[PDF-youth] [Pdf-women] Puberty May Start Earlier Than It Used To

[Terubeimoa Nabetari]

Received it well.
So what we are going to do?

On Thu, 4 Jul 2024, 11:52 Pacific Disability, <infor at pacificdisability.org>
wrote:

>
> *From UN Women Round Network:*
>
>
>
> *Puberty May Start Earlier Than It Used To*
>
> Some girls are starting to develop breasts as early as age 6 or 7.
> Researchers are studying the role of obesity, chemicals and stress.
>
> Credit...Eleni Kalorkoti
>
>
>
> *By **Azeen Ghorayshi <https://www.nytimes.com/by/azeen-ghorayshi>*
>
> *Leer en español
> <https://www.nytimes.com/es/2022/05/31/espanol/edad-inicia-pubertad.html>*
>
> June 22, 2024 - Marcia Herman-Giddens first realized something was
> changing in young girls in the late 1980s, while she was serving as the
> director for the child abuse team at Duke University Medical Center in
> Durham, N.C. During evaluations of girls who had been abused, Dr.
> Herman-Giddens noticed that many of them had started developing breasts at
> ages as young as 6 or 7 years.
>
> “That did not seem right,” said Dr. Herman-Giddens, who is now an adjunct
> professor at the University of North Carolina Gillings School of Global
> Public Health. She wondered whether girls with early breast development
> were more likely to be sexually abused, but she could not find any data
> keeping track of puberty onset in girls in the United States. So she
> decided to collect it herself.
>
> A decade later, she published a study of more than *17,000 girls
> <https://www.publications.aap.org/pediatrics/article-abstract/99/4/505/75275/Secondary-Sexual-Characteristics-and-Menses-in?redirectedFrom=fulltext>* who
> underwent physical examinations at pediatricians’ offices across the
> country. The numbers revealed that, on average, girls in the mid-1990s had
> started to develop breasts — typically the first sign of puberty — around
> age 10, more than a year earlier than previously recorded. The decline was
> even more striking in Black girls, who had begun developing breasts, on
> average, at age 9.
>
> The medical community was shocked by the findings, and many were doubtful
> about a dramatic new trend spotted by an unknown physician assistant, Dr.
> Herman-Giddens recalled. “They were blindsided,” she said.
>
> But the study turned out to be a watershed in the medical understanding of
> puberty. Studies in the *decades since
> <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042934/>* have confirmed,
> in dozens of countries, that the age of puberty in girls has dropped by
> about three months per decade since the 1970s. A *similar pattern
> <https://publications.aap.org/pediatrics/article-abstract/130/5/e1058/32411/Secondary-Sexual-Characteristics-in-Boys-Data-From?redirectedFrom=fulltext>*,
> though less extreme, has been observed in boys.
>
> Although it is difficult to tease apart cause and effect, earlier puberty
> may have harmful impacts, especially for girls. Girls who go through
> puberty early are at a *higher risk
> <https://pubmed.ncbi.nlm.nih.gov/23998670/>* of depression, anxiety,
> substance abuse and other psychological problems, compared with peers who
> hit puberty later. Girls who get their periods earlier may also be at a
> higher risk of *developing breast
> <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/>* or *uterine
> cancer <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566123/>* in
> adulthood.
>
> No one knows what risk factor — or more likely, what combination of
> factors — is driving the age decline or why there are stark race- and
> sex-based differences. Obesity seems to be playing a role, but it cannot
> fully explain the change. Researchers are also investigating other
> potential influences, including chemicals found in certain plastics and
> stress. And for unclear reasons, doctors across the world have reported a
> rise in early puberty cases during the pandemic.
>
> “We are seeing these marked changes in all our children, and we don’t know
> how to prevent it if we wanted to,” said Dr. Anders Juul, a pediatric
> endocrinologist at the University of Copenhagen who has published two
> recent studies on the phenomenon. “We don’t know what is the cause*.”*
>
> *Obesity*
>
> Around the time that Dr. Herman-Giddens published her landmark study, Dr.
