The role of sex hormone replacement therapy on self-perceived competence in adolescents with delayed puberty.

The objective of the present study was to determine the role of sex steroids in the development of self-perceived competence during adolescence. The Harter Self-Perception Scale was administered to 56 adolescents with delayed puberty who were receiving depo-testosterone (males) or conjugated estrogens (females) administered in 3-month blocks alternating with placebo. Treatment was given at three dose levels approximating early, middle, and late pubertal replacement levels. Hormone treatments had a significant positive effect for both males and females in one subscale domain--perceived job competence. Significant positive hormone effects were also obtained for perceptions of romantic appeal and close friendship in females and perception of athletic abilities in males. It can be inferred from the results of this study that the hormonal changes associated with sexual maturation have targeted influences on specific domains of self-perceived competence and that there are clear gender differences.

Children with organic growth hormone deficiency have elevated cortisol responses to stimuli.

The aim of this study was to investigate hypothalamic-pituitary-adrenal (HPA) function in children with GH deficiency. Ninety-four patients were evaluated for GH deficiency and cortisol (F) deficiency using clinical criteria and L-dopa and insulin-induced hypoglycemia stimulation tests. They were assigned to three diagnostic groups: organic GH deficient (OGHD), idiopathic GH deficient (IGHD), and not GH-deficient (NGHD). Time series, cross-sectional, regression analysis revealed statistically significantly elevated F [>828 nmol/L (30 microg/dL)] in the OGHD group vs. the NGHD group. The value for F in the IGHD group was not different from the NGHD group. This finding suggests that dysregulation of the HPA axis is present in most children with OGH deficiency and significantly less often in children with IGH deficiency or without GH deficiency. Anatomical disruption of the control pathways for the HPA axis or stress may cause the dysregulation.

Dysregulation of the hypothalamic-pituitary-adrenal axis in short children with and without growth hormone deficiency.

The effects of L-dopamine (LD) administration and insulin-induced hypoglycemia in adrenocorticotropin (ACTH) and cortisol secretion were studied in 14 short boys. LD caused moderate changes in both hormones. The four boys with isolated, idiopathic growth hormone (GH) deficiency (IGD) demonstrated a greater cortisol increase in response to hypoglycemia than the 10 boys with normal GH secretion. In at least some short children with IGD, abnormal regulation of the hypothalamic-pituitary-adrenal axis may be present.

Self-assessment of physical sexual maturation in boys and girls with delayed puberty.

We studied 49 boys and girls with delayed physical sexual maturation during treatment with sex steroids. We found significant agreements, but also some disagreements between physicians' and subjects' Tanner sexual maturity ratings. We found neither effects of treatment with sex steroids nor gender differences, comparing ratings between physicians and patients.

The effect of sex hormone replacement therapy on behavior problems and moods in adolescents with delayed puberty.

OBJECTIVE: The objective of this clinical study was to determine the effects of sex steroids on behavior and mood in adolescents with hypogonadism. STUDY DESIGN: The experimental design consisted of a randomized, double-blind, placebo-controlled, crossover trial lasting for 21 months. The study group consisted of 39 boys and 16 girls recruited from a pediatric endocrine clinic for delayed puberty. Depo-testosterone (to boys) or conjugated estrogens (to girls) was administered in 3-month blocks, alternating with placebo, at 3 dose levels approximating early, middle, and late pubertal amounts. The Child Behavior Checklist, Youth Self Report, Differential Emotion Scale, and Daily Mood Diary were administered after each placebo and treatment period to ascertain the effect of sex steroids on self- and parent-reported behavior problems and moods. RESULTS: The data demonstrated only one significant treatment effect, namely, an increase in withdrawn behavior problems during administration of low-dose estrogen in girls. There were no consistent sex differences. CONCLUSION: These results demonstrate that administered testosterone or estrogen has minimal effects on behavior problems or mood in adolescents.

Effects of estrogen or testosterone on self-reported sexual responses and behaviors in hypogonadal adolescents.

