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Archive for the ‘Hormone Clinic’ Category

The IUD That Gives Women Options – WIRED

In a taupe-walled exam room at the Womens Community Clinic in San Francisco, lead clinician Lisa Mihaly plucks a small laminated card from a cabinet. Tethered to the card are three T-shaped IUDs, or intrauterine devicesforms of birth control that are, as the name implies, inserted into a womans uterus to prevent pregnancy for up to 12 years. Mihaly points to each device like friends in a group photo: Paragard, with its thin bands of copper coiled around a white plastic trunk and two arms at attention; Mirena, the first hormonal IUD available in the US; and Skyla, an IUD designed for women who have never had children. But theres one option missing, Mihaly says: a newer model called Liletta.

Liletta, which arrived in the clinics inventory this summer, is a small device that manufacturers hope will make a big difference. Public clinics pay a wholesale price of $336 to $400 for each of the IUDs on Mihalys card. Add in doctors visits for placement and the total cost can exceed $1,000. Liletta's manufacturer hopes to see a wholesale price for public clinics as low as $50.

Price point matters, possibly more than ever before. Under the Affordable Care Act, women rarely pay full price for an IUD because of provisions requiring insurers to fully cover at least one option from each of the 18 FDA-approved birth control methods. But when Donald Trump took office on a promise to repeal the ACA, IUD insertion rates soared as women sought long-term contraceptive solutions.

Though the ACA is safe for now, The Wall Street Journal reported in August that the Trump administration is planning to roll back the birth control requirement, allowing employers to demur based on religious or moral objections. And affordable, accessible birth control will always be a public health concern. In April, Trump signed a law giving states more freedom to restrict their spending of federal money from the Title X program, which supports the clinics that care for women with Medicaid, or no insurance at all, at lower cost.

Politics and pricing aside, the IUD has experienced something of a revival in the United States. For years a negative narrative dogged the devicesin the 1980s, the Dalkon Shield caused infections and even deaths. But new, safe models, including Paragard and Mirena, made it to market and the mainstream. Since 2002, the number of American women using IUDs has roughly doubled every four years. But it remains low, internationally speakingjust 8 percent of reproductive-age American women use an IUD, compared to 20 percent of Belgians and nearly 70 percent of South Koreansbut the trend continues upward.

And why not? The IUD is among the most effective contraceptives, preventing pregnancy in 99 percent of women who use it over the course of a year. The levonorgestrel in hormonal IUDs stops ovulation or thins the uterine lining, so eggs are less likely to implant, and the physical presence of a foreign object often thickens cervical mucus enough to stop sperm. Plus, theyre inserted once and last for years. Theres no room for error. You cant forget to take it, or forget to get the resupplies, says Cynthia Harper, a reproductive health researcher at UCSF. Just set it and forget it.

While many women have now heard of IUDs, few know about Lilettapartly because it's produced by Medicines360, a San Francisco nonprofit edging into a product category long dominated by Bayer, the pharmaceutical giant that makes three of the four hormonal IUDs available in the US. When Mirena received FDA approval in 2000, there wasnt a single other hormonal IUD available in the US. It remained the only option until 2013, when Bayer released Skyla, a model specific for nulliparous women. And in 2016a year after Lilleta earned FDA approvalthe company released its third hormonal IUD, Kyleena.

Bayers IUDs netted the company $900 million in the US in 2016, and theyve been among the companys 15 best-selling drugs for the past decade. It's a big businessand it doesnt look like that will change anytime soon.

Bayer has created a suite of IUDs that target women with different birth control needs: Skyla has a three-year lifetime and lower hormone levels, while Mirena and Kyleena are approved for five-year use with slightly higher doses of hormones. And Skyla and Kyleenas smaller size is aimed at women who havent had children.

The differences arent strictly clinical, though. The timing of Bayers product releases also allowed the company to keep its own patent-protected devices on the market. Drug patents typically last 20 years from the day a company files its application. With IUDs specifically, which bundle a drug (the body of the IUD) with a device (the inserter a doctor uses to place it), there are two ways to restart the patent clock: bring a new IUD through clinical trials or design a new inserter.

So in 2010, Bayer put two new IUDsthen experimental LCS16 and LCS12, now Skyla and Kyleenainto a clinical trial in Europe, North America, and South America. The company could have run each trial for five years so the new offerings would match Mirenas efficacy, but it finalized Skylas data at three, releasing it in 2013, before Mirenas patent ran out in 2015. Kyleena stayed in the same trial for two more years, receiving FDA approval in 2016.

Bayer has made other moves to maintain its market dominance. In 2014, the year before Mirenas first patent expired, the FDA established guidelines for studies to approve a generic form of the device, as it does for many drugs. The agency later withdrew the guidelines, but proposed spending up to $250,000 in grant money for researchers to find ways to evaluate drug equivalence of generic versions of Mirena. In response, Bayer submitted a citizen petition to the FDA, a 10-page statement urging the agency to require that proposed generics undergo comprehensive clinical testing rather than lab experiments to prove equivalence. The company submitted the petition one day before Mirenas patent expiration date.

Citizen petitions allow ordinary people to have input on health policy, but drug companies have historically employed them to discourage generic drug production, says Michael Carrier, an intellectual property lawyer at Rutgers Law School. The petitions are all carefully consideredsafety concerns are nothing to ignorebut the FDA ultimately denies many of the requests that large companies submit. If it really were about safety, Carrier says, then why is the company waiting until the very end?

Bayers petition mentions that the company has been waiting patiently for the FDA to update the guidelines for testing generic forms of the Mirena IUD, and the long timeline has led them to submit a citizen petition. The FDA hasnt issued a final response to Bayers citizen petition, and the agency keeps any inquiries about making a generic product confidential. Bayer did not respond to questions by press time.

Like Mirena, Liletta doesnt have patent protection on its IUD body. And Liletta is closely modeled after the Mirena, although technically its not a generic. Its a hybrid new drug, different enough from Mirena to stand on its own but similar enough to simplify the clinical trials that earned it FDA approval.

Lilettas IUD body was developed in the late 1990s, when Mirena was first approved in Europe. Jean Michel Foidart, an ob-gyn at the University of Liege, in Belgium, loved the concept of the hormonal IUD, but not the cost. The IUD itself is just a tiny piece of plastic, less than a tenth of a gram of hormones, and two small strings for removal. So Foidart figured he and his lab could create a much cheaper alternative. They mimicked Mirenas T-shape and dosed their model with the same hormone, levonorgestrel. An equally effective IUD with a lower price, he hoped, would provide better access to effective birth control.

There appeared to be a need for better and more reliable contraception in the US. In the mid 2000s, American women were largely relying on less-effective birth control methods, says Harper, the health researcher. Half of US pregnancies were unplanned. So in 2009, an anonymous donorsince identified as the Susan Thompson Buffett Foundation, which Warren Buffett runs in honor of his late wifefunneled $70 million to Medicines360 to get a lower-cost IUD available in the US.

It was an ambitious undertaking for the tiny company. In 2009, the entire team of Medicines360 consisted of Victoria Hale and then COO Ahvie Herskowitz. They licensed Foidarts IUD for distribution in the US and the developing world, changed the name from Levosert to the more marketable Liletta, and inworked with the pharmaceutical company Watson (which has since become a part of Allergan) for manufacturing.

Having a deep-pocketed benefactor gave Hale and her team the freedom to spend time and money on development. Andrea Olariu, who Medicines360 brought on as VP of clinical affairs in 2011, first called clinicians to understand where they needed helpprofessors at medical schools, MDs, and nurse practitioners. The final version of Liletta, they hoped, would be more affordable, and a better product too.

No one they spoke to raised many complaints about the IUDs. Instead, their feedback focused on insertion. To insert an IUD, a doctor or a nurse uses a wandlike gadget to guide it. A small tube at one end holds a flattened device, so when a nurse threads the tube into the cervix, then nudges the IUD upward, it unfolds into the uterus. The procedure takes just a few minutes, but speed doesnt mean precision. Clinicians found it hard to tell whether an IUD had fully exited an inserter, and complained that straight, rigid guiding tubes didnt accommodate the diverse geometries of uteruses. So Olariu worked alongside an engineer, Robert Deckman, to design and test 10 or so inserter prototypes. The finished product is about a foot long, with a thin handle at one end and the floppy tube that contains the IUD at the other. It makes like a little dome, says Jessica Grossman, who took over as Medicines360s CEO in 2015, so when you insert it into the cervix it doesn't cause trauma, and then you deploy the IUD in the uterus by pulling down on this, she says, pressing a small slider down with her thumb. The IUD exits the insertion tube with an audible clickso a nurse, who cant see whats happening, knows insertion took place.

With a finalized device in hand, Medicines360 was ready for the trickiest part of its process: clinical trials.

In 2009, Olariu cast a wide net as she began to enroll patients in Lilettas phase 3 safety trial. In 2000, Mirena was approved based on data from Finland and Sweden, and she hoped to include a wider range of patients in Medicines360s trial in America. Our goal was, as much as we could, to mirror the US population, Olariu says.

