RESUMO
OBJECTIVE: The objective of this clinical study was to determine the effects of sex steroids on behavior and mood in adolescents with hypogonadism. STUDY DESIGN: The experimental design consisted of a randomized, double-blind, placebo-controlled, crossover trial lasting for 21 months. The study group consisted of 39 boys and 16 girls recruited from a pediatric endocrine clinic for delayed puberty. Depo-testosterone (to boys) or conjugated estrogens (to girls) was administered in 3-month blocks, alternating with placebo, at 3 dose levels approximating early, middle, and late pubertal amounts. The Child Behavior Checklist, Youth Self Report, Differential Emotion Scale, and Daily Mood Diary were administered after each placebo and treatment period to ascertain the effect of sex steroids on self- and parent-reported behavior problems and moods. RESULTS: The data demonstrated only one significant treatment effect, namely, an increase in withdrawn behavior problems during administration of low-dose estrogen in girls. There were no consistent sex differences. CONCLUSION: These results demonstrate that administered testosterone or estrogen has minimal effects on behavior problems or mood in adolescents.
Assuntos
Afeto/efeitos dos fármacos , Anabolizantes/farmacologia , Anabolizantes/uso terapêutico , Estrogênios Conjugados (USP)/farmacologia , Estrogênios Conjugados (USP)/uso terapêutico , Terapia de Reposição Hormonal , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Puberdade Tardia/complicações , Puberdade Tardia/tratamento farmacológico , Testosterona/análogos & derivados , Adolescente , Adulto , Criança , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Puberdade Tardia/psicologia , Testosterona/farmacologia , Testosterona/uso terapêuticoRESUMO
We examined the capacity of children, adolescents, and young adults to assent and consent to participation in biomedical research, and what physician-investigators believe is important for patients in these age groups to know about such participation. The sample included 44 male and female subjects, ranging in age from 7 to 20 years, who were hospitalized to treat either pediatric cancer or obesity. The participants completed a structured interview that assessed knowledge of research participation using the elements outlined in the federal guidelines for informed consent. The study subjects were most knowledgeable about those elements of consent that assessed concrete information (e.g., freedom to ask questions, time elements involved, and the benefits of participation). They were less knowledgeable about those elements of informed consent that assessed abstract information (e.g., scientific vs therapeutic purpose of the study, and alternative treatments). Chronologic age was not related to knowledge of the elements of informed consent. The strategies that the study subjects used to reason about participation in research appeared to parallel their reasoning about other physical phenomena.
Assuntos
Ensaios Clínicos como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Consentimento Livre e Esclarecido , Competência Mental , Sujeitos da Pesquisa , Adolescente , Adulto , Fatores Etários , Criança , Revelação , Feminino , Humanos , Masculino , Médicos , Pesquisa , Medição de RiscoRESUMO
The purpose of this study was to test hypotheses regarding (1) relations among negative affect and hormones of gonadal and adrenal origin in young adolescents, at three times of measurement, over a one-year period; and (2) stability of negative affect. The sample consisted of 10- to 14-year-old boys (N=56) and 9- to 14-year-old girls (N=52). The adolescents were assessed three times at 6-month intervals over one year. Serum levels of gonadotropins, gonadal steroids, adrenal androgens, and cortisol were assessed, as well as stage of pubertal development (Tanner criteria). The negative affect assessments consisted of self-report questionnaire and interview measures of anxiety and depressive affect, as well as mother reports of internalizing behavior problems. In the concurrent (cross-sectional) analyses, boys reporting higher levels of negative affect tended to be those at higher genital stage or older age, with lower testosterone and cortisol levels and lower dehydroepian-drosterone sulphate levels. In the longitudinal analyses, negative affect, and to a lesser extent hormone levels at the first time of measurement predicted negative affect 12 months later. The findings suggest that puberty-related hormone levels should be considered along with psychological characteristics in examining the processes involved in the development of negative affect during the pubertal years.
RESUMO
Relations between adolescent psychosocial adjustment problems and markers of biologic development, including chronologic age, pubertal status, and serum hormone levels, were examined in 56 normal boys and 52 normal girls, ages 9 to 14 years. Adolescent psychosocial adjustment was assessed by adolescent self-ratings of various aspects of self-image (Offer Self-Image Questionnaire for Adolescents) and parent ratings of adolescent behavior problems (Child Behavior Checklist). The pubertal status measure used in the analyses was Tanner genital stage for boys and Tanner breast stage for girls. The hormone measures, determined by radioimmunoassay, were serum levels of gonadotropins (luteinizing hormone and follicle stimulating hormone), sex steroids (testosterone and estradiol), and adrenal androgens (dehydroepiandrosterone and its sulfate, and androstenedione). The testosterone/estradiol ratio also was computed. Overall, findings were stronger, more consistent, and more generalized for boys than for girls. For boys, adjustment problems typically were associated with a multivariate profile that may be characteristic for later maturers: relatively low sex steroid levels, or lower pubertal stage, and relatively high adrenal androgen (androstenedione) levels, frequently in conjunction with higher chronologic age. Univariate relations predominated for girls; that is, associated with adjustment problems for girls were relatively high levels of gonadotropins, relatively low levels of dehydroepiandrosterone sulfate, and relatively high levels of androstenedione on their own or in conjunction with lower pubertal stage. Higher levels of androstenedione, a steroid particularly responsive to stress, were associated with adjustment problems in both boys and girls. This relation may reflect the stress of later maturation, which could result from environmental factors, such as adolescent self-comparisons with same-age peers, or endogenous effects of hormones.