Using PEDSnet data, we will describe the prevalence and demographic characteristics of children diagnosed with a sex or gender difference and changes over the past 8 years. The hypotheses are as follows: 1: Prevalence of our conditions of interest will be significantly greater in 2017 versus 2009; 2. Interrupted time series analysis of prevalence rates will reveal a sharp increase after 2013 for all SCAs and CAIS (commercialization of non-invasive prenatal screening). Prevalence of diagnosis of TS, XXY, XXX, and XYY in infants <12 months of age in the years 2014-2017 will be at least twice that in the years 2010-2013; 3. Longitudinal assessment of prevalence rates for transgender youth will have increased linearly during this time span; 4. Our conditions of interest will have low racial/ethnic and socioeconomic diversity (high proportion will be non-Hispanic white, private insurance).
Additionally, we will describe the clinical management for children diagnosed with a sex or gender difference and changes over the last 8 years, with a focus on hormone prescribing patterns, surgical interventions, and ordering for screening studies. The hypotheses are as follows: 1. The proportion of children >10 years with SCA and transgender who are prescribed a sex steroid or GnRH agonist will increase over time; 2. The average age for 1st prescription of a sex steroid will decrease over time; 3. Rates of surgical interventions (gonadectomy for CAIS and TS with Y mosaicism and clitoroplasty for CAH) will be lower in the past 4 years than in the first 4 years; 4. Practice patterns for ordering laboratory and radiological studies will follow the recommended expert consensus guidelines in TS, CAH, transgender <50% of the time.
Finally, we will determine the morbidity associated with a diagnosis of a sex or gender difference compared to population controls of similar age, race/ethnicity, insurance status and location. The hypotheses are as follows: 1. Practice patterns for ordering laboratory and radiological studies will follow the recommended expert consensus guidelines in TS, CAH, transgender <50% of the time; 2. Cases will all have higher prevalence of any prescriptions for the following medication types: stimulants, antidepressants, antipsychotics; 3. Cases (predominately XXY, TS, CAH and transgender youth) will have higher prevalence of cardio metabolic disorders (hyperlipidemia, obesity, metabolic syndrome, type 2 diabetes, hypertension); 4. TS and XXY will have higher prevalence of atopic conditions and autoimmune diseases as well as higher rate of hospitalizations.