tag:theconversation.com,2011:/id/topics/puberty-4179/articlesPuberty – The Conversation2024-02-13T16:22:48Ztag:theconversation.com,2011:article/2231702024-02-13T16:22:48Z2024-02-13T16:22:48ZThe real threat to gender-diverse children is the politicization of care issues like puberty blockers and detransition<p>Under the pretext of protecting children, Pierre Poilievre, leader of the Conservative Party of Canada, has <a href="https://www.cbc.ca/news/politics/poilievre-transgender-puberty-blockers-1.7107486">said he is opposed</a> to the use of puberty blockers for gender-diverse children.</p>
<p>“I think that we should protect children and their ability to make adult decisions when they’re adults,” Poilievre said.</p>
<p>Poilievre is one among many politicians to wade into debates surrounding gender-affirming health care in recent years. Alberta Premier Danielle Smith has <a href="https://www.cbc.ca/news/canada/edmonton/danielle-smith-unveils-sweeping-changes-to-alberta-s-student-gender-identity-sports-and-surgery-policies-1.7101053">proposed controversial policies that would affect gender-diverse youth</a>, including prohibiting puberty blockers for children aged 15 and under.</p>
<p>But the growth of politicization and misinformation on this issue — on top of already <a href="https://nyupress.org/9781479899371/trans-medicine/">longstanding ideological battles</a> over the <a href="https://www.thestar.com/news/gta/closing-of-camh-clinic-fans-controversy-over-gender-questioning-children/article_ba7595a8-f367-53bc-bc8e-f19555880bf4.html">care of minors</a> — probably pose a bigger threat to gender-diverse people than puberty blockers.</p>
<p><a href="https://www.researchgate.net/profile/Pablo-Exposito-Campos">We are researchers</a> who study the <a href="https://scholar.google.com/citations?user=BH8jEdkAAAAJ&hl=en">experiences of transgender</a> and gender-diverse people who have accessed gender-affirming health care. <a href="https://www.advocate.com/politics/transgender/2014/09/17/photos-meet-first-trans-man-win-gay-games-gold-powerlifting#:%7E:text=Last%2520month%252C%2520Kinnon,before%2520the%2520competition.">One of us is transgender</a> and also a parent. And <a href="https://scholar.google.com/citations?user=9qiUwT0AAAAJ&hl=es">we are among a few</a> who also research <a href="https://doi.org/10.1136/bmj-2022-073584">detransitioning</a> — the process of discontinuing or reversing a gender transition. </p>
<p>We both personally know countless people who have been helped by transitioning, as well as others who were <a href="https://doi.org/10.1371/journal.pone.0293868">let down by the promises of gender-related treatments</a> that can have <a href="https://globalnews.ca/news/10281751/alberta-says-it-consulted-widely-in-drafting-controversial-transgender-rights-policy/">life-altering consequences</a>.</p>
<p>We have noticed that what is presented as “fact” in these debates has distorted real complexities of gender-affirming health care, creating a rift between conservative and progressive information outlets. The result has left many in the dark about what is really at stake.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GmzDMeLLPPA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Conservative leader Pierre Poilievre speaks to the media about puberty blockers and trans children.</span></figcaption>
</figure>
<h2>Fertility and gender-affirming medicine</h2>
<p>Take the <em>New York Times</em> as an example. Two opinion columnists recently wrote about gender-affirming care for minors, making drastically different remarks about the fertility implications of this care. </p>
<p>Opinion columnist <a href="https://www.nytimes.com/2023/12/01/opinion/politics/life-without-regret.html#:%7E:text=Most%2520chilling%2520to,become%2520biological%2520parents.">Lydia Polgreen</a> asserted that it is a “mistaken belief” that infertility routinely results from treatments for gender-diverse children, while <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html#:%7E:text=hormone%2520therapy%2520discontinue%2520its%2520use%2520within%2520four%2520years%252C%2520though%2520the%2520effects%252C%2520including%2520infertility%252C%2520are%2520often%2520irreversible.">Pamela Paul</a>, writing about detransition, claimed that hormonal therapy causes “often irreversible” infertility.</p>
<p>But the reality of fertility and gender-affirming treatments is in the details. Research on fertility outcomes is lackluster to begin with, but outcomes are highly sensitive to whether <a href="https://doi.org/10.1215/23289252-8553202">puberty blockers were taken prior to starting cross-sex hormones and the stage of puberty</a>.</p>
<p>For children who start puberty blockers followed by cross-sex hormones without ever undergoing natal puberty, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979264/#:%7E:text=The%20Endocrine%20Society,cross%2Dsex%20hormones.">infertility is presumed</a> because reproductive maturity is not achieved, and saving sperm or eggs for the future is <a href="https://transcare.ucsf.edu/guidelines/fertility#:%7E:text=Currently%2520it%2520is,undergoing%2520natal%2520puberty.">not possible</a> with current assisted reproductive technologies. However, for transgender people who begin cross-sex hormones after undergoing at least some natal puberty, fertility does not seem to be permanently affected. </p>
<p><a href="https://doi.org/10.1016%2Fj.xcrm.2022.100858">Early</a> <a href="https://doi.org/10.1089/trgh.2022.0023">research</a> indicates that for those who went through natal puberty, taking cross-sex hormones alone is <a href="https://www.huffpost.com/archive/ca/entry/fertility-treatment-trans_ca_5ddeebdce4b00149f728e7c0#:%7E:text=The%2520actual%2520egg,whenever%2520we%2520are.">unlikely to cause permanent sterility</a>.</p>
<h2>Puberty blockers</h2>
<p>The history of transgender medicine and reproductive rights has been fraught with injustice. When puberty blockers <a href="https://doi.org/10.1007/s10508-011-9758-9">were first tested for use with gender dysphoric youth</a>, transgender adults were being coercively sterilized. In 2014, the Netherlands struck down a policy requiring <a href="https://www.hrw.org/news/2020/12/01/netherlands-apologizes-transgender-sterilizations#:%7E:text=The%20Dutch%20government%20has%20apologized%20to%20transgender%20people%20for%20previously%20mandating%20surgeries%2C%20including%20sterilization%2C%20as%20a%20prerequisite%20for%20legal%20gender%20recognition.%20During%20a%20Cabinet%20meeting%20this%20week%2C%20government%20officials%20also%20announced%20plans%20to%20compensate%20people%20who%20underwent%20the%20operations.">sterilizing surgeries to legally change genders and paid out financial reparations as an apology</a>.</p>
<p>Pediatric gender medicine is a <a href="https://www.psychiatrictimes.com/view/gender-affirming-care-for-adolescents-separating-political-polarization-from-medicine">relatively new field</a>, and while the <a href="https://doi.org/10.1146/annurev-med-043021-032007">evidence base is growing steadily</a> it also <a href="https://doi.org/10.1111/apa.16791">shows its novelty</a>. </p>
<p>In fact, fertility is not the only issue at stake with puberty blockers. There are uncertain <a href="https://doi.org/10.1080/15265161.2018.1557284">impacts on bone health, neurodevelopment and social development</a>, as well as <a href="https://www.nytimes.com/2022/06/15/magazine/gender-therapy.html#:%7E:text=Shrier%2520also%2520quoted,stage%2520of%2520development.">sexual function</a> — issues clinicians and researchers are paying close attention to. </p>
<figure class="align-center ">
<img alt="A mother and child and a doctor seen from behind" src="https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575131/original/file-20240212-22-do3611.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Poilievre gives the wrong impression by saying that ‘we should protect the rights of parents to make their own decision with regards to their children,’ because, given the age of the child, parents are typically involved in the decision to start puberty blockers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A team of Dutch clinicians who were among the first to offer transgender children puberty blockers <a href="https://doi.org/10.1093/jsxmed/qdac029">recently acknowledged</a> that these drugs may not be just a “pause button” to explore identity, as originally intended. Instead, they should be thought of as the first step of a medical gender transition, because a <a href="https://doi.org/10.1093/jsxmed/qdac029">majority eventually go on to take hormonal treatments</a>.</p>
<p>But there are also major <a href="https://doi.org/10.1093/oso/9780192895400.003.0008">consequences involved in delaying or withholding treatment with puberty blockers</a>, which could hurt transgender girls more than boys. Testosterone’s effects on the body can be difficult to reverse, so undergoing a masculinizing puberty could render transfeminine kids more <a href="https://doi.org/10.1186/s12939-022-01632-5">vulnerable to future anti-trans discrimination</a>. Irreversible body changes from puberty can not only heighten distress and reduce social acceptance, but also contribute to a need for future surgeries.</p>
<p>Given that puberty may occur as early as <a href="https://www.nytimes.com/2022/05/19/science/early-puberty-medical-reason.html#:%7E:text=But%2520the%2520study,observed%2520in%2520boys.">eight or nine years old</a> for some children, this is a high-stakes medical decision never taken lightly by families or clinicians. <a href="https://www.cbc.ca/news/politics/poilievre-transgender-puberty-blockers-1.7107486">Poilievre gives the wrong impression</a> by saying that “we should protect the rights of parents to make their own decision with regards to their children,” because, given the age of the child, parents are typically involved in the decision to start puberty blockers.</p>
<p>However, there is <a href="https://psycnet.apa.org/record/2024-16010-001">always some risk of getting it wrong</a> — in either direction.</p>
<h2>Detransition debate</h2>
<p>Puberty-blocking drugs are not the only politicized topic in gender-affirming health care. <a href="https://doi.org/10.1136/bmj-2022-073584">Detransition also tops the list</a>. </p>
<p>On one side, opponents of gender-affirming care distort studies to argue detransition has <a href="https://www.nytimes.com/2024/02/02/opinion/transgender-children-gender-dysphoria.html#:%7E:text=Studies%2520show%2520that%2520around%2520eight%2520in%252010%2520cases%2520of%2520childhood%2520gender%2520dysphoria%2520resolve%2520themselves%2520by%2520puberty%2520and%252030%2520percent%2520of%2520people%2520on%2520hormone%2520therapy%2520discontinue%2520its%2520use%2520within%2520four%2520years%252C">reached epidemic proportions</a> and draw from testimonies of regretful detransitioners as a “<a href="https://www.foxnews.com/opinion/stop-mutilation-girls-gender-affirming-care#:%7E:text=Yet%2520the%2520harrowing%2520stories%2520of%2520former%2520trans%252Didentified%2520individuals%2520serve%2520as%2520a%2520cautionary%2520tale%2520against%2520medical%2520transitioning">cautionary tale against medical transitioning</a>.” </p>
<p>Proponents retort by dismissing detransition either by alluding to its <a href="https://www.cbc.ca/kidsnews/post/gender-affirming-care-what-it-means-and-why-its-in-the-news#:%7E:text=However%252C%2520research%2520says,of%2520family%2520support">“rarity,” using outdated</a> and <a href="https://slate.com/technology/2024/02/transgender-youth-health-care-regret-pamela-paul-nyt-data.html">flawed studies</a>, or by <a href="https://www.cbc.ca/kidsnews/post/gender-affirming-care-what-it-means-and-why-its-in-the-news#:%7E:text=Detransitioning%2520or%2520reversing,related%2520care%2520needs.">decoupling the experience from regret</a>.</p>
<p>As a result, the public is exposed to two different sets of “facts,” none of which reflect the heterogeneity that we and others have encountered in <a href="https://slate.com/technology/2023/12/trans-health-care-detransition-research-studies-new.html">researching detransition</a> — different <a href="https://actaspsiquiatria.es/index.php/actas/article/view/36">psychological, medical and social motives</a> for detransitioning; a range of emotions including <a href="https://doi.org/10.1002/icd.2402">regret, resilience, and satisfaction</a>; expansive patterns of <a href="https://www.tandfonline.com/doi/abs/10.1080/00224499.2023.2244926">identity discovery and fluidity</a>. All of it must be studied for gender-related medical care to continue being evidence-informed.</p>
<p>But threats, or outright restrictions, from politicians will not advance this care. What is badly needed from governments is investments in higher quality research and systems of care so treatments can be accessed in the safest possible terms. There are currently gaps in the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0293868#:%7E:text=We%20found%20that,accessing%2C%20care%20services.">Canadian gender-affirming care system</a> affecting access, quality, and safety.</p>
<h2>Guidelines, dilemmas and the need for high-quality research</h2>
<figure class="align-center ">
<img alt="A stethoscope and a transgender flag in the shape of a heart" src="https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=264&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=264&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=264&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=331&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=331&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575130/original/file-20240212-18-4obcs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=331&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Debate should not centre on whether to ban treatments or not, but how to build an accessible and high-quality health and social care system that can support all gender-diverse people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This area of health care already <a href="https://doi.org/10.1080/26895269.2022.2100644">has guidelines</a> developed through a review of the evidence and <a href="https://www.psychiatrictimes.com/view/gender-affirming-care-for-adolescents-separating-political-polarization-from-medicine#:%7E:text=In%2520September%25202022,in%2520the%2520process.">international expert consensus</a>. But that does not mean the science is settled or that the medicine has no room for improvement.</p>
<p>Gender-affirming care is riddled <a href="https://doi.org/10.1007%2Fs10508-018-1287-3">with ethical</a> <a href="https://doi.org/10.1007/s10508-020-01762-3">dilemmas</a> that have <a href="https://nymag.com/intelligencer/article/bell-v-tavistock-transgender-health-care.html#:%7E:text=There%2520are%2520signs,after%2520anguishing%2520month.">spilled over into an explosive political situation</a>. The changing landscape of transgender health care, <a href="https://doi.org/10.1111/apa.16791">debates about puberty blockers</a> and <a href="https://www.nysun.com/article/lawsuits-by-regretful-detransitioners-take-aim-at-medical-establishments-support-for-gender-transition-treatments-for-minors">detransition</a> are all low-hanging fruit for opportunistic politicians like Poilievre.</p>
<p>On the polarization of these topics, anthropologist and medical doctor <a href="https://doi.org/10.1215/23289252-8553202">Sahar Sadjadi</a> — who <a href="https://doi.org/10.14506/ca34.1.10">studied in-depth some of the first American pediatric gender clinics</a> — wrote:</p>
<blockquote>
<p>“It is tempting to take the opposite position of one’s enemy, by defending all medical interventions currently associated with gender transition in children and insisting that they are safe and save children’s lives.” </p>
</blockquote>
<p>But by not being able to tolerate some of the unknowns, or banning treatments outright, we miss a crucial opportunity to advance knowledge that is needed to help gender-diverse children and their families.</p>
<p>Debate should not centre on whether to ban blockers, but on how to build a high-quality health and social care system that can support all gender-diverse people. Doing so depends on our collective ability to tolerate complexity.</p><img src="https://counter.theconversation.com/content/223170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kinnon R. MacKinnon receives funding from the Social Sciences and Humanities Research Council of Canada.
He is a member of the World Professional Association for Transgender Health (WPATH).</span></em></p><p class="fine-print"><em><span>Pablo Expósito-Campos receives funding from the Predoctoral Research Fellowship Program of the Government of the Basque Country, Spain. He is a student member of the World Professional Association for Transgender Health (WPATH) and a member of the "Gonad, identity, and sexual differentiation" Working Group of the Spanish Society of Endocrinology and Nutrition (GT-GIDSEEN).</span></em></p>On both sides of the transgender care debate, what is presented as ‘fact’ distorts real complexities of gender-affirming health care, leaving many in the dark about what is really at stake.Kinnon R. MacKinnon, Assistant Professor, School of Social Work, York University, CanadaPablo Expósito-Campos, Predoctoral researcher in Psychology, Universidad del País Vasco / Euskal Herriko UnibertsitateaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193292024-01-12T00:16:53Z2024-01-12T00:16:53ZFrom straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair<figure><img src="https://images.theconversation.com/files/567011/original/file-20231221-27-ytfbxc.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C6000%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-young-beautiful-woman-white-1489934231">Orawan Pattarawimonchai/Shutterstock</a></span></figcaption></figure><p>Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36631178/">Many different genes</a> determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.</p>
<p>So, what can cause hair to become curlier, thicker, thinner or grey?</p>
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Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
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<h2>Curly or straight? How hair follicle shape plays a role</h2>
<p>Hair is made of <a href="https://my.clevelandclinic.org/health/body/23204-keratin">keratin</a>, a strong and insoluble protein. Each hair strand grows from its own <a href="https://www.ncbi.nlm.nih.gov/books/NBK470321/">hair follicle</a> that extends deep into the skin. </p>
<p>Curly hair forms due to asymmetry of both the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894537/">hair follicle and the keratin</a> in the hair.</p>
<p>Follicles that produce <a href="https://www.medicalnewstoday.com/articles/318524">curly hair</a> are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.</p>
<p>The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow. </p>
<p>Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram shows the hair follicle shape of straight, curly and coiled hair." src="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each hair strand grows from its own hair follicle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/diagram-hair-follicle-shape-vector-illustration-2248429145">Mosterpiece/Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-dandruff-how-do-i-get-rid-of-it-why-does-it-keep-coming-back-201082">What is dandruff? How do I get rid of it? Why does it keep coming back?</a>
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</em>
</p>
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<h2>Life changes, hair changes</h2>
<p>Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.</p>
<p>Each hair follicle contains stem cells, which multiply and <a href="https://www.frontiersin.org/articles/10.3389/fcell.2022.899095/full">grow into a hair strand</a>.</p>
<p>Head hairs spend most of their time in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905671/">the growth phase</a>, which can last for several years. This is why head hair can grow so long. </p>
<p>Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it <a href="https://www.healthline.com/health/stages-of-hair-growth">naturally falls out</a>.</p>
<p>The hair follicle <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13347">remains in the skin</a> and the stems cells grow a new hair to repeat the cycle.</p>
<p>Each hair on the scalp is replaced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/#b3">every three to five years</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with curly hair works on her computer." src="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each hair on the scalp is replaced every three to five years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-businesswoman-office-beautiful-woman-listening-1702284601">Just Life/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Hormone changes during and after pregnancy alter the usual hair cycle</h2>
<p>Many women notice their hair is <a href="https://www.medicalnewstoday.com/articles/pregnancy-hair">thicker during pregnancy</a>.</p>
<p>During pregnancy, high levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908443/">oestrogen, progesterone and prolactin</a> prolong the resting phase of the hair cycle. This means the hair <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">stays in the hair follicle for longer</a>, with less hair loss. </p>
<p>A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way. </p>
<h2>Hair can change around puberty, pregnancy or after chemotherapy</h2>
<p>This is related to the genetics of hair shape, which is an example of <a href="https://www.biologyonline.com/dictionary/incomplete-dominance">incomplete dominance</a>. </p>
<p>Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair. </p>
<p>Hormonal changes that occur around <a href="https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-019-0780-4">puberty</a> and <a href="https://www.mdpi.com/1422-0067/23/20/12698">pregnancy</a> can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.</p>
<p>Researchers have identified that activating specific genes can change hair in pigs <a href="https://www.frontiersin.org/articles/10.3389/fgene.2023.1184015/full">from straight to curly</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759815/">Chemotherapy</a> has very visible effects on hair. Chemotherapy kills rapidly dividing cells, <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2628766">including hair follicles</a>, which causes hair loss. Chemotherapy can also have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1988866/">genetic effects</a> that influence hair follicle shape. This can cause hair to <a href="https://www.medicalnewstoday.com/articles/chemo-curls">regrow with a different shape</a> for the first few cycles of hair regrowth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with wavy hair looks in a mirror" src="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your hair can change at different stages of your life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-redhaired-girl-bathroom-looks-mirror-2139652407">Igor Ivakhno/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Hormonal changes as we age also affect our hair</h2>
<p>Throughout life, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">thyroid hormones</a> are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36578854/">Oestrogen and androgens</a> also regulate hair growth and loss, particularly as we age. </p>
<p>Balding in males is due to <a href="https://theconversation.com/starting-to-thin-out-hair-loss-doesnt-have-to-lead-to-baldness-34984">higher levels of androgens</a>. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269836/">male pattern baldness</a>. </p>
<p>Some women experience <a href="https://theconversation.com/health-check-why-does-womens-hair-thin-out-39126">female pattern hair loss</a>. This is caused by a combination of genetic factors plus lower levels of <a href="https://www.mdpi.com/2077-0383/12/3/893">oestrogen and higher androgens</a> after menopause. The hair follicles become smaller and smaller until they no longer produce hairs. </p>
<p>Reduced function of the cells that produce <a href="https://www.health.com/mind-body/what-going-gray-early-can-tell-you-about-your-health">melanin</a> (the pigment that gives our hair colour) is what causes greying.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-why-dont-burns-bleed-130792">Curious Kids: why don't burns bleed?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/219329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theresa Larkin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changes around puberty and pregnancy can affect the function of genes influencing hair shape. And chemotherapy can cause hair to regrow in a different shape for the first few cycles of hair regrowth.Theresa Larkin, Associate professor of Medical Sciences, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1985762023-03-06T13:35:30Z2023-03-06T13:35:30ZWhat parents and educators need to know about teens’ pornography and sexting experiences at school<figure><img src="https://images.theconversation.com/files/512713/original/file-20230228-2960-yiwjos.jpg?ixlib=rb-1.1.0&rect=12%2C64%2C8634%2C5691&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pornography presents persistent risks for adolescents.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenager-boy-is-using-smartphone-at-home-in-bed-royalty-free-image/1353071585?phrase=teens%20iphones%20school&adppopup=true">EMS-FORSTER-PRODUCTIONS via Getty Images</a></span></figcaption></figure><p>Three out of four teenagers have seen online pornography – often before they even became a teenager. That’s according to a new report from Common Sense Media that examines the <a href="https://www.commonsensemedia.org/research/teens-and-pornography">role pornography plays</a> in the lives of today’s youth.</p>
<p>Some teens do more than just watch pornography. By way of “sexting,” teenagers are also <a href="https://doi.org/10.1016/j.jadohealth.2021.10.026">creating and sending their own images and videos</a> of themselves in the nude.</p>
<p>For the most part, it’s not the job of school staff to worry about what kids are looking at on the internet or sending over their phones. However, as an expert on human development – and as <a href="https://scholar.google.com/citations?hl=en&user=TZgnU_QAAAAJ&view_op=list_works&sortby=pubdate">one who studies adolescent sexuality</a> – I believe parents and educators should be prepared to address potential issues that might arise as a result of students’ engagement with pornography and sexting. This sort of preparedness is especially pertinent today because smartphones enable kids to look at porn and to sext during school hours.</p>
<p>Here are five things that parents and educators should know as pornography use and sexting become more commonplace among students:</p>
<h2>1. Pornography is not what it used to be</h2>
<p>Fifty-two percent of teens have <a href="https://www.commonsensemedia.org/research/teens-and-pornography">seen violent pornography</a>. This includes acts such as choking, slapping, gagging, hitting and crying. This is because the internet changed the way pornography is distributed. There used to be <a href="https://www.mtsu.edu/first-amendment/article/1004/obscenity-and-pornography">more regulations</a> on violent content and age verification to adhere to pay-per-view standards in hotel rooms and DVD sales. Now, self-produced and distributed content reigns on “tube-site” platforms that function similarly to YouTube.</p>
<p>Tube sites like PornHub allow for users to freely view and upload their own content. At its inception, many users assumed it was primarily “<a href="https://doi.org/10.1080/23268743.2016.1184477">amateur content</a>” or homemade and consensual content. However, one <a href="https://academic.oup.com/bjc/article/61/5/1243/6208896">study</a> showed that 1 in 8 titles of videos on the website described sexual violence. <a href="https://www.bbc.com/news/technology-55333403">An investigation</a> by the BBC and New York Times was prompted by victims who learned that video footage of their sexual assaults was being freely viewed on the website. The investigation uncovered millions of videos of suspected abuse and coercion, <a href="https://www.theguardian.com/commentisfree/2020/dec/19/pornhub-abuse-videos-new-york-times-mastercard-visa">causing credit card companies to cut ties</a>. </p>
<p>OnlyFans, another tube-site platform composed of user-uploaded content, also facilitates camming, or live sexual interaction, with content creators for a fee. Although there does not appear to be peer-reviewed research on adolescents’ use of OnlyFans, there are <a href="https://nypost.com/2021/05/27/children-are-selling-explicit-content-on-onlyfans-report/">some reports</a> that minors are bypassing age verification and selling their own sexually explicit images on the platform.</p>
<figure class="align-center ">