> Juul’s research group examined breast development in a cohort of 1,100
> girls in Copenhagen. Unlike the American children, the Danish group matched
> the pattern long described in medical textbooks: Girls began developing
> breasts at an average age of 11 years old.
>
> “I was interviewed quite a lot about the U.S. puberty boom, as we called
> it,” said Dr. Juul. “And I said, ‘it’s not happening in Denmark.’”
>
> At the time, Dr. Juul suggested that the earlier onset of puberty in the
> United States was probably tied to a rise in childhood obesity, which had
> not occurred in Denmark.
>
> Obesity has been linked to earlier periods in girls *since the 1970s
> <https://pubmed.ncbi.nlm.nih.gov/5471242/>*. Numerous *studies since
> <https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-3-3>* *have
> established
> <https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgab092/6145760?redirectedFrom=fulltext&login=false>*
>  *that girls who are overweight or
> <https://academic.oup.com/ije/article/49/3/834/5830815>*obese *tend to
> start <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838525/>* their
> periods earlier than girls of average weights do.
>
> In one *decades-long study
> <https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-3-3>* of
> nearly 1,200 girls in Louisiana published in 2003, childhood obesity was
> linked to earlier periods: Each standard deviation above the average
> childhood weight was associated with a doubled chance of having a period
> before age 12.
>
> And in 2021, *researchers from Britain
> <https://www.nature.com/articles/s41586-021-04088-9>* found that leptin,
> a hormone released by fat cells that limits hunger, acted on a part of the
> brain that also regulated sexual development. Mice and people with certain
> genetic mutations in this region experienced later sexual development.
>
> “I don’t think there’s much controversy that obesity is a major
> contributor to early puberty these days,” said Dr. Natalie Shaw, a
> pediatric endocrinologist at the National Institute of Environmental Health
> Sciences who *has studied
> <https://academic.oup.com/jcem/article-abstract/106/6/1668/6145760?redirectedFrom=fulltext>* the
> effects of obesity on puberty.
>
> Still, she added, many girls who develop early are not overweight.
>
> “Obesity can’t explain all of this,” Dr. Shaw said. “It’s just happened
> too quickly.”
>
> *Chemicals*
>
> In the decade after the Herman-Giddens study, Dr. Juul began noticing an
> increase in the number of referrals for early puberty in Copenhagen, mostly
> of girls who were developing breasts at 7 or 8 years old.
>
> “And then we thought, ‘Is this a real phenomenon?’” Dr. Juul said. Or, he
> wondered, had parents and doctors become “hysterical” because of the news
> coverage of Dr. Herman-Giddens’s study?
>
> In a *2009 study
> <https://publications.aap.org/pediatrics/article-abstract/123/5/e932/71515/Recent-Decline-in-Age-at-Breast-Development-The?redirectedFrom=fulltext>* of
> nearly 1,000 school-aged girls in Copenhagen, his team found that the
> average age of breast development had dropped by a year since his earlier
> study, to a little under 10, with most girls ranging from 7 to 12 years
> old. Girls were also getting their periods earlier, around age 13, about
> four months earlier than what he had reported before.
>
> “That’s a very marked change in a very short period of time,” Dr. Juul
> said.
>
> But, unlike doctors in the United States, he did not think obesity was to
> blame: The body mass index of the Danish children in the 2009 cohort was no
> different than it had been in the 1990s.
>
> Dr. Juul has become one of the most vocal proponents of an alternate
> theory: that chemical exposures are to blame. The girls with the earliest
> breast development in his 2009 study, he said, had the highest urine levels
> of phthalates, substances used to make plastics more durable that are found
> in everything from vinyl flooring to food packaging.
>
> Phthalates belong to a broader class of chemicals called “endocrine
> disrupters,” which can affect the behavior of hormones and have become
> ubiquitous in the environment over the past *several decades
> <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965846/>*. But the
> evidence that they are driving earlier puberty is murky.
