Consensus Parameter: Research Methodologies to Evaluate Neurodevelopmental Effects of Pubertal Suppression in Transgender Youth
Transgender Health, vol. 5, pp. 246–257
Abstract
Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that occur during puberty, a critical question is whether this treatment impacts neurodevelopment. Methods: A Delphi consensus procedure engaged 24 international experts in neurodevelopment, gender development, puberty/adolescence, neuroendocrinology, and statistics/psychometrics to identify priority research methodologies to address the empirical question: is pubertal suppression treatment associated with real-world neurocognitive sequelae? Recommended study approaches reaching 80% consensus were included in the consensus parameter. Results: The Delphi procedure identified 160 initial expert recommendations, 44 of which ultimately achieved consensus. Consensus study design elements include the following: a minimum of three measurement time points, pubertal staging at baseline, statistical modeling of sex in analyses, use of analytic approaches that account for heterogeneity, and use of multiple comparison groups to minimize the limitations of any one group. Consensus study comparison groups include untreated transgender youth matched on pubertal stage, cisgender (i.e., gender congruent) youth matched on pubertal stage, and an independent sample from a large-scale youth development database. The consensus domains for assessment includes: mental health, executive function/cognitive control, and social awareness/functioning. Conclusion: An international interdisciplinary team of experts achieved consensus around primary methods and domains for assessing neurodevelopmental effects (i.e., benefits and/or difficulties) of pubertal suppression treatment in transgender youth.
Authors 31
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Diane Chen corresponding
Northwestern University · Lurie Children's Hospital
Affiliation as printed
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Children's National · George Washington University
Affiliation as printed
Center for Neuroscience, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia, USA
Department of Neurology, George Washington University School of Medicine, Washington, District of Columbia, USA
Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
Department of Psychiatry, George Washington University School of Medicine, Washington, District of Columbia, USA
Division of Neuropsychology, Children's National Medical Center, Washington, District of Columbia, USA
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Affiliation as printed
Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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University of California, San Francisco
Affiliation as printed
Division of Endocrinology, Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
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Emory University · Emory National Primate Research Center
Affiliation as printed
Department of Psychology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
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Boston Children's Hospital · Harvard University
Affiliation as printed
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Affiliation as printed
Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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Affiliation as printed
Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Alfred I. duPont Hospital for Children · Thomas Jefferson University
Affiliation as printed
Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Nemours duPont Hospital for Children, Wilmington, Delaware, USA
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University of Toronto · Holland Bloorview Kids Rehabilitation Hospital · Bloorview Research Institute
Affiliation as printed
Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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Universidad de Deusto · Ghent University
Affiliation as printed
Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
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University of Maryland, Baltimore
Affiliation as printed
Program in Neuroscience, Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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University of California, Los Angeles
Affiliation as printed
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Affiliation as printed
School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
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Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC, Location VUmc, Department of Medical Psychology and Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
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Children's National · George Washington University
Affiliation as printed
Center for Neuroscience, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia, USA
Department of Neurology, George Washington University School of Medicine, Washington, District of Columbia, USA
Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
Department of Psychiatry, George Washington University School of Medicine, Washington, District of Columbia, USA
Division of Neuropsychology, Children's National Medical Center, Washington, District of Columbia, USA
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University of Southern California
Affiliation as printed
Department of Pediatrics, University of Southern California, Los Angeles, California, USA
Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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Affiliation as printed
Section of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Affiliation as printed
Centre for Cognitive Health in Brain Disease, Oslo University Hospital, Oslo, Norway
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University of California, Berkeley
Affiliation as printed
School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Eveline A. Crone Aachen Department of Developmental and Educational Psychology Brain and Development Research Center
Affiliation as printed
Department of Developmental and Educational Psychology, Brain and Development Research Center, Leiden University, Leiden, The Netherlands
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Affiliation as printed
Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Sarah Burke Aachen Department of Developmental and Educational Psychology Brain and Development Research Center
Affiliation as printed
Department of Developmental and Educational Psychology, Brain and Development Research Center, Leiden University, Leiden, The Netherlands
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Affiliation as printed
Department of Pediatrics, The Pennsylvania State University, University Park, Pennsylvania, USA
Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
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Affiliation as printed
Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Affiliation as printed
GIGA Neurosciences, Liège University, Liège, Belgium
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Rosalind Franklin University of Medicine and Science
Affiliation as printed
Department of Neuroscience, Rosalind Franklin University of Medicine & Science, Chicago, Illinois, USA
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Centre National de la Recherche Scientifique · Children's National · George Washington University · Epigenetics, Data, Politics
Affiliation as printed
Center for Genetic Medicine Research, Children's National Medical Center, Washington, District of Columbia, USA
Department of Genomics and Precision Medicine, George Washington University, Washington, District of Columbia, USA
Epigenetics, Data, & Politics at Centre National de la Recherche Scientifique, Paris, France
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Affiliation as printed
Department of Speech, Language, and Hearing Science, George Washington University, Washington, District of Columbia, USA
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Nationwide Children's Hospital · The Ohio State University
Affiliation as printed
Center for Biobehavioral Health, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Northwestern University · Lurie Children's Hospital
Affiliation as printed
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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