<img alt="Five teenagers sit on the floor of a high school hallway with their backs to the wall as they look at their cell phones." src="https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512719/original/file-20230228-18-nu9abs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teens can access cellphones during the school day.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/students-killing-time-in-corridor-between-classes-royalty-free-image/1411412809?phrase=teens%20iphones%20school&adppopup=true">Rafa Fernandez Torres via Getty Images</a></span>
</figcaption>
</figure>
<h2>2. Pornography is a source of sex education for teens</h2>
<p>Without widespread <a href="https://doi.org/10.1016/j.jadohealth.2020.07.036">comprehensive sex education in the U.S.</a>, young adults have identified pornography as a primary <a href="https://doi.org/10.1007/s10508-020-01877-7">source of sex education</a>. However, the pornography that teens have the easiest access to – tube-site pornography – <a href="https://academic.oup.com/bjc/article/61/5/1243/6208896">tends to portray</a> more sexual aggression, degradation of women and people of color and lack of sexual consent.</p>
<p>For example, <a href="https://doi.org/10.1080/10410236.2021.1991641">choking or strangulation during sex has been increasing in porn</a>. This is concerning to violence researchers, neurologists and <a href="https://doi.org/10.1080/0092623X.2021.1985025">mental health professionals</a> because recent reports indicate that <a href="https://doi.org/10.1007/s10508-022-02347-y">1 in 3 women were choked</a> during their last sexual experience. Although the majority of women reported feelings of euphoria, <a href="https://doi.org/10.1007/s10508-022-02347-y">strangulation during sex</a> carries the <a href="https://doi.org/10.1089/neu.2022.0146">same risk for brain damage due</a> to loss of oxygen as being strangled in other contexts.</p>
<p>What’s also concerning is that male adolescents exposed to violent pornography are <a href="https://doi.org/10.1080/10810730.2021.1887980">more likely</a> to be higher in sexual aggression and are <a href="https://doi.org/10.1007/s10508-019-1435-4">two to three times more likely</a> to have pressured a partner to engage in sexual activity the partner did not want to engage in than male adolescents who view less violent pornography or less pornography overall. For teen girls, their violent pornography exposure is associated with nonviolent risk behaviors, such as <a href="https://doi.org/10.1177/105984051456">substance use, buying or selling sex, and sexual victimization</a>. </p>
<h2>3. Although it is not wise, sexting is not always harmful</h2>
<p>Although many adults cringe when they learn about teens sharing nudes with each other – <a href="https://cyberbullying.org/sexting-laws">many states</a> still define sexting among teens as the distribution of child sexual abuse material – consensual sexting can be a normal and healthy part of adolescent sexuality. Some teens are <a href="https://doi.org/10.1007/s12119-022-09952-y">motivated to use sexting</a> to explore their sexuality by expressing their feelings and desires while practicing trust and vulnerability with intimate images. However, if sexting is coercive, or the sexts are shared outside of the couple without permission, it can be considered by law enforcement and violence researchers a form of sexual harassment or <a href="https://doi.org/10.4324/9781351135153">image-based sexual abuse</a>.</p>
<figure class="align-center ">
<img alt="A girl with glasses is underneath a bedcover as the green glare of an iPhone illuminates her surprised and bespectacled face." src="https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512716/original/file-20230228-691-q9katl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Three out of four teens have viewed online pornography.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cute-girl-watching-video-on-phone-with-shocked-royalty-free-image/1390528082?phrase=teens%20iphones&adppopup=true">Alihan Usullu via Getty Images</a></span>
</figcaption>
</figure>
<p>It’s important to note that, as with many issues related to teenage development, <a href="https://doi.org/10.1007/978-3-319-71882-8_4">potential harms or benefits of sexting</a> are dependent on factors such as maturity, the nature of the relationship between the individuals involved and gender. For example, <a href="https://doi.org/10.1007/s13178-022-00775-y">one study</a> found that boys were more likely than girls to disseminate sexts to peers without the consent of those in the picture. </p>
<h2>4. Sending other people’s sexual content is often harmful and illegal</h2>
<p>Once an image or video is shared, it can be difficult to control how it is used or distributed, which can lead to feelings of shame, guilt and embarrassment for the original sender. The sending of others’ sexual content can take many forms, such as sharing a nude image via small groups or posting an image more publicly to a website. Such images and videos can be shared widely or even secretly among private social media accounts and group email lists known as “<a href="https://theconversation.com/jocks-and-frat-boys-more-likely-than-other-men-in-college-to-visit-slut-pages-and-post-nude-images-without-consent-156365">slut pages</a>.” </p>
<p>Slut pages have the ability to <a href="https://www.wbur.org/npr/467959873/teen-girls-and-social-media-a-story-of-secret-lives-and-misogyny">shape a school’s culture on sexual violence</a>, as they are intended to make nonconsensual pornography seem amusing. This can encourage peers and even adults to minimize the emotional trauma a person may experience when they learn that their images are posted on a slut page.</p>
<h2>5. Schools can be liable for online sexual misconduct under Title IX</h2>
<p><a href="https://www2.ed.gov/about/offices/list/ocr/docs/title-ix-rights-201104.html">Title IX</a>, a federal law that prohibits discrimination on the basis of sex in education programs and activities that receive federal funding, can potentially be used to address nonconsensual pornography in high schools. When school administrators know or reasonably should know about nonconsensual pornography, Title IX requires them to take prompt and effective steps to end the harassment, prevent its recurrence and address its effects. This can include conducting investigations, taking disciplinary action against the individuals involved and providing support and resources for affected students.</p>
<p>However, a <a href="https://www.knowyourix.org/wp-content/uploads/2021/03/Know-Your-IX-2021-Report-Final-Copy.pdf">study</a> conducted by Advocates for Youth showed that school staff tended to minimize sexual harassment as a typical right of passage. Without staff training that targets this bias, the victims of nonconsensual pornography can feel uncomfortable going to staff <a href="https://www.knowyourix.org/">because victim blaming can be so prevalent</a>. For example, in <a href="https://www.tandfonline.com/doi/abs/10.1080/15546128.2022.2076757">our experiences training</a> school staff, a common response to the distribution of a student’s nude images is often, “Why did she send him that picture in the first place?” which is understandable. Educators could also consider asking, “Why did he share that picture with the whole school?”</p>
<h2>Is there anything that can be done?</h2>
<p>In our study, we found that public school administrators, staff and educators <a href="https://doi.org/10.1080/15546128.2022.2076757">overwhelmingly agree</a> that education for school staff, parents and students needs to happen to improve the social lives of today’s digital natives. We found that when school staff received education that included facts about how teens engage with pornography and sexting and some examples of how to respond when problems occur, they were more confident and less embarrassed discussing these topics if they were to arise at school. </p>
<p>We also think if schools’ sexual misconduct policies address digital behavior, that could also play a major role in determining how schools both prevent and respond to nonconsensual sexting and pornography among students. We are currently researching which schools do this well to provide an example that other schools can follow.</p><img src="https://counter.theconversation.com/content/198576/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan K. Maas does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An expert on adolescent sexuality weighs in on how technology has changed the amount and type of pornography that teens can consume – and what that means when it happens at school.Megan K. Maas, Assistant Professor of Human Development and Family Studies, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1895622022-09-11T08:24:43Z2022-09-11T08:24:43ZOvarian condition that can cause missed menstrual periods and infertility is going undetected in Nigeria<figure><img src="https://images.theconversation.com/files/483220/original/file-20220907-15-1d1rn.jpg?ixlib=rb-1.1.0&rect=50%2C42%2C5615%2C3690&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women with Polycystic Ovarian Syndrome often battle infertility and may not conceive easily. Photo by Florian Plaucheur/AFP via Getty Images.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/young-nigerian-girl-who-fled-maiduguri-to-kano-with-78-news-photo/463348590?adppopup=true">from www,gettyimages.com</a></span></figcaption></figure><p><em>Polycystic ovary syndrome is the most common gynaecological endocrine disorder in women of reproductive age. It affects between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879843/#:%7E:text=Background%3A,women%20of%20reproductive%20age%20worldwide">4% and 20% of women globally</a> and is influenced by genetic and environmental factors. Despite its prevalence, it remains a conundrum amongst clinicians and allied health professionals. The Conversation Africa’s Nigeria based commissioning editor Kofoworola Belo-Osagie asked public health lecturer Ajike Saratu Omagbemi to explain the syndrome and the challenges around how it’s being detected.</em> </p>
<h2>What is polycystic ovarian syndrome?</h2>
<p><a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo">The condition</a> refers to the presence of small, benign and painless cysts in the ovaries, which result in a range of symptoms and changes in hormonal levels. </p>
<p>It is characterised by elevated androgen levels. In turn this leads to <a href="https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome">excessive body and facial hair</a> and menstrual irregularities (no period or a long period).</p>
<p>It’s called a <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/syndrome">syndrome</a> because it’s a collection of signs and symptoms which occur consistently together. </p>
<p>Polycystic ovary syndrome <a href="https://academic.oup.com/humrep/article/17/9/2219/563943">can</a> mildly or severely disturb the reproductive, endocrine and metabolic functioning of a woman. </p>
<h2>How big a problem is it in Nigeria?</h2>
<p>Polycystic ovary syndrome affects <a href="https://pubmed.ncbi.nlm.nih.gov/24283091/#:%7E:text=Conclusion%3A%20PCOS%20is%20fairly%20common,are%20the%20commonest%20presenting%20features">one in six</a> infertile women in Nigeria. Local <a href="https://www.itmedicalteam.pl/articles/prevalence-of-polycystic-ovarian-syndrome-pcos-in-women-of-child-bearing-age-within-port-harcourt-metropolis-in-nigeria-.pdf">studies</a> have reported rates of between <a href="https://www.scirp.org/journal/paperinformation.aspx?paperid=87687">13.8%</a> and <a href="https://www.researchgate.net/publication/258956774_Prevalence_presentation_and_management_of_polycystic_ovary_syndrome_in_Enugu_south_east_Nigeria">18.1%</a>, amongst study populations of women in their reproductive age. </p>
<p>Local studies have mostly focused on determining its prevalence, treatment and management techniques. Only a couple of studies have focused on knowledge about the condition; and their findings were mixed. It’s not clear how much people know about polycystic ovarian syndrome in Nigeria. </p>
<p>It’s important to close the knowledge gap on the condition in Nigeria. The country <a href="https://www.researchgate.net/publication/288971582_Double_Burden_Non-Communicable_Diseases_And_Risk_Factors_Evaluation_In_Sub-Saharan_Africa_The_Nigerian_Experience">suffers</a> from a double burden of infectious and non-infectious diseases such as HIV/AIDS, tuberculosis, cardiovascular disease, diabetes and obesity. There is growing <a href="https://academic.oup.com/jcem/article/91/2/492/2843344">evidence</a> that these are linked to polycystic ovarian syndrome.</p>
<h2>What is the impact?</h2>
<p>Polycystic ovary syndrome can greatly affect the health and well-being of girls and women in the short, middle and long term, leading to deterioration of the quality of life. </p>
<p>It can begin as early as the start of puberty. A girl may not understand what she is experiencing or be aware of her risk of ill health. Older women may not seek or receive targeted care early enough. They may have years of <a href="https://journals.lww.com/progprevmed/fulltext/2020/06000/cross_sectional_study_on_the_knowledge_and.1.aspx">unrecognised ill health</a> before getting a diagnosis. </p>
<p>Symptoms are often related to a deterioration in a woman’s self-esteem and self-image and may thus affect her <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941334/">psychosocial</a> health.</p>
<p>Infertility, a classic symptom of polycystic ovarian syndrome, remains a critical concern in many African societies. There’s a great deal of stigma attached to women in Nigeria if they <a href="https://www.researchgate.net/publication/261903427_The_Social_meaning_of_meaning_of_infertility_in_Southwest_Nigeria">can’t become pregnant</a>. Th psycho-social and other <a href="https://www.ajol.info/index.php/njfp/article/view/157342#:%7E:text=The%20main%20negative%20psychosocial%20effects,confidence%20in%20oneself%20(7.7%25">consequences</a> may include deprivation and neglect, violence, marital problems and mental health issues. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Secondary school students sit in a group outside their classroom" src="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">It is often difficult for teenage girls to recognise the symptoms of Polycystic Ovarian Syndrome at puberty.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/public-school-for-girls-in-mainland-area-on-march-17-2016-news-photo/648348944?adppopup=true">from www.gettyimages.com</a></span>
</figcaption>
</figure>
<h2>Why is the syndrome difficult to recognise?</h2>
<p>Polycystic ovary syndrome is most often diagnosed two or three years <a href="http://dx.doi.org/10.1097/GCO.0b013e3282f10e22">after</a> the start of puberty because the menstrual patterning stabilises around that time. There are different manifestations at this stage of development. Some adolescents more frequently experience menstrual irregularity – a good marker of a heightened androgen level. That in turn leads to unwanted developments such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835258/#:%7E:text=Hyperandrogenemia%20is%20a%20salient%20feature,resistance%20in%20women%20with%20PCOS">male-pattern hair growth on the chest, back and face, male-pattern baldness</a>, and acne. It’s thought that heightened androgen results in the development of polycystic ovary syndrome in adulthood.</p>
<p>The syndrome is not the only cause of missed ovulation in the menstrual cycle, but is strongly associated with menstrual irregularities.</p>
<p>Other manifestations are a skin condition known as <a href="https://www.mayoclinic.org/diseases-conditions/acanthosis-nigricans/symptoms-causes/syc-20368983#:%7E:text=Acanthosis%20nigricans%20is%20a%20skin,the%20armpits%2C%20groin%20and%20neck">acanthosis nigricans</a>, which causes darker skin in the folds of the body, and <a href="https://pubmed.ncbi.nlm.nih.gov/18502254/">premature pubarche</a>, where pubertal changes take place too early – often before eight years of age.</p>
<p>It is easy to miss the condition in adolescents. And in the transition between adolescence and adulthood, normal changes can mimic the syndrome’s characteristics. </p>
<h2>Why are older women not likely to seek treatment early?</h2>
<p>Polycystic ovarian syndrome shows up in multiple ways and so it’s usually treated as different things. Health professionals still struggle with understanding it themselves, so they can’t always give women the information they need. Sometimes women eventually just try to treat their symptoms themselves. </p>
<p>Women who are using contraceptives may not realise that the hormonal changes they are experiencing are actually <a href="https://pubmed.ncbi.nlm.nih.gov/14748678/">symptoms</a> of polycystic ovarian syndrome. Only when they are off the contraceptive and trying to conceive without success do they seek help. </p>
<h2>What social and lifestyle factors may cause the syndrome?</h2>
<p>The exact cause is not known. Factors such as genetics and lifestyle have been linked to the development of polycystic ovarian syndrome. One can inherit the risk. Studies have <a href="https://www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/what-causes-pcos-how-will-it-affect-body">found</a> familial links.</p>
<p>Women with polycystic ovarian syndrome have an imbalance of insulin and androgens. Higher levels of insulin are suggestive of a high caloric diet and sedentary lifestyle. Up to 85% of women with polycystic ovarian syndrome also experience <a href="https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline">insulin resistance</a> – when their body’s cells stop responding normally to insulin, and instead block the entry of glucose into the cell and thus cannot maintain normal glucose levels. Insulin resistance is brought on by certain <a href="https://www.jeanhailes.org.au/health-a-z/pcos/symptoms-causes">lifestyle factors</a> such as poor diet and physical inactivity. Physical activity plays a <a href="https://pubmed.ncbi.nlm.nih.gov/1681160/">role</a> in insulin resistance disorders such as diabetes.</p>
<h2>What needs to be done?</h2>
<p>The big challenge is to fill the knowledge gaps about the condition. Then people can manage the disease better, prevent complications, and be less anxious about fertility. </p>
<p>Women and girls with the condition and those at risk need to be educated about the possibility of <a href="https://academic.oup.com/jcem/article/91/2/492/2843344">metabolic complications</a> so they can make lifestyle changes.</p><img src="https://counter.theconversation.com/content/189562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ajike Saratu Omagbemi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Polycystic Ovarian Syndrome is common among women and girls in Nigeria but not many know its impact on their lives and reproductive health.Ajike Saratu Omagbemi, Lecturer, Babcock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1875012022-08-26T12:21:01Z2022-08-26T12:21:01ZThe US lacks adequate education around puberty and menstruation for young people – an expert on menstrual health explains<figure><img src="https://images.theconversation.com/files/478167/original/file-20220808-8307-ysycaa.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many young people receive limited guidance about what to expect as they near menstruation.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-with-cramps-royalty-free-image/503117005?adppopup=true">SolStock/E+ via Getty Images</a></span></figcaption></figure><p>One thing few people have been talking about since <a href="https://theconversation.com/supreme-court-overturns-roe-upends-50-years-of-abortion-rights-5-essential-reads-on-what-happens-next-184697">Roe v. Wade was overturned</a> is how abortion restrictions will affect young girls across the United States. </p>
<p>Around the time of their first period, many young people learn the basic mechanics of managing their periods, such as how to put on a pad or tampon and that it happens once a month. Traditionally they might also receive some admonishment to keep their period hidden. Young people may get information about menstruation from a family member, friends or a teacher, or by searching on the internet. </p>
<p>But often it is only later that they learn and truly understand the more complex details about the menstrual cycle. This includes guidance around regular and irregular patterns and when to seek medical care for any shifts in timing, duration or the overall experience, including the severity of menstrual pain or heavy bleeding. These conversations also have clear implications for <a href="https://www.waier.org.au/educating-tomorrows-women-ovulatory-menstrual-health-literacy-as-a-lifelong-skill/">ovulation and pregnancy prevention</a>.</p>
<p>Now, with <a href="https://theconversation.com/roe-overturned-what-you-need-to-know-about-the-supreme-court-abortion-decision-184692">the overturning of Roe v. Wade</a>, young people who begin to menstruate will also need to learn early on how to recognize a missed period as soon as possible. In the past, a young person’s delay in mentioning that a period was late or skipped a few months might not have presented any particular urgency. However, going forward, in contexts where a ban on abortions beyond a very short period of weeks exists, even one missed period could have serious implications for a young person’s life. </p>
<p>Conversely, it’s critical that young people know that irregular periods can be normal and that it’s not always cause for alarm.</p>
<p>I have been <a href="https://scholar.google.com/citations?user=9PD6D4kAAAAJ&hl=en">researching young people’s experiences with menarche</a> – the onset of menstruation – around the world for almost 20 years. In 2018, my team began to explore the experiences of American girls with their periods, including their recommendations for <a href="https://doi.org/10.1080/02673843.2020.1867207">what all young girls need to know</a> as they enter puberty and begin to menstruate. </p>
<p>Based on those suggestions and insights, we published “<a href="https://www.agirlsguide.org/">A Girl’s Guide to Puberty and Periods</a>,” a body-positive illustrated graphic novel-style book that includes first period stories, advice and questions written by girls. </p>
<p>Globally, I have learned that girls growing up in Africa, Asia and here in the U.S. often receive inadequate information and support about their periods. </p>
<h2>Information about menstruation is inadequate</h2>
<p>Menstrual health literacy, or a <a href="https://doi.org/10.1080/26410397.2021.1911618">person’s understanding of the menstrual cycle</a> and its intersection with one’s health and well-being, is essential from the time leading up to the first menstrual period through menopause. </p>
<p>Both the <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/menstruation-in-girls-and-adolescents-using-the-menstrual-cycle-as-a-vital-sign">American College of Obstetricians and Gynecologists</a> and the <a href="https://doi.org/10.1542/peds.2015-4480">American Academy of Pediatrics</a> have recommended that just as doctors and nurses check someone’s blood pressure or temperature at each visit, they should also ask about periods. </p>
<p>These professional societies suggest that health care providers prepare girls and their families for the onset of menstruation and ensure that they understand the variation in menstrual patterns. </p>
<p>My team’s U.S. study focused on <a href="https://doi.org/10.1080/02673843.2020.1867207">adolescent girls</a> in Los Angeles, New York and Chicago. Our findings, along with research on <a href="https://doi.org/10.1111/josh.13135">state-level menstruation education standards</a> across the country, suggest that the U.S. is a long way from delivering menstrual health literacy to the population. Our research indicated that many girls received no guidance before their first period or had been given information that felt dated and hard to relate to. Think educational videos made in the 1990s. </p>
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<figcaption><span class="caption">The menstrual cycle can lead to highs and lows in mood and energy level.</span></figcaption>
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<p>A recent publication from the U.S. Centers for Disease Control and Prevention found that the median age of onset of menstruation <a href="https://www.cdc.gov/nchs/data/nhsr/nhsr146-508.pdf">decreased from 12.1 years old in 1995 to 11.9 by 2017</a>. This means that nowadays, many girls are in elementary school when they get their first period. </p>
<p>For this reason, it’s clear that young people in fourth or fifth grade need to be receiving health education that addresses menstruation. <a href="https://doi.org/10.1016/S0140-6736(19)30300-9">Girls who do not receive education and support</a> – particularly those who get their first period at a young age – are more likely to experience depression and low self-esteem. Low-income and minority girls are <a href="https://doi.org/10.1016/j.jadohealth.2016.10.008">particularly vulnerable</a>. </p>
<p>Yet many American girls still do not learn the basic facts about their menstrual cycles at home or school or from health care providers. As our study found, parents are <a href="https://doi.org/10.1080/02673843.2020.1867207">often uncomfortable discussing periods</a>, perhaps because it feels too linked to sexuality. </p>
<p>Our research also <a href="https://storymaps.arcgis.com/stories/4f8da19484ea46e0abaacee95312f26c">captured American girls’ first-period stories</a> across 25 states and found that many young people are afraid, ashamed and do not know whom to ask for advice when their menstruation starts. </p>
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<figcaption><span class="caption">How to discuss the menstrual cycle with a young person.</span></figcaption>
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<h2>Missed opportunities</h2>
<p>The internet and social media, which are important sources of news and guidance for many young people, may <a href="https://keep.lib.asu.edu/_flysystem/fedora/c7/Santora_asu_0010N_20765.pdf">deliver misinformation or reinforce menstrual stigma</a>. And a 2020 study of members of the American Academy of Pediatricians found that 24% of pediatricians surveyed <a href="https://doi.org/10.1515/ijamh-2019-0179">do not regularly provide guidance</a> before the first period. Furthermore, 33% do not discuss periods with their menstruating patients. Male pediatricians were also less likely to assess a patient’s menstrual cycles and provide information, perhaps because of discomfort with the topic. </p>
<p>Schools also may not be delivering the necessary guidance. In New York state, where I work, there is no requirement for the provision of menstrual health education, and sexual education <a href="https://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx">is not required to be taught or to be medically accurate</a>. Only 30 states and Washington, D.C., mandate sexual education in schools, but not all of them require medical accuracy. </p>
<p>It’s hard to know if many states are even including menstrual health in the curriculum, as data is limited and public information is not always available. I believe that, given the critical importance of some menstrual health literacy by late elementary school, schools could consider delivering puberty education – including menstrual health – separate from sexual education. This is particularly true in states that are hesitant to mandate sexual education.</p>
<h2>Menstrual health literacy translates to health literacy</h2>
<p>One survey of women of childbearing age suggested that <a href="https://doi.org/10.1111/birt.12237">fewer than 50% knew</a> the average number of days of a regular menstrual cycle. Not knowing what is “normal or not normal” in relation to an average menstrual cycle – ranging from how often you get your period to the extent of bleeding or pain experienced – increases the health risk for an adolescent girl or woman. </p>
<p>Health – including menstrual health – is a <a href="https://www.ohchr.org/sites/default/files/Documents/Publications/Factsheet31.pdf">basic human right</a>. For those who menstruate, this means a right to menstrual health literacy, along with being able to seek care for the myriad menstrual and reproductive health disorders. These range from <a href="https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods">dysmenorrhea</a>, or severe pain, to <a href="https://www.womenshealth.gov/a-z-topics/endometriosis">endometriosis</a>, a condition in which endometrial tissue grows outside the uterus and can cause menstrual irregularities and significant discomfort. Both require diagnosis and treatment. </p>