The purpose of this study was to investigate the effects of administration of sex steroids on self-reported sexual responses and behaviors in hypogonadal adolescents. We used a randomized, double blind, placebo-controlled, cross-over, clinical trial as the experimental design. The subjects were 39 boys and 16 girls with delayed puberty. We treated girls with oral conjugated estrogen and boys with testosterone enanthate in 3 dose levels intended to simulate early, middle, and late pubertal levels. We administered a modification of the Udry sexual behavior questionnaire after each 3-month placebo and treatment period to detect the effect of sex steroids on self-reported sexual behaviors and responses. We employed a strict intent to treat statistical analytical model. The data showed significant effects of the administration of testosterone to boys causing increases in nocturnal emission and touching behaviors at the mid- and high doses. No other treatment effects on sexual behaviors or responses were seen in boys. For girls, there was a significant increase in necking caused by the administration of estrogen only at the late pubertal dose. No other treatment effects on sexual behaviors or responses were seen in girls. We noted some gender differences for thinking about sex, sexual "turn-on," and the nature of sexual behavior. The administration of physiological doses of sex steroids to boys or girls with delayed puberty have few effects on sexual behaviors and responses.

Estrogen or testosterone increases self-reported aggressive behaviors in hypogonadal adolescents.

A randomized, double-blinded, placebo-controlled cross-over clinical trial was used to determine the role of sex steroids on the development of aggressive behaviors in 35 boys and 14 girls. Depo-testosterone (to boys) or conjugated estrogens (to girls) was administered in 3-month blocks alternating with placebo at three dose levels approximating early, middle and late pubertal amounts. The Olweus Multifaceted Aggression Inventory was administered after each placebo and treatment period to ascertain the effect of sex steroids on self-reported aggressive behaviors. We employed a strict intent-to-treat analytical model. The data demonstrated significant hormone effects on physical aggressive behaviors and aggressive impulses, but not in verbal aggressive behaviors nor aggressive inhibitions in both boys and girls. These results are the first to causally relate the administration of physiological doses of sex steroids to changes in aggressive behaviors in adolescents.

Diversity of pubertal testosterone changes in boys with constitutional delay in growth and/or adolescence.

In a group of 22 boys with constitutional delay in growth and/or adolescence, intermittent testosterone enanthate treatment was employed in a randomized clinical trial at multiple doses ranging from 25-100 mg every two weeks for three month periods extending over 15-21 months. Twelve of the patients displayed a prompt increase in endogenous testosterone levels during the study period, reaching levels in the adult male range (> 250 ng/dl). The remaining 10 boys showed sluggish changes in endogenous testosterone during the investigation, ranging from 35-177 ng/dl. The bone ages and testicular sizes of the two groups at study initiation did not differ though urine LH was significantly less at study entry in the slowly maturing group. The data reveal a great diversity in the pace and pattern of endogenous testosterone changes in the study population. The results also suggest that exogenous sex steroid treatment of such patients does not speed up the central nervous system processes controlling the onset and progression of puberty. Boys with delayed puberty should be followed until endogenous testosterone levels reach the adult male range in order to rule out mild gonadotropin deficits.

The effect of developmental changes in adolescence on drug disposition.

Biological and behavioral change occurs throughout the lifespan. The nature and rapidity of change during adolescence is striking. The effects of rapid growth, sexual maturation, and psychological reorganization on pharmacodynamics and pharmacokinetics must be considered during studies on teenagers. It is important to consider the large amount of variability in the timing of normal developmental events. The concept of developmental rather than chronological age should be considered. Measurement of organismic and behavioral variables includes whole organism measures such as body height, weight, surface area, body mass index, self-concept, sexual identity/role, and many other behavioral measures. Pubertal development may be assessed by sexual maturity ratings. Bone age may be a particularly useful estimate of developmental status. Biochemical measures include gonadotropin, sex steroids, other hormonal or hormone receptor values.

The relationship between aggressive behavior and puberty in normal adolescents: a longitudinal study.

PURPOSE: To assess changes in aggressive behaviors as related to progression from early to late puberty in normal adolescents. METHODS: Subjects were normal English schoolchildren. An observational cohort design was employed. Pubertal status was measured by Tanner staging. Self-reports of verbal aggression against adults, physical aggression against peers, aggressive impulses and aggressive inhibitory responses, were collected at three points in time. Analyses were performed for the entire group of 106 subjects in 1983, 77 subjects in 1985 and 70 subjects in 1987. Statistical methods included analysis of variance, regression and correlation and cluster formation. RESULTS: There were decreases in all aggression variables except in aggressive impulses over this time period. When analyzed by gender, boys were initially more aggressive than girls, but by late puberty all gender differences in self-reported aggressive behaviors had disappeared. When only those subjects who were evaluated at all three data collection times were grouped by similar responses on both aggression and physical variables, three clusters of boys and girls were identified. Clusters contained varying proportions of boys and girls. Cluster one (48.5% of the entire sample) was a low aggression group. Cluster two (30.3%) was a high aggression group, and cluster three (21.2%) was an intermediate aggression group. These clusters seemed to have relatively stable aggression characteristics over time. CONCLUSIONS: These data suggest that groups of boys and girls who report similar aggression characteristics and have similar growth and pubertal characteristics can be identified. Neither gender alone, nor pubertal status alone, nor by inference, hormones alone is sufficient to explain the complex set of behaviors which are involved in aggression.

