PUP – Perfect Until Puberty
There is a commonly presenting problem in general practice that I have named Perfect Until Puberty, the acronym for which is PUP.
Observing the adolescent rite of passage over 40 years in General Practice has led me to coin this term.
As GPs, we have all witnessed the chaos for some adolescents as they approach the hurdles of the pubescent and teenage years.
Some falter and fail; most however, bravely and successfully traverse the storm.
The nurture/nature debate has added little to our management, but the advances in the understanding of genetic variances and the understanding of epigenetics has allowed insights and potential treatment options that previously eluded the medical fraternity. Vilification of both the sufferer and their parents as being responsible has been unhelpful (yes, there are exceptions).
A real challenge facing this population is the dysregulation and dysfunction of the HPA axis (the Hypothalamic Pituitary Adrenal axis controls our reactions to stress) during pubescence; this is something that results in disorders ranging from anxiety, social phobias, self-harm, eating disorders, and promiscuity – to physical disorders such as PCOS (Polycystic Ovary Syndrome) and endometriosis.
Our DNA is being bathed in an ever-toxic broth.
In a less toxic environment, the dysregulation may have had an evolutionary advantage but in today’s xenoestrogen-filled world it probably has lost some of its potential benefit. One has to ask oneself; what on this earth is driving breast cancer, endometriosis, PCOS epidemics and male infertility?
We have had very few tools in our toolbox to help these young people and often they are wrongly labelled and treated in less than beneficial ways.
The overuse of the (contraceptive) PILL to control ‘hormonal stuff’ is a result of our lack of understanding regarding Dopamine, Adrenaline, Oestrogen, Cortisol, and their relationship to COMt (Catechol O-Methyltransferase: a gene that manages hormones, which in turn affect stress reactivity, mental and physical health) gene variances in association with individual’s variances in the inflammatory control pathways.
An interesting study on the COMt gene SNP (Single Nucleotide Polymorphisms are frequently called SNPs and are pronounced “snips”; they are the most common type of genetic variation among people. Each SNP represents a difference in a single DNA building block, called a nucleotide) variances and prefrontal blood flow in pubescent females showed a marked variation and was associated with related differing emotional scores.
An equally revealing and challenging study would be to monitor blood flow in the male adolescent. Dysregulation of the HPA axis in this group under the influence of destructive powers of testosterone may reveal interesting insights.
The way forward involves individualisation of treatments through identification of genomic variants relevant to both hormonal and behavioural pathways.