<p>Menstruation is <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2014.302525">an issue of public health</a>, and one long overdue for increased attention and resources, starting with – but not limited to – menstrual health literacy. The fall of Roe adds urgency to this public health priority.</p><img src="https://counter.theconversation.com/content/187501/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marni Sommer receives funding from the Bill & Melinda Gates Foundation to develop guidance on indicators and related measures for improving national level monitoring of progress on menstrual health and hygiene globally. </span></em></p>Research shows that many girls are in elementary school when they have their first period. But often they have not received adequate health education.Marni Sommer, Associate Professor of Sociomedical Sciences, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1552952021-02-18T19:12:27Z2021-02-18T19:12:27ZFears loom for teens undergoing vital brain development during COVID. Telling stories might help<figure><img src="https://images.theconversation.com/files/384414/original/file-20210216-14-1bxaidp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/WFBVn6fSgys">Unsplash/Priscilla Du Preez</a></span></figcaption></figure><p>“At the end of the war men returned from the battlefield grown silent — not richer, but poorer in communicable experience”, wrote Walter Benjamin after the first world war. So too, school students may reflect on the pandemic of 2020 and its effect on their experiences.</p>
<p>Almost every day, they heard anxiety-provoking news from across the globe, doled out in rapid fire. Yet many will be poor in the stories of their anticipated rituals and rites of passage to retell in later years. </p>
<p>They have other stories though, of cancellation and loss.</p>
<p>Gather any group of students together and they spontaneously tell different stories — of how their formal was cancelled or modified; how their classes were delivered remotely; how they adjusted to the rules of social distancing; or how they missed the opportunity to celebrate their milestone birthday with friends. </p>
<p>And they are instantly captivated by each other’s experiences. </p>
<p>The telling of stories is a <a href="https://www.psychologytoday.com/us/blog/two-takes-depression/201401/why-your-story-matters#:%7E:text=Research%20has%20long%20shown%20that,you%20emerge%20from%20the%20experience.">crucial coping device</a>, enabling individuals to situate themselves in relation to a bigger event and to gain perspective on the human experience. </p>
<p>We recommend storytelling using oral, written and creative arts formats, linking key events to form a plot, to adapt and improvise, and to share the story to reveal how very different people can share the same life experience. And how human nature can transcend this moment. </p>
<h2>Missing stories</h2>
<p>The loss of significant events — whether traditions such as school graduation celebrations, or more mundane everyday losses such as routine sport or other extracurricular activities — can have profound, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535346/">long-term impacts</a> on students. </p>
<p>Rite-of-passage events, such as formals, are <a href="https://theconversation.com/no-festivals-no-schoolies-young-people-are-missing-out-on-vital-rites-of-passage-during-covid-145097">important cultural markers</a>, cementing peer relationships and firming the foundations for ongoing well-being. </p>
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Read more:
<a href="https://theconversation.com/no-festivals-no-schoolies-young-people-are-missing-out-on-vital-rites-of-passage-during-covid-145097">No festivals, no schoolies: young people are missing out on vital rites of passage during COVID</a>
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<p>They are the stories we tell again and again during our lives, locating our belonging with and for others. But it is not just a simple loss of moments and unmade memories. </p>
<p>At this crucial stage in the development of the adolescent brain, the foundations are laid for decades to come through their experiences. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Silhouettes of young people on a beach, in the evening around a fire." src="https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384416/original/file-20210216-15-1mfviv0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rites of passage events are important cultural markers. They’re stories we tell again and again.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/AZMmUy2qL6A">Unsplash/Kimson Doan</a></span>
</figcaption>
</figure>
<p>The adolescent years, known as the <a href="https://pubmed.ncbi.nlm.nih.gov/26419496/">second sensitive period of brain development</a>, are important because this is when shaping of the brain occurs in earnest, in response to the unique environmental experiences of the individual. </p>
<p>This process of synaptic pruning — which starts with the onset of puberty and continues for at least the next five years — results in unused connections being removed. While those that are used are strengthened and “hard wired” with a coating of a substance called myelin. </p>
<p>Memory and <a href="https://theconversation.com/it-really-sucks-how-some-year-12-students-in-queensland-feel-about-2020-144004?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20August%2018%202020%20-%201706316470&utm_content=Latest%20from%20The%20Conversation%20for%20August%2018%202020%20-%201706316470+CID_d508796947200e4a672361095036aefb&utm_source=campaign_monitor&utm_term=It%20really%20sucks%20how%20some%20Year%2012%20students%20in%20Queensland%20feel%20about%202020">processing are enhanced</a> and there is a <a href="https://theconversation.com/it-really-sucks-how-some-year-12-students-in-queensland-feel-about-2020-144004?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20August%2018%202020%20-%201706316470&utm_content=Latest%20from%20The%20Conversation%20for%20August%2018%202020%20-%201706316470+CID_d508796947200e4a672361095036aefb&utm_source=campaign_monitor&utm_term=It%20really%20sucks%20how%20some%20Year%2012%20students%20in%20Queensland%20feel%20about%202020">heightened vulnerability</a> to risk-taking and sensitivity to mental illness because of the intense brain shaping under way. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-missing-middle-puberty-is-a-critical-time-at-school-so-why-arent-we-investing-in-it-more-150071">The missing middle: puberty is a critical time at school, so why aren’t we investing in it more?</a>
</strong>
</em>
</p>
<hr>
<p>The spectre looms of brains shaped by unmet expectations, disrupted routines, missing significant events, ongoing anxiety, fear and stress about what may be ahead the next day, week, month or year. </p>
<p>Our understanding of neuroscience points to such experiences as paving the way for <a href="https://pubmed.ncbi.nlm.nih.gov/28982627/">lifelong reduced outcomes</a>, such as poorer health, lowered educational achievement and the loss of optimism and hope. </p>
<h2>Everything is different</h2>
<p>The United Nations International Children’s Emergency Fund estimates 1.6 billion students and 91% of schools in 2020 <a href="https://www.unicef.org/coronavirus/keeping-worlds-children-learning-through-covid-19">experienced emergency education</a>. That means there was an adaptation to the usual routines of teaching, learning, attendance and curriculum, as a response to the COVID-19 disaster. </p>
<p>There is much talk of <a href="https://www.thecut.com/2018/05/how-to-be-happy.html">schools</a> and <a href="https://www.thecut.com/2018/05/how-to-be-happy.html">universities</a> needing to help our adolescents become more resilient, <a href="https://www.newyorker.com/culture/culture-desk/the-limits-of-grit">acquire greater grit</a>, and to be equipped with positive psychology strategies such as learned optimism. </p>
<p>There is a physiological tipping point though, when toxic stress resulting from strong, frequent or prolonged activation of the body’s stress response system, can lead to adverse impacts on brain structures. And students will not learn as before, especially if their brains have become <a href="https://developingchild.harvard.edu/resources/wp3/">hardwired during times of stress</a>, anxiety and trauma.</p>
<p>How can we ensure our young people are happy and uncompromised along <a href="https://wellbeingindicators.stats.govt.nz/en/subjective-wellbeing/">well-being indicators</a>, including a person’s ambitions and understanding of the qualities of their life? </p>
<p>Meeting and slightly exceeding expectations is the key to happiness and well-being. When a person is <a href="https://www.theatlantic.com/family/archive/2020/04/how-increase-happiness-according-research/609619/">happy there is an alignment</a>, or a slight increase between what is ideal or expected, and reality. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young person in the air while rollerblading." src="https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384418/original/file-20210216-21-l678h1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meeting and slightly exceeding expectations is the key to happiness.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/qQtYfzT-99Q">Unsplash/ Nicolas Picard</a></span>
</figcaption>
</figure>
<p>In a year of unmet expectations, negative impacts on well-being and subjective happiness are unavoidable. This can be seen with numbers seeking the support of mental-health providers <a href="https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey">increasing dramatically</a> during 2020. </p>
<p>There is a brooding concern identified globally and by the <a href="https://www.fya.org.au/wp-content/uploads/2020/07/localandvocal_National.pdf">Foundation of Young Australians</a>, that every aspect of how young people</p>
<blockquote>
<p>live, learn and work has been forever changed by COVID-19 and will continue to be felt by young people in the decade to come.</p>
</blockquote>
<h2>The importance of telling the stories of 2020</h2>
<p>Young people can benefit from opportunities to create and remember stories, and to use storytelling as a way to come to terms with their experiences of the pandemic, to aid healing and to create optimism for the future — both for themselves and their communities. </p>
<p>Storytelling requires a listener, and hence a community of shared experience emerges, building understanding and acceptance. These are crucial for <a href="https://www.researchgate.net/publication/327482874_Engaging_Marginalized_At-Risk_Middle-Level_Students_A_Focus_on_the_Importance_of_a_Sense_of_Belonging_at_School">promoting a sense of belonging</a> and well-being. </p>
<p>The acceleration of change and the likelihood of a “new normal” points to the need to tell the story of how and why change has occurred, and how the individual has experienced this change.</p>
<p>Research in <a href="https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=2970&context=tqr">health settings shows</a> storytelling can be therapeutic. People telling stories as a way of dealing with topics such as trauma, anxiety and illness, are “encouraged to work through their experiences and reflect on and deepen their understanding of what really matters in their lives”. </p>
<p><a href="https://www.patientvoices.org.uk/">Health professionals</a> have increasingly been drawn to collective storytelling for this reason. Now, more than ever, it is needed in schools and in universities, where teachers intersect with the lives of students constantly and have the capacity to make a significant impact.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young woman lying on bed with photographs around her." src="https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384419/original/file-20210216-21-1rwg9hu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Storytelling helps young people make sense of memories.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/FgSyP02I0gw">Unsplash/ian dooley</a></span>
</figcaption>
</figure>
<p>The lived experiences and disappointments can be shared through the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010736/">storytelling skills</a>, such as learning how to appreciate multiple points of view and that listeners and tellers can perceive events differently. These can provide us with a way to chronicle, share, and make meaning of experience, thereby enabling a retelling of the events, even when they reflect a poverty of expectations. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-stories-a-nation-tells-itself-matter-how-will-the-covid-generation-remember-2020-154367">'The stories a nation tells itself matter': how will the COVID generation remember 2020?</a>
</strong>
</em>
</p>
<hr>
<p>Teachers are the pivotal gate keepers of the future in so many ways, not only in grade setting but in recounting stories of success, both personal and from near and far, opening new future-oriented windows of opportunity to think and act. </p>
<p>In doing so, we reconnect with the important processes of adolescent cognition to rewire the brain, leading to the potential for a more optimistic, hopeful perspective rather than one of disappointment, loss and regret. </p>
<p>The importance of storytelling for all students will continue to grow as we tread the uncertain path of 2021 and beyond.</p><img src="https://counter.theconversation.com/content/155295/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The adolescent brain is particularly vulnerable to experience. Puberty is is the time brain networks are hardwired around milestone events. We should help teenagers make meaning of the pandemic.Donna Pendergast, Dean, School of Educational and Professional Studies, Griffith UniversityStephen Dobson, Professor and Dean of Education, Te Herenga Waka — Victoria University of WellingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1517112020-12-11T18:01:35Z2020-12-11T18:01:35ZIt will take lot more than free period products to end stigma around menstruation<figure><img src="https://images.theconversation.com/files/374501/original/file-20201211-23-eo71t7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2915%2C1941&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are several building blocks towards reducing menstruation stigma</span> <span class="attribution"><a class="source" href="https://webgate.epa.eu/thumb.php/54913609.jpg?eJw1jrEOgjAURf_lzQ6Plrav3QwLJqKJmKiTAUpdjIPIJP67V4jTyb3npn1vKtYUUnMf-hUVJQUi8EwhAy4zthsKCthB9o_bdRwabCokk_tMW_a_eJy39TytCwo5UC0d1Os54v3Tog8UHDNi9Rd7CPKm1612KWndJRPFsRWjULqu8RI1fsGppBjlpFixTG0UY20rYhJzHg19vk45Mo0~">Will Oliver/EPA</a></span></figcaption></figure><p>Pad by pad, efforts to challenge the stigma of menstruation are putting periods in the spotlight. The latest move comes from the Scottish parliament, which just passed a <a href="https://beta.parliament.scot/bills-and-laws/bills/period-products-free-provision-scotland-bill?qry=period%20product%20provision">landmark bill</a> to combat “period poverty”. Led by Labour MSP Monica Lennon, lawmakers unanimously voted to provide free menstrual products for all people who menstruate. </p>
<p>Just two years after becoming the first to <a href="https://theconversation.com/ending-period-poverty-scotlands-plan-for-free-menstrual-products-shatters-taboos-and-leads-a-global-movement-103138">provide period products</a> in all schools, colleges and universities, Scotland is the first nation in the world to guarantee access to menstrual products. Although this is the first time menstrual products have been been provided universally, Scotland follows in the footsteps of other pioneering efforts. Most notably, Kenya has provided free products in schools for years. </p>
<p>The Scottish bill emphasises the importance of menstrual health education in schools and promotes efforts to dismantle taboos around periods. Yet the importance of education and challenging stigma is often overshadowed by product rollouts.</p>
<figure class="align-center ">
<img alt="Person clutching their stomach" src="https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374407/original/file-20201211-23-1y0kthf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People need more than pads, they need knowledge and support.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-painful-expression-holding-hands-against-1518190793">Photoroyalty/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Beyond products</h2>
<p>For decades, activists have been <a href="https://link.springer.com/chapter/10.1007/978-981-15-0614-7_71">campaigning</a> for better menstrual health education, tax-free products and more. Yet governmental and media interest in the provision of period products is only recently gaining momentum. </p>
<p>Since around 2015, the movement has become increasingly visible. Campaigns and initiatives run the gamut. The common theme across most of these efforts, however, is that they are product-focused. By placing the pad, tampon, cup, or pants at the centre of attention, we may be missing the larger problem: stigma.</p>
<p>Initiatives featuring products and period poverty span from Netflix’s <a href="https://www.youtube.com/watch?v=Lrm2pD0qofM">Period. End of Sentence.</a>, an Oscar-winning documentary about reducing period stigma in India, to the <a href="https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftheconversation.com%2Fceltic-fc-leads-way-in-tackling-period-poverty-now-other-clubs-need-to-follow-96748&data=04%7C01%7Csarah.zipp%40stir.ac.uk%7C16c35688bee64816ef2508d8979981cd%7C4e8d09f7cc794ccb9149a4238dd17422%7C0%7C1%7C637426033739648920%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=EcIMVAwiAmQ3IDLcJmco6iYuPjLmGuynSl%2BKlzjUEt8%3D&reserved=0">On the Ball campaign</a> in professional football (an effort to provide period products on football grounds).</p>
<p>Other taboo-smashing campaigns and commercials include <a href="https://www.youtube.com/channel/UCGL9nHMvNVRawDxwazMMPgA/videos">HelloFlo</a> (sponsored by Kotex), Bodyform’s <a href="https://www.thinkwithgoogle.com/intl/en-gb/marketing-strategies/video/how-bodyform-got-real-their-bloodnormal-campaign/">Real Blood campaign</a> and Indian cricket’s <a href="https://www.thenationalnews.com/uae/health/ipl-2020-rajasthan-royals-highlight-period-taboos-with-bold-campaign-1.1101540">Rajasthan Royals</a> campaign. Additionally, an explosion in new menstrual management technologies, aka “FemTech”, has transformed the commercial landscape in menstrual health. Sustainable period product companies like <a href="https://www.heygirls.co.uk/">Hey Girls</a> and <a href="https://www.shethinx.com/?gclid=CjwKCAiAq8f-BRBtEiwAGr3DgX1Bhvg_VsP57joDDVGHbMoD1CZDoUOmohkNN9z6ztIuKmTbeTrEWBoCDzgQAvD_BwE">THINX</a>are flooding the market, along with period-tracking apps. In the UK, charity groups such as<a href="https://www.bloodygoodperiod.com/">Bloody Good Period</a> and <a href="https://www.bigredbox.org/">Big Red Box</a>are busy distributing products. </p>
<figure class="align-center ">
<img alt="Teenagers playing football" src="https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374503/original/file-20201211-13-1hjt3fq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Harmful myths and restrictions about periods can lead to avoiding activities like sports.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girls-playing-soccer-64938637">Fotokostic/Shutterstock</a></span>
</figcaption>
</figure>
<p>But people need more than pads, they need knowledge and support. Access to products is enormously important, no doubt. But upon deeper reflection, it is (in part) a continuation of the same old taboo. As women’s, gender and sexuality studies professor Chris Bobel observes in <a href="https://www.palgrave.com/gp/book/9783319894133#aboutBook">her recent book</a>, the good period is the period we don’t see or know about. Cover it up, conceal it and get on with life. What lies beneath is a messy reality that we rarely deal with or see. </p>
<h2>Period shame</h2>
<p>Navigating period woes can be daunting. From excessive bleeding and pain to hormonal changes and period poverty, many suffer in silence due to menstrual stigma. Dangerous traditions, such as <a href="https://www.nytimes.com/2019/12/27/world/asia/nepal-menstruation-hut-chhaupadi.html">menstrual huts in Nepal</a> are abusive and sometimes deadly. Globally, <a href="https://helloclue.com/articles/culture/36-superstitions-about-periods-from-around-world">harmful myths and restrictions</a> prevent many from participating in important activities, from sport to school to cooking.</p>
<p>We know that strong taboos often prevent people from asking for help and support, including asking for free products. A <a href="https://plan-uk.org/media-centre/plan-international-uks-research-on-period-poverty-and-stigma">Plan International UK study</a> found that nearly half of girls between 14 and 21 were embarrassed by their periods. The shame persists into adulthood: about <a href="https://www.actionaid.org.uk/blog/news/2017/05/24/1-in-4-uk-women-dont-understand-their-menstrual-cycle">20% of UK women</a> surveyed by ActionAid also felt uncomfortable talking about their periods and whether they had a difficult or easy cycle. </p>
<p>The experience of non-binary and trans people is less clear, but <a href="https://publichealth.pitt.edu/Portals/0/Main/Research%20and%20Practice/CHE/journal%20club%20articles/Queer%20periods%20-%20attitudes%20toward%20and%20experiences%20with%20menstruation%20in%20the%20masculine%20of%20center%20and%20transgender%20community%20%28003%29.pdf">recent research shows</a> that they face these challenges with additional distress over using public toilets, gender dysphoria, and discrimination. </p>
<figure class="align-center ">
<img alt="A genderqueer person receiving menstrual products from a doctor" src="https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374405/original/file-20201211-15-9jn9nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research shows non-binary and trans people can face additional challenges relating to period taboos.</span>
<span class="attribution"><a class="source" href="https://uploads-ssl.webflow.com/5c6ef9c489c368149f717a22/5c96a79a4476fb5fff918501_Day%203%20-%20Callen-Lorde3378.jpg">Zackary Drucker/The Gender Spectrum Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Smashing stigma</h2>
<p>The broader menstruation movement seeks to fill the gaps that products cannot fill. Creative approaches to educating about menstruation include work from <a href="https://doi.org/10.1002/9781119429128.iegmc282">artists</a>, <a href="https://www.goodreads.com/book/show/34510547-the-adventures-of-toni-the-tampon">comic book writers</a> and <a href="https://wellcomecollection.org/articles/We70GR4AAHEelso2">zine makers</a>. Advocacy groups such as <a href="https://link.springer.com/book/10.1007%2F978-981-15-0614-7">Days for Girls</a>, <a href="https://womenwinlearninglab.thinkific.com/">The Women Win Foundation</a> and <a href="https://www.menstrupedia.com/">Menstrupedia</a> have developed education resources. </p>
<p>Research groups in the <a href="https://menstruationresearchnetwork.co.uk/">UK</a> and <a href="https://www.menstruationresearch.org/">USA</a> are collaborating with international partners to better understand the lived-experiences of menstruation around the world. <a href="https://link.springer.com/book/10.1007%2F978-981-15-0614-7">The Palgrave Handbook of Critical Menstruation Studies</a> is a first-of-its kind global, open-access collection of research on menstruation. </p>
<p>So, where do we go from here? There are several key things that will help reduce menstruation stigma, including:</p>
<ul>
<li><p>Better, more inclusive, menstrual cycle and health education for all, beginning in primary school and including boys. This education should continue throughout secondary school, as teens progress through puberty and have evolving needs. Educating teachers and <a href="https://menstruationresearchnetwork.co.uk/videos-">coaches</a> is also key. </p></li>
<li><p>Access to adequate, safe and environmentally sustainable products that are freely available to all people who menstruate, and include a range of technological options to fit all body types and needs. </p></li>
<li><p>Support in terms of coping with pain, emotional and physical changes and more. Normalising menstruation is key to helping people feel comfortable and shedding the shame of periods. Here, research can support our understanding. A <a href="https://www.womeninsport.org/wp-content/uploads/2018/08/PP-Puberty-Research.pdf?x99836">Sport England</a> study highlighted barriers for participation in sport and PE amongst adolescents, with period-related issues being one of them. There may be some fairly easy fixes, such as not requiring white shorts for sport teams. Other strategies for coping, from nutrition to pain medicine, could also make a big difference. Including diverse perspectives from the LBTQ+ community, people with disabilities and people from varied cultural/ethnic backgrounds is key. </p></li>
</ul>
<p>Above all, we need to talk about menstruation more freely, and work towards shedding the shame that has kept people in the dark about their own bodies for generations.</p>
<hr>
<p><em>Independent researcher <a href="https://theconversation.com/profiles/lilamani-de-soysa-731640">Lilamani de Soysa</a> contributed to this article.</em></p><img src="https://counter.theconversation.com/content/151711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The building blocks towards reducing stigma go far beyond providing period productsSarah Zipp, Lecturer, Faculty of Health Science and Sport, University of StirlingCamilla Mørk Røstvik, Research Fellow, University of St AndrewsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1513842020-12-10T11:36:35Z2020-12-10T11:36:35ZWhat are puberty blockers, and how do they work?<p>The use of puberty blocking drugs to treat adolescents with gender dysphoria or incongruence has recently come under scrutiny following a <a href="https://www.bbc.co.uk/news/uk-england-cambridgeshire-55144148">decision by the UK High Court</a>. Three judges ruled that children under 16 were unlikely to be able to give informed consent to undergo such treatment.</p>
<p>The case has raised questions about the effects so-called puberty blockers have on adolescents, whether the drugs are safe and whether their effects are reversible. The difficulty in answering these questions is that the evidence for the use of these drugs on adolescents with gender incongruence is limited, and more research is needed.</p>
<p>But while treating gender incongruence with puberty blockers is a relatively recent application, these drugs have been used on children since the 1980s for slowing down puberty if it happens too early or too quickly. Currently, there’s sufficient evidence to show the drugs are safe and well-tolerated in children with early puberty.</p>
<p>Puberty starts when the <a href="https://www.sciencedirect.com/topics/neuroscience/hypothalamic-pituitary-gonadal-axis">body’s glands</a> begin producing the hormones needed to reach sexual maturity. Normally, puberty rarely occurs before the age of eight in girls, and nine in boys. But if it happens very early or very fast, physicians may consider the use of drugs to slow down or stop puberty. </p>
<p>This is done so the child can reach the physical milestones associated with puberty at a steady rate, and which are appropriate for their age. For instance, it’s possible that if puberty happens too early and too fast, there won’t be enough time for the adolescent to grow properly. </p>
<p>The most common form of early puberty in children is premature activation of gonadotrophin releasing hormone (GnRH). This hormone is essential for development as it causes the pituitary gland to begin producing the hormones that subsequently trigger the testes and ovaries to start making the sex hormones testosterone and oestradiol (oestrogen). </p>
<p>But because GnRH is naturally released in pulses, sustained exposure to the hormone (or an artificial version of it) will actually stop the GnRH receptors (located in the pituitary gland) from producing sex hormones, effectively pausing puberty. The receptors will begin working again and puberty will restart once exposure is stopped.</p>
<p>The most common puberty blockers are GnRH analogues, a synthetic form of the hormone. These are usually administered as injections either monthly, or at three or six month intervals. Generally, these puberty blockers are continued until the child is around 11 to 12. Once stopped, children begin puberty again as normal. In such cases, menstrual periods in girls start on average about 18 months after stopping puberty blockers.</p>
<figure class="align-center ">
<img alt="A pre-teen girl and her father consult with a female doctor." src="https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373868/original/file-20201209-13-10vuztl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The doctor will take a child off puberty blockers when they’re around 11-12 years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-examines-throat-teenager-girl-father-1369246748">Dmitriy Utlanov/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In children, most evidence supporting the use of puberty blockers for stopping early puberty has looked at GnRH analogues. Research shows these drugs are very effective at temporarily pausing puberty, and don’t effect a child’s <a href="https://pediatrics.aappublications.org/content/123/4/e752">overall height</a> development once stopped. </p>
