BACKGROUND: Human beings with a difference in sexual development (DSD) often underwent gender reassignment surgery during early childhood. However, the medical decision was often not congruent with the gender identity that affected persons developed later on.
OBJECTIVE: To represent the interests of affected persons, an interdisciplinary guideline in cooperation with support groups was written.
METHODS: The revision of the first version of the guideline, published in 2016, was edited by 18 professional societies and working groups as well as 3 support groups. A literature search was performed for each of the 12 chapters. Recommendations and statements created by the working groups were voted on during four consensus conferences.
RESULTS: The guideline highlights the right of self-determination of affected persons. In this context, new legal requirements are reported. Other than necessary primary diagnostics, medical procedures should be postponed. Most important is the psychological support of parents and patients. Tumor risk of the gonads and protection of fertility are analyzed and discussed in detail.
CONCLUSIONS: The content of the guideline represents a paradigm shift in dealing with human beings with a difference of sexual development. Projects as DSD Care and Empower-DSD help to promote the practical implementation of the guideline\'s recommendations.
UNASSIGNED: HINTERGRUND: Menschen mit einer Variante der Geschlechtsentwicklung wurden lange Zeit im frühen Kindesalter an das männliche oder weibliche Geschlecht angeglichen. Die aus medizinischer Sicht gewählte Angleichung entsprach nicht immer der späteren Geschlechtsidentität der Betroffenen.
UNASSIGNED: Um die Interessen der Betroffenen zu vertreten, wurde eine interdisziplinäre Leitlinie unter Beteiligung von Selbsthilfegruppen erarbeitet.
METHODS: An der Überarbeitung der primär 2016 publizierten Leitlinie arbeiteten 18 Fachgesellschaften bzw. Fachverbände sowie 3 Selbsthilfegruppen mit. Für die 12 Kapitel wurden systematische Literaturrecherchen durchgeführt. Die in den Arbeitsgruppen verfassten Empfehlungen und Statements wurden in 4 Konsensuskonferenzen abgestimmt.
UNASSIGNED: Die Leitlinie stellt das Selbstbestimmungsrecht der Betroffenen in den Mittelpunkt. In diesem Zusammenhang werden auch die neuen gesetzlichen Vorgaben dargestellt. Außer der notwendigen Primärdiagnostik sollen medizinische Maßnahmen eher in den Hintergrund gestellt werden. Wichtig ist besonders die psychologische Unterstützung von Eltern und den Betroffenen selbst. Ausgiebig wird das Tumorrisiko der verschiedenen Formen der Varianten der Geschlechtsentwicklung analysiert und auf die Fertilitätsprotektion eingegangen.
UNASSIGNED: Der Inhalt der Leitlinie stellt ein Paradigmenwechsel im Umgang mit Menschen mit einer Variante der Geschlechtsentwicklung dar. Die Projekte DSD-Care und Empower-DSD fördern die praktische Umsetzung der Leitlinienempfehlungen.

There has been increasing interest in endocrine-disrupting chemicals (EDCs) among scientists and public authorities over the last 30 years, notably because of their wide use and the increasing evidence of detrimental effects on humans and the environment. However, test systems for the detection of potential EDCs as well as testing strategies still require optimization. Thus, the aim of the present project was the development of an integrated test protocol that merges the existing OECD test guidelines (TGs) 229 (fish short-term reproduction assay) and 234 (fish sexual development test) and implements thyroid-related endpoints for fish. The integrated fish endocrine disruptor test (iFEDT) represents a comprehensive approach for fish testing, which covers reproduction, early development, and sexual differentiation, and will thus allow the identification of multiple endocrine-disruptive effects in fish. Using zebrafish (Danio rerio) as a model organism, two exposure tests were performed with well-studied EDCs: 6-propyl-2-thiouracil (PTU), an inhibitor of thyroid hormone synthesis, and 17α-ethinylestradiol (EE2), an estrogen receptor agonist. In part A of this article, the effects of PTU and EE2 on established endpoints of the two existing TGs are reported, whereas part B focuses on the novel thyroid-related endpoints. Results of part A document that, as expected, both PTU and EE2 had strong effects on various endocrine-related endpoints in zebrafish and their offspring. Merging of TGs 229 and 234 proved feasible, and all established biomarkers and endpoints were responsive as expected, including reproductive and morphometric changes (PTU and EE2), vitellogenin levels, sex ratio, gonad maturation, and histopathology (only for EE2) of different life stages. A validation of the iFEDT with other well-known EDCs will allow verification of the sensitivity and usability and confirm its capacity to improve the existing testing strategy for EDCs in fish. Integr Environ Assess Manag 2024;20:817-829. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

暂无摘要。

The risk of suffering from gonadal germ cell tumors (GCT) is increased in some patients with different sexual development (DSD), mainly in those with Y chromosome material. This risk, however, varies considerably depending on a multitude of factors that make the decision for prophylactic gonadectomy extremely difficult. In order to make informed recommendations on the convenience of this procedure in cases where there is potential for malignancy, this consensus guide evaluates the latest clinical evidence, which is generally low, and updates the existing knowledge in this field.