They extended their age range to include women between 16 and 45, rather than the typical 18 to 35 demographic of contraceptive studies, to recruit more women who had never given birth. And by enrolling 2,000 women from 27 cities around the country, their enrollment reflected the US census pretty closely. Roughly a quarter of participants were overweight or obese women, who often are excluded from these trials as researchers are uncertain of how weight might affect response to hormones.

Liletta received FDA approval for three-year use in February 2015, two months after Bayer submitted its citizen petition to require stringent testing for any generic versions of Mirena. The unresolved petition never caused Liletta any trouble, as its a unique drugthe Liletta IUD releases a slightly different amount of hormone per day (18.6 micrograms to Mirenas 20), and has a custom-designed inserter.

In rolling clinical trials, Liletta has now been approved for four years of contraception, and Medicines360 will submit their data for five-year approval soon. More than 600 clinics stock Liletta, and in two years theyve provided nearly a hundred thousand patients with IUDs, Grossman says. The difference with Liletta is that its much cheaper than the other IUDs, says Kristyn Brandi, an ob-gyn from the American College of Obstetricians and Gynecologists.

With more options becoming available, the American Congress of Obstetricians and Gynecologists maintains that IUDs are one of many good birth control options. There are clearly differences between hormonal and copper IUDs, and even some differences in lower and higher doses of levonorgestrel. But smaller sizing, one of the marketing points for Bayers latest releases, might not make as much of a difference for the majority of women. Some women like the idea that a smaller IUD might be less painful on insertion, but in general all the IUDs are well tolerated, Brandi says.

Lilettas approval might open a faster, easier, and cheaper route to an IUD, particularly for women who are uninsured, as many of the patients who Lisa Mihaly sees are. But the women sitting in the Womens Community Clinic waiting room, like other women around the country, might still lean toward the other options. Say your sister has Mirena, and your best friend uses Skyla, and you see an ad for Kyleena as youre flipping through a magazine while you wait. Its going to be hard to opt for the unfamiliar Liletta. And Medicines360s nonprofit budget doesnt provide for an advertising campaign like the one Bayer once used to offer a free yoga class alongside Break Up With The Pill messaging at Canadian universities.

Since Lilettas initial approval in 2015, Mihaly still hasnt had a patient ask directly for a Liletta IUD. But the devices are in stock, and shes trained to place one as soon as someone is interested. I'm excited that Liletta exists, and that there's another option, she says, because we have, really when you think about it, so few.

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The IUD That Gives Women Options - WIRED

I’m in My 50s and Still Get Acne What Can I Do? – Health Essentials from Cleveland Clinic (blog)

Q: Im still getting blackheads in my 50s. What can I do?

A: Many think acne is predominantly a teenage condition, but it peaks at two times in our lives. We see a lot of acne in the teen years with the first rush of hormones into the system. But we also see acne affecting people in their 40s and 50s, often around the mouth. Again, later outbreaks are related to hormones (from menopause, for example).

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

When you come to see a dermatologist, he or she will assess your acne. If it appears to be hormone-related, we may treat it with hormonal therapy, prescribingcommon oral contraceptive drugs or a drug like spironolactone. If the acne is severe, we may prescribe oral tretinoin or isotretinoin products.

However, the majority of acne can be controlled with topical medications, including:

Some over-the-counter products that contain alpha or beta hydroxy acids (like glycolic acid or salicylic acid) are also very helpful.

Also, as stress willdefinitely aggravate any skin condition, modifying the stress in your life as much as you canand adopting healthy stress management habits will help your skin condition.

Dermatologist Christine Poblete-Lopez, MD

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I'm in My 50s and Still Get Acne What Can I Do? - Health Essentials from Cleveland Clinic (blog)

Is drinking from a garden hose safe for children? – WXYZ

(WXYZ) - Doctors at the Cleveland Clinic wanted to know if drinking from a garden hose was safe.

It's something people have done for years. But, it looks like it carries some serious risks.

"Probably the biggest risk is some of the chemicals that are in the water itself. Many garden hoses are not made for drinking water and so they'll release lead, they will release different chemicals in the plastics, much like a lot of the plastics that have been banned in kids' products," Dr. Dan Allan said.

Some of those chemicals include BPA or PVC, poly vinyl chloride.

Allan says that ingesting these chemicals can increase your risk of cancer, hormone problems or neurological problems, and can even affect development in children.

If you can't seem to avoid drinking from the garden hose, you can do take some precautions.

Look for hoses made from polyurethane or natural rubber, which will not release any chemicals. Also, let the water run for a few minutes before you take a drink. It's also important to check the hose fitting.

"If it's brass, that will release a lot of lead and if you run the water for enough time to flush the hose, that first bit of water that was up by the brass fitting is going to be loaded with lead, so you have to let it run for a couple of minutes to make sure you're safe," he added.

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Is drinking from a garden hose safe for children? - WXYZ

Flame Retardants Linked To Lower Fertility Rates In Women – HuffPost

New research examining the link between common flame retardant chemicals and fertility rates finds that women with higher levels of the chemicals in their bodies have lower chances of fertilization, pregnancy and live birth compared with women who have low levels of the chemicals in their bodies.

If this finding is confirmed in a larger number of study participants, couples struggling to get pregnant may want to take a second look at their furniture and carpet, experts say, as some of these items tend to have flame retardant components. However, because this is the first study of its kind to find a link between organophosphate flame retardants and fertility outcomes, couples struggling to get pregnant should not worry about getting a new couch or mattress pad to aid conception just yet.

Researchers at the Harvard T.H. Chan School of Public Health recruited 211 women undergoing in vitro fertilization treatments to participate in the study. For each IVF cycle they went through, the women contributed one or two urine samples, and the scientists, led by environmental epidemiologist Courtney Carignan (now of Michigan State University), analyzed the urine for the byproducts of five flame retardant chemicals to estimate how much flame retardant they were exposed to in their everyday life.

The scientists then compared the levels of chemical byproducts to the womens outcomes during IVF and found that the women with the highest levels of three of the chemicals showed a 10 percent decrease in the rate of fertilization, a 31 percent decreased rate of embryo implantation, a 41 percent decreased rate of a clinical pregnancy (when a heartbeat is detected via sonogram) and a 38 percent decreased rate of live birth compared with the women who had the lowest amounts of byproduct in their urine.

Carignan chose to examine women undergoing the IVF process because it was the best way to observe every step of conception and early pregnancy, as opposed to women who conceive naturally and may not know they are pregnant until they are six to eight weeks along. Because of this, Carignan writes in the study, the results are at least generalizable to the population of women seeking treatment at an infertility clinic, and perhaps among all women in general, presuming that their bodies would have the same biological response to these chemicals as the women in the study.

Animal studies suggest that these flame retardant chemicals disrupt the thyroid and sex hormones in animals, as well as harm embryo development.If people want to limit their exposure to these chemicals and theyre due to replace a couch, Carignan suggested looking for furniture that doesnt have flame retardant chemicals, such as furniture with barrier technology or a naturally flame retardant fabric, like leather or wool, that meets flammability standards. She added that while mattresses do not typically contain flame retardants, polyurethane foam mattress pads can.

Other options are carpet-free floors or carpet with padding that isnt made from foam treated with these chemicals. Still, she said she understands these are big purchases that people make only a few times in their life, and many people dont have much choice about the furniture they have. In that case, they should wash their hands often, especially before meals, as Carignans past research has found that people who do this have lower levels of these chemicals in their body.

There are a lot of contributors to infertility, Carignan said. This is just one factor, and people need to be careful not to beat themselves up over these types of exposures.

Still, Carignan takes her research to heart. She waited nine years to upgrade from a futon to a couch because she was waiting for a policy change that allowed furniture without chemical flame retardants to hit the market. She also recently purchased a home, and one of her major concerns was that it be carpet-free, since padding under carpets is often made with recycled foam that is treated with flame retardant chemicals.

I do what I can with the time and the resources that I have, but there are so many things I certainly cant avoid, she said. Thats why we have chemical policies so people dont have to have a Ph.D. in environmental health to be a conscientious consumer.

The organophosphate flame retardants, or PFRs, that Carignan studied have replaced more toxic and long-lasting flame retardants like polybrominated diphenyl ethers, or PBDEs, that were phased out in 2004 over concerns about their effects on hormones and neurodevelopment in children.

The good thing about PFRs, Carignan said, is that they clear out of your body in a matter of days, versus years for the older class of flame retardants. However, her research suggests that PFRs may also disrupt the bodys hormone systems and interfere with fertility, and she called for more research on PFRs effects on male fertility and in children.

Dr. Brian Levine, a practice director at CCRM, a nationwide network of fertility clinics, was not involved in the study, but he said its findings were concerning. Still, he would need more corroboration from other kinds of research before he could start mentioning flame retardants to his patients and advising them to avoid them.

As a reproductive endocrinologist, he already counsels infertile patients under his care to avoid processed foods, eat organic fruits and vegetables, exercise moderately and shun alcohol and illicit drugs while theyre undergoing IVF all reasonable lifestyle changes that may help move the needle, even a tiny bit, in an infertile couples favor.