<p>As for side effects, some studies have reported weight gain with the use of puberty blockers – but this has not been a <a href="https://www.karger.com/Article/FullText/501336">consistent finding</a>. Other studies have looked at the effect of puberty blockers on bone health in children with early puberty and not found any <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233750">long-term problems</a>.</p>
<p>Researchers have also investigated whether puberty blockers may lead to the development of polycystic ovaries in women. This condition affects the ovaries, and may cause irregular periods and difficulty getting pregnant. Again there are no <a href="https://www.karger.com/Article/FullText/501336">consistent findings</a> here either. In studies that have shown a link between puberty blockers and polycystic ovary syndrome, it’s unclear whether this is because of the underlying condition which caused early puberty or the effect of the drug itself. </p>
<p>No studies to date have shown any adverse effect of GnRH therapy on neurocognitive development. These drugs are <a href="https://www.karger.com/Article/FullText/501336">generally safe and well-tolerated</a> in children with early puberty. Once stopped, the child begins puberty and develops as expected. </p>
<h2>Other uses</h2>
<p>GnRH analogues have also been used in fertility medicine, to treat hormone-sensitive prostate and breast cancers, and in other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452955/">gynaecological conditions</a>, such as endometriosis. </p>
<p>But more recently, these drugs have been used in <a href="https://pubmed.ncbi.nlm.nih.gov/28945902/">children and adolescents with gender incongruence</a>. In such cases, blocking puberty gives the adolescent more time to explore their options and to live in their preferred gender, and avoid developing any secondary sexual characteristics such as the growth of breasts or facial hair.</p>
<p>If they and their doctors decide it is suitable, the young person can then start taking gender-affirming hormones – such as testosterone in trans boys and oestrogen in trans girls – which can have irreversible effects. But the use of GnRH analogues in these circumstances is temporary until a firm decision has been made about the child’s gender.</p>
<p>However, there’s still limited evidence on the effects of puberty blockers in these adolescents in whom puberty had started normally. During the time that puberty is blocked, it’s possible that growth and bone health may be affected. But further research is required in this area. There’s also limited information on the long-term effects of the use of puberty blockers in children and adolescents with gender incongruence. </p>
<p>In general, while the evidence is clear that the use of puberty blockers in children with early puberty can be considered safe and well tolerated, the extended use of puberty blockers for other uses needs further research.</p><img src="https://counter.theconversation.com/content/151384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>So-called “puberty blockers” work by temporarily suppressing the action of a specific hormone in the body.Faisal Ahmed, Professor of Paediatric Endocrinology, University of GlasgowAngela Lucas-Herald, Clinical Lecturer, Paediatric Endocrinology and Diabetes, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1500712020-11-30T19:08:02Z2020-11-30T19:08:02ZThe missing middle: puberty is a critical time at school, so why aren’t we investing in it more?<figure><img src="https://images.theconversation.com/files/371895/original/file-20201130-19-pt7zvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-teenage-students-sitting-outside-school-779645410">Shutterstock</a></span></figcaption></figure><p>The middle years of school are defined as being from 8-14 years of age. These were often described as a <a href="https://www.pep-web.org/document.php?id=se.007.0123a">latent</a> or quiet phase of development. </p>
<p>We now understand this is not the case — the middle years are a <a href="https://www.sciencedirect.com/science/article/abs/pii/S027322970800035X">foundational period</a> for development. But there is not enough support in the education system to help young people during this period — which includes the often stressful transition from primary to secondary school.</p>
<h2>The importance of the middle years</h2>
<p>Much of our new understanding on the importance of the middle years comes from studies looking at the effects of puberty, such as the Childhood to Adolescence Transition Study (<a href="http://cats.mcri.edu.au/">CATS</a>). This has been following 1,200 Melbourne students from when they were in Year 3. In 2020, members of the group are aged 16-17.</p>
<p>Most of our knowledge of puberty has <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-7795.2010.00722.x">focused on a period</a> that begins at around 10-11 years of age with the production of oestrogen and testosterone. This results in the development of secondary sexual characteristics (breasts, facial hair) and the ability to reproduce.</p>
<p>Before this period, is a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-7795.2010.00722.">process that begins</a> at around 6-8 years of age with a rise in adrenal hormones. These hormones lead to the development of armpit hair and pubic hair, as well as acne. </p>
<p>Apart from infancy, the biological changes of puberty bring the greatest shifts in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00579-1/fulltext">brain development</a>. These pubertal changes drive a different engagement with the social world. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/book-review-the-new-puberty-80877">Book review: The New Puberty</a>
</strong>
</em>
</p>
<hr>
<p>During the middle years, which coincide with puberty, peer relationships become increasingly important. In a <a href="https://www.academicpedsjnl.net/article/S1876-2859(20)30568-4/abstract">recent study</a>, we found two-thirds of students between the ages of 8 and 14 reported being bullied frequently in the past four weeks. And 35% reported frequent bullying in multiple forms, such as physical and verbal attacks. </p>
<p>It is now increasingly recognised bullying peaks during these middle years — rates are typically lower in <a href="https://journals.sagepub.com/doi/abs/10.1177/0886260508317185?casa_token=ar8cjLuUu60AAAAA:94nZhe8EfzDs7xDhM4frTa9dYVPx5OqbO92PnpKTq_FvGj-MFxPPk13CrTi7j9ahwiV1z1YEwD_q">early primary school</a>. For boys, bullying declines with age, but for girls it persists into secondary school. </p>
<h2>How children’s health affects education</h2>
<p>There is a close connection between health and education during the middle years, particularly in the transition to secondary school. </p>
<p>In a typical classroom in mid-primary school, around <a href="https://docs.education.gov.au/documents/student-wellbeing-engagement-and-learning-across-middle-years">five students</a> have emotional problems and five have behavioural problems. These students will begin secondary school a year behind their peers in numeracy skills. </p>
<p>This is independent of the presence of <a href="https://docs.education.gov.au/documents/effects-schooling-outcomes-early-developmental-vulnerabilities-children">developmental vulnerabilities</a> children may have when they start school. These <a href="https://www.aedc.gov.au/about-the-aedc/about-the-aedc-domains">include</a> having problems that impact physical health and/or language and communication skills.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-out-of-10-girls-skip-class-because-of-painful-periods-and-most-wont-talk-to-their-teacher-about-it-150286">3 out of 10 girls skip class because of painful periods. And most won't talk to their teacher about it</a>
</strong>
</em>
</p>
<hr>
<p>Governments have invested heavily in preschool education and preparing children for school entry, such as <a href="https://www.education.gov.au/news/preschool-funding-extended-2021">increasing funding for more children to attend kindergarten</a>. They also invest in identification and support of younger children with particular <a href="https://www.aedc.gov.au/">developmental vulnerabilities</a>. But the middle years haven’t seen the same level of commitment.</p>
<p>In 2015, the Victorian Auditor General <a href="https://www.audit.vic.gov.au/report/education-transitions?section=">tabled a report</a> into school transitions (early childhood to prep, prep to primary and primary to secondary). It noted the education department …</p>
<blockquote>
<p>has developed a comprehensive and well-researched framework to support early-years transitions. This has led to a greater uniformity of approach and contributed to improved early-years transition outcomes. However, it does not provide the same levels of support and guidance to schools to transition students from primary to secondary school. </p>
</blockquote>
<p>Similarly, there is still a lack of evidence-based, system-wide strategies that adequately respond to the educational, social and emotional needs of children in the transition to secondary school. This is despite evidence a stressful transition to secondary school may have <a href="https://link.springer.com/article/10.1007/s40688-014-0044-4">long-term negative outcomes</a>, such as school disengagement and poor academic performance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl on a swing." src="https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371910/original/file-20201130-14-3becd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Half of adult mental health problems emerge by the age of 14.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-beautiful-girl-sits-on-swing-1753843244">Shutterstock</a></span>
</figcaption>
</figure>
<p>The middle years have also been neglected when it comes to health. There have been major investments in service delivery systems for students in the early years and older adolescents (such as <a href="https://headspace.org.au/blog/headspace-welcomes-funding-to-reduce-wait-times-in-headspace-centres/">Headspace</a>). In contrast, little attention has been given to the middle years. Yet one half of all adult mental health problems <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/208678">emerge by age 14</a> with symptoms often appearing in the preceding years.</p>
<h2>Remote learning could have made it worse</h2>
<p><a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30186-3/fulltext">Remote learning and physical distancing</a> during COVID- 19 may have an unequal effect on students’ mental health and learning during the middle years. </p>
<p>Remote learning could cause greater disengagement and loss of learning for students who have recently transitioned to secondary school. With the disruption, many students may not have established strong routines and relationships with peers and teachers. </p>
<p>Students who fall behind during this period may find it difficult to catch up without proper support. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/one-quarter-of-australian-11-12-year-olds-dont-have-the-literacy-and-numeracy-skills-they-need-148912">One quarter of Australian 11-12 year olds don't have the literacy and numeracy skills they need</a>
</strong>
</em>
</p>
<hr>
<p>During the middle years, there is a shift in the relationship between parents and children — as children start to orient away from parents, towards their peer group. These changes can be seen as an opportunity to reestablish parent-child relationships, especially in the COVID-19 climate. </p>
<p>Research shows <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00579-1/fulltext">when parents are interested</a> in their child’s learning, involved in an age appropriate way and have good communication with their child, it helps the child’s development, reduces risky behaviours and leads to fewer mental health problems. </p>
<p><a href="https://www.oecd-ilibrary.org/education/parental-involvement-in-selected-pisa-countries-and-economies_5k990rk0jsjj-en">Parents’ involvement in their child’s learning</a> also leads to better academic performance and stronger school engagement.</p>
<p>The rise in remote learning and move to COVID-normal offers a chance for parents to become more actively involved with their child’s learning.</p>
<p>Beyond the family home, schools are the most important context for development. School teachers can successfully <a href="https://docs.education.gov.au/documents/student-wellbeing-engagement-and-learning-across-middle-years">identify students </a> that are likely to encounter issues in Year 7. Connection and familiarity between teachers and students can improve engagement with school. </p>
<p>Teachers also have an important role in providing a positive social environment for peer relationships and skill development.</p>
<p>Although the middle years are a time when students are at risk of school disengagement and health problems, these years are also a time of opportunity. Environmental effects, such as the school and peer environment, are particularly strong and intervention may have the greatest impact. </p>
<p>All <a href="https://mcri.figshare.com/articles/online_resource/Promoting_wellbeing_and_learning_in_the_middle_years_an_opportune_time_for_intervention/13146512">young people</a> must be supported during this phase of life. And governments must provide targeted programs to support those most at risk.</p>
<p>This should be aimed at strengthening social and emotional learning, improving the primary to secondary school transition, and enabling more effective links between education and health services. </p>
<p><em>This article was written with input from masters student Helen Ramsay.</em></p><img src="https://counter.theconversation.com/content/150071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Mundy receives funding from the National Health and Medical Research Council and the Commonwealth Department of Education, Skills and Employment. Previous funding has been from the Victorian Department of Education and Training, Australian Rotary Health Research, the Royal Children's Hospital Foundation and the Invergowrie Foundation.</span></em></p>The middle years (between 8 and 14 years old) are a foundational period for development. But these years don’t receive enough support from the education system.Lisa Mundy, Senior research fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1443892020-09-17T11:24:18Z2020-09-17T11:24:18ZHow to keep teen boys happily singing – instead of giving up when their voices start to change<figure><img src="https://images.theconversation.com/files/357043/original/file-20200908-24-1bx9n9u.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C4583%2C3394&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Helping boys through their voice change can keep the joy of singing alive.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/MacysAnnualGreatTreeLighting/86b33d3b5cf244e186ea0733bc15fedc">Tomas Ovalle/AP Images for Macy's</a></span></figcaption></figure><p>Boys like to sing. Adolescent boys around the world report the same thing: <a href="https://doi.org/10.1017/S026505171400031X">They enjoy singing</a> and want to get better at it. </p>
<p>Yet <a href="https://www.washingtonpost.com/news/morning-mix/wp/2015/02/13/cincinnati-boychoir-plans-to-examine-science-behind-boys-changing-voices/">many boys stop singing</a> during the transition from childhood to adolescence. There is a misconception that boys stop because their voices start to change. Boys don’t actually say that. What they say is, as their voices develop through puberty, they <a href="https://doi.org/10.1177/1321103X09344382">become convinced they are no longer good singers</a>. </p>
<p>As a <a href="https://scholar.google.com/citations?hl=en&user=FLXq7m4AAAAJ&view_op=list_works&gmla=AJsN-F4QskfmkV0fEfSlc3Bn_KtUYPIVRdyw0R8LUKD4dwM8SLMu2ccvDqWpimDXU-MB7oxh6YxA-TMcqC9Yn7yEhFqPMNsXfE2PBIIFL9SKzgly_ShaAiI">music professor and researcher</a>, I’ve interviewed hundreds of boys about why they sing and, more importantly, why they don’t. My goal is to learn what boys want from singing – and how parents and teachers can provide the necessary skills, guidance and support to help them grow into their adult voices.</p>
<h2>Friends and role models</h2>
<p>Adolescent boys are powerfully influenced by peers, family and teachers. These individuals can provide direction and motivation during a boy’s transition from childhood to adolescence, especially if they are supportive and share his goals. It used to be thought that <a href="https://doi.org/10.1177/0027432108321076">boys stopped singing because of peer pressure</a>. While this may remain true for some, many boys report the opposite: The <a href="https://doi.org/10.1177/1321103X09344382">support of their peers</a> is what attracts them to singing and keeps them involved, especially in school choirs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&rect=0%2C10%2C3444%2C2536&q=45&auto=format&w=1000&fit=clip"><img alt="Ten boys ranging in age from roughly eight to 16, stand facing the same direction singing." src="https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&rect=0%2C10%2C3444%2C2536&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357033/original/file-20200908-16-1fyyzv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">From boys to men.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/SpoletoFestivalUSA/1b2b37dd54854fc4abe59c727429a69a">AP Photo/Bruce Smith</a></span>
</figcaption>
</figure>
<p>Older role models are important, because they provide images of what the boy could become in the future. A boy who has a positive role model can make decisions about what he needs to do in order to become like that role model. The <a href="https://doi.org/10.2147/NDT.S39776">adolescent brain makes this kind of forward-oriented thinking possible</a>, marking a change from childhood, when the focus is on the here and now.</p>
<p>If a boy has an older role model who sings, he can envision a future in which he sings, too – possibly even with friends. That idea might lead him to join a singing group or choir in school. <a href="https://www.ted.com/talks/patrick_freer_from_bowling_alone_to_singing_together">Better yet, he might decide to do it with a group of buddies</a>. </p>
<h2>Supporting singing through voice change</h2>
<p>Adolescent boys who sing have unique concerns that must be addressed by teachers or supportive adults. </p>
<p>Boys want to know why their voices crack, when they will be able to sing lower pitches and what to expect during the development process. They also want to know they will be protected from embarrassment. </p>
<p>Providing information about vocal anatomy helps boys understand why and how their voices are changing. A <a href="https://acda-publications.s3.us-east-2.amazonaws.com/choral_journals/Thurman.pdf">boy’s voice change occurs in stages</a>, each clearly defined in terms of the range of high to low notes that can be sung in each stage. The <a href="https://acda-publications.s3.us-east-2.amazonaws.com/choral_journals/Thurman.pdf">six stages of voice change</a> correspond with the six stages of male pubertal development.</p>
<p>Instruction should be adapted to the changing needs (and voices) of adolescent boys. For instance, pitches that were easily sung a month ago might not be accessible today, requiring teachers to adjust the repertoire and voice parts they assign. </p>
<p>Boys can be <a href="https://doi.org/10.1177/8755123318779880">enlisted to discover and chronicle</a> the changes in their own voices. This strategy embraces the autonomy that is so important for adolescent boys. </p>
<p>Adult role models can describe their own voice change, compare notes with the boy and reinforce that older boys and adult men sing. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Four Black teen singing together." src="https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357047/original/file-20200908-16-1l9z8c8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Singing need not be in a choir.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenagers-rehearsing-on-stage-royalty-free-image/105657687">Hill Street Studios/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Building musical skill during adolescence</h2>
<p>Many boys will thrive in a school choir, but others will prefer to sing individually or in self-formed groups with friends. The same dynamic occurs in sports, where some athletes join teams while others focus on individual sports or pickup games. What matters is that the boy is presented with ever-increasing challenges appropriate to his growing level of musical skill. </p>
<p>Developing singers have much to learn, such as mastering breath control; understanding how the larynx will grow and change to enlarge their vocal range; coordinating the muscles that will eventually allow for lower (and often louder) pitches; and reading music written in the bass clef. Instead, boys report they are not taught these fundamental components of musical growth, leading them to <a href="https://doi.org/10.1080/14613808.2015.1014330">give up hope of ever being “good singers” again</a>. </p>
<h2>Performing</h2>
<p>Music teachers are often evaluated by school administrators the way athletic coaches are judged – by the outcome of a choral performance or game. This is problematic, because adolescent boys say they value the <a href="https://www.questia.com/magazine/1P3-3957114091/reclaiming-group-vocal-instruction">process of learning more than the act of performing</a>.</p>
<p>A public celebration of musical achievement, in front of friends and family, at the precise moment a boy feels most vulnerable about his changing voice, is exactly what many boys say they don’t want at the crux of pubertal development. Instead, many boys I’ve spoken with say they would continue singing were it not for the public performance. The obvious question becomes, “Do all choirs need to sing in public?” These boys suggest the answer is, “No – not until I’m more confident.”</p>
<p>The COVID-19 pandemic has changed the spaces where boys sing. <a href="https://theconversation.com/young-musicians-can-perform-on-virtual-stages-when-schools-are-closed-140820">Virtual choirs, like Zoom choirs, have proliferated</a>. Technology has enhanced the ability for boys to connect socially while making music together. Software featuring amazing production tools is free and easily accessible. But even in this environment, boys will benefit greatly from virtual musical guidance and the support of teachers and other adults.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>A recent nationwide survey found that <a href="https://www.chorusamerica.org/resource/chorus-impact-study-singing-lifetime">54 million Americans (one in six) sing in choirs</a>, and many more enjoy singing in other settings. Research shows <a href="https://doi.org/10.1007/s10865-004-0006-9">singing improves mood, lowers stress</a> and <a href="https://www.chorusamerica.org/resource/chorus-impact-study-singing-lifetime">builds community</a>. It is my hope that, with a little understanding, the singing boys of today can become the singing fathers, teachers and buddies of tomorrow – who together can join in song.</p>
<p><em>(Note: In this article, “boys” refers to biological sex, not gender identification. Families may wish to discuss the intersections of biology, gender and singing as related to puberty and adolescent development.)</em></p><img src="https://counter.theconversation.com/content/144389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick K. Freer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many boys stop singing at adolescence – but with the right support, they can continue to sing through their voice change and emerge as lifetime singers.Patrick K. Freer, Professor of Music Education, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1227912019-10-04T02:49:04Z2019-10-04T02:49:04ZCurious Kids: why does my older sister not want to play LEGO with me anymore and stays in her room?<figure><img src="https://images.theconversation.com/files/290476/original/file-20190902-175673-1103xqc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C9577%2C5387&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Change is tough for everyone.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2NzQzMjM4MSwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTM1NDQ3MzYzNSIsImsiOiJwaG90by8xMzU0NDczNjM1L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJzUkxVTVpiNG9TcXlXQXA5UW1JdVZHTDJjZkkiXQ%2Fshutterstock_1354473635.jpg&pi=41133566&m=1354473635&src=-1-13">www.shuttershock.com </a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au.</em> </p>
<hr>
<blockquote>
<p><strong>Why does my older sister, aged 13, not want to play LEGO with me anymore and stays in her room the whole day? – Beth, age 10, Australia.</strong></p>
</blockquote>
<hr>
<p>I am sorry to hear your 13-year-old sister does not want to play LEGO with you anymore and stays in her room all day. This must make you feel sad and maybe a bit rejected. </p>
<p>It is not your fault. There are many reasons why this could be happening and I can’t say for sure what it is. In this article, I am going to talk mostly about one of the possible reasons that could be involved (but it may not explain everything).</p>
<p>Like many 13-year-old girls, your sister is going through a change in her mind and body called puberty. It may be making her behave differently. Puberty is when your body changes from being a child to becoming an adult.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-does-the-sun-spin-as-well-as-the-planets-119877">Curious Kids: does the Sun spin as well as the planets?</a>
</strong>
</em>
</p>
<hr>
<h2>What is puberty?</h2>
<p>During puberty, a person’s brain and body suddenly starts to produce a lot more hormones. Hormones are chemical messengers that send signals from the brain to body glands. </p>
<p>The main hormones that cause puberty changes are found in two parts of the brain – the hypothalamus and the pituitary. These brain parts make hormones called luteinising hormone and follicle stimulating hormone. The main puberty gland in girls are the ovaries, and in boys it is the testes. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=511&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=511&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=511&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=642&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=642&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292372/original/file-20190913-35611-r42ooy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=642&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The main hormones that drive puberty changes are found in two parts of the brain – the hypothalamus and the pituitary.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In girls, eggs are stored in the ovaries, which are in the lower belly. The ovaries make other hormones called estrogen and progesterone.</p>
<p>Estrogen and progesterone in girls cause lots of body changes like growing breasts and having periods (bleeding from the vagina) once a month. </p>
<h2>Hormones can affect how we feel</h2>
<p>The increase in all of the hormones in the brain also affects other parts of the brain to cause some people (girls and boys) to become sad and angry. They might be upset at times or really happy at other times. </p>
<p>As hormone levels go up and down, that can trigger changes in brain chemicals called “serotonin” and “dopamine”. Serotonin and dopamine can change a person’s mood and behaviour. Some people get very moody and feel really irritated by small things that did not bother them before. </p>
<p>Puberty changes in the brain can also make kids start to feel more grown up. Your sister might also look more like an adult woman in her body and feel that she is too grown up to play LEGO anymore. She might want more of her own space to chill out. </p>
<p>But it is important for your parents to find out why she is staying in her room so much – in case she is feeling too sad or actually depressed (which is severe sadness) and wanting help. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290488/original/file-20190902-175714-3fkvye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your sister may want more space these days.</span>
<span class="attribution"><span class="source">wwww.shuttershock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What do you do now?</h2>
<p>I suggest that you keep being nice to your sister and let her know that you care about her. Try waiting for her to chat to you. Change is tough for everyone. Your sister is trying to cope with the changes of puberty, and you are trying to deal with the changes in your sister. </p>
<p>Most brothers and sisters end up being good friends again – but it can take a bit of time. </p>
<p>Hang in there!</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-people-grow-to-certain-sizes-105131">Curious Kids: Why do people grow to certain sizes?</a>
</strong>
</em>
</p>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em> <em>Please tell us your name, age and which city you live in. We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/122791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Jayashri Kulkarni does not work for, consult with or own shares in any company or organisation that would benefit from this article.
