Sexual Development

Introduction/aimOptimizing Management of Endocrine Complications in Duchenne Muscular Dystrophy (OPTIMIZE DMD) is an international consortium of clinicians created to advance endocrine and bone clinical care in DMD. The aim of this study was to better understand current views and practices regarding investigation and management of growth and puberty concerns in individuals with DMD, relative to the 2018 Care Considerations and to inform updated guidance around endocrine care.MethodsA survey was created and sent to 47 OPTIMIZE DMD Consortium members and allied clinicians between September and November 2024. Areas surveyed included evaluation of growth, puberty, and arrested puberty/hypogonadism, and related management including use of vamorolone, growth hormone and testosterone.ResultsSurvey responses were received from 37 clinicians (79%). Most individuals were referred to endocrinology for growth and puberty concerns, with referral patterns contingent upon the endocrinology/multidisciplinary clinic model. Management discussions for growth concerns involved continued monitoring (95% of clinicians), glucocorticoid adjustment (54%) including vamorolone (35%), and growth hormone (41%). For pubertal delay, 88% of endocrinologists offered testosterone for pubertal induction, most commonly intramuscular 4-weekly testosterone injections. Most endocrinologists (92%) offered testosterone supplementation for arrested puberty/hypogonadism, some (24%) on a case-by-case basis. Delivery routes were more varied, with subcutaneous injections prescribed by 52%.DiscussionCompared with the 2018 Care Considerations, monitoring practices for growth and puberty remain largely consistent, while variability persists in management approaches. These findings provide important insights to inform future guidance and identify priorities for further education and research in endocrine management for individuals with DMD.

BackgroundMenopause is accompanied by accelerated losses in muscle mass and strength and declining bone density. Whether creatine monohydrate benefits postmenopausal women are uncertain.MethodsWe systematically reviewed randomized, placebo-controlled trials examining creatine supplementation, with or without resistance training (RT), in postmenopausal women. MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, and Cochrane CENTRAL were searched from 2000 to August 2025, supplemented by trial registries and reference-list screening. Eligible studies included postmenopausal women aged ≥40-45 years, intervention durations ≥6 weeks for primary analyses, and outcomes including DXA-derived lean mass, one-repetition maximum (1RM) strength, bone mineral density, physical function, and safety. Dual screening, duplicate extraction, and Cochrane RoB 2 assessment were performed. Random-effects meta-analysis used the Paule-Mandel estimator for τ² with Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity (τ², I²), 95% prediction intervals, subgroup analyses by RT status, exploratory dose/duration meta-regression, small-study effects, and GRADE certainty were assessed.ResultsSeven RCTs (n = 608 randomized; duration 12-104 weeks, median 38 weeks) enrolled postmenopausal women (mean age ≈ 62 y). Lean mass (k = 5; n = 338) favored creatine: mean difference (MD) + 0.37 kg (95% CI + 0.05 to + 0.69; I² = 25%; τ² = 0.01; 95% PI -0.10 to + 0.84). Leg-press 1RM (k = 3; n = 111) improved with creatine: MD + 7.5 kg (95% CI + 2.2 to + 12.8; I² = 0%). Benefits were evident when creatine ≥ 5 g·day⁻¹ was combined with RT; trials using ≤ 3 g·day⁻¹ without RT showed no measurable effect. Bone density was unchanged overall. Adverse events were mild and similar to placebo; renal indices were unchanged. Risk of bias was mostly "some concerns;" one large, preregistered, double-blind RCT was at low risk.ConclusionsIn postmenopausal women, creatine, particularly ≥ 5 g·day⁻¹ with RT, yields small but meaningful gains in lean mass and strength without evidence of harm. Effects on bone density remain unclear.Registration: This review was not prospectively registered. De-identified data and supplementary materials were deposited on OSF after completion of the analysis (DOI: 10.17605/OSF.IO/BVTRZ).

ImportanceWeight gain is common during menopause, and healthy dietary patterns are key to its management. However, effectiveness of different diets for weight management during this period remains unclear.ObjectiveTo examine and compare associations of multiple dietary patterns with weight gain and obesity risk in the years surrounding menopause.Design, setting, and participantsThis prospective, population-based cohort study included women observed over a 12-year period surrounding menopause in the Nurses' Health Study II (1989-2019). Data analysis was performed between November 2024 and May 2025.ExposuresDiet was assessed every 4 years using validated food frequency questionnaires. Dietary scores included the plant-based diet index (PDI), healthy PDI, unhealthy PDI, Mediterranean diet, Dietary Approaches to Stop Hypertension, Planetary Health Diet Index (PHDI), low-carbohydrate diet (LCD), healthy LCD, unhealthy LCD, empirical dietary inflammatory pattern, empirical dietary index for hyperinsulinemia (EDIH), and ultraprocessed food intake.Main outcomes and measuresThe outcomes were annual changes in self-reported body weight (kilograms per year) and incident obesity. Generalized estimating equations were used to estimate annual weight change across dietary patterns. Cox proportional hazards models were used to estimate risk of obesity across dietary patterns.ResultsAmong 38 283 women (mean [SD] age, 45.6 [3.0] years), the mean (SD) weight gain was 0.80 (1.00) kg per year. During 340 122 person-years of follow-up, 5214 women developed obesity. After adjusting for age, race and ethnicity, marital status, income, postmenopausal hormone therapy use, parity, smoking, alcohol, energy intake, physical activity, and baseline body mass index, the reverse EDIH (quintile 5 vs 1) was associated with the largest reduction in weight gain (mean, -0.28 kg/y; 95% CI, -0.30 to -0.26 kg/y). For incident obesity, the lowest risk was observed for the PHDI (hazard ratio, 0.46; 95% CI, 0.42 to 0.51) and reverse EDIH (hazard ratio, 0.51; 95% CI, 0.46 to 0.56). EDIH showed the largest positive correlations with red or processed meats, sodium, and French fries. PHDI showed the largest positive correlations with nuts, unsaturated fats, whole grain carbohydrates, and vegetable protein.Conclusions and relevanceIn this prospective cohort study of women during menopause, adopting low-insulinemic and planetary health diets, low in red and processed meats, sodium, potatoes, and French fries and rich in nuts, legumes, fruits, vegetables, and whole grains, was associated with optimized weight management.