Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): A systematic review and meta-analysis

Babu, Ramesh; Shah, Utsav

doi:10.1016/j.jpurol.2020.11.017

Cited by 55 publications

(35 citation statements)

References 39 publications

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“…The 20 recent articles [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] on meta-analyses were published in the JPUrol between October 9, 2017, and May 17, 2021. Of these, only seven [19][20][21][22][23][24][25] were included for the calculation of FI.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, only seven [19][20][21][22][23][24][25] were included for the calculation of FI. The remaining were excluded as they incorporated non-comparative studies [6][7][8][9][10][11][12][13][14][15][16][17] and/or none of the defined methods for pooling the estimates (Mantel-Haenszel or inverse variance or Peto) were identified in them [6][7][8][9][10][11][12][13][14][15][16][17][18]. Among the seven included studies, there were 22 individual meta-analyses.…”

Section: Resultsmentioning

confidence: 99%

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Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation

Anand¹,

Kainth²

2021

Cureus

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Background and objectiveFragility Index (FI) of meta-analyses determines their stability in terms of the level of confidence and strength behind the results depicted by them. The present study was conducted to estimate the FI of recently published meta-analyses in the Journal of Pediatric Urology (JPUrol). MethodTwenty recently published articles on meta-analyses were screened to identify the eligible ones. The baseline data of each meta-analysis including the details of the author, number of included studies, total sample size, the total number of events, the status of the overall outcome (significant or non-significant), type of effect measure, type of method used for pooling the estimates, and type of effects model were recorded. FI was calculated by doing each single status modification. The 95% CI of the treatment effect was re-calculated until the statistical significance of the meta-analysis was reversed. ResultsA total of seven articles incorporating 22 meta-analyses were included. Seven (32%) of them had a statistically significant outcome prior to FI estimation. The risk ratio (17/22; 77%) was the most commonly used effect measure. The random-effects model (15/22; 68%) and the Mantel-Haenszel method (20/22; 91%) of pooling the estimates were utilized in the majority of meta-analyses. The median (Q1-Q3; range) FI of statistically significant, non-significant, and total meta-analyses were 5 (3-19.5; 2-39), 5 (3.5-6; 1-17), and 5 (3-13; 1-39) respectively. FI of ≤5 was noticed in four out of seven (57%), 9/15 (60%), and 13/22 (59%) of these meta-analyses respectively. ConclusionBased on our findings, the majority of the recently published meta-analyses in the field of pediatric urology are fragile and depend upon the event status of ≤5 participants.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation

Anand¹,

Kainth²

2021

Cureus

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“…This irreversible surgery, which used to be performed early in infancy decades ago, is now usually delayed until just before the age of puberty, thus allowing the participation of the child in decision-making. Patient's participation in decision-making, whenever possible, is particularly important in the case of individuals with DSD, since some of these disorders show a higher risk of gender dysphoria, i.e., the sense of discomfort or distress that may be felt by persons whose gender identity differs from the sex assigned, resulting in gender change [20][21][22].…”

Section: Congenital Disorders Of Sex Development and Their Managementmentioning

confidence: 99%

Are We Prepared to Abandon the Idea of Sex Binarism? A Biomedical Perspective

Rey

2022

Biomed Hub

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“…This can be seen in the existence both endosex transgender populations and intersex individuals who affirm a gender that does not correlate with how they were reared. 23,24 Some researchers have proposed that prenatal androgen exposure affects not just the structures of the clitorophallus but also the brain, and therefore the development of a male or female gender identity. While there is evidence to support this hypothesis, it is difficult to disambiguate the role of non-androgenic effects on identity formation, including both the sex of rearing and the effects of clitorophallus anatomy on self-conceptualization.…”

Section: The Clitorophallus At the Time Of B Irthmentioning

confidence: 99%

The role of androgens in clitorophallus development and possible applications to transgender patients

et al. 2021

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Background:The clitorophallus, or glans, is a critical structure in sexual development and plays an important role in how gender is conceptualized across the life span. This can be seen in both the evaluation and treatment of intersex individuals and the use of gender-affirming masculinizing therapies to help those born with a clitoris (small clitorophallus with separate urethra) enlarge or alter the function of that structure.Objectives: To review the role of testosterone in clitorophallus development from embryo to adulthood, including how exogenous testosterone is used to stimulate clitorophallus enlargement in masculinizing gender-affirming therapy. Materials and Methods:Relevant English-language literature was identified and evaluated for data regarding clitorophallus development in endosex and intersex individuals and the utilization of hormonal and surgical masculinizing therapies on the clitorophallus. Studies included evaluated the spectrum of terms regarding the clitorophallus (genital tubercle, clitoris, micropenis, penis).Results: Endogenous testosterone, and its more active metabolite dihydrotestosterone, plays an important role in the development of the genital tubercle into the clitorophallus, primarily during the prenatal and early postnatal periods and then again during puberty. Androgens contribute to not only growth but also the inclusion of a urethra on the ventral aspect. Exogenous testosterone can be used to enlarge the small clitorophallus (clitoris or micropenis) as part of both intersex and genderaffirming care (in transmasculine patients, up to 2 cm of additional growth). Where testosterone is insufficient to provide the degree of masculinization desired, surgical options including phalloplasty and metoidioplasty are available. Discussion and Conclusion:Endogenous testosterone plays an important role in clitorophallus development, and there are circumstances where exogenous testosterone may be useful for masculinization. Surgical options may also help some patients reach their personal goals. As masculinizing gender-affirming care advances, the options available for clitorophallus modifications will likely continue to expand and improve.

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Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): A systematic review and meta-analysis

Cited by 55 publications

References 39 publications

Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation

Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation

Are We Prepared to Abandon the Idea of Sex Binarism? A Biomedical Perspective

The role of androgens in clitorophallus development and possible applications to transgender patients

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