His clinic also takes pains to make sure that embryos in storage are exposed to the least amount of potentially harmful chemicals. No patient or staffer is allowed to wear cologne, perfume or other scented personal products, as they contain chemicals that could disrupt embryo health. Clients are advised to skip nail salons and exposure to paint and paint thinner, and cleaning crews dont use bleach or any agent with volatile organic compounds, which canalso be harmful to embryos.The clinic walls are also painted with low-VOC paint.

Because of the precautions Levine already employs at his clinic, he takes Carignans research seriously. But a single studys results would not be enough for Levine to add flame retardants to the long list of chemicals his patients should try to avoid. Levine wants to know how Carignans participants were exposed to these chemicals. It could be, for instance, that the women with the highest levels spend the most time in their cars and sedentary lifestyles tend to have a negative effect on fertility health. Hypothetical correlations like this need to be worked out before he can tell his patients to start shopping for new furniture.

You have to always wonder about a very small subset, said Levine. Theres only 211 patients, and asking people to remove all the carpet in their house is quite an expensive endeavor.

Carignans research was published in the Environmental Health Perspectives journal.

CORRECTION:A previous version of this story suggested that beds are among the furniture items that contain flame retardants. While mattresses typically do not, foam mattress pads may.

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Flame Retardants Linked To Lower Fertility Rates In Women - HuffPost

Free fertility roadshow in West Norfolk could help improve your chances of having a baby – Norfolk Eastern Daily Press

PUBLISHED: 14:42 23 August 2017 | UPDATED: 16:02 23 August 2017

Taz Ali

Free fertility roadshow in Kings Lynn on Thursday, August 31 could help improve your chances of having a baby. Picture: Bourn Hall

Bourn Hall

A free event hosted by fertility experts will give couples a chance to find out how they can get fertility fit and boost their chances of conceiving.

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The Bourn Hall Clinic based in Kings Lynn will provide visitors with the opportunity to have an informal chat about their current situation and plans on moving forward.

Specialists from the clinic will offer advice on how a change of lifestyle can enable women to get pregnant without the need for IVF.

Simples measures such as keeping a diary to track ovulation, leading a healthy lifestyle, drinking less alcohol and caffeine and getting more sleep can help couples improve their fertility.

Experts also advise couples to take some time to wind down and enjoy each others company as emotional stress has profound effects on fertility.

Of the 800 couples that have been referred to the clinic since it opened two years ago, almost half have successfully conceived.

Carol Steel, lead specialist fertility nurse at Bourn Hall Clinic, said: 80pc of couples will become pregnant within one year of actively trying to conceive, so if you are still not pregnant after this length of time you should seek advice.

The good news, however, is that there are many things which you can do to improve your chances of conceiving.

The event will be of benefit to anyone who is trying to get pregnant, or thinking about it, whether they are struggling to conceive or not. Couples can also find out about the more common reasons for infertility such as low sperm count, failure to release eggs (ovulate) regularly, fibroids and endometriosis and how to treat them.

The event will take place on Thursday, August 31 at the Knights Hill Hotel, in South Wootton at 6pm.

The evening will include expert presentations and an opportunity to have a private, free mini consultation with a Bourn Hall Clinic fertility nurse specialist.

Norfolk was one of the first counties to provide an integrated fertility service. GPs can refer couples to the Bourn Hall Clinic, in Kings Lynn and Wymondham, for treatment on the NHS.

For more information, visit the Bourn Hall Clinic website.

Simple measures can help couples improve their fertility:

Calculate when you are ovulating and keep a diary - Many people are unaware that there are only around six days each month when you can get pregnant. Your best chance of conceiving is on the day of ovulation, when one of the ovaries releases a ripe egg.

For a woman on a regular 28-day cycle the day of ovulation will be around 14 days after the start of her period but this can vary so it helps to keep a diary.

There are also a number of ovulation prediction kits available which might help.

Drink less alcohol and caffeine and cut out smoking altogether - Smoking harms sperm and can reduce a mans sex drive; in women it affects ovulation and reduces fertility. The best thing would be to to stop completely.

Heavy drinking (more than six units per day) can lower a mans sperm count and affect the health of the sperm so men should really watch their alcohol intake.

Women should ideally avoid alcohol altogether when they are trying to conceive as it can affect a developing foetus and cause birth defects.

In addition it is thought that caffeine affects the fertility level of both men and women so cutting back is a sensible precaution. Caffeine is not just found in tea and coffee but in chocolate and some soft drinks too.

Keep to a healthy weight, eat well and do more exercise - Eating a healthy, balanced diet is good news all round. It helps maintain an ideal body weight, helps to regulate hormones and improves the health of the reproductive system. Excess body fat in men is also a significant cause of low sperm count.

Vitamins C and E and zinc may play key roles in fertility, increasing sperm count and motility (movement) and supporting the female reproductive organs. Foods such as green leafy vegetables, eggs and dairy, nuts, seeds and citrus fruits provide key nutrients.

Doing some exercise every day is key to maintaining a healthy body, helping to burn off excess body fat and reducing the effect of stress on hormone levels. For men it can boost the fertility hormone testosterone, but it is important that women avoid excessive exercise as this can result in irregular periods. Try low-impact activities that you enjoy such as walking, swimming, cycling, pilates and yoga.

Ditch the hard bike seats and keep your cool - For men, overheated testicles can temporarily lower sperm counts, so it is important to avoid saunas, hot baths, sunbathing and tight underwear.

In addition, cycling regularly and for long periods of time on hard bike seats can also reduce fertility through pressure on the perineum, potentially damaging nerves and blood vessels to the genital area. Think about buying yourself a gel seat for your bike to provide more cushioning.

Consider your health - Get some advice about any treatments you might be taking to see if they are affecting your fertility. As well as over-the-counter medicines, some herbal remedies such as St Johns Wort, ginko biloba and Echinacea might have an adverse effect on your fertility.

Take it easy and get more sleep - Getting a good nights sleep of about eight hours a day or more can help men and women optimise their fertility. Not getting enough sleep can have a negative impact on hormone levels and studies of female professionals with sleep deprivation have shown an increase in irregular periods.

Couples should not forget to take the time to wind down and enjoy each others company. Emotional stress has profound effects on fertility, including interfering with the hormones responsible for egg and sperm production.

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Free fertility roadshow in West Norfolk could help improve your chances of having a baby - Norfolk Eastern Daily Press

Decision to remove both breasts is a personal one – News8000.com – WKBT

By Mayo Clinic News Network

Removing the normal breast is not required as part of the treatment for your breast cancer. The decision to have a mastectomy on the cancer side and also remove a breast that does not have cancer (the other side) is a very personal one. There are valid reasons some women choose to pursue this surgery. But it will have a long-term effect on your body, so you need to be comfortable with the decision you make.

A mastectomy is surgery that involves removing the majority of breast tissue from a breast as a way to treat or prevent cancer. For cancer prevention, this surgery reduces the risk of developing breast cancer by about 90 to 95 percent. It is not 100 percent because some areas of breast tissue do remain after a mastectomy. Those areas of tissue could develop breast cancer, although the chances of that happening are very small.

When you have a mastectomy to treat cancer in one breast, you could have the breast that does not have cancer removed at the same time. Some women opt to do this because they are anxious about developing cancer in the other breast. But you can also keep the normal breast. Research shows that this decision does not have an impact on overall survival.

Current medical evidence indicates the risk of developing a cancer in the other breast to be reasonably low at about half a percent a year. For women who have hormone therapy after a mastectomy because their tumors are hormone receptor positive, this risk is reduced by about 50 percent.

Certain factors can make a difference in your risk, though. If you have a strong family history of breast cancer or if you have tested positive for a mutation in one of the breast cancer genes, then the chances you will develop cancer in your other breast are significantly higher. Before you make a decision about having a double mastectomy, carefully review your personal risk of breast cancer with your doctor.

If you do not have other factors that raise your risk, there are additional questions to consider. First, if you do have a double mastectomy, are you comfortable with the risks of a more complex and longer operation? Having both breasts removed, rather than just one, increases the possibility of surgical complications such as bleeding and infection.

Second, if you do not have a double mastectomy, are you willing to participate in ongoing monitoring for cancer in your other breast? If you do not have both breasts removed, you will still need regular mammograms once a year on the breast that remains.

Third, how important is it to you that your breasts look similar? If you have one breast reconstructed after a mastectomy, it is unlikely that your remaining breast will match its appearance without some type of cosmetic surgery on the natural breast.

Talk with your doctor about these topics, along with any other concerns or questions you may have. Also, discuss what will happen before, during and after surgery, so you can set your expectations accordingly. Choosing to have a double mastectomy is a big decision. Make sure you are well informed about all the possible benefits and drawbacks for your situation before you move forward. -- Judy C. Boughey, M.D., Surgery, Mayo Clinic, Rochester, Minn.

Source: http://newsnetwork.mayoclinic.org/discussion/tuesday-q-and-a-decision-to-remove-breast-that-does-not-have-cancer-a-personal-one/

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Decision to remove both breasts is a personal one - News8000.com - WKBT

It all starts at groundfloor salon – Tulsa World

Celeste McCracken had a choice to make.

She could stay in bed for the rest of her life or get better and make a difference in other peoples lives.

After an illness had her bed-ridden for about seven years, Celeste refused to be a victim to her illness anymore and now has one of the top hair salons in Sand Springs groundfloor salon. And shes only been open since June 1.

