Norman Spack | Harvard Medical School (original) (raw)

Papers by Norman Spack

Research paper thumbnail of Medical Complications of Anorexia Nervosa and Bulimia

Anorexia nervosa and bulimia nervosa are multisystem diseases with medical complications affectin... more Anorexia nervosa and bulimia nervosa are multisystem diseases with medical complications affecting all body systems. The medical complications of anorexia nervosa are due to malnutrition and weight loss. Additional complications of anorexia nervosa, binge-eating/purging type are due to the frequency and mode of purging behaviors. The medical complications of bulimia nervosa are due to the frequency and mode of purging behaviors.

Research paper thumbnail of Transgenderism

Research paper thumbnail of Medical Treatment of the Transgender Adolescent

American Academy of Pediatrics eBooks, Mar 10, 2011

Research paper thumbnail of Intersex in the Age of Ethics, edited by Alice Domurat Dreger

Research paper thumbnail of Psychology's Role in the New Recommended Treatment for Transgender Youth

Research paper thumbnail of Hacia un enfoque local: En las economías emergentes y en desarrollo, el gasto público en salud está pasando de los gobiernos centrales a los estados y ciudades

Finanzas Y Desarrollo Publicacion Trimestral Del Fondo Monetario Internacional Y Del Banco Mundial, 2014

Research paper thumbnail of Care for Transgender Persons—Reply

JAMA, 2013

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.

Research paper thumbnail of History of Care of Transgender Youth

Pubertal Suppression in Transgender Youth, 2019

Research paper thumbnail of Hypopituitarism in PHACES Association

Pediatric Dermatology, 2006

The association consisting of posterior fossal malformations, cervicofacial, hemangiomas, arteria... more The association consisting of posterior fossal malformations, cervicofacial, hemangiomas, arterial anomalies, cardiac defects, eye anomalies, and sternal clefting, or supraumbilical raphe, refers to the occurrence of congenital structural and vascular anomalies in the presence of a facial hemangioma. We report a patient with this association, growth retardation, and developmental delay who was found to have a partially empty sella turcica, central hypothyroidism, and growth hormone deficiency. Endocrinologic evaluation should be considered in any infant with this association.

Research paper thumbnail of Management of Transgenderism

JAMA, 2013

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.

Research paper thumbnail of BOOK REVIEW: Shifting Paradigms in the Treatment of Intersexuality

Research paper thumbnail of An Endocrine Perspective on the Care of Transgender Adolescents

Journal of Gay & Lesbian Mental Health, 2009

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.

Research paper thumbnail of An Endocrine Perspective on the Care of Transgender Adolescents

Journal of Gay & Lesbian Mental Health, 2009

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.

Research paper thumbnail of The Impact of Early Medical Treatment in Transgender Youth: The Trans Youth Care Study (Preprint)

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...

Research paper thumbnail of Transgenderism

Medical ethics (Burlington, Mass.), 2005

Research paper thumbnail of Diabetes Mellitus in Adolescents

Adolescent medicine (Philadelphia, Pa.), 1991

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.

Research paper thumbnail of M45 – Management of gender-Variant youth

2012 Meet-The-Professor: Endocrine Case Management, 2012

Research paper thumbnail of Recent Advances in the Care of Patients with Juvenile Diabetes Mellitus

Pediatrics in Review, 1980

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%.

Research paper thumbnail of Subcutaneous Injection of Testosterone is an Effective and Preferred Alternative to Intramuscular Injection: Demonstration in Female-to-Male Transgender Patients

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 ...

Research paper thumbnail of Advances in the Care of Transgender Children and Adolescents

Advances in Pediatrics, 2016

Research paper thumbnail of Medical Complications of Anorexia Nervosa and Bulimia

Anorexia nervosa and bulimia nervosa are multisystem diseases with medical complications affectin... more Anorexia nervosa and bulimia nervosa are multisystem diseases with medical complications affecting all body systems. The medical complications of anorexia nervosa are due to malnutrition and weight loss. Additional complications of anorexia nervosa, binge-eating/purging type are due to the frequency and mode of purging behaviors. The medical complications of bulimia nervosa are due to the frequency and mode of purging behaviors.

Research paper thumbnail of Transgenderism

Research paper thumbnail of Medical Treatment of the Transgender Adolescent

American Academy of Pediatrics eBooks, Mar 10, 2011

Research paper thumbnail of Intersex in the Age of Ethics, edited by Alice Domurat Dreger

Research paper thumbnail of Psychology's Role in the New Recommended Treatment for Transgender Youth

Research paper thumbnail of Hacia un enfoque local: En las economías emergentes y en desarrollo, el gasto público en salud está pasando de los gobiernos centrales a los estados y ciudades

Finanzas Y Desarrollo Publicacion Trimestral Del Fondo Monetario Internacional Y Del Banco Mundial, 2014

Research paper thumbnail of Care for Transgender Persons—Reply

JAMA, 2013

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.

Research paper thumbnail of History of Care of Transgender Youth

Pubertal Suppression in Transgender Youth, 2019

Research paper thumbnail of Hypopituitarism in PHACES Association

Pediatric Dermatology, 2006

The association consisting of posterior fossal malformations, cervicofacial, hemangiomas, arteria... more The association consisting of posterior fossal malformations, cervicofacial, hemangiomas, arterial anomalies, cardiac defects, eye anomalies, and sternal clefting, or supraumbilical raphe, refers to the occurrence of congenital structural and vascular anomalies in the presence of a facial hemangioma. We report a patient with this association, growth retardation, and developmental delay who was found to have a partially empty sella turcica, central hypothyroidism, and growth hormone deficiency. Endocrinologic evaluation should be considered in any infant with this association.

Research paper thumbnail of Management of Transgenderism

JAMA, 2013

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.

Research paper thumbnail of BOOK REVIEW: Shifting Paradigms in the Treatment of Intersexuality

Research paper thumbnail of An Endocrine Perspective on the Care of Transgender Adolescents

Journal of Gay & Lesbian Mental Health, 2009

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.

Research paper thumbnail of An Endocrine Perspective on the Care of Transgender Adolescents

Journal of Gay & Lesbian Mental Health, 2009

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.

Research paper thumbnail of The Impact of Early Medical Treatment in Transgender Youth: The Trans Youth Care Study (Preprint)

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...

Research paper thumbnail of Transgenderism

Medical ethics (Burlington, Mass.), 2005

Research paper thumbnail of Diabetes Mellitus in Adolescents

Adolescent medicine (Philadelphia, Pa.), 1991

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.

Research paper thumbnail of M45 – Management of gender-Variant youth

2012 Meet-The-Professor: Endocrine Case Management, 2012

Research paper thumbnail of Recent Advances in the Care of Patients with Juvenile Diabetes Mellitus

Pediatrics in Review, 1980

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%.

Research paper thumbnail of Subcutaneous Injection of Testosterone is an Effective and Preferred Alternative to Intramuscular Injection: Demonstration in Female-to-Male Transgender Patients

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 ...

Research paper thumbnail of Advances in the Care of Transgender Children and Adolescents

Advances in Pediatrics, 2016