>
> In a *review article <https://pubmed.ncbi.nlm.nih.gov/35466359/>* published
> last month, Dr. Juul and a team of researchers analyzed hundreds of studies
> looking at endocrine disrupters and their effects on puberty. The methods
> of the studies varied widely; some were done in boys, others in girls, and
> they tested for many different chemicals at different ages of exposure. In
> the end, the analysis included 23 studies that were similar enough to
> compare, but it was unable to show a clear association between any
> individual chemical and the age of puberty.
>
> *“*The big takeaway is that there’s few publications and a paucity of
> data to explore this question,” said Dr. Russ Hauser, an environmental
> epidemiologist at the Harvard T.H. Chan School of Public Health and a
> co-author of the analysis.
>
> That lack of data has led many scientists to be skeptical of the theory,
> said Dr. Hauser, who recently reported on how *endocrine disrupters
> affect puberty in boys
> <https://www.sciencedirect.com/science/article/abs/pii/S001393512200545X>*.
> “We don’t have enough data to build a strong case for a specific class of
> chemicals.”
>
> Image
>
> Credit...Eleni Kalorkoti
>
> *Stress and lifestyle*
>
> Other factors may also be involved in earlier puberty, at least in girls. *Sexual
> abuse
> <https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/impact-of-sexual-abuse-on-female-development-lessons-from-a-multigenerational-longitudinal-research-study/586040ABB47E550DA0347E7BCC82E82A>* in
> early childhood has been linked to *earlier puberty onset
> <https://pubmed.ncbi.nlm.nih.gov/27836531/>*. Causal arrows are difficult
> to draw, however. Stress and trauma could prompt earlier development, or,
> as Dr. Herman-Giddens hypothesized decades ago, girls who physically
> develop earlier could be more vulnerable to abuse.
>
> Girls whose mothers have a *history of mood disorders
> <https://pubmed.ncbi.nlm.nih.gov/10834479/>* also seem more likely to
> reach puberty early, as are girls who do not live with their *biological
> fathers <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079910/>*.
> Lifestyle factors like a lack of physical activity have also *been linked
> to <https://www.sciencedirect.com/science/article/pii/S2210909915300977>* changes
> in pubertal timing.
>
> And during the pandemic, pediatric endocrinologists from across the world
> noticed that referrals were increasing for earlier puberty in girls. A *study
> published <https://pubmed.ncbi.nlm.nih.gov/35029543/>* in Italy in
> February showed that 328 girls were referred to five clinics across the
> country during a seven month period in 2020, compared with 140 during the
> same period in 2019. (No difference was found in boys.) Anecdotally, the
> same thing might be happening in *India, Turkey
> <https://www.washingtonpost.com/lifestyle/2022/03/28/early-puberty-pandemic-girls/>* and
> the United States.
>
> “I’ve asked my colleagues around the country and a number of them are
> saying, yes, we’re seeing a similar trend*,” *said Dr. Paul Kaplowitz, a
> professor emeritus of pediatrics at Children’s National Hospital in
> Washington. It’s unclear whether the trend was caused by increased stress,
> a more sedentary lifestyle or parents being in close enough quarters with
> their children to notice early changes.
>
> Several factors are most likely contributing at once. And many of these
> issues disproportionately impact lower-income families, which may partly
> explain the racial differences in puberty onset in the United States, the
> researchers said.
>
>
>  Link to the main article:
> *https://www.nytimes.com/2022/05/19/science/early-puberty-medical-reason.html#:~:text=Girls%20who%20go%20through%20puberty,or%20uterine%20cancer%20in%20adulthood
> <https://www.nytimes.com/2022/05/19/science/early-puberty-medical-reason.html#:~:text=Girls%20who%20go%20through%20puberty,or%20uterine%20cancer%20in%20adulthood>*
> .
>
>
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>
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