I decided to go back to school and get my (cosmetology) license. I didnt want my illness to define me. Ive always wanted to be a hair stylist, but I never took the leap. Well I decided to jump.

Despite being healthy all of her life through ballet and dance, Celeste started gaining weight and was diagnosed with hypothyroidism, where her body didnt produce enough of the thyroid hormone. Then, it stopped working all together.

She had her thyroid removed, but the surgeon also removed the parathyroid, which controls the bodys calcium. She had to take synthetic hormones and vitamins, but her body wouldnt absorb them, and she needed eight-hour infusions at least four times a week just to stay alive. Her electrolytes would crash to critical levels, and she also had seizures. She spent the majority of the time at the hospital and couldnt work. When she wasnt at the hospital, she was at home in bed.

However, a trip to the Mayo Clinic in Arizona got her back on track and her medications started working.

Thats when I knew I had to do something. I had to start living again and I wanted to help people, she said.

Going back to school at age 40 wasnt easy, but, for her, cosmetology was easy.

It just clicks with me. Its as easy as making breakfast, she said.

After building a clientele for several years in other towns, Celeste decided to open a salon in Sand Springs, and she said the reception has been amazing.

I wasnt sure at first. We live here and my husband works here, but I didnt know if I could start over in a different town. Well, my fears were put to rest immediately, Celeste said.

She didnt know where she wanted her salon, and she looked at several locations that just werent right. She had one more space to look at, and she knew right away it was the one, but she had help deciding.

When I showed up to look at it, Monte and Betty Box were waiting at the door. I hadnt met Monte before, but my husband had told me about him. We connected right away. He told me this is the place for you, and he was right. Monte and Betty have been amazing, Celeste said.

Located at 401 E. Broadway Court in the Village Square Shopping Center, Celeste specializes in color corrections, womens cuts, mens cuts and childrens cuts.

I think it is my mission to make others look great and feel great about themselves. God gave me a gift and He is the reason I can do this every day. It took a lot of prayer and a lot of hard work, but Im ready to spend the next half of my life being healthy and serving others, she said.

Celeste said she chose the name groundfloor salon because everything has a starting point.

Whether its beauty, faith, your career, relationships, it all starts somewhere. It all starts on the ground floor. It starts here, she said.

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It all starts at groundfloor salon - Tulsa World

Indian Trans Couple, Soon To Marry, Finds Love At Mumbai Clinic While Transitioning – Huffington Post India

Aarav Appukuttan, born a woman, always felt trapped in his own body. Sukanyeah Krishna, born a man, could exactly identify with the feeling of emotional churn and societal pressure growing up. A three-hour wait at a doctor's clinic for consultation for gender reassignment, and snatches of an overheard conversation turned out to be the factors the brought the two of them together for friendship, love and soon, matrimony.

Aarav, 46, is now a man and Sukanyeah, 22, a woman. According to the Hindustan Times, Aarav spent a large part of his school years uncomfortable in his own skin. He used to have long hair and would sit next to the girls in his class, but "felt unnerved by his attraction to them." His gender identity disorder (GID) only got worse, he told the paper, and after he lost his mother and had to take care of his siblings. He knew that he would have to wait before he got help for himself.

"I had to restrain myself and keep my feelings in check for 45 years. I always behaved like everything was normal," he told the paper.

Things have been tough for Sukanyeah as well. Her mother took her to a doctor who started her on male hormone therapy, according to the report. Both Sukanyeah and Aarav endured humiliation and mockery from strangers growing up for not fully embracing the gender they were born with and the transitioning has been tough.

"No one understood what I was going through. During my Class 10 board exams, I fainted owing to the pressure," she told HT.

Sukanyeah was speaking on the phone at the Mumbai clinic in Malayalam when Aarav overheard parts of the conversation. The two got talking and soon a bond of friendship and understanding grew.

"He went to Kerala and I returned to Bangalore, where I had moved two years ago for my job. A day later, Aarav called me and we discussed our surgeries and our treatment in detail. At first, we would speak once a week, then it became twice a week. Soon, we started talking very day," she told Mid-day.

Their mutual desire to help other children with GID, long conversations on phone, and a familiar history of family troubles brought them closer together. They plan to marry next month.

"We are now planning to get married in a temple, with all the rituals. Both our families are happy for us. We have also decided to adopt a child, since we are aware that post surgery I won't be able to conceive," Aarav, who's a tour manager, told Mid-Day.

"We are India's first complete transgender couple and we are happy," Sukanyeah told the Deccan Chronicle.

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Indian Trans Couple, Soon To Marry, Finds Love At Mumbai Clinic While Transitioning - Huffington Post India

Is This Treatment the Cure for Hair Loss? – New York Times

Harklinikken does not advertise, but the 25-year-old multinational company is beginning an aggressive expansion into the $3.6 billion hair-loss market in the United States, meaning youre likely to hear a lot more about it. A New York clinic opened in June inside the Core Club in Midtown (you dont need to be a member to get an appointment); and in August, Harklinikken consultations became available at some 70 Womens Care Florida obstetrics and gynecology clinics. (Roughly 75 percent of the companys 50,000 active users are female.)

Mr. Skjoth said the plan is to have a presence in every state in the next two years. The company recently opened outposts in Tampa, Fla., and Beverly Hills, Calif.

Panos Vasiloudes, a Tampa dermatologist and Harklinikkens medical director, said the company has double-blind, placebo-controlled studies it hopes to publish next year in peer-reviewed journals. Such studies are the one thing some dermatologists say they need to recommend the product to patients.

For now, Maryanne Senna, a dermatologist and the director of the Hair Academic Innovative Research Unit at Massachusetts General Hospital in Boston, said the best she can tell patients who ask and a lot of them do is that Harklinikken wont do any harm.

Dont get me wrong I really want it to work, said Dr. Senna, who also teaches at Harvard Medical School. There arent a lot of options, and Id love to be able to say to my patients, This is something you can try that is worth the money. But I cant do that yet.

Harklinikkens formula, refined over 20 years, is derived from plants and cows milk. Thats the most Mr. Skjoth will say about it. In the 1990s, clients mixed it with Rogaine, Mr. Skjoth said, and then we took the Rogaine part away and started focusing on the actual liquid.

Small studies have shown the efficacy of various plant-derived ingredients, mostly in mice. But two potential explanations for Harklinikkens success have little to do with its formula.

One is how much emphasis the company places on compliance, the major stumbling block in the efficacy of any treatment, said Dr. Senna, an author of studies on the subject. Prospective users are questioned about their ability to stick to a regimen because the extract must be applied every day, and they are told that the more conscientious they are, the better. Users are also reminded and encouraged with regular check-ins.

Clients must also use the companys shampoo, conditioner and styling products, forsaking all others a psychological as well as a financial buy-in, Dr. Senna said. (Mr. Skjoth, who has a masters degree in nutrition and chemistry but is not a doctor, said this is because other products may clog the scalp, causing hair loss.)

Hair changes about as fast as grass grows, which is to say its extraordinarily slow and not visible to anyone checking impatiently in the mirror every day. But during regular follow-up appointments, Harklinikken uses high-tech equipment to photograph and magnify the scalp and count new hairs and active follicles, which motivates users to adhere to the regimen. Too many people give up on treatments like Rogaine and low-level-light devices before theyve had a chance to work, Dr. Senna said.

Its also possible that some of Harklinikkens users are women whose hair would have grown back even if theyd done nothing. Many women who arrive in a dermatologists office with prior diagnoses of female pattern hair loss actually have whats called telogen effluvium. Thats a period of acute shedding of hair meaning up to 60 percent of hair three months after a triggering event like pregnancy, significant weight loss or starting or stopping hormone medications.

Once that hair has stopped shedding, it does regrow, at a rate of about a centimeter a month, said Dr. Senna, who suffered from the condition after each of her pregnancies. She shares photos of herself with patients, to show she can sympathize. In one, her entire frontal hairline clearly is growing back in. If Id used a treatment, I would have thought it was a miracle drug, she said.

Users of the extract say that one of the strengths of Harklinikken is that it doesnt claim to be a miracle.

It wasnt: Youre going to get a full head of hair, said Jon Centella, 35, of Apollo Beach, Fla., who started seeing peach fuzz after four months. It was: Well give you 30 percent, and thats what made me comfortable enough to give it a shot.

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Is This Treatment the Cure for Hair Loss? - New York Times

Woman who was a man to marry man who was a woman – Hindustan Times

Born a girl and now a man, Aarav Appukuttan, a 46-year-old from Kerala, says he was trapped inside a womans body for years. After undergoing a gender reassignment surgery at a Mumbai hospital, he fell in love with Sukanyeah Krishna 22, a man who underwent surgery at the same clinic to become a woman.

Aarav said he decided to eavesdrop while Sukanyeah was speaking to her family on the phone in Malayalam, as he knew the language. A casual conversation between the two led to them exchanging numbers. Their phone calls became more frequent in the coming months and cupid struck.

Neither of them has had an easy childhood. Aarav said he had long hair when he was 13. He would sit next to girls in his class, but felt unnerved by his attraction to them.