Sanitary product use by white, black, and Mexican American women.

In 1988-89, the use of menstrual sanitary products was surveyed among 699 white, 477 black, and 425 Mexican American women to detect age and racial or ethnic differences in product use that might explain the differences in the incidence of toxic shock syndrome (TSS) in these demographic categories. Forty percent of the women had never used tampons. Significantly more whites used tampons alone (26 percent) or with pads (36 percent) than did blacks. Proportionately more blacks used tampons alone (16 percent) or with pads (27 percent) compared with Mexican Americans, 11 percent of whom used tampons alone and 21 percent of whom used tampons and pads. Since a substantial proportion of black women used tampons, racial-ethnic variations in use patterns alone cannot completely explain the low incidence of TSS among black women. Tampon use started in the early teen years, but women in the age group 20-29 had the highest frequency of use of tampons either alone (26 percent) or with pads (33 percent). These percentages suggest that age-related differences in product use may not explain the age-related differences in the incidence of TSS. Fear was the most common specific reason for not using tampons in response to information about TSS. Decreased use of tampons in response to information about TSS was reported by 39 percent of whites, 50 percent of blacks, 46 percent of Mexican Americans, and by 36 percent of women less than 19 years, 41 percent of 20-29-year-olds, and 47 percent of women 30 years and older.

A survey of pediatricians' attitudes and practices about maternal employment.

A survey of 281 members (31 percent) of the Texas Pediatric Society was performed in 1981 to assess members' knowledge of, attitudes toward, and practices regarding mothers who work outside the home. Only 15 percent correctly answered two of three knowledge questions about maternal employment. Thirty-five percent of the pediatricians failed to inquire about maternal employment. Although only 1 percent advised all mothers not to work, 22 percent said that mothers with children at home should not work. Most pediatricians had traditional conservative attitudes and opinions (exemplified by the statement "a woman's place is in the home") in regard to two factors, "acceptability of maternal employment" and "effects of maternal employment on children." More liberal views were associated with more recent graduation from medical school, being a woman, having a working wife, being in favor of wife's working status, and knowledge of statistics concerning maternal employment. These results suggest that if the practices of those Texas pediatricians who responded correspond with other pediatricians' practices in the United States, a large proportion of pediatricians may not be providing adequate support for the 17 million working mothers and their children.

Physical and hormonal evaluation of transsexual patients: a longitudinal study.

The physical and hormonal characteristics of 60 male-to-female transsexuals and 30 female-to-male transsexuals were measured before or during treatment with commonly used forms and dosages of hormones. Only two patients (both female-to-male) had either a congenital defect in hormonal production or abnormal genital development. Patients were seen at 3- to 6-month intervals for an average of 18 months. The response to therapy was examined over time; physical parameters, hormonal concentrations, liver function tests, lipids, and glucose were measured. Three patients were changed from ethinyl estradiol to conjugated estrogen because of liver enzyme elevations. Ethinyl estradiol (0.1-0.5 mg/day) was equal to conjugated estrogen (7.5-10 mg/day) in its ability to suppress testosterone and gonadotropins and to promote breast growth. Maximum breast growth required 2 years of therapy. During treatment with testosterone, female-to-male transsexuals had a significant mild elevation of cholesterol and triglyceride. The female-to-male transsexuals receiving testosterone cypionate, 200 mg every 2 weeks, ceased to have menstrual periods and became progressively masculinized. A mean maximal clitoral length of 4.6 cm which achieved by 1 year of therapy. Based on the data generated by this study, we recommend as hormonal therapy 0.1-0.5 mg/day of ethinyl estradiol or 7.5-10 mg/day of conjugated estrogen for male-to-female transsexuals, and intramuscular testosterone cypionate, 200 mg every 2 weeks, for female-to-male transsexuals.

Twenty-four-hour cortisol profiles demonstrate exaggerated nocturnal rise in diabetic children.

Plasma cortisol was measured every 20 min for 24 h in 12 normal and 8 insulin-dependent, nonketotic, diabetic children treated with one daily injection of insulin. Plasma glucose was also measured every 20 min in the diabetic children. The diurnal pattern of cortisol secretion was identical. The mean 24-h plasma cortisol was similar in both groups, but significantly elevated in the diabetic children between 0200 and 0920 h. Peak cortisol levels were higher in the diabetic than in the normal children. No correlation was found between average plasma glucose and average plasma cortisol, or between the nocturnal change in plasma glucose and average nocturnal plasma cortisol in the diabetic subjects. These studies demonstrate an exaggeration of the normal nocturnal rise in plasma cortisol in diabetic children not related to the levels of plasma glucose.

