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Consensus parameter : research methodologies to evaluate neurodevelopmental effects of pubertal suppression in transgender youth

(2020) TRANSGENDER HEALTH. 5(4). p.246-257
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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.
Keywords
expert consensus, Delphi, puberty blockers, GnRHa, transgender, adolescents

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MLA
Chen, Diane, et al. “Consensus Parameter : Research Methodologies to Evaluate Neurodevelopmental Effects of Pubertal Suppression in Transgender Youth.” TRANSGENDER HEALTH, vol. 5, no. 4, 2020, pp. 246–57, doi:10.1089/trgh.2020.0006.
APA
Chen, D., Strang, J. F., Kolbuck, V. D., Rosenthal, S. M., Wallen, K., Waber, D. P., … Garofalo, R. (2020). Consensus parameter : research methodologies to evaluate neurodevelopmental effects of pubertal suppression in transgender youth. TRANSGENDER HEALTH, 5(4), 246–257. https://doi.org/10.1089/trgh.2020.0006
Chicago author-date
Chen, Diane, John F. Strang, Victoria D. Kolbuck, Stephen M. Rosenthal, Kim Wallen, Deborah P. Waber, Laurence Steinberg, et al. 2020. “Consensus Parameter : Research Methodologies to Evaluate Neurodevelopmental Effects of Pubertal Suppression in Transgender Youth.” TRANSGENDER HEALTH 5 (4): 246–57. https://doi.org/10.1089/trgh.2020.0006.
Chicago author-date (all authors)
Chen, Diane, John F. Strang, Victoria D. Kolbuck, Stephen M. Rosenthal, Kim Wallen, Deborah P. Waber, Laurence Steinberg, Cheryl L. Sisk, Judith Ross, Tomas Paus, Sven Müller, Margaret M. McCarthy, Paul E. Micevych, Carol L. Martin, Baudewijntje P.C. Kreukels, Lauren Kenworthy, Megan M. Herting, Agneta Herlitz, Ira R.J. Hebold Haraldsen, Ronald Dahl, Eveline A. Crone, Gordon J. Chelune, Sarah M. Burke, Sheri A. Berenbaum, Adriene M. Beltz, Julie Bakker, Lise Eliot, Eric Vilain, Gregory L. Wallace, Eric E. Nelson, and Robert Garofalo. 2020. “Consensus Parameter : Research Methodologies to Evaluate Neurodevelopmental Effects of Pubertal Suppression in Transgender Youth.” TRANSGENDER HEALTH 5 (4): 246–257. doi:10.1089/trgh.2020.0006.
Vancouver
1.
Chen D, Strang JF, Kolbuck VD, Rosenthal SM, Wallen K, Waber DP, et al. Consensus parameter : research methodologies to evaluate neurodevelopmental effects of pubertal suppression in transgender youth. TRANSGENDER HEALTH. 2020;5(4):246–57.
IEEE
[1]
D. Chen et al., “Consensus parameter : research methodologies to evaluate neurodevelopmental effects of pubertal suppression in transgender youth,” TRANSGENDER HEALTH, vol. 5, no. 4, pp. 246–257, 2020.
@article{8686896,
  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.}},
  author       = {{Chen, Diane and Strang, John F. and Kolbuck, Victoria D. and Rosenthal, Stephen M. and Wallen, Kim and Waber, Deborah P. and Steinberg, Laurence and Sisk, Cheryl L. and Ross, Judith and Paus, Tomas and Müller, Sven and McCarthy, Margaret M. and Micevych, Paul E. and Martin, Carol L. and Kreukels, Baudewijntje P.C. and Kenworthy, Lauren and Herting, Megan M. and Herlitz, Agneta and Haraldsen, Ira R.J. Hebold and Dahl, Ronald and Crone, Eveline A. and Chelune, Gordon J. and Burke, Sarah M. and Berenbaum, Sheri A. and Beltz, Adriene M. and Bakker, Julie and Eliot, Lise and Vilain, Eric and Wallace, Gregory L. and Nelson, Eric E. and Garofalo, Robert}},
  issn         = {{2688-4887}},
  journal      = {{TRANSGENDER HEALTH}},
  keywords     = {{expert consensus,Delphi,puberty blockers,GnRHa,transgender,adolescents}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{246--257}},
  title        = {{Consensus parameter : research methodologies to evaluate neurodevelopmental effects of pubertal suppression in transgender youth}},
  url          = {{http://dx.doi.org/10.1089/trgh.2020.0006}},
  volume       = {{5}},
  year         = {{2020}},
}

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