He confided in his mother, who took him to a doctor. The doctor said such problems were likely to happen at the onset of puberty, owing to hormonal imbalances. He asked Aarav to wait for a few years before opting for treatment.

However, Aarav, said his gender identity disorder (GID) only became more severe. In the next few years, he lost his mother and knew he had to take care of his siblings before he could focus on his own problems. My father remarried, he said.

I used to hate my body and wanted to cut it sometimes. But, I had to restrain myself and keep my feelings in check for 45 years. I always behaved like everything was normal, he added.

Sukanyeah said she also experienced GID during her childhood. After her father died, her mother took her to a doctor, who started her on male hormone therapy immediately. With the therapy, my facial and body structure changed. I started developing muscles, my shoulders became broader and I lost a lot of hair on my head, she said.

She said she was put on a high-protein diet, meant to aid her muscle development. No one understood what I was going through. During my Class 10 board exams, I fainted owing to the pressure, she said.She dropped out of school, studied software engineering and now works as a freelance web developer.

As the couple awaits their marriage ceremony, their friends say they expect a grand celebration. We wanted a small marriage ceremony, but our friends are asking for a treat. So, we will have a grand wedding. said Aarav.

He adds that he and Sukanyeah want to counsel those whose children are experiencing GID.

Dr Sanjay Pandey, from Kokilaben Dhirubhai Ambani Hospital, Andheri, who operated both of them said those who experience GID are just as normal and competent as we are. The only difference is that they feel trapped in the body of a gender they do not want to be. This is psychologically and emotionally tough, he said.

He said gender reassignment surgery costs between Rs18 lakh to Rs19 lakh in places such as Thailand, where it is popular. In India, it costs between Rs 4 lakh to Rs5 lakh.

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Woman who was a man to marry man who was a woman - Hindustan Times

Pet Talk: A pyometra is a ‘true veterinary emergency’ – Champaign/Urbana News-Gazette

By HANNAH BEERSUI College of Veterinary Medicine

When a middle-aged, intact female dog comes into the clinic with complaints from her owner that she has been depressed and lethargic, one of the first concerns that likely pops into the veterinarian's mind is a potential pyometra.

"A pyometra is a uterine infection, and it is a true veterinary emergency," said Dr. Gary Brummet, the veterinarian who leads the primary care service at the UI Veterinary Teaching Hospital in Urbana.

What causes pyometras

Pyometras develop as a result of hormonal changes that take place in the reproductive tract during the normal hormonal cycle of a female. After an estrus (often referred to as "heat"), a hormone called progesterone remains elevated to assist the uterine lining in thickening in preparation for a potential pregnancy. Sometimes, if there are multiple cycles that persist without a pregnancy, the uterine lining can continue to thicken and secrete fluids, creating an environment that allows bacteria to grow quite well.

"Often pyometras become evident two to three months after the dog's last heat cycle," Brummet said.

Pyometras are categorized as "open" or "closed." In an open pyometra, infectious material leaks from the uterus; owners may notice a bloody, yellow or cream-colored discharge on their dog's fur near the uterine opening or on their bedding. A closed pyometra means that all the infectious material is trapped inside the uterus and builds up.

Symptoms of pyometras

Pyometras are most often found in dogs of any breed between the age of 6 and 10 and may be more common in dogs that have never had puppies. They do not occur in spayed animals, since a spay surgery involves removing the uterus. In extremely rare instances, pyometras can occur in cats.

"Along with appearing fatigued and depressed, dogs may stop eating, spike fever, have an abdomen that is distended and painful to touch, and urinate and drink more frequently," Brummet said.

Bacteria may release toxins that alter kidney function and impair the kidney's ability to manage and retain fluid. This can cause the increased urine production that is often seen and in turn the increased drinking may be the dog's attempt to compensate for the loss in fluid.

If a pup is showing any of these signs, she should be taken to the veterinarian immediately. There is a risk of sepsis with an untreated pyometra. Sepsis is when bacteria from an infection gets into the blood and thus is spread throughout the body via the circulatory system.

Diagnosis and treatment of pyometras

Your veterinarian may elect to do blood work, take a radiograph (X-ray) and/or perform an ultrasound to diagnose the pyometra. Pyometras are most often treated by surgical removal of the uterus.

"Surgery for removing a uterus that has a pyometra is much more risky than a spay. The uterine wall will be fragile, and there is a chance that it could rupture and introduce infectious material into the dog's abdomen during the procedure," Brummet said.

The only sure way to prevent this emergency is to spay the dog.

"The risk of a pyometra is one of the factors owners need to weigh when making the decision to spay or leave the female intact," Brummet said.

An archive of pet columns from the UI College of Veterinary Medicine is available at vetmed.illinois.edu/petcolumns/. Requests for reprints of this article may be directed to Chris Beuoy at beuoy@illinois.edu.

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Pet Talk: A pyometra is a 'true veterinary emergency' - Champaign/Urbana News-Gazette

7 Tips to Help Cope With Your Eating Disorder – TeenVogue.com

I have a radio station in my head. Ten years ago, before I pursued recovery for bulimia, this radio station played very loudly. Today, its still there, but very faint white noise. A vast majority of the time, I dont pay attention to it and keep moving. But sometimes, in quiet moments, it can sound like the radio station is tuned between stationsits mostly grainy, but I can decipher some words. Sometimes I even stop and listen to it for a few minutes.

The radio station, when its discernible, says stuff like exercise every day or you should feel bad for eating that or your bellys disgusting." One of the things I did 10 years ago when the radio station was blaring nearly every day was enter Cognitive Behavioral Therapy, which is a type of talk therapy, according to the Mayo clinic, that helps you recognize negative thinking so you can better cope with challenges. According to a 2010 study published in Psychiatric Clinics of North America, CBT has been found to have a sustained and marked effect on certain eating disorder behaviors, and the Mayo Clinic notes its effectiveness for people with eating disorders in general. Ive teamed up with Cecilia Dintino, Psy.D, a psychologist who practices CBT with many eating disordered patients, to share some of the activities I do whenever Dana FM gets a little too loud.

Lie in bed with a heating pad/hot water bottle. As an eating disordered person, I thought doing anything to my body that wouldnt cause a change in my appearance was pointless. But I learned that getting cozy is a powerful tool.

Dr. Dintino: Placing heat on the body calms the nervous system and soothes the body. Soothing the body calms the mind.

Use Yoga Toes. Sometimes the best thing to do when experiencing negative thoughts is to be still. I sit with these foot stretchers on and read a magazine or watch tv and its great because you cant walk around with them while youre wearing them.

Dr. Dintino: I like this method of instilling stillness. We all have trouble slowing down and when we keep our feet running our brain follows. While you let your toes stretch, practice cultivating a mindful presence. The benefits of mindfulness are plentiful, and include self-awareness, self-control and distress tolerance.

Light a candle/incense/burn some sage. I am a big fan of incense. Ill burn a stick and promise Ill engage in a positive behavior (like cleaning my bedroom) for at least the duration of time it takes for the whole stick to burn.

Dr. Dintino: Smell is the most powerful of the senses and we often underestimate its potency. Observing scents provides focus and soothing. And housecleaning provides many benefits. Fully participating in the activity of cleaning provides a distraction and leads to a sense of mastery. A clean room regulates our bodies and minds.

Hula hoop. Its a low-impact exercise that doesnt feel like exercise. Itll get excess nervous energy out and its difficult to sustain for extended periods of time. Your body will tell you when youre finished. I only hula hoop for the duration of one or two songs.

Dr. Dintino: Love this. Hula-hooping is a form of movement that can serve to shift energy, increase heart variability and get the endorphins flowing. It also takes skill and concentration so the mind has to pivot from automatic thoughts to the strategic rhythm and balance that hooping requires.

Turn on the radio and sing along with it. The best way to drown out the voice in your head is to sing louder than it.

Dr. Dintino: There is endless research declaring musics capacity to elicit, shift and transform emotions. Singing is an ancient method of healing. Every major sacred ritual includes a chant or a song. Singing lowers stress, releases muscle tension and decreases the stress hormone cortisol.

Call a friend. Or even betterwrite a friend a letter. Resist the urge to text; sometimes its better to hear a voice on the other end of the phone. Ive had a pen pal (that I met in eating disorder rehab) for the last 11 years and I love it because its like writing a diary entry without the pressure of keeping a diary and receiving mail is the BEST.

Dr. Dintino: Reciprocal relationships are significantly correlated with well-being and life satisfaction. Contributing to others improves mood. Even thinking about others that we love or love us increases a feel good hormone called oxytocin. Writing down our thoughts and feelings has been proven to promote psychological healing and post-traumatic growth.

Take a bubble bath. I also recommend putting on a face mask because you cant do anything self-harming until it dries (and by the time it dries, you probably wont feel like doing that anyway).

Dr. Dintino: Water is an all-time tincture for emotional distress. Hot water works for anxiety, cold water for anger.Overall, all of these activities will serve to build new habits that in time will replace the old, says Dr. Dintino. Remember, unlearning is harder than learning. Doing new and different things gives our brains and bodies more options.