Teenage pregnancy and parenthood: outcomes for mother and child.

This study reports some general health and related outcomes for all women ages 14, 15, and 16 and their children delivered at our hospital in 1976. These outcomes are contrasted with 100 women ages 20-30 years and their children born the same year. Data were collected by retrospective chart review. For the teenage group, 70% were unmarried, most of the fathers were 4-5 years older than the teenaged mother, most teen mothers were living with their parents, and all had incomes in the poverty range. A comparison of black and white teenaged mothers showed that: (1) 14-15-year-old blacks had proportionally more pregnancies than whites, (2) the first prenatal visit was later for blacks, and (3) children of the white teenagers had more acute illness visits during the 2-yr follow up. When the age of the teenage mother is considered, the 1-min Apgar scores for the children of 14-year olds were lower and the school drop out rate was higher with increasing maternal age. In comparing the teen to the 20-30-year-old group, the only finding was higher complication rate for pregnancy and delivery for the teen group. The physical growth of all children was normal. These results must be interpreted with caution, because of missing data for some variables; however, this data should be of some use in planning future research and intervention programs.

Hospital-based employees' opinions about adolescents of four racial-ethnic groups.

We obtained opinions about adolescents' characteristics and behaviors from 290 employees of a medical school and its hospitals. Employees were asked for their opinions about 4 positive, 2 neutral, and 6 negative characteristics and about 5 sexual, 8 substance use, and 5 relationship behaviors. Most employees were willing to characterize adolescents in general, but fewer were willing to express opinions about white, black, Mexican-American or Oriental teens in particular. There was poor correspondence between the general adolescent ratings, the ratings of the racial-ethnic groups, and reports in the literature. The respondents, unable to accurately describe white and black teens, could not characterize Mexican-American teens and characterized Oriental teens predominantly in the category "least likely to behave this way." The data suggest that adults' stereotyping of adolescents' behaviors and characteristics is common and suggests the need for programs to better inform adults about adolescents.

Physical and hormonal evaluation of transsexual patients during hormonal therapy.

The optimal hormonal therapy for transsexual patients is not known. The physical and hormonal characteristics of 38 noncastrate male-to-female transsexuals and 14 noncastrate female-to-male transsexuals have been measured before and/or during therapy with various forms and dosages of hormonal therapy. All patients were hormonally and physically normal prior to therapy. Ethinyl estradiol was superior to conjugated estrogen in suppression of testosterone and gonadotropins but equal in effecting breast growth. The changes in physical and hormonal characteristics were the same for 0.1 mg/d and 0.5 mg/d of ethinyl estradiol. The female-to-male transsexuals were well managed with a dose of intramuscular testosterone cypionate of 400 mg/month, usually given 200 mg every two weeks. The maximal clitoral length reached was usually 4 cm. Higher doses of testosterone did not further increase clitoral length or suppression of gonadotropins; lower doses did not suppress the gonadotropins. Based on the information found in this study, we recommend 0.1 mg/d of ethinyl estradiol for the noncastrate male-to-female transsexual and 200 mg of intramuscular testosterone cypionate every two weeks for the noncastrate female-to-male transsexual.

Hospitalization of adolescents: collecting the data base. Variations and implications.

A survey of 2208 adolescents (aged 12 through 18 years) hospitalized during 1977 identified variations in data-base development and unrecognized health problems. Forty-eight percent were admitted to obstetrics and gynecology, 29% to surgery, 13% to pediatrics/internal medicine combined, and 10% to psychiatry. Historical, physical, and laboratory data bases and diagnoses were examined from 325 records. All records included a history of present illness and blood pressure, and most included a past medical and family history. Excluding pediatric records, a minority of records included social, immunization, school, or perinatal histories. Pediatric records were lacking in histories of alcohol or tobacco use. Most records lacked dietary or drug-abuse histories. A majority of records contained growth parameters, hemoglobin, urinalysis, and chest x-ray. Despite a high prevalence of anemia, the diagnosis was infrequently recorded. This survey suggests that clinical departments collect data on sick adolescents in differing ways--none of which seems optimal. Clinical departments should examine their training programs regarding the collection and interpretation of the data base in order to provide optimal care for hospitalized adolescents.