She receives funding from the NHMRC for research, and has received honoraria from Servier, Jansen & Lundbeck Pharmaceutical companies for giving medical educational talks, none of which is related to this article. </span></em></p>Puberty can make us behave differently.Jayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1214702019-08-09T15:10:46Z2019-08-09T15:10:46ZTeens who hit puberty later could face bone health issues later in life, studies suggest<figure><img src="https://images.theconversation.com/files/287511/original/file-20190809-144838-7qa9n0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Puberty is a time of dramatic development for both boys and girls. Not only are those hormones raging, but there’s all the bodily changes to contend with. </p>
<p><a href="https://www.nhs.uk/live-well/sexual-health/stages-of-puberty-what-happens-to-boys-and-girls/">Puberty</a> is driven by the activity of <a href="https://www.sciencedirect.com/science/article/abs/pii/S2213858715004180?via%3Dihub">sex hormones</a> and its onset is <a href="https://www.ncbi.nlm.nih.gov/books/NBK279024/">announced</a> by the appearance of pubic hair, <a href="https://study.com/academy/lesson/secondary-sex-characteristics-definition-lesson-quiz.html">beards and breasts</a>. Along with the dramatic hormone-driven changes to a child’s body, another defining features of puberty is <a href="https://www.jahonline.org/article/S1054-139X(02)00485-8/fulltext">the adolescent growth spurt</a> – children become taller and eventually physically mature into adults. </p>
<p>For boys and girls this <a href="https://www.fatherly.com/health-science/when-do-kids-grow-puberty/">growth spurt</a> generally happens at different ages. And there can be <a href="https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Physical-Development-Whats-Normal-Whats-Not.aspx">big differences as to when</a> the growth spurt happens. For girls, rapid growth generally occurs around age eleven and a half years but can begin as early as eight or as late as 14 while for boys it generally happens a year or two later than girls. Children continue to get taller during their growth spurt until the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397276/">ends of their long bones fuse</a> and stop increasing in length, which <a href="https://courses.lumenlearning.com/boundless-ap/chapter/bone-development/">happens around the end of puberty</a>.</p>
<p><a href="https://link.springer.com/article/10.1385%2FENDO%3A17%3A1%3A43">Children’s bones develop rapidly during puberty</a>. <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747698">And our new findings</a> published in <a href="https://jamanetwork.com/journals/jamanetworkopen">JAMA Network Open</a> suggest that teens who have their pubertal growth spurt later could have more problems with their bone health in the future. In essence our research shows that the timing of puberty might influence or at least signal a child’s bone strength throughout adolescence and into early adulthood.</p>
<h2>Weak bones</h2>
<p>Our study is not the first to report a link between the timing of puberty and bone strength. A 2016 <a href="https://academic.oup.com/ije/article/45/4/1125/2951914">study of British people born in 1946</a> showed that children who had their growth spurt at an older age had lower bone density near the end of their forearm bone when measured decades later in old age, making them more likely to get a <a href="https://orthoinfo.aaos.org/en/diseases--conditions/distal-radius-fractures-broken-wrist/">broken wrist</a>. </p>
<p>More recently, a study of <a href="https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3320">adolescents and young adults from Philadelphia</a> showed that people who were genetically predisposed to later puberty had lower bone density at the spine and hips sites which are known to be susceptible to <a href="https://theros.org.uk/information-and-support/understanding-osteoporosis/">osteoporosis</a> in later life. This is an ageing-related condition where bones lose their strength and become more likely to break. </p>
<p>Our study tracked the development of bone strength in a group of British children through to adulthood and found that teens who hit puberty at an older age tend to have <a href="https://www.nhs.uk/conditions/dexa-scan/">lower bone mineral density</a> which is a strong indicator of having weaker bones. We found that this continued to be the case for up to several years of their adult life. </p>
<h2>Measuring puberty</h2>
<p>We analysed data from more than 6000 children from the <a href="http://www.bristol.ac.uk/alspac/">Children of the 90s</a> study. This is a multi-generational <a href="https://himmelfarb.gwu.edu/tutorials/studydesign101/cohorts.cfm">study</a> that has tracked the lives of a large group of people <a href="https://academic.oup.com/ije/article/42/1/111/694290">born in the early 90s</a> around Bristol in the south west of England. </p>
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<img alt="" src="https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287508/original/file-20190809-144843-1szhia4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Children whose genetic makeup triggers a later-than-average start to puberty are at increased risk of having weaker bones as adults.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>We made use of multiple <a href="https://www.nhs.uk/conditions/dexa-scan/">bone density scans</a> taken from each child to assess their bone strength across a 15-year period between the ages of ten and 25 years. </p>
<p>To calculate the age when the children went through puberty, we tracked each child’s height and used this information to estimate the age when each child went through <a href="https://www.ncbi.nlm.nih.gov/pubmed/20647267">the adolescent growth spurt</a>. We then assumed that children that had their growth spurt at an older age must have started puberty later. As a check, we repeated our analysis in girls using the age they reported getting their first period as a different indicator of when they hit puberty and we came to the same conclusions.</p>
<h2>Rebuilding bone density</h2>
<p>Our research adds to the growing evidence that children who mature later may be at increased risk of breaking a bone as they grow and mature. And that they may also have an increased risk of getting osteoporosis later in life. </p>
<p>Of course, there are things people can do to <a href="https://theros.org.uk/information-and-support/looking-after-your-bones/lifestyle-for-bone-health-checklist/">strengthen their bones</a>. But given our findings, it is clear there is now a need for bigger and more detailed studies into the very complex relationships between puberty, growth and bone development. Continuing to track the lives of the people in our study will be crucial if we are to discover how puberty might impact people’s bones as they go through adult life and eventually move into old age. This will help to further understand the causes of osteoporosis and ultimately help people to maintain healthy bones throughout their lives.</p><img src="https://counter.theconversation.com/content/121470/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmed Elhakeem does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The timing of puberty can influence a child’s bone strength throughout adolescence and into early adulthood.Ahmed Elhakeem, Epidemiologist, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1162062019-05-02T14:32:41Z2019-05-02T14:32:41ZBreast ironing: a harmful practice that doesn’t get sufficient attention<figure><img src="https://images.theconversation.com/files/272193/original/file-20190502-103045-lqz7eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mothers iron their daughters' breasts as a way of preventing early marriage and keeping their daughters in school for longer. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Recent news reports in the UK of <a href="https://www.theguardian.com/global-development/2019/mar/04/breast-ironing-victims-urge-stronger-action-to-root-out-dangerous-custom">breast ironing</a> portray yet more ways in which culture causes harm to young girls. The reports followed renewed calls for stronger action against the <a href="https://fic.tufts.edu/assets/Understanding-breast-flattening.pdf">practice</a>, which is observed to prevent the development of a girl’s breasts and subsequently reduce the sexual attention she may receive. It involves using an object to massage, pound, or press the breasts flat. </p>
<p>Breast ironing is <a href="https://fic.tufts.edu/assets/Understanding-breast-flattening.pdf">common</a> in West and Central Africa, including Guinea-Bissau, Chad, Togo, Benin, Guinea-Conakry, Côte d’Ivoire, Kenya and Zimbabwe. It’s particularly prevalent in <a href="https://www.athensjournals.gr/health/2016-3-4-5-Vitalis-Pemunta.pdf">Cameroon</a>: there, the number of girls who have been subjected to breast ironing is estimated be as high as one in three (around 1.3 million). </p>
<p>According to the United Nations, <a href="https://www.athensjournals.gr/health/2016-3-4-5-Vitalis-Pemunta.pdf">3.8 million teenagers</a> worldwide have been affected by breast flattening. It’s estimated that about <a href="https://www.theweek.co.uk/71429/what-is-breast-ironing-and-how-common-is-it-in-britain">1 000 girls</a> from West African communities across the UK have been subjected to the practice, but the figure could be much higher. </p>
<p>While reports on the horrors of female genital mutilation, forced marriage and so-called honour killings are common, people are perhaps less aware of the practice where young girls, as puberty sets in, have their breasts ironed flat. </p>
<p>I have established this during 15 years of research into “<a href="https://www.routledge.com/products/isbn/9781472428882">harmful cultural</a> practices” around the world. The practice mirrors ugly misogynistic beliefs and values that underpin other abusive practices. It is ultimately reflective of a power dynamic that demands female submissiveness and complete control over the sexuality of women and girls. </p>
<h2>The socialisation of young girls</h2>
<p>Breast ironing has been an embedded part of the socialisation of young girls from affected communities for quite some time. The medical consequences can be severe. The practice can include the use of grinding stones, spatulas, brooms and belts to tie or bind the breasts flat. Sometimes leaves which are believed to have medicinal or healing qualities are used, as well as plantain peels, hot stones and electric irons. </p>
<p>The practice is usually carried out by mothers, shamans and healers. Some midwives perform the practice. This makes it a source of income, in a way that’s similar to <a href="https://journals.sagepub.com/doi/pdf/10.1177/1464993416674299">female genital mutilation</a>. </p>
<p>The growth of a girl’s breasts during puberty is seen as linked to the emergence of her sexuality; if left unchecked, this will bring “problematic” and “destructive” implications for family and community <a href="https://researchportal.port.ac.uk/portal/en/publications/women-violence-and-tradition-taking-fgm-and-other-practices-to-a-secular-state(cfa5fe44-a87c-4593-980e-69cbe830c159).html">status quo</a> (patriarchy). </p>
<p>However, this gendered reading of the practice is further complicated by <a href="https://fic.tufts.edu/assets/Understanding-breast-flattening.pdf">research</a> that suggests mothers begin ironing the breasts of their daughters as a way of trying to prevent early marriage and keep daughters in school for longer. </p>
<p>In other words, if a girl’s breasts can be held back from developing they will not be <a href="https://www.bbc.co.uk/news/education-47695169">viewed</a> as ready for marriage and childbirth and so will be free to continue with their education for longer. </p>
<p>Understanding the <a href="http://news.trust.org//item/20131205132047-15osx/">drivers</a> behind the practice is obviously critical if routes to change are going to be identified. Clearly breast ironing is not the answer to child marriage. But in contexts where there are few choices, it seems to offer some mothers the only viable way of giving their daughters a little longer to become educated enough to have options.</p>
<h2>A global problem</h2>
<p>Female genital mutilation and breast ironing needs to be situated within a broader ideology that sees female sexuality as shameful and something to be hidden and denied. </p>
<p>Globally, there are efforts to reverse this mindset. UK Aid, for example, funds a social movement called <a href="https://www.thegirlgeneration.org/">The Girls Generation</a> which works throughout Africa to reverse the social norms underpinning female genital mutilation. </p>
<p>The replacement of harmful practices such as female genital mutilation and breast ironing with other new rituals that celebrate the female body will hopefully, in time, help reverse these negative views. </p>
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Read more:
<a href="https://theconversation.com/how-to-target-resources-in-efforts-to-end-female-genital-mutilation-109805">How to target resources in efforts to end female genital mutilation</a>
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<p>Unravelling the prevalence of this practice and the reasons behind it will not be helped by <a href="https://www.theweek.co.uk/71429/what-is-breast-ironing-and-how-common-is-it-in-britain">news reporting</a> – as happened in the UK – that depicts breast ironing as evidence of yet more horrors harboured by “other cultures”. </p>
<p>The focus needs to be on the underlying structural inequalities that continue to devalue the bodies of women and girls. This is a global problem and not something unique to specific parts of the world.</p><img src="https://counter.theconversation.com/content/116206/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamsin Bradley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Close to 4 million teenage girls are subjected to breast ironing worldwide. This harmful cultural practice, which is most prevalent in West and Central Africa, needs to stop.Tamsin Bradley, Professor of International Development Studies, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1118772019-02-14T21:40:01Z2019-02-14T21:40:01ZMove over testosterone, another hormone is also vital for making boys – and it doesn’t come from the testes<figure><img src="https://images.theconversation.com/files/259112/original/file-20190214-1751-1i0273f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Little boy blue. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-4-day-old-baby-boy-115541389?src=iUQ6kT-yWLCpx-YHU2uQMg-1-91">noBorders - Brayden Howie</a></span></figcaption></figure><p>Often the first question parents are asked after the birth of their child is “congratulations, girl or boy?”. For <a href="https://www.ncbi.nlm.nih.gov/pubmed/17875484">parents of</a> one in 2,000 to 4,000 births, however, there is not an easy answer. This is when the baby has “ambiguous” genitalia, where it is not clear which sex they belong to. In baby boys, this was long thought to be caused by problems linked to testosterone – as were more common disorders such as undescended testicles and malformed penises, which <a href="https://www.ncbi.nlm.nih.gov/pubmed/20865786">respectively occur</a> in 9% and 1% of births. </p>
<p>But now it is clear that the reality is slightly different. According <a href="http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000002">to new research</a> in which I am a co-author, another hormone known as androsterone – which originates in the placenta and foetal adrenal gland – is also vital to the process that turns foetuses in boys. These insights have the potential to make a big difference to how we treat sexual disorders in male babies in future – and are also relevant to the whole debate about male and female identity. </p>
<p>Even small children are aware that men and women usually look different. It is common knowledge that boys become men because the testes of the man produce the “male” hormone testosterone and, in turn, testosterone makes men masculine. We know this thanks to the French endocrinologist Alfred Jost’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/18577872">groundbreaking studies</a> in the early 1950s.</p>
<p>There are several times in boys’ lives in which bursts of testosterone play a key role in their development as males. The most well known is of course puberty, in which the testes start making much more testosterone. This makes boys hairier, grows their genitals and makes their voices break. </p>
<p>The other times are the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462291/">mini-puberty</a>” that takes place at around three months after birth, which leads certain changes in the testes and brain; and when a boy is still a foetus in the womb, around three months into his mother’s pregnancy. While all these bursts of testosterone are probably very important in making a normal male, it is the one in the womb that affects whether the child will be a boy at all. What is now clear is that testosterone and the testes have been hogging the podium when in fact we need to share the honours around. </p>
<h2>Testosterone and super-testosterone</h2>
<p>Testosterone is part a family of male sex hormones called androgens. To get a normal male, testosterone needs to be turned into another androgen called dihyrotestosterone or DHT, a “super-testosterone” that is five times more potent than its cousin. This conversion is done in the tissue of what will become the penis, along with the other parts of the body that develop male characteristics. The consequences of the process are clear: boys who cannot turn testosterone into DHT are born looking female and only become more obviously male at puberty. </p>
<p>These include the <em><a href="https://www.bbc.co.uk/news/magazine-34290981">Guevedoces</a></em> in the Dominican Republic, who, due to a genetic mutation, lack the enzymes to make the DHT conversion. Studying these extraordinary children in the early 1970s led the American researcher <a href="http://vivo.med.cornell.edu/display/cwid-jimperat">Julianne Imperato-McGinley</a> to <a href="http://science.sciencemag.org/content/186/4170/1213">develop</a> the drug finasteride to treat prostate cancer. </p>
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<p>For years, this story was considered complete – masculinisation was due to testosterone and the conversion of testosterone to DHT. Then an Australian zoologist named Marilyn Renfree, in an elegant <a href="https://www.ncbi.nlm.nih.gov/pubmed/12538619">series of studies</a> in the 2000s, <a href="https://www.newscientist.com/article/dn18782-how-female-wallabies-boost-their-males-testosterone/">published</a> the first evidence that things may not be that simple. She was actually studying wallabies, since the young in the pouch were easily accessible for experimental purposes and they mimic much of the period of pregnancy in humans and other <a href="http://www.ucmp.berkeley.edu/mammal/eutheria/placental.html">mammals with placentas</a>. Renfree found that the genitals of the young male wallabies made DHT even without testosterone from their testes. The only reliable conclusion was that they were converting other androgens to DHT.</p>
<p>It became clear that there are two ways to make a “male signal” in a wallaby foetus, both of which are necessary to normal sexual development. The first is by testosterone from the testes. The second is through different androgens that can also be made by other organs in the human, including the foetus’s adrenal glands, liver and the placenta. These other processes came to be known as the “backdoor” pathway. </p>
<p>But was the same thing true in humans? It was <a href="https://www.ncbi.nlm.nih.gov/pubmed/17875484">later shown</a> that it was, by studying male human newborns who were not properly masculinised; they had undescended testes and ambiguous genitals, despite having testes that made testosterone. It turned out they were unable to make the backdoor androgens because they had mutations in the genes of enzymes that were key to the process of the conversion into DHT. </p>
<p>As further evidence that both types of male signal are essential to normal development of human male foetuses, it was <a href="https://www.ncbi.nlm.nih.gov/pubmed/28755466">also discovered</a> that foetuses whose placentas are not working properly are around twice as likely to be born with undescended testes or with malformed penises – especially if they are also born abnormally small (for their gestational age). </p>
<h2>What we have shown</h2>
<p>In our research, which also involved the University of Glasgow and French and Swedish collaborators, we have been able to explain why. We measured the levels of different male sex hormones in the blood of male and female foetuses, and were surprised to find that only two androgens were higher in males than females: testosterone and androsterone. The relevance to the placenta is that it is up to 6,000 times heavier than the foetus and it makes large amounts of a hormone called progesterone, which it can convert into androsterone – as can the foetal liver and adrenal glands. The human foetuses’ testes have no ability to make this conversion. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Foetal development.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-fetus-727111831?src=_Sa4j1zE-PH_P17EdzcYww-1-28">Sebastian Kaulitzki</a></span>
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<p>We then also showed that the testosterone and adrosterone were converted into DHT in male target tissues like the penis. And not only are both androgens required to masculinise the foetus, there can be abnormalities where levels are lower than normal: for example, a good index of the degree of masculinisation is the distance between the anus and genitals, and this is shorter than usual in newborns with malformed penises. </p>
<p>People affected by disorders of sexual development, including malformed penises, can have a very difficult time and face delicate surgery, hormone therapy and other treatments. Every new piece of information into how masculinisation happens raises the prospect of improving when and how these disorders are detected and treated in future. Early enough diagnosis of reduced placental function related to androgen production in early pregnancy might enable treatment before penis formation is complete, avoiding the need for corrective surgery later in life. </p>
<p>A final take-home message from our study is that while testosterone and androsterone are indeed higher on average in male than female foetuses, the difference is quite small. There is also considerable overlap between the lowest levels in boys and the highest levels in girls. Those in society who are adamant that the only choice for people is a binary choice of man or woman are not basing their views on biological reality. Treasured beliefs about the supremacy of testosterone and the testes in making a man are also obviously flawed.</p><img src="https://counter.theconversation.com/content/111877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Fowler receives/has received funding from the MRC, BBSRC, Wellcome Trust, European Commission, Chief Scientist Office, NHS Grampian Endowment, Glasgow Children’s Hospital Charity, Tenovus, Society for the Study of Fertility, Society for Endocrinology, Endocrine Society, Holly Hill Trust, Arthritis Research UK, Royal Society.</span></em></p>What we thought we knew about male development since the 1950s has now been turned on its head.Paul A. Fowler, Chair in Translational Medical Services, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1108632019-02-06T11:34:25Z2019-02-06T11:34:25ZI Need to Know … The Conversation launches Q&A for teenagers<figure><img src="https://images.theconversation.com/files/257280/original/file-20190205-86195-1tobxve.jpg?ixlib=rb-1.1.0&rect=275%2C107%2C1434%2C907&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>When you’re a teenager, life throws up lots of questions that might sound weird but need serious answers. Many aren’t the type of thing you want to ask at home or in class, and although the wisdom of Google is only a few taps away, there’s always a hitch: how do you know you can trust what it throws up? </p>
<p>That’s where The Conversation comes in. We have access to top academic experts, and we want to use their knowledge to answer these burning questions. </p>
<p>There are stacks of things many of us have needed to know, at one time or another: is this normal? How do I tell if I’m being taken advantage of? What are my rights if I’m stopped by the police? Is it legal to divorce your parents? </p>
<hr>
<p><em>If you’re a teenager and have questions you’d like answered, then you can help us kick things off! Send in your questions now, and yours could be the first to get a response from an expert. You can send an audio recording of your question too, if you want.</em></p>
<p><em>Please tell us your first name, age and which town or city you live in (let us know if you’d prefer to remain anonymous). Send as many questions as you like. We won’t be able to answer every question, but we will do our best.</em></p>
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<p><em>We have a huge pool of experts at our fingertips, and we can’t wait to share their knowledge with you.</em></p><img src="https://counter.theconversation.com/content/110863/count.gif" alt="The Conversation" width="1" height="1" />
The Conversation has access to top academic experts, and we want them to use their knowledge to answer questions from teenagers.Emily Lindsay Brown, Editor for Cities and Young People, UK editionLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1011732018-08-29T10:45:19Z2018-08-29T10:45:19ZFor the parents of gender-nonconforming kids, a new approach to care<figure><img src="https://images.theconversation.com/files/233711/original/file-20180827-75987-11t802s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Self-knowledge rarely comes packaged in a single coherent narrative. Yet this is the expectation we have of the children in our lives.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dark-silhouette-human-on-782335870?src=0Rg-D5nwbfa_AopTZPIj0w-1-0">Billion Photos</a></span></figcaption></figure><p>Ari had a difficult time talking about his gender. </p>
<p>He had always been feminine, insisting on wearing only androgynous clothing, flowing pants in bright colors, patterned shirts and scarves. His hair was long and carefully arranged, and his nails were usually painted with a kaleidoscope of colors. By the time he was 12, he vacillated between using male and female names and pronouns. At school, he mostly socialized with female classmates while performing in school plays and making art. </p>
<p>When I met his mother, Sandy, at an event for parents of trans and gender-nonconforming children, she spoke anxiously about his experience of puberty, his struggles with depression and the daunting task of helping him cope with the changes in his body. Sandy read every parenting manual on gender nonconformity she could get her hands on. She wasn’t sure whether Ari would grow up to be a gay man or a transgender woman, and she felt a tremendous amount of discomfort with that uncertainty.</p>