Related: Lena Dunham Talked About How She Copes With OCD

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7 Tips to Help Cope With Your Eating Disorder - TeenVogue.com

Survey Finds Over Half of American Adults Would Support Their Teenager’s Request to Transition to Another Gender – Markets Insider

CHICAGO, Aug. 16, 2017 /PRNewswire/ --In a sign of growing acceptance for transgender children, a new survey conducted online by Harris Poll on behalf of the American Osteopathic Association finds 53% of American adults would support their teenage child's request to transition to another gender.

Early intervention and family support are shown to improve mental, physical and emotional outcomes for children with gender dysphoria, broadly defined as a conflict between a person's anatomy and the gender with which they identify.

The importance of family"Parents have a significant role in raising transgender kids," says Laura Arrowsmith, DO, who practices at a transgender clinic in Oklahoma. "Once they get on boardoften after stages of denial, rejection, condemnation and griefthey become powerful advocates at school and with extended family. This is crucial to the child's well-being."

Historically, transgender youth and adults experience higher rates of homelessness, substance abuse, HIV infection, depression, anxiety, self-harm and thoughts of suicide than the general population. Rejection by family and community are considered the main catalysts for these issues.

"Watch your child for eating disorders, self-harm, substance abuse and suicidal tendencies," says Dr. Arrowsmith. "A mental health counselor who is familiar with transgender people and local support groups can make all the difference."

Transgender and gender-expansive children do best when their family helps them cope with social pressure and bullying while affirming their journey. Simple actions can ensure a child feels safe and loved. In many cases, patience, support and careful listening are the best 'medicine'.

What parents need to know"Trans children are living in a body that doesn't match how they view themselves," says Dr. Arrowsmith. "To address the dysphoria, some may wish to transition socially or to medically transition through gender-confirmation surgery and/or hormone treatment."

For children who have not reached puberty, gender transition consists solely of social changes like name, pronoun and gender expression.

The clinical protocol for children indicates that when a child who has socially transitioned is "consistently" and "persistently insisting" they are transgender, they can be placed on puberty-blocking medications to postpone physical traits.

These medications prevent the child from developing the secondary sex characteristics of their birth gender, such as breasts for females or facial hair for males. Stopping the onset of puberty is reversible and makes medical treatment simpler if the patient decides to fully transition. On average, adolescents stay on the puberty-blocking medications from one to three years.

"We know that if a child persists through puberty in identifying as the sex not assigned to them at birth, then it's pretty certain that they are transgender," says Dr. Arrowsmith. "Should they decide to change course and stop the puberty-blocking medications, they will simply go through a delayed puberty of their birth gender."

What parents can doParents should understand that early intervention eases transition. A young patient may choose to delay the onset of puberty through puberty blockers, which prevent biological changes and allow additional time to consider transitioningor not. Adolescents who initiate hormone therapy prior to puberty do not require the same level of medical care as a fully developed adult. Females transitioning to males take testosterone while males transitioning to females receive estrogen with an androgen inhibitor. Unlike social transitioning and puberty suppression, hormone therapy is only partially reversible after puberty.

Parents first need to educate themselves on gender dysphoria, gender identity and the complexities of living transgender. Often, support groups are the turning point for families who are struggling with accepting their transgender children, says Dr. Arrowsmith. Once they meet other parents and see children who have transitioned, they are more likely to be supportive.

Support is available to guide families and children through gender transition. Depending on the person's age and individual needs, the steps may include medical, social, surgical and legal changes. For more information, speak with your physician. Additional resources are available online, including the Human Rights Campaign's detailed reference guide Supporting & Caring for Transgender Children.

Survey MethodologyThis survey was conducted online within the United States by Harris Poll on behalf of American Osteopathic Association from June 20-22, 2017among 2,192 adults ages 18 and older. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contactJessica Bardoulas.

About the American Osteopathic AssociationThe American Osteopathic Association (AOA) represents more than 129,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. VisitDoctorsThatDO.orgto learn more.

View original content:http://www.prnewswire.com/news-releases/survey-finds-over-half-of-american-adults-would-support-their-teenagers-request-to-transition-to-another-gender-300505118.html

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Why you should be wary of ‘ovarian reserve testing’ events at fertility clinics – HealthNewsReview.org

Joy Victory is Deputy Managing Editor of HealthNewsReview.org. She tweets at @thejoyvictory.

In Austin where I live, the Texas Fertility Center has been promotinga free ovarian reserve testing event to women who are concerned about their chances for getting pregnanteither now or in the somewhat-distant future.

I caught wind of this promotion, which also was the focus of a recent KTBC Fox 7 Austin news segment, after a friend of a friend shared the clinics post about the event on Facebook.

A recent Facebook post from Texas Fertility Center on ovarian reserve testing.

A quick online search reveals this isnt just going on in Austin. A clinic in Atlanta, for example, offers a monthly seminar open to anyone, where theyll receive a voucher for a Free Blood Test to check their eggs, and a Connecticut clinic held a free event last year for women to take a baby deadline test.

I would urge women (and journalists) to be cautious about these events. For a woman who isnt actively trying to become pregnant, they come with questionable benefits and significant potential risks. These risks arent addressed in any of the promotional materials I read, nor in the KTBC news segment.

What the tests typically measure: FSH (follicle stimulating hormone) and estradiol (estrogen) on day 3 of the menstrual cycle, and AMH (anti-Mullerian hormone), measured any time.

Notably, these tests arent specialtheyre available at most ob/gyn offices. Like any screening test, theyre not perfectly accurateand theyre far from definitive.Theyre considered only part of the testing process to search out causes of infertility.

When marketed by fertility clinics, they take on a different scope: To get new patients in the door. They do this in what I would say is a deceptive way, by framing these tests inaccurately as special baby deadline tests and egg checks and other simplified misnomers that play off the fears of women who arent ready yet to start a family, but may want to one day.

Undergoing these tests at a fertility clinic event can unfold in potentially harmful ways. First, the clinics have a business incentive to encourage their new clients to freeze their eggs or take other pricey steps to preserve their fertility sooner rather than later, regardless of what their ovarian reserve testing reveals.

This was a potential risk we pointed out in our 2016 review of an NBC News story that told female readers they can beat their biological clock with an AMH baby deadline test, but didnt point out any negative consequences of such testing.

Women may act upon the test resultsfor example, undergoing invasive and expensive treatments like egg retrieval and freezingwhen those actions may have not been necessary, reviewers noted.

On the flip side, women who find out they have a normal ovarian reserve may leave the screening event reassured that they should be in no rush to try and have a baby. But thats also potentially harmful, because there are far more factors involved in getting pregnant than what these tests can reveal.

Its false reassurance because other factorsfor example tubal scarring from endometriosis or past infectionthat have nothing to do with the quality of eggs may be the cause of infertility, said Dr. Karen Carlson, MD, a HealthNewsReview.org contributor and Director of Womens Health Associates at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School.

Not to mention male factor that causes about 25% of infertility, she added.

Who should get the tests, and when? Carlson explained that the general clinical guideline is that for any couple where the woman is under 35, fertility is not considered to be a problem until there has a been a full year of unprotected intercourse without a pregnancy. An exception is made if a woman has a history of irregular cycles or other conditions that might predispose to infertility.

Promoting these events to the general public, including anyone who wants to learn more about the test and fertility testing in general, as the Texas Fertility Clinic representative described it in the KTBC interview, will invariably attract women who dont fit the profile for testing.

As pointed out in this in-depth look at ovarian reserve screening in the newsletter OB/GYN Clinical Alert, the evidence indicates that these tests should not be used indiscriminately.

There are several reasons why. One big drawback is that test results can fluctuate considerably from menstrual cycle to menstrual cycle, explains Robert W. Rebar, MD, a professor of obstetrics and gynecology at Western Michigan University. Also, evidence of a lower egg count doesnt necessarily equate with inability to conceive, he noted.

It means that these tests have very little value in providing predictions regarding the possibility of future pregnancy for individual women. It means that we are likely to worry more normal women unnecessarily when suspicious results are obtained on ovarian reserve testing of large numbers of women, he says.

These observations lead to the obvious final conclusion: Use these tests with caution and in limited scope.

Human beings are naturally equipped with a system to regulate fluid intake. Its thirst, and

Cancer recurrence. Antibiotic resistance. Heart failure. Attractivelips. All have been the subject of recently published

Wellness programs in the United States are an $8 billion industry. Over 50 million Americans

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Why you should be wary of 'ovarian reserve testing' events at fertility clinics - HealthNewsReview.org

Alaska Supreme Court denies medical license revocation – Fairbanks Daily News-Miner

FAIRBANKS Alaskas high court has struck down the State Medical Boards medical license revocation for a Fairbanks doctor who specializes in anti-aging and weight loss treatment.

In what had been the states first medical license revocation since 2009, Alaskas medical board revoked Dr. David Odoms medical license in 2014. The board pulled Odoms license after concluding he prescribed drugs inappropriately to his patientSonja Carlson Quebbemann in 2007.Quebbemann died from heart failure about six months after last seeing Odom, but the state investigatorsdidnt directly accuse Odoms treatment of causing her death.

In a 27-page opinion, the courts five justices stated the Medical Board treated Odoms case incorrectly, both intheprocess the board used to pull his license and in the substanceof the boards conclusion that Odoms treatment didnt meet professional standards.

