Author Affiliation: Los Angeles Biomedical Research Institute, Harbor-University of California at... more Author Affiliation: Los Angeles Biomedical Research Institute, Harbor-University of California at Los Angeles Medical Center, Torrance (bspellberg@labiomed .org). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported receiving grant and contract support from Cubist, Pfizer, Bristol-Myers Squibb, and Cempra; being a consultant for GlaxoSmithKline, Meiji, Cardeas, aRigen, and Synthetic Biologics; and receiving honoraria from Cubist.
Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical... more Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical standpoints. Awareness of the condition appears to be increasing, probably because of greater societal acceptance and available hormonal treatment. Therapeutic options include hormone and surgical treatments but may be limited by insurance coverage because costs are high. For patients seeking male-to-female (MTF) change, hormone treatment includes estrogens, finasteride, spironolactone, and gonadotropin-releasing hormone (GnRH) analogs. Surgical options include feminizing genital and facial surgery, breast augmentation, and various fat transplantations. For patients seeking a female-to-male (FTM) gender change, medical therapy includes testosterone and GnRH analogs and surgical therapy includes mammoplasty and phalloplasty. Medical therapy for both FTM and MTF can be started in early puberty, although long-term effects are not known. All patients considering treatment need counseling and medical monitoring.
ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children&... more ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children's Hospital, discusses his experience treating disorders of sexual development in adolescents and young adult transgender individuals. He began treating transgender young adults in 1985. He discusses his early career development as well as his use of a protocol developed in Holland for treating trans-youth.
ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children&... more ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children's Hospital, discusses his experience treating disorders of sexual development in adolescents and young adult transgender individuals. He began treating transgender young adults in 1985. He discusses his early career development as well as his use of a protocol developed in Holland for treating trans-youth.
BACKGROUND Transgender children and adolescents, those who experience incongruence between assign... more BACKGROUND Transgender children and adolescents, those who experience incongruence between assigned sex at birth and internal gender identity, are a poorly understood and understudied population in the United States. Since 2008, medical care for transgender youth has generally followed guidelines developed by professional consensus given the paucity of empirical research, particularly in a U.S. setting. OBJECTIVE The objective of this research is to provide evidence-based data to inform clinical care for transgender youth. The study aims to: 1) evaluate the impact of gonadotropin-releasing hormone (GnRH) agonists administered for puberty suppression on mental health, psychological well-being, and metabolic and physiologic parameters including bone health in a cohort of children and adolescents (Tanner stages 2-4) with gender dysphoria, comparing baseline and follow-up assessments; and 2) evaluate the impact of gender-affirming hormones (e.g. estradiol, testosterone, etc.) administer...
This chapter focuses on new scientific developments in the physiology, management, and psychologi... more This chapter focuses on new scientific developments in the physiology, management, and psychological impact of diabetes in adolescents.
GENETICS AND ETIOLOGY: IMPLICATIONS FOR COUNSELING Until recently, diabetics were classified into... more GENETICS AND ETIOLOGY: IMPLICATIONS FOR COUNSELING Until recently, diabetics were classified into juvenile- or maturity-onset categories on the basis of the age at onset of disease. We now consider diabetes to be a syndrome in which various factors, diminished or absent beta cell secretory capacity, increased levels of gluconeogenic hormones, or altered insulin receptor binding, can produce the common denominator of hyperglycemia. Although a rare form of mild diabetes has been characterized in children and appears to be inherited in autosomal dominant fashion (termed MODY-Maturity Onset Diabetes of the Young)1, the overwhelming majority of diabetic children and adolescents develop the insulin-dependent variety of the disease. Recent studies in Michigan define the prevalence of the latter form to be 1.89 cases per 1000 school-aged children (ages 5 to 18 years), with an annual incidence of 1.6 cases per 100,000 children (ages 5 to 18 years). Whereas increased risk has long been observed in relatives of insulin-dependent diabetics, several factors have confounded the geneticists: patients sharing the same genetic blueprint do not share equal likelihood for developing the disease. When one member of a monozygotic twinship develops diabetes under age 45, his twin has but a 50% chance of becoming diabetic. On the other hand, if a twin develops the disease over the age of 45, the risk to the other twin approaches 100%.
The Journal of clinical endocrinology and metabolism, Jul 3, 2017
Testosterone is commonly administered intramuscularly (IM) to treat hypogonadal males and female-... more Testosterone is commonly administered intramuscularly (IM) to treat hypogonadal males and female-to-male transgender (FTM) patients. However, these injections can involve significant discomfort and may require arrangements for administration by others. We assessed whether T could be administered effectively and safely by the subcutaneously (SC) as an alternative to IM injections. Retrospective cohort study. Outpatient Reproductive Endocrinology Clinic at an academic medical center. Sixty-three FTM transgender patients aged >18 years electing to receive SC T therapy for gender transition were included. Fifty-three patients were premenopausal. Patients were administered T cypionate or enanthate weekly at an initial dose of 50mg. Dose was adjusted if needed to achieve serum total T levels within the normal male range. Serum concentrations of free and total T and total estradiol (E2), masculinization and surveillance for reactions at injection sites. Serum T levels within the normal ...