Hypospadias is the most frequent genital variation in male newborns with an incidence of 1:200-300. The variation within this anomaly is very high, from isolated distal hypospadias to very complex penoscrotal cases with accompanying genital or nongenital anomalies, genetic anomalies or even disorders of sexual differentiation. In the literature one can find up to 250 different surgical techniques for hypospadias repair. The goal of the new S2k guideline on hypospadias (AWMF registry no. 006-026), developed by the German Association of Urology (DGU) and the German Association of Pediatric Surgery (DGKCH), was a certain standardisation of the preoperative diagnostic workup, the surgical management and the postoperative care of patients with distal, middle or proximal hypospadias. In this article, the most important facts of the guideline are presented using a fictional case of an infant with distal hypospadias. For further reading, we refer to the S2k guideline, which can be easily accessed by scanning the pictured QR code.
UNASSIGNED: Die Hypospadie ist mit einer Inzidenz von 1:200–300 die häufigste Fehlbildung bei männlichen Neugeborenen. Dabei ist die Variabilität der Ausprägung sehr hoch, von einer isolierten distalen Hypospadie bis hin zu komplexen penoskrotalen Hypospadien mit begleitenden genitalen oder nicht-genitalen Anomalien und ggf. auch genetischen Anomalien und Störungen der Geschlechtsentwicklung. In der Literatur finden sich bis zu 250 verschiedene operative Verfahren zur Korrektur einer Hypospadie. Die Zielsetzung der hier anhand eines Fallbeispiels präsentierten S2k-Leitlinie für Hypospadie (AWMF-Register Nr. 006-026 [Arbeitsgemeinschaft Medizinisch-Wissenschaftlicher Fachgesellschaften]), herausgegeben von der Deutschen Gesellschaft für Urologie e. V. (DGU) und der Deutschen Gesellschaft für Kinderchirurgie e. V. (DGKCH), ist eine Standardisierung der präoperativen Diagnostik, des operativen Vorgehens und der postoperativen Behandlung sowie der Nachsorge bei distalen, mittleren und proximalen Hypospadien. Anhand eines fiktiven Falles einer distalen Hypospadie sollen die wichtigsten Punkte der Leitlinie anschaulich dargestellt werden. Zur Vertiefung der Thematik verweisen wir auf die Leitlinie, die mittels abgebildeten QR-Codes direkt aufgerufen werden kann.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport\'s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete\'s unique makeup.

We present key points from the updated Dutch-Flemish guideline on comprehensive diagnostics in disorders/differences of sex development (DSD) that have not been widely addressed in the current (inter)national literature. These points are of interest to physicians working in DSD (expert) centres and to professionals who come across persons with a DSD but have no (or limited) experience in this area. The Dutch-Flemish guideline is based on internationally accepted principles. Recent initiatives striving for uniform high-quality care across Europe, and beyond, such as the completed COST action 1303 and the European Reference Network for rare endocrine conditions (EndoERN), have generated several excellent papers covering nearly all aspects of DSD. The Dutch-Flemish guideline follows these international consensus papers and covers a number of other topics relevant to daily practice. For instance, although next-generation sequencing (NGS)-based molecular diagnostics are becoming the gold standard for genetic evaluation, it can be difficult to prove variant causality or relate the genotype to the clinical presentation. Network formation and centralisation are essential to promote functional studies that assess the effects of genetic variants and to the correct histological assessment of gonadal material from DSD patients, as well as allowing for maximisation of expertise and possible cost reductions. The Dutch-Flemish guidelines uniquely address three aspects of DSD. First, we propose an algorithm for counselling and diagnostic evaluation when a DSD is suspected prenatally, a clinical situation that is becoming more common. Referral to ultrasound sonographers and obstetricians who are part of a DSD team is increasingly important here. Second, we pay special attention to healthcare professionals not working within a DSD centre as they are often the first to diagnose or suspect a DSD, but are not regularly exposed to DSDs and may have limited experience. Their thoughtful communication to patients, carers and colleagues, and the accessibility of protocols for first-line management and efficient referral are essential. Careful communication in the prenatal to neonatal period and the adolescent to adult transition are equally important and relatively under-reported in the literature. Third, we discuss the timing of (NGS-based) molecular diagnostics in the initial workup of new patients and in people with a diagnosis made solely on clinical grounds or those who had earlier genetic testing that is not compatible with current state-of-the-art diagnostics.

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Kisspeptins, a family of neuropeptides encoded by the Kiss1 gene that are mainly expressed in discrete neuronal populations of the hypothalamus, have recently emerged as essential upstream regulatory elements of GnRH (gonadotropin-releasing hormone) neurons and, thereby, potent elicitors of gonadotropin secretion. Indeed, kisspeptins are now recognized as important regulators of key aspects of the maturation and function of the reproductive axis, including the sexual differentiation of the brain, the timing of puberty, the adult regulation of gonadotropin secretion by gonadal hormones, and the control of fertility by metabolic and environmental (e.g., photoperiod) cues. Appreciation of these fundamental biological features has led to the contention that kisspeptins are indispensable elements of the reproductive brain whose relevance goes beyond their crucial physiological roles and may pose potential pathophysiological and therapeutic interest. In spite of such a consensus, recent developments in the field have helped to expand, and somewhat challenged, our current understanding of the neuroendocrine and molecular mechanisms whereby some of the effects of kisspeptins are conducted. This review aims to provide a synoptic and balanced account of the consensus knowledge and recent findings in the field of kisspeptin physiology, which we predict will be crucial in shaping the progress of our understanding of the roles played by this family of neuropeptides in reproductive biology.