The Medical Boards decisional document is legally insufficient not only with regard to its choice of sanction, but also in its conclusion that Dr. Odom acted incompetently, the court stated in an opinion written by Justice Peter Maassen.

Odom, 74, has been practicing medicine in Palm Springs, California since he lost his licenseto practice in Alaska.Odom said in an interview Friday that he believes the action to take his license was an act of retribution by Banner Health, the nonprofit organization that previously operated Fairbanks Memorial Hospital and the Tanana Valley Clinic. Between 1993 and 2003,Odom fought a legal battle with the hospital over his interest in opening a surgery center in Fairbanks.

In my mind, Banner knewbecause their agent is the one who pursued my licenseand they gave a license to their own employee so basically he could take over my practice, he said.

Odomsaid hed like to come to split his time between California and Alaska practices now that he can practice in Alaska again.

The case against Odomwas based on his prescription of two drugs for weight loss and hormone treatment: the stimulant phentermine, and thyroid hormone drug Armour Thyroid. State investigatorsat theAlaska Division of Corporate, Business and Professional Licensing said Odom prescribed too large of a dose of Armour Thyroid and should not have prescribedphentermine because his patient had cardiomyopathy, a heart condition.

The first judge to hear the case sided with Odom. Administrative Law JudgeAndrew Hemenway concluded in 2014 that the state failed to prove Odoms treatment was below the required standard of care.

However, the Medical Board which ismade up of five physicians, one physicians assistant and two members of the public chose to revoke Odoms license after a meeting in closed-door executive session in June 2014.

In their opinion, the Supreme Court justices stated that revoking Odoms license was too strong a sanction. License revocations are usually caused by offenses like criminal convictions or medical license revocations in other states, the opinion states. In their decision to revokeOdoms license, the State Medical Board went beyond the recommendations of Division of Corporate, Business and Professional Licensing investigators who had suggested a suspension or fine.

In addition, the Medical Board failed to produce a written explanation for its actions as the law requires, the opinion states.

Contact Outdoors Editor Sam Friedman at 459-7545. Follow him on Twitter:@FDNMoutdoors.

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Alaska Supreme Court denies medical license revocation - Fairbanks Daily News-Miner

There is a cure for your child’s lack of growth – Star2.com

Often times when we meet someone who is short, we are likely to think that its just the luck of their genes.

Even if they are much shorter than average, we are likely to brush it off as just being their lot in life.

And that is a problem as some children suffering from short stature can actually be treated.

In a sense, we are fighting for recognition because growth disorders are usually not life-threatening, so they dont get as much immediate recognition and publicity as, for example, cancer, diabetes and problems with neonatal disorders, says University of London, United Kingdom, consultant paediatric endocrinologist Prof Emeritus Dr Martin Savage.

He explains that the growth meant here refers to height, or linear growth.

Short stature is not always recognised or perceived by the general public to be a problem, and a problem that can be successfully treated in some circumstances, he adds.

Universiti Kebangsaan Malaysia Medical Centres Paediatric Endocrine Unit head Prof Dr Wu Loo Ling agrees.

Prof Wu stresses that patients and their family need to start treatment as early as possible and be compliant to it in order to reap the maximum benefits within the limited period of growth the child has.

There are a lot of people out there who can be helped, and yet, they are not getting help.

We actually lack awareness even among the doctors among the public, the parents, even the schools; they are very complacent, they think that we are just small people, she says.

Among the problematic attitudes she has encountered are that the child looks healthy despite being unusually short; that being petite is cute; that the child still has many years to catch up in height, especially when they hit puberty; and that the child is a picky eater and as long as they improve their appetite or take supplements or traditional medicine, they will be fine.

Doctor-shopping is another problem, she says, where parents of an affected child go from doctor to doctor hoping that the next one will tell them what they want to hear.

However, the senior consultant paediatric endocrinologist and diabetologist warns that these attitudes will only result in delayed referral to the right specialist, by which time the child might have missed the window of opportunity for treatment.

What is short?

Our period of growth starts at birth and stops once we hit our mid to late teens on the average, 16 years of age for females and 18 years for males.

Explains Prof Emeritus Savage, who also practices at The London Clinic Centre for Endocrinology: Basically, children grow because in their long bones, which are the bones of the arms, the legs and the spine, there is a layer of cartilage, which is the site of active growth.

This is called the growth plate. And this growth plate is made up of cartilage cells called chondrocytes.

Essentially, a child grows by these cartilage cells developing, differentiating, expanding, and eventually becoming formed as bone.

The cells in the growth plate are triggered by growth hormones, which are produced by our pituitary gland.

The growth hormone circulates around the body until it eventually comes to the growth plate where it is transformed to another hormone called IGF-1 insulin growth factor-1 and it is IGF-1 that actually stimulates the growth plate to expand and grow, adds Prof Emeritus Savage.

Our period of growth ends when our growth plates close and are replaced by bone.

For those with treatable growth disorders, this represents the end of the window of opportunity for treatment.

There are three general causes of short stature: variants of normal growth, endocrine causes and non-endocrine disorders, says Prof Emeritus Savage.

Variants of normal growth include children that are otherwise healthy, but not growing as fast as the rest of their age group, as well as children whose parents are naturally short.

Non-endocrine disorders include chronic conditions like malnutrition and renal failure, chromosomal defects like Turner syndrome, as well as intra-uterine growth retardation (IUGR) and small for gestational age (SGA).

And endocrine causes include growth hormone deficiency and resistance, hypothyroidism and Cushings syndrome, among others.

Short stature, Prof Emeritus Savage explains, is actually a statistical definition.

It is when a childs height is more than two standard deviations from the mean height of children their age, sex and pubertal stage.

Says Prof Wu: Any child who has fallen short of the normal centile below the third centile, as Prof Savage said the shorter the child is, the more likely you are to find a pathological condition in this person.

So any short child, especially a very short one, or those children who are slowly deviating from their centile, are likely to be abnormal.

So they must be recognised, evaluated and investigated, so that the appropriate treatment can be given.

Treatment for three

According to the Health Ministrys 2010 clinical practice guidelines on the subject, the use of recombinant growth hormone therapy is indicated in three conditions: growth hormone deficiency, SGA and Turner syndrome.

Argentinian footballer Lionel Messi was diagnosed with idiopathic short stature as a child and received recombinant growth hormone therapy to achieve his current height. Photo: AFP

Certain countries, like the United States, have also approved the therapy for use in children with chronic renal insufficiency whose height is affected (up to one-third of such patients) and idiopathic short stature, according to Prof Emeritus Savage.

Growth hormone deficiency, as indicated by its name, means that the body is not producing enough growth hormone due to a problem with the pituitary gland.

The problem can be present from birth (congenital), or a result of a tumour, infection, radiation or a severe head injury.

Says Prof Wu: There are a lot of metabolic effects from the lack of growth hormone this person is not just short, but also not well.

She explains that growth hormone deficiency results in the deposition of fat around the abdomen, lack of muscle mass, poor stamina and poor bone health, among others.

In this condition, treatment needs to be initiated as soon as possible after diagnosis.

Meanwhile, SGA means that the baby is born with a length and/or weight that is below the normal range for their gestational age.

This occurs in about 5% of newborns.

We now know that a proportion of these babies do not catch up they stay small. They become small children and small adults, says Prof Emeritus Savage.

As some SGA children do catch up in growth after a while, treatment is only started if the child does not catch up after four years of age.

In the case of Turner syndrome, which affects only females, patients are born with only one fully-functional X chromosome.

Just because they have Turner syndrome, they are already 20%-25% shorter than they would have been without Turner syndrome. Thats almost one foot! says Prof Wu.

This syndrome can be diagnosed at birth, and the affected children one in 2,500 female babies need to be monitored for their growth.

According to Prof Wu, growth hormone therapy is initiated as soon as a drop in their height centile is observed, as this means that their body is no longer able to supply the adequate amount of growth hormone.

She also notes that those who are SGA and those who have Turner syndrome are normal people, saying: They have normal IQs, but they are people of low self-esteem because they are very, very short.

Prof Emeritus Savage agrees: An adult who is abnormally short has major disadvantages physical disadvantages, psychological disadvantages, disadvantages in terms of employment, self-esteem, well-being, etc.

That is what we are trying to avoid (with treatment).

In Malaysia, recombinant growth hormone therapy is available in a number of public and university hospitals across the country.

According to Prof Wu, the treatment, which is weight-dependent and can come up to RM3,000 a month for a teenager, is not free; however, there are limited public and NGO funds available for deserving patients.

Both Prof Wu and Prof Emeritus Savage were speaking to the media at a roundtable after the SEA Growth Summit organised by pharmaceutical company Novo Nordisk in Kuala Lumpur recently.

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There is a cure for your child's lack of growth - Star2.com

Modern Fertility is offering a comprehensive fertility test for women who hope to be moms someday – TechCrunch

There are a number of ways to find out more about your fertility these days including from several at-home fertility test startups that have started to pop up in the last few years.Modern Fertility hopes to soon operate in much the same way, but with a more affordable option for testing 10 key hormones affecting womens fertility.

Though Modern Fertilitys at-home test wont be available till later this year, you can pre-order it on their website for $149 though the price will go up after the pre-order at a yet-to-be determined date. Should you want to get started now, the startup also offers the comprehensive screening through a lab near you, though its not clear what the price is for that.

