experience only mild symptoms. MS has no known cure, but treatments can slow the disease’s progression and help patients manage symptoms.

“We have a lot more treatment options for our patients, and we’re treating our patients earlier than we ever did before,” Silbermann said.

But now that there are so many more medications, the researchers wanted to know if people are still using complementary or alternative medicines.

To find out, Silbermann’s team surveyed MS patients in Oregon and Washington between August 2018 and March 2019.

The investigators found that 80 percent of respondents used dietary supplements (such as vitamins, minerals, and herbs) compared to 65 percent in 2001.

Around 70 percent reported using conventional medications to manage their MS symptoms.

The percentage using mind-body therapies (such as mindfulness and massage) nearly tripled — 39 percent of current patients, up from 14 percent in the earlier survey. More than eight in 10 were exercising, an increase from 67 percent in 2001.

Good evidence for exercise

Exercise is one of the only alternative therapies in the survey that has strong evidence of success in curbing MS symptoms.

“This is a disease that does cause physical disability and weakness, so it’s very natural to refer patients to physical therapy and to encourage them to be physically active,” Silbermann explained. “There’s pretty good evidence that things like stretching can be helpful for MS-related muscle tightness, and that staying physically active and doing some aerobic exercise can be very helpful for our patients.”

In the current survey, about 30 percent of participants reported using marijuana in a variety of forms. Pot is legal in Oregon and Washington, where the study was conducted, potentially limiting generalization of the results.

There is some evidence that marijuana can help patients with muscle “spasticity” or tightness.

“When you ask patients to report how tight their muscles feel, they will report consistently that their muscles feel less tight when they are using cannabis, which is great,” said Silbermann.

Pot’s pros and cons

Sean Hennessy, an epidemiologist at the University of Pennsylvania Perelman School of Medicine in Philadelphia, said, “One of the few uses for cannabis-based products for which there’s reasonable evidence of effectiveness is muscle spasticity associated with multiple sclerosis.”

Hennessy was involved in a 2017 report from the National Academies of Sciences, Engineering, and Medicine that synthesized available information on cannabis products and their use in medicine.

But pot can potentially exacerbate existing MS symptoms, including muddled thinking and memory problems. Silbermann said that “it goes to show us that everything does have a side effect that we have to consider as part of an overall treatment strategy and plan.”

One of the most significant findings of the new survey was that over half of respondents said they spoke to their doctors about their use of alternative medicines, compared to the dismal 7 percent in 2001.

Silbermann said she hopes this is because patients feel that physicians are more accepting and knowledgeable about other treatment options. However, not enough is known about alternative therapies for physicians to decide which are safe and effective, she added.

Physicians need to know what supplements or drugs you might be taking for many reasons, but especially to ensure that the medications they prescribe don’t have any potentially negative interactions. But alternative medicines like supplements and cannabis are not well-regulated or well-studied, limiting the ability to assess their safety and efficacy.

“It’s hard to know exactly what you’re getting. So there’s always a concern about the purity of whatever you’re taking, and that’s especially true in cannabis,” Silbermann explained.

According to Hennessy, there are not enough referenced resources that physicians can rely on to know what medications interact poorly with cannabis.

“So, yes, it’s a good idea to tell your physician if you’re using cannabis, but they don’t really have anywhere to look to see whether cannabis interacts with whatever other drugs you’re taking,” Hennessy said.

Silbermann stressed that more research is needed to back up any recommendations about alternative therapies. “It’s an entire other field of medicine, and I think that we’re just learning how important it is to our patients,” she said.

The results were recently published online in the journal Multiple Sclerosis and Related Disorders.

More information

There’s more about multiple sclerosis at the National Multiple Sclerosis Society.

Copyright 2020 HealthDay. All rights reserved.

Source link

Continue Reading


90% of COVID-19 patients recover sense of smell, taste within 4 weeks, study finds



July 2 (UPI) — Nearly 90 percent of COVID-19 patients who lose their sense of smell or taste or both after becoming infected will see these symptoms begin to resolve within a few weeks, according to a study published Thursday by JAMA Otolaryngology-Head & Neck Surgery.

Even in patients for whom the symptoms remain, or worsen, the lingering effects are not a sign that the new coronavirus, SARS-CoV-2, remains in their system, the researchers said.

“The loss of smell or taste is among the most common and persistent symptoms of COVID-19 in patients with mildly symptomatic disease,” the authors wrote.

“However, at four weeks from the onset, most patients reported a complete resolution or improvement of these symptoms,” they said.

An earlier analysis by the same team of researchers — from Treviso Regional Hospital in Italy and St. Thomas Hospital in London — found that roughly two-thirds of patients with mild COVID-19 lose their sense of smell and/or taste. That finding was based on an assessment of 202 patients treated at Treviso.

For this study, the researchers surveyed the same group of 202 patients in mid-April — roughly four weeks after they were first diagnosed with COVID-19 — and asked them about their symptoms and retested them for the virus.

Fifty-five patients — or nearly 49 percent — reported complete resolution of their smell and/or taste impairment, while 46 — or just under 41 percent — indicated that they had experienced an improvement in symptom severity, the researchers said.

Only 12 — or less than 11 percent — reported that their smell/taste deficiencies remained or had worsened, they said.

The duration of smell or taste impairment in recovered patients was approximately 11 days, the researchers said.

However, persistent loss of smell and taste was not necessarily an indicator of the continued presence of SARS-CoV-2, they said.

Of the 58 patients who still were experiencing smell and/or taste deficiencies four weeks after symptom onset, 31 — or roughly 54 percent — still tested positive for the virus, compared to 26 — or just over 46 percent — of fully recovered patients, the researchers said.

“A higher severity of smell and taste impairment at [onset of infection], reasonably due to a more severe injury … was associated with a lower likelihood of recovery at four weeks,” the authors wrote.

Source link

Continue Reading