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Brain development, brain functioning, growth and metabolic aspects in the clinical management of transsexual adolescents.


- candidate number2399
- NTR NumberNTR868
- ISRCTNISRCTN81574253
- Date ISRCTN created2-mei-2007
- date ISRCTN requested20-apr-2007
- Date Registered NTR10-jan-2007
- Secondary IDs 
- Public TitleBrain development, brain functioning, growth and metabolic aspects in the clinical management of transsexual adolescents.
- Scientific TitleBrain development, brain functioning, growth and metabolic aspects in the clinical management of transsexual adolescents.
- ACRONYMclinical study on transsexual adolescents
- hypothesisThe hypothesis of this study is that the pubertal delay in transsexual adolescents, induced by treatment with GnRH analogues, will cause a difference in the development of brain structures and brain function between transsexuals and age matched control subjects without transsexuality. If cross-sex hormones are added from the age of sixteen, a catch up of brain development is expected. It is of great interest to investigate if this brain development will occur in the direction of the biologic or desired sex. Gender dysphoria is associated with atypical levels of sex hormones during pregnancy. The hypothesis of this study is that already at a young age, development of brain structures and brain function in gender dysphoric children will occur in the direction of the desired instead of the biologic sex.
- Healt Condition(s) or Problem(s) studiedBrain development, Transsexualism, DSM IV criteria
- Inclusion criteriaInclusion criteria pubertal patients:
1. Girls and boys with transsexualism who are eligible for sex reassignment according to psychologist and psychiatrist (If they are older than 12 years, psychologically stable and live in a stable social environment);
2. Girls have to be in stage B2 and boys in G2-G3 with measurable estradiol and testosterone levels respectively;


Inclusion criteria pre-pubertal patients:
1. Girls and boys with high probability of transsexualism according to psychologist or psychiatrist and the age of 9-12 years;
2. Girls have to be in an earlier stage than B2 and boys in an earlier stage than G2-G3;


Inclusion criteria healthy subjects:
1. Girls and boys who are similar aged friends of the transsexual patients.
- Exclusion criteriaExclusion criteria patients:
1. Intersex conditions;


Exclusion criteria healthy subjects:
1. Puberty delaying treatment or hormonal therapy; oral anticonception users are not excluded.
- mec approval receivedno
- multicenter trialyes
- randomisedno
- groupParallel
- Type[default]
- Studytypeintervention
- planned startdate 1-feb-2007
- planned closingdate31-dec-2009
- Target number of participants264
- InterventionsPatients: measurements will be performed at a prepubertal stage, before start of GNrH analogue Triptoreline/ Decapeptyl-CR (current puberty delaying medication for transsexual adolescents in the VUmc from the age of 12 and if puberty has already started i.e. Tanner stage B2 in girls, G1-2 in boys), before start of cross-sex hormones (17 beta oestradiol in male-to-female transsexuals and sustanon in female-to-male transsexuals), one year after start of cross-sex hormones and 1-2 years after gender reassignment surgery.

Age matched control subjects (friends of the transsexual patients): measurements will be performed if the transsexual friend starts with puberty delaying treatment, if the transsexual friend starts with cross-sex hormones and 1-2 years after surgery of the transsexual friend.


Interventions:
1. Structural MRI, method used: voxel based morphometry, ROI analysis;
2. Functional MRI (BOLD) during which 3 cognition tasks will be performed (mental rotation, verbal fluency and emotional faces);
3. Physical examination with anthropometric measurements and gathering of information about pubertal stage according to Tanner;
4. Digital photographs and physical appearance list;
5. Salivary testosterone measurements;
6. Family pedigree research: homosexuality/ transsexuality in family.


The duration of the intervention will be approximately three hours for every visit, which means at maximum 5 visits (if patients will be followed longitudinally) for the patients and three visits (if control subjects will be followed longitudinally) for the control subjects.
- Primary outcome1. Cognition: performance and reaction time on three cognition tasks (verbal fluency task, mental rotation task and emotional faces task), reaction times and performance will be measured;
2. Functional MRI: data during the verbal fluency task, mental rotation task and emotional faces task;
3. Structural MRI: data on total brain volume, gray and white matter (amount and percentage), CSF, volume frontal and temporal lobe, gyrification, brain asymmetry. ROI analysis of basal ganglia, amygdala, hippocampus, corpus callosum, hypothalamus.
- Secondary outcome1. Score from -10 to 10 on handedness questionairre;
2. Performance score on adapted WISC-III questionairre (4 items: 2 performance, 2 verbal);
3. Information about psychological functioning (parent questionairre);
4. Anthropometric data, information about pubertal stage according to Tanner;
5. Information about homosexuality/ transsexuality in familymembers;
6. Digital photographs and physical appearance list (14 items).
- TimepointsN/A
- Trial web siteUnder construction.
- statusopen: patient inclusion
- CONTACT FOR PUBLIC QUERIES F.M. Wouters
- CONTACT for SCIENTIFIC QUERIES F.M. Wouters
- Sponsor/Initiator VU University Medical Center, Department of Pediatric Endocrinology , VU University Medical Center, Department of Medical Psychology, VU University Medical Center, Department of Pediatrics
- Funding
(Source(s) of Monetary or Material Support)
Ferring Pharmaceuticals Denmark
- PublicationsDelemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects.Eur J Endocrinol. 2006 Nov;155 Suppl 1:S131-7.
- Brief summaryThe present study will focus on the consequences of long-term delay of puberty induced by treatment with Decapeptyl-CR. We will investigate the effects of this treatment in regard to brain functioning, brain development, various endocrine, metabolic and anthropometric aspects before, during and after treatment with Decapeptyl-CR alone and in combination with cross-sex hormones in juvenile transsexuals. Hereby we will focus on sex differences between transsexual adolescents and similar aged individuals of both sexes by investigating brain development and brain functioning, as well as on possible determinants of the aetiology of transsexuality by means of structural and functional MRI and family pedigree research.
- Main changes (audit trail)
- RECORD10-jan-2007 - 6-mei-2008


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