<p>Sandy was like many parents I met while doing research for <a href="https://teymeadow.com/trans-kids/">my new book</a> on families raising gender-nonconforming children. These parents often struggled with the question of how to tell if their child was really transgender, merely experimenting with gender or, instead, simply growing into an adolescent gay identity. </p>
<h2>The media teaches parents to doubt</h2>
<p>The parents and clinicians with whom I spoke all wished that there was some foolproof method to determine whether kids were actually trans. They longed for a formula that would tell them, with certainty, that they could safely assist these kids with social and medical gender transition without fear of mistake or regret.</p>
<p>News articles and blog posts on the subject seem to appear weekly. In July, for example, The Atlantic published a <a href="https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/">cover story</a> about Claire, a gender-nonconforming 14-year-old. After a period of consideration, Claire decided that she didn’t ultimately feel the need to transition. The author of that article, Jesse Singal, used Claire’s experience to illustrate the complexities of parenting gender-diverse children.</p>
<p>I found the article troubling, however, because it was a prime example of two dangerous trends in public discussions of parenting gender-nonconforming youth.</p>
<p>First, Claire’s experience is not at all typical. The American Psychological Association <a href="http://www.apadivisions.org/division-44/resources/advocacy/transgender-children.pdf">has found</a> that children who “consistently, persistently and insistently” tell the adults who surround them that they are transgender almost never have a sudden and complete change of heart. Indeed, they say, gender identity is resistant – if not immutable – to environmental intervention. Children can and do learn to “cover,” <a href="https://www.nytimes.com/2006/01/15/magazine/the-pressure-to-cover.html">a term sociologists use</a> for downplaying parts of one’s identity to assimilate. But that’s different from no longer feeling transgender.</p>
<p>Second – and perhaps more important – this article and others shift the focus from whether a child might be transgender to asking how it might be possible for them to not be. </p>
<p>This is called “<a href="https://tearaway.co.nz/cisheteronormativity/">cisnormativity</a>” – the cultural belief that being gender-normative is inherently better than being trans. And the media is, at times, its biggest proponent. </p>
<p>Stories and false statistics that exaggerate the proportion of children who stop exhibiting gender nonconformity may offer comfort to anxious parents who long for an easy life for their kids. They also prompt those parents to interpret any signs of struggle or ambivalence as de facto evidence their child is not trans, to withhold information about transgender lives from interested children and to create an atmosphere in which children learn to hide the complexities of their experiences to garner the approval of adults.</p>
<h2>Embracing uncertainty</h2>
<p>This is not a new story. </p>
<p>For decades, transgender adults <a href="https://www.umass.edu/stonewall/sites/default/files/Infoforandabout/transpeople/genny_beemyn_transgender_history_in_the_united_states.pdf">have written about</a> how, when seeking gender reassignment, they needed to seem authentically trans – and report a total identification with the other gender – to physicians and psychologists. This could entail an exclusive preference for clothing and activities consistent with the other gender, a heterosexual sexual orientation and an ability to pass as a member of that gender. Absent those criteria, trans people would be turned away from medical care and disbelieved by friends and family. </p>
<p>As a result, many learned to cover up their ambivalences, struggles and self-doubts. They learned to present a version of trans that seemed foolproof to cisgender people: a narrative in which gender is certain, impervious to the vicissitudes of actual emotional life. </p>
<p>This is not to say these trans people were uncertain about who they were. That’s simply untrue. But self-knowledge rarely comes packaged in a single coherent narrative. </p>
<p>And yet, this is the expectation we have of the children in our lives.</p>
<p>It’s possible to do better. Development is not a linear process. It can weave through joy and ambivalence, through pain and delight. Adult gender doesn’t come easily to anyone. It’s fertile ground for self-doubt and humiliation, experimentation and adaptation. </p>
<p>Think for a moment about your own adolescence, the time when you experienced rapid bodily changes, social maturity and emergent sexuality. Few of us remember this process as smooth and linear. Now imagine you had adults – perhaps even your parents – scrutinizing this process each step of the way and trying to nudge you to fit neatly into an identity or way of behaving that felt uncomfortable. This is a recipe for depression and anxiety in children. In anyone, really.</p>
<p>It doesn’t have to be that way. Gender-nonconforming children who are supported by their parents in expressing their identities by and large thrive. In fact, recent studies show that trans youth who are affirmed and supported by their families to transition <a href="http://pediatrics.aappublications.org/content/early/2016/02/24/peds.2015-3223">are psychologically healthier</a> than children who are gender-nonconforming but receive no such encouragement.</p>
<h2>Moving toward an affirmative model</h2>
<p>Dealing with uncertainty and ambivalence can be especially difficult for parents who fear their children will face discrimination in their communities. But the truth is, it’s difficult for all parents. </p>
<p>As more families grapple with the complexities of gender development, we see stories of children and parents being offered guidance and support by clinicians who work from “<a href="http://www.apa.org/pubs/books/4317487.aspx?tab=1">an affirmative model of care</a>.” </p>
<p>This affirmative model doesn’t push kids toward a transgender outcome or even a linear narrative. Instead, clinicians teach parents to pause, absorb the messages their children are sending and then articulate what they are seeing back to their children. Parents and psychologists help children express their genders in authentic ways, and then work to understand the significance of the things they are saying and doing. It takes time and practice.</p>
<p>Affirmative clinical work treats all gender variations as <a href="https://www.tandfonline.com/doi/abs/10.1080/00107530.2014.942591?scroll=top&needAccess=true&journalCode=uucp20">signs of health</a> – not illness – and supports the unhurried unfolding of a child’s emergent self. In this context, uncertainty and ambivalence are a part of transgender development, just as they are for all gender development.</p>
<p>After some time and discussion, Sandy, Ari and his therapist decided to put Ari on Lupon, one of a <a href="http://gendercreativekids.ca/wp-content/uploads/2014/01/TransActive-OHSC-Testimony.pdf">class of drugs</a> used to suspend the body’s production of the hormones that incite puberty. Sandy works hard to allow Ari to vacillate in his gender presentation and in his sense of self. </p>
<p>When we last spoke, she told me she didn’t know where he would end up. She knew there was no foolproof way to tell, only a process to endure. </p>
<p>Whatever the conclusion, she told me, Ari knew that she was walking alongside him – but letting him lead the way.</p><img src="https://counter.theconversation.com/content/101173/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tey Meadow does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The signs might be there. But parents and clinicians will still wonder if there’s some foolproof way to determine whether their children are actually trans. There isn’t one – and that’s okay.Tey Meadow, Assistant Professor of Sociology, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/910952018-02-12T13:35:58Z2018-02-12T13:35:58ZChildren aren’t starting puberty younger, medieval skeletons reveal<figure><img src="https://images.theconversation.com/files/204914/original/file-20180205-14067-1ycq4gc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=25524277">anonymous illustrator/Wikimedia Commons</a></span></figcaption></figure><p>Children are entering puberty younger than before, according to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613238/pdf/nihms397878.pdf">recent studies</a>, raising concerns that childhood obesity and hormone-contaminated water supplies may be to blame. However, <a href="http://onlinelibrary.wiley.com/doi/10.1002/ajhb.22761/full">our archaeological research</a> suggests that there’s nothing to worry about. Children in medieval England entered puberty between ten and 12 years of age – the same as today.</p>
<p>Puberty is divided into five clinical stages, with pre-puberty at stage one and onset (or thelarche) at stage two. Menarche (a girls first period) occurs at stage three. The age at which a child enters puberty (stage one) varies. Today, puberty onset occurs between the ages of ten and 14 in girls and 12 to 16 in boys, with some ethnic groups starting around a year earlier. The end of puberty, or full maturation, is reached by 13-17 years for girls, and 15-18 years for boys. </p>
<p>Our understanding of the normal timing of puberty comes from historical sources and is measured using data for the age of menarche. </p>
<p>A girl’s first period is a significant milestone in her development, but it is a highly variable and environmentally fragile indicator of maturation. Today, menarche starts at a median age of 12.5 years in the UK, with 2-3% of girls experiencing menarche at ten. </p>
<p>In England, just before the industrial revolution, historical sources suggest menarche occurred between 12-14 years. By the 1840s, girls had their first period between 14-17 years. While we have a rich record for ages of menarche, there are no written sources to tell us when children in the past first entered puberty. </p>
<p>To understand the natural blueprint for the onset of puberty, we need to look further back in time, to the bodies of girls and boys growing up before the industrial revolution and the nutritional challenges of the early 20th century. We need to look to medieval England. </p>
<h2>What the bones reveal</h2>
<p>In our study of 994 medieval adolescents from medieval England, who died between 900-1550, we traced the stages of puberty by examining their canine teeth; the shape of their neck and wrist bones; and the fusion of their elbows, wrists, fingers and pelvises. Using these clues, we were able to work out the average age the children started puberty, reached their growth spurt, and reached full maturity. We were also able to work out when girls had their first period.</p>
<p>The average age at which children entered puberty was the same as for most boys and girls today: between ten to 12 years. But medieval teenagers took longer to reach the later milestones, including menarche. </p>
<p>The adolescent growth spurt that signals the most obvious external physical changes occurred between 11-16 years, and menarche at 12-16 years, with the average age at 15 years. In medieval London, some girls were as old as 17 before they had a period. And boys and girls did not complete their adolescent growth spurt until 17 or 18 years. </p>
<p>For these teenagers, growing up in a rapidly expanding and overcrowded London, 26% had not completed puberty before they died at 25 years of age. The age at which modern and medieval children progressed through the pubertal stages after puberty onset was different. However, just as today, there was a wide age range of children within each stage, including the presence of some early maturers. </p>
<h2>Severe environment</h2>
<p><a href="https://rbej.biomedcentral.com/articles/10.1186/1477-7827-8-115%E2%80%8B">Factors</a> such as poverty, poor nutrition, alcohol consumption, air pollution, violence and neglect delay menarche as malnutrition and physical stress limit the body’s ability to sustain a pregnancy. These severe environmental conditions were likely to have been experienced by all teenagers living and working in medieval England. </p>
<p>Many children experienced strenuous physical labour and exposure to urban pollution. Others suffered from chronic diseases such a tuberculosis, leprosy and syphilis. But it was medieval London that provided the greatest challenges. Here menarche was not reached by girls until two years after their peers living in other urban areas. </p>
<p>The picture from medieval England demonstrates the impact of poor environmental conditions on the tempo of puberty and the start of menarche. But despite these hardships, the more subtle changes signalling the onset of puberty remained the same, at around ten years. While data is more limited, evidence from Roman Britain and medieval Spain show the <a href="https://link.springer.com/article/10.1007/s12520-017-0543-0">same age</a> for the onset of puberty at ten to 12 years. </p>
<p>As our health and nutrition has improved, the age at which boys and girls move through the stages of sexual maturation has begun to decline and there is evidence that this decline has <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1532-7795.2010.00722.x/full">now begun to stabilise</a>. Our impression of what is the normal age for a child to reach each puberty milestone has been tainted by the use of data from children growing up in the challenging conditions of the last century, and an over reliance on the age of menarche, rather than the age at which children actually entered puberty, which appears to be unchanged. </p>
<p>Once puberty has started, severe living conditions retard progression through puberty. Without these factors, children appear to be returning to a natural blueprint of maturation, moving through the stages without delay, rather than experiencing the changes of puberty at an unnaturally early age.</p><img src="https://counter.theconversation.com/content/91095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Lewis has received funding from the Leverhulme Trust. </span></em></p>The panic about British children reaching puberty younger is unwarranted. Medieval skeletons provide a different answer.Mary Lewis, Associate Professor in Bioarchaeoloy, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/896082018-01-18T11:39:23Z2018-01-18T11:39:23ZPuberty is starting earlier for many children – sex education must catch up with this new reality<figure><img src="https://images.theconversation.com/files/202286/original/file-20180117-53328-1paalyp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some girls as young as six and seven are showing the early signs of puberty. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/home">via shutterstock.com</a></span></figcaption></figure><p>The British government is <a href="https://consult.education.gov.uk/life-skills/pshe-rse-call-for-evidence/consultation/intro/">consulting</a> on a new curriculum for sex and relationship education in English schools. This change provides a timely opportunity to update how, when and what children are taught about puberty. </p>
<p>Astonishingly, the Department for Education (DfE) guidance on sex education <a href="http://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06103">has not changed</a> for nearly two decades. But after concerted <a href="http://www.sexeducationforum.org.uk/policy-campaigns.aspx">lobbying</a>, <a href="http://bmjopen.bmj.com/content/5/3/e007834.short">research</a>, and the <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/education-committee/news-parliament-2015/comment-sex-education-15-16/">recommendations</a> of multiple committees of MPs, in 2017, the <a href="http://www.legislation.gov.uk/ukpga/2017/16/contents/enacted">Children and Social Work Act</a> finally acknowledged the need to provide “sex education for the 21st century”.</p>
<p>New statutory guidance for schools will be published following the public consultation, which closes in mid February. From 2019, secondary schools will be obliged to offer relationships and sex education, and primary schools to offer relationships education. Parents will retain the right to remove their children from sex education – other than that which is covered in the science curriculum – but will not be allowed to remove them from relationships education.</p>
<p>These changes are underpinned by widespread concern about the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/595828/170301_Policy_statement_PSHEv2.pdf?mc_cid=09d2dfed4f&mc_eid=2146076377">negative effects</a> of digital technologies on young people’s sexual lives, particularly sexting, child sexual abuse and exploitation, and “strangers online”. The new curriculum will, it seems, teach children and young people what healthy relationships look like in the fraught context of smart phones, online porn and Instagram. </p>
<h2>The new puberty</h2>
<p>But the new curriculum should also take account of what is happening to the bodies of young people in the 21st century. Not only do kids seem to be growing up much faster today, many of them are actually starting to develop physically earlier than ever before. </p>
<p>According to many scientists and clinicians, we are living in the era of “<a href="http://thenewpuberty.com/">the new puberty</a>” in which increasing numbers of girls start to develop sexually at age seven or eight. In the 1960s, only 1% of girls would enter puberty before their ninth birthday. Today, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20696727">up to 40%</a> of some populations in both <a href="https://academic.oup.com/edrv/article/24/5/668/2424459">rich and poor countries</a> are doing so.</p>
<p>Sexual development is also being stretched out for longer, with many girls starting to grow breasts and pubic hair two to three years before they have their first period. While there is less evidence that boys’ development is changing so rapidly, some studies also indicate that <a href="https://www.cambridge.org/core/books/puberty-in-crisis/08B498BA9DCCE1AD65C20AA48805EF6F">earlier entry</a> into puberty’s initial stages is becoming more common.</p>
<hr>
<p><em><strong>Listen to Celia Roberts talk about early puberty in this extract from <a href="https://theconversation.com/uk/podcasts/the-anthill">The Anthill podcast on Growing up</a>.</strong></em></p>
<p><audio preload="metadata" controls="controls" data-duration="857" data-image="" data-title="" data-size="13624773" data-source="" data-source-url="" data-license="CC BY-ND" data-license-url="http://creativecommons.org/licenses/by-nd/4.0/">
<source src="https://cdn.theconversation.com/audio/1028/puberty-segment-1.mp3" type="audio/mpeg">
</audio>
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a><span class="download"><span>13 MB</span> <a target="_blank" href="https://cdn.theconversation.com/audio/1028/puberty-segment-1.mp3">(download)</a></span></span>
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<hr>
<p>The causes of these changes <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00380-0/fulltext">remain unclear</a>. Many scientists <a href="http://journals.sagepub.com/doi/abs/10.1111/j.1467-954X.2010.01912.x?journalCode=sora">point to</a> the simultaneous increase in childhood obesity, while others study the <a href="http://www.mdpi.com/1660-4601/14/9/1044">effects of environmental chemicals</a>, such as Bisphenol A or BPA (which is found in some plastics), on the body. Other research has explored the effects of social factors, including family structures, experiences of <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)00038-3/fulltext">early life trauma</a> and <a href="http://pediatrics.aappublications.org/content/early/2017/05/19/peds.2016-4099?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token">socioeconomic disadvantage</a>. This range of explanations points to how complex a phenomenon puberty is.</p>
<p>The current DfE guidance states that:</p>
<blockquote>
<p>All children, including those who develop earlier than the average, need to know about puberty before they experience the onset of physical changes. </p>
</blockquote>
<p>But it leaves schools to decide, in consultation with parents, “the appropriate age” to teach children about puberty. In 2017, the Personal, Social and Health Education Association <a href="https://www.pshe-association.org.uk/news/reform-national-curriculum-england-pshe">argued</a> that this should be when they’re age seven. But talking to seven-year-olds about breasts, pubic hair, body odour and genital changes may not be easy for many teachers, or for many parents. Being seven is supposed to be a time of freedom, play and innocence.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/202290/original/file-20180117-53317-1digmz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Getting ready for puberty.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/home">via www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Updating sex education</h2>
<p>Children who develop early, present a challenge both to cultural thinking about sex and to sex education policy. While many parents and <a href="http://bmjopen.bmj.com/content/5/3/e007834.short">young people want</a> updated <a href="http://www.sexeducationforum.org.uk/policy-campaigns/the-puberty-issue.aspx">sex education</a>, this usually comes with the proviso that such education be “age appropriate”. Although very important, this phrase is painfully vague – and it’s unclear whether it refers to chronological age, emotional age or stage of physical development. </p>
<p>Today, some seven-year-olds may be emotionally young but also starting to grow breasts and pubic hair. Other early developers who have experienced early life stress – such as abandonment or abuse – may feel more mature than their peers and be <a href="http://journals.sagepub.com/doi/abs/10.1177/0272431607302936">ready earlier</a> to learn about puberty and sexuality. The widening gap in the timing of boys’ and girls’ sexual development also poses a challenge. Teaching girls separately, or earlier than boys – the strategy in my own child’s primary school – risks reinforcing harmful gender norms and notions of secrecy around issues such as menstruation. </p>
<p>Instead, perhaps we could try to disentangle puberty from teenage sexuality and to develop accounts of puberty that do not frame it as the dawn of adolescence. A seven-year-old with breasts is not “becoming a woman”, and a menstruating nine-year-old is probably not going to want to have intercourse anytime soon. </p>
<p>Ultimately, this means moving beyond traditional portrayals of female bodies that focus on reproductive capacity in order to explore wider meanings and experiences of being a girl. Growing up is also about new horizons, such as strength, health, <a href="https://theconversation.com/sex-and-relationship-education-should-be-about-rights-and-equity-not-just-biology-88806">even pleasure</a>. Sex and relationships education might even then include puberty as something to be anticipated, noticed, even celebrated – rather than as yet another risk.</p><img src="https://counter.theconversation.com/content/89608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Celia Roberts has received funding from the European Research Council, The European Commission, The Foundation for the Sociology of Health and Illness, Intel Labs, the Economic and Social Research Council and the Arts and Humanities Research Council.</span></em></p>More and more girls are starting puberty early – but it’s a mistake to see this reality as a crisis.Celia Roberts, Professor of Gender and Science Studies, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/902472018-01-17T17:03:40Z2018-01-17T17:03:40ZAnthill 21: Growing up<figure><img src="https://images.theconversation.com/files/202280/original/file-20180117-53310-lcgz1w.jpg?ixlib=rb-1.1.0&rect=25%2C55%2C877%2C672&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/home">www.shutterstock.com</a></span></figcaption></figure><p>Welcome to the 21st episode of <a href="https://theconversation.com/uk/podcasts/the-anthill">The Anthill</a>. It seems appropriate, as we come of age, to talk about growing up. In this episode of the podcast, we bring you stories on parenting, puberty and what it’s like to grow up as a minority in Britain.</p>
<p>Parenting is arguably the single most important factor when it comes to children’s development – and human approaches to it have changed markedly throughout history. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=794&fit=crop&dpr=1 600w, https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=794&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=794&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=997&fit=crop&dpr=1 754w, https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=997&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/202282/original/file-20180117-53292-a625or.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=997&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Helicopter parenting.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/home">via www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The past few decades have seen the rise of <a href="https://theconversation.com/helicopter-or-lawnmower-modern-parenting-styles-can-get-in-the-way-of-raising-well-balanced-children-81060">“helicopter parents”</a> – people who are extremely protective and involved in every detail of their children’s lives. We hear from Line Caes, a psychologist at the University of Stirling, and Teresa Belton, a visiting researcher at the University of East Anglia, to find out what effect this parenting style is actually having on kids. </p>
<p>Next up, we fast forward to puberty – probably not a stage of growing up that many of us remember with much fondness. In recent years, a growing body of research has highlighted how puberty is starting at an <a href="https://theconversation.com/why-some-girls-grow-breasts-early-and-how-new-findings-could-cut-cancer-risks-70767">earlier age</a> than it used to in young girls. Gillian Wilson, who studies immunology at the University of Glasgow, explains what happens in a girl’s body when she starts puberty. And Celia Roberts, an expert on gender at Lancaster University, argues that early onset puberty is often mistakenly seen as a crisis.</p>
<hr>
<p><em><strong>More listening from our In Depth, Out Loud podcast: <a href="https://theconversation.com/how-slimming-became-an-obsession-with-women-in-post-war-britain-podcast-89823">How slimming became an obsession with women in post-war Britain – podcast</a></strong></em> </p>
<hr>
<p>Lastly, we explore what it’s like for Muslims growing up in Britain at a time when <a href="https://theconversation.com/finsbury-park-attack-shows-the-harm-islamophobia-continues-to-inflict-on-muslim-communities-79682">Islamaphobic attacks</a> are on the rise. Coventry University’s Sariya Cheruvallil-Contractor tells us how hard it is for young Muslims who must juggle their teenage angst alongside acting as mediators between their faith community and the wider world. Jo-Pei Tan from Manchester Metropolitan University explains how children growing up in multi-ethnic families navigate their way between different cultures. And Bradford University sociologist, Yunis Alam, tells us why cars play a role in ethnic relations in the city, which has the youngest and fastest growing Muslim population outside of London.</p>
<hr>
<p><em>The Anthill theme music is by <a href="https://www.melodyloops.com/search/How+to+Steal+a+Million+Dollars/">Alex Grey for Melody Loops</a>.