Author Affiliation: Los Angeles Biomedical Research Institute, Harbor-University of California at... more Author Affiliation: Los Angeles Biomedical Research Institute, Harbor-University of California at Los Angeles Medical Center, Torrance (bspellberg@labiomed .org). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported receiving grant and contract support from Cubist, Pfizer, Bristol-Myers Squibb, and Cempra; being a consultant for GlaxoSmithKline, Meiji, Cardeas, aRigen, and Synthetic Biologics; and receiving honoraria from Cubist.
Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical... more Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical standpoints. Awareness of the condition appears to be increasing, probably because of greater societal acceptance and available hormonal treatment. Therapeutic options include hormone and surgical treatments but may be limited by insurance coverage because costs are high. For patients seeking male-to-female (MTF) change, hormone treatment includes estrogens, finasteride, spironolactone, and gonadotropin-releasing hormone (GnRH) analogs. Surgical options include feminizing genital and facial surgery, breast augmentation, and various fat transplantations. For patients seeking a female-to-male (FTM) gender change, medical therapy includes testosterone and GnRH analogs and surgical therapy includes mammoplasty and phalloplasty. Medical therapy for both FTM and MTF can be started in early puberty, although long-term effects are not known. All patients considering treatment need counseling and medical monitoring.
ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children&... more ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children's Hospital, discusses his experience treating disorders of sexual development in adolescents and young adult transgender individuals. He began treating transgender young adults in 1985. He discusses his early career development as well as his use of a protocol developed in Holland for treating trans-youth.
ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children&... more ABSTRACT The author, an endocrinologist and co-founder of Gender Management Services at Children's Hospital, discusses his experience treating disorders of sexual development in adolescents and young adult transgender individuals. He began treating transgender young adults in 1985. He discusses his early career development as well as his use of a protocol developed in Holland for treating trans-youth.
BACKGROUND Transgender children and adolescents, those who experience incongruence between assign... more BACKGROUND Transgender children and adolescents, those who experience incongruence between assigned sex at birth and internal gender identity, are a poorly understood and understudied population in the United States. Since 2008, medical care for transgender youth has generally followed guidelines developed by professional consensus given the paucity of empirical research, particularly in a U.S. setting. OBJECTIVE The objective of this research is to provide evidence-based data to inform clinical care for transgender youth. The study aims to: 1) evaluate the impact of gonadotropin-releasing hormone (GnRH) agonists administered for puberty suppression on mental health, psychological well-being, and metabolic and physiologic parameters including bone health in a cohort of children and adolescents (Tanner stages 2-4) with gender dysphoria, comparing baseline and follow-up assessments; and 2) evaluate the impact of gender-affirming hormones (e.g. estradiol, testosterone, etc.) administer...
This chapter focuses on new scientific developments in the physiology, management, and psychologi... more This chapter focuses on new scientific developments in the physiology, management, and psychological impact of diabetes in adolescents.
GENETICS AND ETIOLOGY: IMPLICATIONS FOR COUNSELING Until recently, diabetics were classified into... more GENETICS AND ETIOLOGY: IMPLICATIONS FOR COUNSELING Until recently, diabetics were classified into juvenile- or maturity-onset categories on the basis of the age at onset of disease. We now consider diabetes to be a syndrome in which various factors, diminished or absent beta cell secretory capacity, increased levels of gluconeogenic hormones, or altered insulin receptor binding, can produce the common denominator of hyperglycemia. Although a rare form of mild diabetes has been characterized in children and appears to be inherited in autosomal dominant fashion (termed MODY-Maturity Onset Diabetes of the Young)1, the overwhelming majority of diabetic children and adolescents develop the insulin-dependent variety of the disease. Recent studies in Michigan define the prevalence of the latter form to be 1.89 cases per 1000 school-aged children (ages 5 to 18 years), with an annual incidence of 1.6 cases per 100,000 children (ages 5 to 18 years). Whereas increased risk has long been observed in relatives of insulin-dependent diabetics, several factors have confounded the geneticists: patients sharing the same genetic blueprint do not share equal likelihood for developing the disease. When one member of a monozygotic twinship develops diabetes under age 45, his twin has but a 50% chance of becoming diabetic. On the other hand, if a twin develops the disease over the age of 45, the risk to the other twin approaches 100%.
The Journal of clinical endocrinology and metabolism, Jul 3, 2017
Testosterone is commonly administered intramuscularly (IM) to treat hypogonadal males and female-... more Testosterone is commonly administered intramuscularly (IM) to treat hypogonadal males and female-to-male transgender (FTM) patients. However, these injections can involve significant discomfort and may require arrangements for administration by others. We assessed whether T could be administered effectively and safely by the subcutaneously (SC) as an alternative to IM injections. Retrospective cohort study. Outpatient Reproductive Endocrinology Clinic at an academic medical center. Sixty-three FTM transgender patients aged >18 years electing to receive SC T therapy for gender transition were included. Fifty-three patients were premenopausal. Patients were administered T cypionate or enanthate weekly at an initial dose of 50mg. Dose was adjusted if needed to achieve serum total T levels within the normal male range. Serum concentrations of free and total T and total estradiol (E2), masculinization and surveillance for reactions at injection sites. Serum T levels within the normal ...
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Papers by Norman Spack