Peers Matter: Social Problems in Kindergarten and the Development of Psychopathology

Koot, J.M. [Promotor]Lier, P.A.C. van [Promotor]Stegge, G.T.M. [Copromotor

Endocrinology of Transgender Medicine

Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population

Endocrine treatment of aging transgender people

High quality empirical data assessing morbidity and mortality and cancer incidence among transgender people are almost non-existent. Sex hormone treatment of conditions in older non-transgender people might as yet be taken as the best available analogy to hormone administration to aging transgender persons. Testosterone administration to transgender men carries little risk with regard to cardiovascular disease and cancer. A dose adaptation may be needed in men with a high hematocrit or cardiac insufficiency. In transgender men, even after breast ablation, breast cancer may occur in residual mammary tissue. Treatment with estrogens (specifically oral ethinylestradiol) of transgender women, particularly in combination with progestins, carries a significant relative risk of developing cardiovascular disease (almost a twofold incidence compared to the general population). The dose of estrogens may have to be reduced with aging. A change from oral to probably safer transdermal estrogens must be considered. Though rare, tumors of the breasts, prostate, meninges and pituitary have been encountered. Based upon the available expertise, initiation of cross-sex hormone treatment in elderly subjects is without disproportionate risks

The Role of Testosterone in the Etiology and Treatment of Obesity, the Metabolic Syndrome, and Diabetes Mellitus Type 2

Obesity has become a major health problem. Testosterone plays a significant role in obesity, glucose homeostasis, and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis, and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a proinflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Lower total testosterone and sex hormone-binding globulin (SHBG) predict a higher incidence of the metabolic syndrome. Administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile for the development of diabetes and atherosclerosis

Improvement of the diabetic foot upon testosterone administration to hypogonadal men with peripheral arterial disease. Report of three cases

<p>Abstract</p> <p>Background</p> <p>Lower extremity complications (neuropathy, ulceration, infection, and peripheral arterial disease) are common in diabetes mellitus. There is an inverse relation between plasma testosterone and insulin sensitivity, type 2 diabetes mellitus and HbA1c concentrations.</p> <p>Methods</p> <p>We report the beneficial effects of administration of testosterone to three men with a diabetic foot whose serum testosterone was subnormal.</p> <p>Results</p> <p>Upon normalization of serum testosterone there was an improvement of hyperglycemia, a decrease of leukocytes and of fibrinogen levels, an increase of antithrombin III activity and of tissue oxygen pressure. The wound showed granulation.</p> <p>Conclusion</p> <p>Beneficial effects of administration of testosterone to hypogonadal with a diabetic foot may be due to improved vascularization and to anti-inflammatory action.</p

Measuring very negative water potentials with polymer tensiometers: principles, performance and applications

In recent years, a polymer tensiometer (POT) was developed and tested to directly measure matric potentials in dry soils. By extending the measurement range to wilting point (a 20-fold increase compared to conventional, water-filled tensiometers), a myriad of previously unapproachable research questions are now open to experimental exploration. Furthermore, the instrument may well allow the development of more water-efficient irrigation strategies by recording water potential rather than soil water content. The principle of the sensor is to fill it with a polymer solution instead of water, thereby building up osmotic pressure inside the sensor. A high-quality ceramic allows the exchange of water with the soil while retaining the polymer. The ceramic has pores sufficiently small to remain saturated even under very negative matric potentials. Installing the sensor in an unsaturated soil causes the high pressure of the polymer solution to drop as the water potentials in the soil and in the POT equilibrate. As long as the pressure inside the polymer chamber remains sufficiently large to prevent cavitation, the sensor will function properly. If the osmotic potential in the polymer chamber can produce a pressure of approximately 2.0 MPa when the sensor is placed in water, proper readings down to wilting point are secured. Various tests in disturbed soil, including an experiment with root water uptake, demonstrate the operation and performance of the new polymer tensiometer and illustrate how processes such as root water uptake can be studied in more detail than before. The paper discusses the available data and explores the long term perspectives offered by the instrument

Een overheid op drift: de strafrechtelijke beheersing van seks en jongeren

The study at hand focuses on the control of sex and youngsters through the response by authorities most notably from within criminal justice. This dissertation consists of five articles and a concluding chapter. The emphasis of this study is on the societal interests as protected by the authorities. This approach provides a useful complement to more conventional research on sexual abuse and sexual transgression. In a lot of studies the behavior of individuals receives most attention and not the response by authorities, which can be indicative of the way authorities envision the organization of society. It is this organization through the control of youth and sex that sets this study apart from other studies.Criminal Justice: Legitimacy, accountability, and effectivit