Music in the puberty segment is <a href="http://freemusicarchive.org/music/Kai_Engel/Sustains/Kai_Engel_-_Sustains_-_03_Holiday_Gift">Holiday Gift</a>, by Kai Engel via Free Music Archive.</em> </p>
<p><em>Click here to listen to more episodes of The Anthill, on themes including <a href="https://theconversation.com/anthill-20-myths-89107">Myths</a>, <a href="https://theconversation.com/anthill-10-the-future-73404">The Future</a> and <a href="https://theconversation.com/anthill-19-pain-87538">Pain</a>.</em></p>
<p><em>A big thanks to City University London’s Department of Journalism for letting us use their studios to record.</em></p><img src="https://counter.theconversation.com/content/90247/count.gif" alt="The Conversation" width="1" height="1" />
In this episode of The Anthill podcast, we bring you stories on helicopter parenting, early puberty, and what it's like to grow up as a Muslim in Britain.Annabel Bligh, Business & Economy Editor and Podcast Producer, The Conversation UKGemma Ware, Head of AudioMiriam Frankel, Senior Science EditorHolly Squire, Special Projects Editor, The Conversation UKLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808772017-08-15T02:26:33Z2017-08-15T02:26:33ZBook review: The New Puberty<figure><img src="https://images.theconversation.com/files/181916/original/file-20170814-28472-ffp03x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We're still not really sure whether puberty is starting earlier. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Puberty is a topic we often feel uncomfortable talking about in society, let alone with our children. But Amanda Dunn’s book The New Puberty takes the reader on a journey through the complex and sometimes seemingly mysterious world of puberty. </p>
<p>By interviewing experts and critically reviewing the literature, Dunn provides an up-to-date and accurate review of current research on puberty. With a relaxed, chatty tone and including her own personal stories, Dunn explains the biological processes of puberty, associated medical conditions, the changing world children are growing up in, and examines what this all means for education.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-ongoing-taboo-of-menstruation-in-australia-53984">The ongoing taboo of menstruation in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>So what is puberty?</h2>
<p>Dunn describes when she first became aware of puberty when standing on a crowded tram at 11 years of age.</p>
<blockquote>
<p>Without warning, the man standing in front of me turned around and accidentally elbowed me in the chest. The pain was terrible, like something hard yet tender and a little bit alien had taken residence in my body, shocking me so much I almost burst into tears […] I had no idea what breast buds were, but they had introduced themselves to me in no uncertain terms.</p>
</blockquote>
<p>But why is so little known about puberty? When asked the question “when does puberty begin?” – most people will answer around 12 years of age. But we now understand that the earliest hormonal changes of puberty begin long before then. In fact, they begin around seven years of age with a surge in hormones called <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1532-7795.2010.00722.x/full">“adrenarche”</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=927&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=927&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=927&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1165&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1165&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1165&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The New Puberty, by Amanda Dunn.</span>
<span class="attribution"><span class="source">Screenshot, MUP</span></span>
</figcaption>
</figure>
<p>“True puberty” is sometimes referred to as gonadarche, which is a rise in the hormones testosterone (the male hormone) and oestradiol (the female hormone) and leads to the development of secondary sexual characteristics. These secondary sexual characteristics include breast development in females, and voice deepening and facial hair in males.</p>
<p>These are complex processes that we still don’t fully understand and as such there is even disagreement among scientists about how best to describe these processes. Yet Dunn accurately explains them in an accessible way.</p>
<p>Where the book is perhaps less clear is when exploring whether puberty is starting earlier. Certainly our more recent knowledge of adrenarche has led us to understand that the hormonal changes of the pubertal cascade are starting earlier than we first thought. </p>
<p>But this is a different question from whether the timing of puberty has actually changed and this distinction could be made clearer. </p>
<p>With regards to the timing of the physical events, as Dunn reviews, there is now compelling evidence that <a href="http://pediatrics.aappublications.org/content/123/5/e932?__hstc=241005276.f325666d716fad139a5cfb34edb32d91.1474243200076.1474243200078.1474243200079.2&__hssc=241005276.1.1474243200079&__hsfp=1773666937">breast development is starting at an earlier age</a>. The same study showed that although there was a decline in the age of onset of later events, such as menarche (first period), this was not as dramatic as the decline seen with breast development and so this suggests the overall length of puberty may be increasing.</p>
<h2>Puberty and brain development</h2>
<p>Until a couple of decades ago, we thought brain development stopped in mid childhood. But with the introduction of magnetic resonance imaging (MRI), we now know the <a href="http://psycnet.apa.org/record/2005-07183-000">brain undergoes significant reorganisation</a> in the transition from childhood to adolescence. </p>
<p>Importantly, as Dunn notes, there is increasing evidence suggesting pubertal hormones have an impact on brain development during this time. So rather than this being a quiet or “latent” period of life, we now realise it’s a critical phase of development and is in fact a foundational phase of life.</p>
<h2>The changing world</h2>
<p>Dunn also examines the increasing rise of social media and its effects on how children are growing up today. Dunn notes “there’s really little point in trying to defeat social media – it is a forlorn pursuit”. But there are practical steps that parents can take and important skills that can be provided to students to help them navigate the online world. With some studies suggesting around <a href="http://jamanetwork.com/journals/jamapediatrics/fullarticle/1212181">a third of youth are involved in sexting</a>, the advice to parents and teachers is particularly timely.</p>
<p>The role of sexualisation is also explored. Dunn reports findings from an <a href="http://www.sciencedirect.com/science/article/pii/S1740144514000357">Australian study</a>, which showed girls aged 6-11 years reported levels of self-objectification that were similar to those of older girls and adult women. Self-objectification was in turn linked with body image problems and eating disorders. This chapter is filled with expert advice for parents and carers to help them provide a safe and supportive environment for their children to grow up in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/twelve-going-on-20-are-girls-reaching-puberty-earlier-1383">Twelve going on 20: are girls reaching puberty earlier?</a>
</strong>
</em>
</p>
<hr>
<hr>
<h2>What does this mean for education?</h2>
<p>Given our increasing understanding of pubertal development, Dunn explores what this means for education and in particular the need to revisit how sexuality education is taught in schools. As Dunn suggests, sexuality education </p>
<blockquote>
<p>is not an easy subject to teach. But it would be a lot easier if teachers were properly trained in it. </p>
</blockquote>
<p>Dunn describes her own sexuality education and how thankful she was when her Year 8 teacher showed how a tampon worked by placing it into water:</p>
<blockquote>
<p>we watched in wonder as its white fluffy body took on the water and expanded.</p>
</blockquote>
<p>Dunn argues that providing students with information about puberty once they have already started the pubertal process (or in some cases completed puberty) is too late. We need to be talking to children in the first years of primary school about their bodies and relationships, and then the curriculum should develop throughout primary and secondary school to meet the age-appropriate needs of students.</p>
<p>The New Puberty is a timely book for parents and teachers; concisely explaining puberty, its impact on development and dispelling many of the myths associated with puberty along the way. But it goes much further than this by providing the advice and strategies required to support young people through this foundational phase of life.</p>
<hr>
<p><em>The author of The New Puberty, Amanda Dunn, is an editor at The Conversation. She was not involved in commissioning or editing this review.</em></p><img src="https://counter.theconversation.com/content/80877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Mundy receives funding from NHMRC and the Commonwealth Department of Education and Training. Lisa Mundy has previously received funding from Australian Rotary Health, the Invergowrie Foundation and the Victorian Department of Education and Training.</span></em></p>A new book on puberty has explored why we find it so difficult to talk about puberty, and why we need to start talking about it earlier.Lisa Mundy, Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/781782017-05-24T05:06:46Z2017-05-24T05:06:46ZPoor kids hit puberty sooner and risk a lifetime of health problems<figure><img src="https://images.theconversation.com/files/170686/original/file-20170524-5749-1mdge6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It can be a tough time for children going through the physical and emotional changes of puberty. And if they enter puberty early, the health impacts can stay with them for life.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/525638404?src=Zg0uuHb8KUaaM5_85T6a_w-1-9&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Shape-shifting bodies. Cracking voices. Hairs sprouting in new places. Puberty marks a dramatic period of change for young people. Now new research shows children who grow up in poor homes enter puberty early.</p>
<p>Not only do they experience more emotional, behavioural and social problems compared to their peers, early puberty puts them at risk of a range of health issues for the rest of their lives.</p>
<p>The research, published today in the journal <a href="http://pediatrics.aappublications.org/">Pediatrics</a>, adds to a body of work showing the cumulative effect of adversity in childhood can have lifelong physical, mental and behavioural repercussions.</p>
<p>However, the reason why these disadvantaged children enter puberty early remains unclear. And work is continuing to pinpoint factors that trigger the cascade of hormones that mark this critical period of development.</p>
<h2>What is puberty?</h2>
<p>Puberty is an inherently awkward transition in which a child’s body matures to allow reproduction.</p>
<p>In girls, it typically begins with breast development between the ages of eight and 13 and ends with menarche, or the first period. In boys, puberty begins between ages nine and 14, on average, starting with growth of the sexual organs and wrapping up with facial hair and a deepened voice.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=808&fit=crop&dpr=1 600w, https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=808&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=808&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1015&fit=crop&dpr=1 754w, https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1015&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/170674/original/file-20170523-5790-ymkul8.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1015&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What causes puberty? One of Science’s 125 big questions of all time that still remains unanswered today.</span>
<span class="attribution"><a class="source" href="http://science.sciencemag.org/content/309/5731/news-summaries">Science/AAAS</a></span>
</figcaption>
</figure>
<p>But changes at puberty are not all physical. Puberty also triggers rapid biological and social change, and increasing risk for <a href="https://theconversation.com/growing-up-too-fast-early-puberty-and-mental-illness-13159">psychological health problems</a>, like depression and anxiety, substance use and abuse, self-harm and eating disorders.</p>
<p>We still don’t know exactly what triggers the cascade of hormone secretions that, over time, produces these tell-tale changes. And “What triggers puberty?” was one of the 125 questions posed in Science magazine’s 125th anniversary edition in 2005 that still remains unanswered today.</p>
<p>In particular, we still don’t know exactly what <em>causes</em> some children to enter puberty earlier than others, although there have been many factors <em>linked</em> to early puberty.</p>
<p>These include <a href="http://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-031914-122606?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">childhood obesity</a>, being born <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kws159">small for gestational age</a> and exposure to <a href="https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2015-2706">environmental chemicals</a>. Other researchers have linked early puberty with <a href="https://www.jstor.org/stable/41995770?seq=1#page_scan_tab_contents">living with a stepfather</a> or having experienced <a href="https://www.ncbi.nlm.nih.gov/pubmed/26358357">stressful life events</a>, such as childhood maltreatment and abuse.</p>
<h2>What we did</h2>
<p>Previous studies looking into social impacts on the timing of puberty have had mixed results. While one Indian study found poor girls started their periods <a href="https://www.degruyter.com/view/j/ijamh.2015.27.issue-4/ijamh-2014-0056/ijamh-2014-0056.xml">later than normal</a>, a UK study found girls who grew up the poorest were twice as likely to have started their periods <a href="http://adc.bmj.com/content/102/3/232.long">earlier</a> than the richest.</p>
<p>So, we carried out the first study of its kind in Australia to see how cumulative exposure to social disadvantage affected the age children entered puberty.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/170684/original/file-20170524-5790-1ucy3v9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We asked whether children had gone through puberty at the age of 10-11 then matched their answers with family income levels and other indicators.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/374710399?src=Zg0uuHb8KUaaM5_85T6a_w-1-4&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>We asked parents of 3,700 children in the <a href="http://www.growingupinaustralia.gov.au/">Growing Up in Australia Study</a> to report signs of their children’s puberty at age eight to nine, and then again at ten to 11. Signs included: a growth spurt, pubic hair and skin changes; breast growth and menstruation in girls; and voice deepening and facial hair in boys.</p>
<p>We then compared the family’s socioeconomic position – as measured by their parent’s annual income, education and employment – of those who started puberty early with others who started on time.</p>
<p>At ten to 11 years old, about 19% of boys and 21% of girls were classified in the early puberty group. In other words, they had entered puberty earlier compared to their counterparts.</p>
<p>Boys from very disadvantaged homes had a four-fold increase in the rate of early puberty, while girls’ risk increased nearly two-fold compared with kids that came from the richest families.</p>
<h2>How could this happen?</h2>
<p>Research on the <a href="http://www.pnas.org/content/109/Supplement_2/17143.full">biology of stress</a> shows how major adversity, like extreme poverty, can permanently set the body’s stress response to high alert, affecting the brain’s circuits. This might, in turn, influence how reproductive hormones are regulated, so affecting the timing and trajectory of puberty.</p>
<p>Another body of research <a href="http://physiologyonline.physiology.org/content/26/6/412.long">suggests</a> the social environment can influence so-called <a href="https://theconversation.com/explainer-what-is-epigenetics-13877">epigenetic changes</a> in our genes. These changes might affect the regulation of genes involved in reproductive development, switching some on or off sooner than usual.</p>
<p>Another <a href="http://psycnet.apa.org/psycinfo/2004-20177-005">theory</a> is that in the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.1991.tb01558.x/full">face of hardship</a> – for instance, economic disadvantage, harsh physical environment, the absence of a father – children may be programmed to start the reproductive process earlier to ensure their genes are passed on to the next generation.</p>
<p>Yet, we still don’t know exactly how poverty or disadvantage triggers early puberty.</p>
<h2>Why this matters</h2>
<p>What we do know, however, is early puberty is linked with a range of <a href="http://pediatrics.aappublications.org/content/121/Supplement_3/S218">health issues</a>.</p>
<p>For instance, in girls, it’s linked with emotional, behavioural and social problems during adolescence including: depressive disorders, substance disorders, eating disorders and earlier-than-usual displays of sexuality.</p>
<p>Early puberty also affects people’s health far beyond their teenage years. It places them at a <a href="http://www.nature.com/ijo/journal/v37/n8/full/ijo2012177a.html">greater risk</a> of developing obesity, reproductive cancers and cardiometabolic diseases (diabetes, heart disease or stroke) in later life.</p><img src="https://counter.theconversation.com/content/78178/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ying Sun is originally from Anhui Medical University, China.</span></em></p>Shape-shifting bodies. Cracking voices. Hairs sprouting in new places. Why do some children enter puberty early?Ying Sun, Associate Professor and Visiting Academic, Centre for Adolescent Health, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/739132017-03-07T19:24:30Z2017-03-07T19:24:30ZGirls with early first periods become women with greater risk of gestational diabetes<figure><img src="https://images.theconversation.com/files/159701/original/image-20170307-20756-1i9knd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Western societies, average age of first period has dropped from 17 to 13 years over the past century. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/justanotherhuman/27448588632/in/photolist-HPxc79-4pN4PD-foCbk5-55ucKn-qVJgbB-4Kyj2S-fnXLsA-4kq3Lh-55yGqb-p177e3-4CnSjg-nwez1e-foBtCh-avGoyL-9qk8P4-foAzxb-fnJtpB-fondQ8-fo5oXG-nPmnCe-r1iASv-dxTNMh-foBnxC-4kq345-4Uufqh-a3b1gZ-pJfqWe-9F4dKY-foAzL7-ddVKBU-fnXTvw-nyYn36-gP7CjH-d4sSE5-foCaMj-4kq3Ys-bpFkbt-4UpZxP-gN7gLp-cdKSvN-biHqSa-fo4LA5-55uuUH-fomgWa-7ANPHM-5u3bw8-4km1ep-vsKHF-foBrp7-Qh156i">justanotherhuman/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>As a young girl, getting your period for the first time is a big deal. It comes with mental and social expectations around “becoming a woman” and a host of cultural practices that act to celebrate or stigmatise menstruation. </p>
<p>But <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">evidence</a> now suggests the timing of this event could also have health implications for girls who get their first period earlier than their peers. </p>
<p>During puberty our bodies change and sexually mature, and a girl’s first period is an important point in this process. The age when girls get their first period varies, however younger than 12 years is generally considered to be “early”. The possibility that a first period before the age of 12 is linked with pregnancy health was explored in our <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">recent study</a>. We found that girls who had early first periods were more likely to develop diabetes when they later became pregnant as an adult. </p>
<p>Gestational diabetes is a <a href="https://www.diabetesaustralia.com.au/gestational-diabetes">serious pregnancy complication</a>, as it increases the risk of pre-term labour and giving birth to a large baby. It is also considered a “stress test” for the later development of type 2 diabetes; both the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990903/">mother</a> and <a href="http://diabetes.diabetesjournals.org/content/60/7/1849">child</a> in affected pregnancies face a six to seven fold increased risk of developing type 2 diabetes. </p>
<h2>Age of first period and diabetes during pregnancy</h2>
<p>We studied a group of more than 4,700 women from the <a href="http://www.alswh.org.au">Australian Longitudinal Study on Women’s Health</a> (also known as Women’s Health Australia). This longitudinal study has collected detailed health and well-being information from the same women at multiple points in time over the past 20 years. The women were 18-23 years old in 1996 when the study started. The women reported on the age of their first period and were followed throughout their pregnancies. </p>
<p>Most women experienced their first period between age 12 and 13, but 12% had early first periods. We found girls who had their first periods before age 12 were more likely to be from a disadvantaged background in childhood. They were also more likely to report being overweight in childhood and in adult life, compared with women who had their first period at a later age. While taking these early life and adulthood characteristics into account, women with earlier first periods were still <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">50% more likely to develop diabetes during pregnancy</a>. </p>
<h2>Is the age at first period changing?</h2>
<p>The age of first menstruation has decreased in most Western countries, from an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16757103">average of 17 more than a century ago, to around 13 today</a>. This decline seems to have <a href="http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-10-175">stabilised</a>, however discussion persists about whether the trend is continuing at a slower rate. The initial decline is likely explained by improved health and nutrition. The more recent declines may also be largely attributable to environmental and lifestyle factors. </p>
<p>We know circumstances in early life – including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287288/">psychosocial stressors</a>, such as parental divorce and abuse, as well as <a href="http://www.sciencedirect.com/science/article/pii/S1043276009000587">childhood obesity</a> – can trigger early reproductive development. Other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065309/">recent environmental changes</a> – such as the use of hair products, plastic water bottles, and food packaging – have also been examined as a possible cause of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958977/">early age at first period</a>.</p>
<h2>What does this mean for women’s health?</h2>
<p>An early transition to adulthood can be characterised by increased stresses and challenges as girls have to adapt to their new social roles. Girls with an early first period are at greater risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927128/">depression and anxiety</a>, and display higher rates of risky-behaviours such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892192/">smoking, drinking, illicit drug use</a>, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19958543">unprotected sex</a>. </p>
<p>The falling age of first menstruation is concerning as it also increases the risk of health conditions. In addition to the higher risk of <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">diabetes during pregnancy</a> found in our study, early menstruation has also been shown to increase the risk of developing chronic conditions in later life, such as <a href="http://link.springer.com/article/10.1007%2Fs00592-014-0579-x">type 2 diabetes</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/">breast cancer</a>. </p>
<h2>What can we do?</h2>
<p>Ideally we would one day be able to prevent girls from having their first period too early, but there is no one single cause that determines when this happens. However, supporting healthy environments and behaviours from early in life are important strategies. Childhood obesity is a well-known factor increasing the likelihood of early age at first period. Given that <a href="http://www.aihw.gov.au/overweight-and-obesity/">one in four children in Australia are overweight or obese</a>, promoting healthy eating and physical activity should be a priority for young mothers, schools, and health policy. </p>
