Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up

Puberty suppression by means of gonadotropin releasing hormone (GnRH) analogs is considered a diagnostic aid in gender dysphoric adolescents. However, there are also concerns about potential risks, such as poor outcome or post-surgical regret, adverse effects on metabolic and endocrine status, impaired increment of bone mass, and interference with brain development. This case report is on a 22-year follow-up of a female-to-male transsexual, treated with GnRH analogs at 13 years of age and considered eligible for androgen treatment at age 17, and who had gender reassignment surgery at 20 and 22 years of age. At follow-up, he indicated no regrets about his treatment. He was functioning well psychologically, intellectually, and socially; however, he experienced some feelings of sadness about choices he had made in a long-lasting intimate relationship. There were no clinical signs of a negative impact on brain development. He was physically in good health, and metabolic and endocrine parameters were within reference ranges. Bone mineral density was within the normal range for both sexes. His final height was short as compared to Dutch males; however, his body proportions were within normal range. This first report on long-term effects of puberty suppression suggests that negative side effects are limited and that it can be a useful additional tool in the diagnosis and treatment of gender dysphoric adolescents

Clinical management of gender dysphoria in adolescents

The chapter describes the clinical management of gender dysphoria in adolescents as offered by the Gender Identity Development Service at the Tavistock Centre in London. It provides a description of the presentations of gender dysphoria in adolescents, the associated psychosocial difficulties and a brief summary of the current explanatory models. It introduces the concept of ‘atypical gender identity organisation’ and its relevance to management. The clinical management and therapy described are based on a staged approach in line with the Standards of Care by the World Professional Association for Transgender Health. The chapter highlights an approach which integrates psychological, social and physical interventions within a multidisciplinary and well-integrated team. The current eligibility criteria for early pubertal suppression adopted by the service are described. The chapter concludes that the management of gender dysphoria is in continuous evolution and that new models of care will be developed as clinical and research evidence progresses. Clinical vignettes are used to illustrate the approach to management described

A Method for Facilitating 4D Modeling by Automating Task Information Generation and Mapping

4D modeling integrates 3D model with project time schedule to provide virtual simulation for identifying spatio-temporal problems earlier in construction projects. However, constructing a 4D model takes a significant amount of time and is prone to man-made errors due to its manual steps and repetitive nature. Therefore, in this study, a model based two-phase method is developed to facilitate linking 3D model with the schedule by automating the cumbersome steps. In the first phase, 4D Task IDs are created and assigned automatically to the model elements using a pattern that depends on their properties. In the second phase, using these IDs, the method generates a task ID list for scheduling and the search sets for simulation in order to map the model elements with the schedule tasks automatically, according to matching IDs. Hence, using shared IDs enhances the communication between 4D modeling tools. The efficiency of the method was tested with a well-known office building model constructed in Revit. The schedule was completed in Microsoft Project and 4D simulation is performed in Navisworks. The automated steps offered by the method were coded in Dynamo add-in of Revit. The analysis result showed that the developed method generated a 4D model in a shorter time compared to the manually performed one

Hormone therapy and patient satisfaction with treatment, in a large cohort of diverse disorders of sex development

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