<p>Clinicians including GPs and specialists, who provide advice and treatment for women, should be aware of the importance of early age at first menstruation as a potential marker of future health issues. Early monitoring and advice on a healthy diet and weight and physical activity may help women to lower these risks.</p><img src="https://counter.theconversation.com/content/73913/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Girls who have their first period at a young age are more likely to experience poorer health as a adult, including an elevated risk of diabetes during pregnancy.Danielle Schoenaker, PhD Candidate and Research Officer, The University of QueenslandGita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/721642017-03-07T03:15:02Z2017-03-07T03:15:02ZLow-income girls often feel unprepared for puberty<figure><img src="https://images.theconversation.com/files/158358/original/image-20170224-22986-1f5exrz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many low-income girls in the U.S. don't feel prepared for puberty.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/221280163?src=esoV9IbIin8Prv8M5kqJwA-1-67&size=huge_jpg">Image of girls via www.shutterstock.com.</a></span></figcaption></figure><p>My colleagues and I have conducted research focused on understanding and addressing the <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001962">gap in menstrual support</a> in countries around the world for over a decade. </p>
<p>Sometimes the problem is that girls don’t have access to toilets or clean water. But sometimes it’s that girls haven’t been given a lot of information about menstruation. Girls we’ve spoken to in Tanzania, Ghana, Ethiopia, Pakistan and Cambodia have described the fear and shame they experienced with their first periods. Some said they feared they were dying or had a terrible disease. </p>
<p>In response, we worked to develop <a href="http://www.growandknow.org/books.html">puberty books for girls</a> – and boys – ages 10 to 14 in many countries to help them understand what is happening to their bodies. We have helped distribute over one million books since 2010.</p>
<p>As these books gained attention, we received requests to develop a puberty book for low-income girls in the U.S. I hesitated. I assumed that girls in the U.S. likely felt adequately supported and informed. </p>
<p>But I heard so many requests that my colleague Ann Herbert and I along with students at Columbia University’s <a href="https://www.mailman.columbia.edu">Mailman School of Public Health</a> decided to review the research to find out whether low-income girls in the U.S. really feel prepared for puberty.</p>
<p>What we learned <a href="http://dx.doi.org/10.1016/j.jadohealth.2016.10.008">was eye-opening</a>. Across the research we reviewed, many girls reported negative experiences of and lack of preparation for puberty, and of menstruation in particular.</p>
<h2>How did we find this out?</h2>
<p>We examined qualitative research (research designed to explore a population’s experiences, behaviors and perspectives) on the pubertal experiences of low-income girls growing up in the U.S. from 2000 through 2014, focusing on studies that had been conducted with girls who went through a normal (not uncommonly early or delayed) pubertal experience.</p>
<p>This let us capture girls’ actual experiences and stories as they told them, rather than the numbers or statistics that may reflect pubertal change but not the rich details of their thoughts and perspectives. </p>
<p>We ultimately included 20 qualitative research articles for deeper analysis. Given the decades of attention that adolescent girls’ sexuality and related topics have received in research, advocacy and public health, the relatively small amount of literature on puberty was surprising to us. This means there are gaps in what we know about low-income girls growing up in the U.S. today.</p>
<p>Most of the articles that we found focused on samples of low-income urban girls in the northeast U.S. Studies of African-American and Hispanic girls tended to focus on sexuality and sexual behavior. For studies conducted with Caucasian girls, the onset of menstruation was usually the focus.</p>
<p>These differences in focus shape and limit our understanding of the broad spectrum of low-income girls’ pubertal experiences today.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/158360/original/image-20170224-23000-w83kw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">How do girls feel about puberty?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dictionary-series-puberty-86839072?src=jXtYFrdzcmXvrAPbvvyxZg-2-47">Dictionary page image via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>What did we find?</h2>
<p>Many girls reported feeling scared, traumatized and embarrassed at the arrival of their first period, along with feeling dirty and “gross.” This is <a href="http://dx.doi.org/10.2105/AJPH.2013.301374">similar to findings from low-income countries</a>.</p>
<p>In general, the more negative descriptions were associated with girls feeling underprepared, not knowing what would happen with their first menstruation, or feeling they did not know enough about how to practically manage the blood flow and related discomfort that can arise with menstruation. There were also some neutral or ambivalent responses, although this included one girl suggesting she felt “scared and relieved.” </p>
<p>Some of the studies that assessed girls’ level of understanding of menstruation found that they did not always understand what was happening with their bodies. Across many of the studies, girls reported feeling that they had not received enough information or support to cope with menstruation, or feeling like the information they did receive was too little and too late. For instance, one girl reported believing she might be raped and get pregnant after she was told by her mother that “now [having started menstruating] she could have babies.”</p>
<p>More positively, girls reported feeling that the messages they received about menstruation made them feel like they were growing up.</p>
<p>Most of the studies were not designed to systematically capture girls’ level of puberty and menstrual knowledge. This limits the conclusions that can be drawn from the studies about what girls do and don’t know about these topics.</p>
<p>There was much less written about breast development, with only some of the studies describing girls’ experiences. However, for the girls who did mention how they felt about their breast development, their comments were generally more positive than about menstruation. But some girls reported wearing baggy clothing and avoiding activities such as running that would make their breast development more obvious. </p>
<p>Girls across sampling categories (Caucasian, Hispanic, Arab, African-American) reported receiving messages about “becoming a woman” and the sense that they were becoming part of a female club whose members were able to share experiences. For some girls, these messages felt like a rite of passage. But for girls who perceived menstrual onset to be linked to rules that restricted their behavior, such as no longer being allowed to play freely with their male friends, the experience was more negative.</p>
<p>They described being told to dress more “girly” or “not being able to swim or do anything again.” </p>
<h2>Factors influencing girls’ pubertal experiences</h2>
<p>Starting menstruation at an earlier age was associated with more negative experiences. Celebrating the arrival of menstruation, particularly when gifts were received, was described by some girls as a more positive experience. However, other girls reported feeling that their mothers’ enthusiastic reactions were exaggerated and embarrassing. Girls reported mothers as their primary sources of information, but mothers in return reported feeling inadequately prepared to speak with their daughters, and uncomfortable with this role.</p>
<p>In contrast, the onset of puberty and menstruation appears to create a distancing between many girls and their fathers. </p>
<p>Peers were found to be helpful sources of support and information. But they can also convey misinformation about the body changes happening to girls. And male peers were sometimes reported to be sources of bullying and teasing that could increase girls’ discomfort with menstruation.</p>
<h2>Why does any of this matter?</h2>
<p>For one, puberty is a critical period of development that lays the foundation for future sexual and reproductive health. </p>
<p>Just as girls (and boys) need to understand how their lungs and breathing works and the importance of not smoking tobacco, or how their food is digested in their bodies and the importance of good nutrition, they need to understand how their reproductive processes are developing and functioning. </p>
<p>Two, a key step in building girls’ (or boys’) confidence and self-esteem about their changing bodies is helping them feel supported and prepared as new, and often, confusing changes happen emotionally and physically inside of them. </p>
<p>All girls growing up in the U.S. today should be encouraged, informed and confident about their changing bodies, developing sexuality and future reproductive health. There is an urgent need for new research that focuses on the diversity of low-income girls’ experiences of puberty in the U.S. today, but also new programs that will better support both them and their parents at this critical developmental stage of life.</p><img src="https://counter.theconversation.com/content/72164/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In developing countries, many girls feel unprepared when they go through puberty. And research indicates that low-income girls in the US may feel the same way.Marni Sommer, Associate Professor of Sociomedical Sciences, Columbia UniversityAnn Herbert, Ph.D. student, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/707672017-01-03T16:52:16Z2017-01-03T16:52:16ZWhy some girls grow breasts early – and how new findings could cut cancer risks<figure><img src="https://images.theconversation.com/files/151583/original/image-20170103-29222-7bm0oz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Where first is not best.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-508653874/stock-photo-young-girl-with-beautiful-hair-standing-on-the-road-in-colorful-autumn-forest-back-view-original-wallpaper-with-space-for-your-montage.html?src=RptKaMYCbO4dOuMRr0yQkw-1-61">kovop58</a></span></figcaption></figure><p>When a girl’s breasts start growing early, it can be a sign she will develop certain diseases later in life. There is <a href="http://www.nature.com/articles/srep11208">evidence</a> of early puberty leading to increased risk of obesity, type 2 diabetes, heart disease and cancer – <a href="https://breast-cancer-research.biomedcentral.com/articles/10.1186/bcr3613">particularly</a> breast cancer. Girls who develop breasts before the age of ten have around a 20% higher risk of breast cancer in later life than girls who develop breasts between the ages of 11 and 12. </p>
<p>If you could prevent breasts from growing early, you might be able to reduce the girl’s risks of developing these diseases. Until now, unfortunately, scientists have poorly understood the processes that make some girls develop younger than others. But <a href="http://dev.biologists.org/">new findings</a> from our research at the University of Glasgow solve a large part of the mystery and could have important health implications as a result. </p>
<p>It is <a href="http://pediatrics.aappublications.org/content/early/2013/10/30/peds.2012-3773">usual for</a> girls to develop breasts around the age of ten, though <a href="https://www.ncbi.nlm.nih.gov/pubmed/17489932">plenty</a> start earlier or later and this is often seen as normal and harmless. Yet the higher risks of earlier developers ending up with breast cancer or the other diseases are a significant concern, not to mention other psychological and physical problems that can crop up. </p>
<p>In addition to potential feelings of isolation and embarrassment, early puberty is <a href="http://www.nature.com/ng/journal/v48/n6/full/ng.3551.html">linked to</a> earlier sexual activity, which can lead to emotional damage as well as unwanted pregnancies and sexually transmitted diseases. Studies show correlations with <a href="https://www.researchgate.net/profile/Riittakerttu_Kaltiala-Heino/publication/10647348_Early_puberty_is_associated_with_mental_health_problems_in_middle_adolescence/links/0912f50df117acaf3e000000.pdf">depression</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761220/">eating disorders</a>; and early developers <a href="https://www.ncbi.nlm.nih.gov/pubmed/15073143">tend to be</a> tall for their age but actually shorter as adults. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/151588/original/image-20170103-18653-16zzdvb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘Why me?’</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-465216848/stock-photo-sad-girl-on-the-riverbank.html?src=jRqQUHmAQx1t874vWhzoIA-8-9">Anna Jurkovska</a></span>
</figcaption>
</figure>
<p>The bad news is that throughout the world, puberty <a href="http://humupd.oxfordjournals.org/content/7/3/287.full.pdf">is beginning</a> earlier and earlier. In the US, it is <a href="http://www.webmd.com/children/guide/causes-symptoms#1">believed to be</a> happening a full year earlier than a few decades ago. However, the reasons are largely unknown. </p>
<p>A number of studies <a href="https://www.ncbi.nlm.nih.gov/pubmed/17332182">have shown</a> an association with childhood obesity. But while this is a popular theory as obesity is <a href="http://press.endocrine.org/doi/abs/10.1210/jcem.82.9.4235">known to</a> affect hormone levels, it does not explain why onset <a href="http://adc.bmj.com/content/early/2016/09/26/archdischild-2016-310475.full">varies substantially</a> between different ethnic and socio-economic groups – earlier among black girls and those from poorer backgrounds. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572204/">Another theory</a> is that we are increasingly exposed to chemicals in the environment which mimic hormones that may be accelerating puberty.</p>
<h2>How breasts develop</h2>
<p>For girls to begin to develop breasts, a thin layer of specialised cells called epithelial branches must form within the tissue. These branches provide the breasts with a structural scaffold for their fatty tissue, allowing them to develop in size and shape. </p>
<p>The branches continue to grow and change throughout a woman’s reproductive lifetime – uniquely for human tissue. They stop growing in early adulthood when breasts are fully developed, but start again during pregnancy to make way for milk-producing glands, then transform once more when a mother stops breastfeeding. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=762&fit=crop&dpr=1 600w, https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=762&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=762&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=958&fit=crop&dpr=1 754w, https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=958&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/151590/original/image-20170103-18641-17u92hd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=958&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Breast intentions.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/x1klima/15221016421">x1klima</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>The branches depend on certain hormones but crucially also immune cells called macrophages, which help them change during each process. Until now it had not been clear how these cells arrive at the correct place and time. </p>
<p>What our research has revealed is the role played by an immune molecule called ACKR2 in this process. ACKR2 stops the macrophages from moving into the breasts until the female is old enough, which prevents premature breast development. We found that mice that do not have ACKR2 start puberty early because the macrophage cells arrive in the breasts prematurely. </p>
<h2>Future responses</h2>
<p>Doctors currently only slow down the onset of puberty in children if it starts before the age of seven and if it is caused by a hormonal imbalance. They do this by administering drugs that stop the pituitary glands from producing the hormones that trigger puberty. Now that we know that ACKR2 is a key molecule in preventing premature breast development, there may be a strong argument for developing new pharmaceutical interventions – particularly given the range of problems associated with the condition. </p>
<p>The next step is to carry out studies in human patients to find out whether pre-pubertal girls with low levels of ACKR2 go on to develop breasts early. If so, it may be possible to predict early puberty by testing young children and boosting levels of the molecule to halt the process. </p>
<p>It would then be for those in charge of health spending to decide whether the risks of later disease and the other problems associated with early breast development are grave enough to justify this course of action. They would have to take account of the fact that researchers still need to definitively determine the molecular mechanisms by which early puberty raises the risk of disease. </p>
<p>At this stage, however, there are grounds for optimism. We could be talking about an intervention that leads to significant health benefits and enhances the quality of girls’ lives – both as children and adults.</p><img src="https://counter.theconversation.com/content/70767/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gillian Wilson receives funding from the Medical Research Council. </span></em></p>Until now, the processes that lead some girls to start developing before others have been poorly understood.Gillian Wilson, Research Associate, Institute of Infection Immunity and Inflammation , University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/580042016-04-18T15:48:19Z2016-04-18T15:48:19ZLosing your virginity: how we discovered that genes could play a part<figure><img src="https://images.theconversation.com/files/119152/original/image-20160418-1263-1tgrwyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source"> Alex Brylov/Shutterstock</span></span></figcaption></figure><p>As far as big life decisions go, choosing when to lose your virginity or the best time start a family are probably right up there for most people. It may seem that such decisions are mostly driven by social factors, such as whether you’ve met the right partner, social pressure or even your financial situation. But scientists are increasingly realising that such sexual milestones are also influenced by our genes.</p>
<p>In a new study of more than 125,000 people, <a href="http://nature.com/articles/doi:10.1038/ng.3551">published in Nature Genetics</a>, we identified gene variants that affect when we start puberty, lose our virginity and have our first child. This is hugely important as the timing of these events affect educational achievements as well as physical and mental health.</p>
<p>Children can start puberty at <a href="http://www.nhs.uk/Livewell/puberty/Pages/puberty-signs.aspx">any time between eight and 14-years-old</a>. Yet it is only in recent years that we have begun to understand the biological reasons for this. Through studies of both animals and humans, we now know that there’s a complex molecular machinery in the brain that silences <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495948/">puberty hormones</a> until the right time. At this point, chemical messengers secreted from the brain begin a cascade of events, leading to the production of sex hormones and reproductive maturity.</p>
<p>Human genetics studies have identified many genes that are linked to <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=25231870">individual differences in the onset of puberty</a>. There are broadly two approaches used to map such genes – studies of patients affected by rare disorders that affect puberty and large-scale population studies. The former is helpful because it can investigate gene variants that cause extremely early or delayed/absent puberty. </p>
<p>In previous research, we used population studies to survey a large number of individuals using questionnaires and then genome-wide association studies to scan these same participants for common genetic differences. We could then assess whether the participants’ reported age at puberty was related to particular gene variants. In this way, we have in a number of studies identified <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=25231870">more than 100 such variants</a>, each modifying puberty timing by just a few weeks. However, together they contribute substantially. </p>
<p>We now understand that both nature and nurture play a roughly equal role in regulating the timing of puberty. For example, studies have consistently shown that obesity and excessive nutrition in children <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931339/">can cause an early onset of puberty</a>.</p>
<h2>Genetic factors</h2>
<p>However, we know far less about the biological and genetic factors behind the ages that we first have sexual intercourse or have a first child. This is because previous research has focused more on <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=20358457">environmental and family factors</a> than genetics. But the launch of <a href="http://www.ukbiobank.ac.uk/">UK Biobank</a>, a study with over half a million participants, has greatly helped to fill this lack of knowledge. </p>
<p>In our new study, we used this data to survey some 125,000 people in the same way as in the puberty studies. We found 38 gene variants associated with the age of first sexual intercourse. The genes that we identified fall broadly into two groups. One category is genes with known roles in other aspects of reproductive biology and pubertal development, such as the oestrogen receptors, a group of proteins found on cells in the reproductive tract and also in behaviour control centres of the brain.</p>
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<img alt="" src="https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119144/original/image-20160418-1238-18hs5mi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If you went through puberty early you are more likely to have many children in life.</span>
<span class="attribution"><span class="source">Tom Adriaenssen/wikimedia</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>The other group includes genes which play roles in brain development and personality. For example, the gene <a href="http://www.genecards.org/cgi-bin/carddisp.pl?gene=CADM2">CADM2</a>, which controls brain activity and also has strong effects on whether we regard ourselves to be risk-takers. We discovered that this gene was also associated with losing your virginity early and having a higher number of children throughout life. Similarly, the gene <a href="http://www.genecards.org/cgi-bin/carddisp.pl?gene=MSRA">MSRA</a>, linked to how irritable we are, was also associated with age at first sexual intercourse. Specifically, people who are more irritable typically have a later encounter. However, more research is needed to show exactly how these genes help regulate the timing of the reproductive milestones.</p>
<p>We were also able to quantify that around 25% of the variation in these milestones was due to genetic differences rather than other factors.</p>
<h2>Implications for public health</h2>
<p>An important reason why we study reproductive ageing is that these milestones impact reproductive outcomes and also broader health risks. Epidemiological studies show that individuals who go through puberty at younger ages have higher risks of many diseases of old age, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/26084728">diabetes, heart disease and breast cancer</a>. Similarly, first sexual intercourse at an earlier age is linked to a number of <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=20358457">adverse behavioural, educational and health outcomes</a>. </p>
<p>Using a statistical genetics approach called <a href="http://www.mendelianrandomization.com/index.php">Mendelian Randomisation</a>, a technique that helps clarify the causal relationship between human characteristics, these studies can tell us whether such epidemiological associations are likely to be causal rather than just random associations. We managed to show that early puberty actually contributes to a higher likelihood of risk-taking behaviours, such as sexual intercourse at an earlier age. It was also linked to having children earlier, and having more children throughout life.</p>
<p>These findings, along with previous studies linking early puberty and loss of virginity to social and health risks, back the idea that future public health interventions should aim to help children avoid early puberty, for example by diet and physical activity and avoiding excess weight gain. Our findings predict that this would have benefits both on improving adolescent health and educational outcomes and also for future health at older ages.</p><img src="https://counter.theconversation.com/content/58004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Perry receives funding from the Medical Research Council (UK)</span></em></p><p class="fine-print"><em><span>Ken Ong receives funding from the Medical Research Council (Unit Programme numbers MC_UU_12015/2). </span></em></p>Study finds that gene linked to risk-taking is associated with losing your virginity early.John Perry, Senior Investigator Scientist, University of CambridgeKen Ong, Group Leader of the Development Programme at the MRC Epidemiology Unit, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.