The kit includes checking your hormone levels for:

Anti-mullerian hormone (AMH)

Follicle stimulating hormone (FSH)

Estradiol (E2)

Luteinizing hormone (LH)

Thyroid stimulating hormone (TSH)

Free thyroxine (FT4)

Progesterone (P4)

Prolactin (PRL)

Free Testosterone (Free T)

Total Testosterone (T)

Modern Fertility competitor Future Family, a startup offering financing optionsfor egg freezing and IVF procedures, also sells two separate fertility tests you can take at home. The first test kit goes for $300 and includes the three most key hormone tests: AMH, FSH and E2. Future Familys second test, Fertility Age Test Plus, includes testing for the first three hormones and three tests for thyroid dysfunctions TSH, TPO (thyroperoxidase) and T3/T4. (triiodothironine andthyroxine levels) for a similar price.

Everlywell, a startup offering myriad home health tests, includes a similarly comprehensive fertility kitas Modern Fertility for $400, but with 11 hormone tests and not all of them are the same ones.

Half the price for more hormone testing seems like a deal. However, theres a hot debate among these startups over just how many of these hormone tests, and which ones, are necessary. Everlywell, for instance, doesnt include AMH because they consider that only necessary if you are about to undergo IVF. Future Family told TechCrunch only the three key tests are necessary unless you need thyroid testing, because the other hormone tests are widely accepted by doctors as not being true indicators of fertility.

How does each startup determine what is necessary? Everlywell and Future Family are staffed with a chief medical officer to guide them. Modern Fertility is currently in search of the same, but says it pulls its information from medical advisors and has held initial conversations with fertility doctors.

Obviously, ask your doctor which kit is right for you (or if theres another they suggest). The overall goal for all three is the same empower women with knowledge about their fertility.

Modern Fertilitys main target is young women who want a family someday, but not necessarily today.

Were building a test that makes this info accessible to women early in their lives,co-founder Afton Vechery said. We believe that information is the first step.

Vechery, who was a product lead at 23andMe before starting Modern Family, says she became interested in the space after doing some due diligence in the infertility space for a healthcare private equity firm earlier in her career.

Thats when I learned the emotional aspect of infertility. Its crazy to me that infertility is not seen as a medical condition in the majority of the U.S. and that such a small percentage of women get the education and services they need to start a family, she said. Thats the part that stuck with me.

She then went through some testing at a clinic to find out more about her own fertility. That was an impactful moment for her. That is, until she got the $1,500 bill in the mail.

As I started talking to more women it was clear there was a lot of anxiety over fertility but no way to afford to test it, Vechery said. Every woman should have access to this information that is a better predictor than just our ages.

Modern Fertility is currently in Y Combinators latest batch. You can catch them later this month at YC Demo Day.

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Modern Fertility is offering a comprehensive fertility test for women who hope to be moms someday - TechCrunch

Elevated TSH level doesn’t always mean medication is necessary – Post-Bulletin

DEAR MAYO CLINIC: I started taking levothyroxine more than five years ago for hypothyroidism. I had my TSH level tested about six months after I began taking it but have not had it checked since. I recently read a study saying this medication is often prescribed even when it's not necessary. Should I see my doctor to be retested?

Yes. Make an appointment to have your condition re-evaluated at this time. For some people, lifelong treatment of hypothyroidism with the drug levothyroxine is necessary. But studies have found that for many others who have elevated levels of thyroid-stimulating hormone, or TSH, the medication isn't needed. In fact, if it's taken incorrectly or in doses that are too large, levothyroxine can cause harmful side effects.

Your thyroid is a small, butterfly-shaped gland at the base of the front of your neck. The thyroid gland makes two hormones -- triiodothyronine, or T3, and thyroxine, or T4 -- that have a large impact on your health, affecting all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins. The rate at which your thyroid makes T3 and T4 is regulated by another hormone that your pituitary gland produces, called TSH.

Hypothyroidism, sometimes called underactive thyroid, is a condition in which your thyroid gland doesn't produce enough T3 or T4. When blood tests show that you have high levels of TSH and low levels of T3 or T4 in your body, then a diagnosis of hypothyroidism is clear. Treatment with levothyroxine -- a synthetic version of thyroid hormones -- is necessary in almost all cases. But hypothyroidism is rare, affecting only about 0.2 percent of the population.

Much more common, affecting about 12 percent of the population, is a condition known as subclinical hypothyroidism. With this condition, your TSH level is above normal, but T3 and T4 levels are normal.

If a blood test shows you have subclinical hypothyroidism, and you don't have any symptoms -- such as fluid retention, fatigue, increased sensitivity to cold, constipation, muscle weakness or painful joints -- treatment typically is not recommended. There are a few reasons for that.

First, about 30 percent of people whose condition falls into the category of subclinical hypothyroidism have their TSH levels return to normal within one year without treatment. Only 3 percent per year go on to develop hypothyroidism. Second, if you take too much levothyroxine or if you don't take it correctly, it can negatively affect a variety of your body's systems, including your brain, heart and muscle function. It also can interfere with how your body handles fluid and fats.

If, as in your case, you are receiving treatment for hypothyroidism, it's important to have regular checkups. Testing TSH is one way to see if treatment is working. It's also important for your health care provider to check your T4 levels.

Talk with your health care provider about the goals of treatment, too. If you started taking levothyroxine to control symptoms, make sure that you are seeing some benefit. Also, keep in mind that the symptoms of hypothyroidism often can be vague. If your symptoms don't go away when you're taking thyroid medication, it's possible those symptoms could be linked to another medical condition.

Getting your TSH and T4 levels checked and reviewing any symptoms you may have with your health care provider should help clarify whether you need to continue taking levothyroxine. -- Juan Brito Campana, M.B.B.S., Endocrinology, Mayo Clinic, Rochester.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ&A@mayo.edu. For more information, visit http://www.mayoclinic.org.

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Transgender clinic for kids and teens opens in St. Louis | WGN-TV – WGN-TV

St. Louis is now home to a first-of-its-kind clinic for transgender teens and kids. It's being administered by Washington University Physicians based out of St. Louis Children's hospital.

St. Louis is now home to a first-of-its-kind clinic for transgender teens and kids. It's being administered by Washington University Physicians based out of St. Louis Children's hospital.

St. Louis, MO St. Louis is now home to a first-of-its-kind clinic for transgender teens and kids. Its being administered by Washington University physicians based out of St. Louis Childrens hospital.

The clinic aims to provide transgender children and teens with comprehensive health care including mental health resources, hormonal therapy, voice therapy, and reconstructive surgery. Washington University physicians have been taking care of transgender children and teens since 2009 and noticed the growing demand which sparked the push to establish a fully operating clinic.

In 2016, Washington University physicians had 74 transgender patients. From just January to May 2017, theyve already seen 71 patients.

This clinic is a huge milestone for the Seay family this month, especially for 15-year-old Leslie.

Sometimes I identify as a girl, sometimes a boy, sometimes neither, said Leslie Seay.

She started exploring gender identity at 13-years-old, ultimately assigning to being gender fluid, which means she will always feel a mix of identifying between a boy and a girl.

I would really like to go on hormone blockers so that my voice doesnt get any more feminine and [no] more feminine features show up, said Seay.

Leslies identity is simple to her, so she needs a pediatrician who understands transgender health simply too.

Having support and acceptance is extremely important for this patient population, said Dr. Christopher Lewis, founder and physician of the Transgender clinic. Transgender patients already deal with harassment and discrimination within the medical community and that is a barrier to them accessing care.

Leslies dad, Peter Seay, is thrilled to know his child is in safe, supportive care with an expertise in transgender health.

To find out that the gender center was opening this month was something weve been celebrating for a little while. Weve been very excited about this, said Peter Seay. There could not be a greater value, the gratitude will not stop.

The Transgender Center of Excellence opened the first week of August. They are already booked through mid-September with new patient appointments. Its the only clinic of its kind within a 250-mile radius.

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Transgender convict in Hokkaido asks to be treated as female inmate – The Japan Times

SAPPORO A 38-year-old transgender woman in Hokkaido who has been convicted of theft has asked the Justice Ministry and local prosecutors to be treated as a female inmate, despite being listed as male in her family registry.

She has been living as a woman and wants to be supervised by female prison officers while continuing hormone treatment, a source close to her said Tuesday.

She was indicted last year without arrest for shoplifting in the city of Sapporo. A district court handed down a prison sentence of 18 months, and the judgment was upheld by a high court. In July, the Supreme Court rejected an appeal and the woman is set to be imprisoned soon.

She also served 16 months in prison between 2011 and 2013 for theft, and complained of mental anguish as a result of being overseen by male prison guards as well as palpitations and insomnia after being deprived of hormone therapy.

Prisons are determined according to sex as recorded in family registries, but transgender women can be overseen by female officers if they have had male genitalia removed, according to the Justice Ministry. The woman in this case has not completed transition nor changed her family registry.

The ministrys Correction Bureau said male officers would normally oversee an inmate in a similar situation unless the head of a prison determines otherwise. But it added that it has paid due consideration to people in similar circumstances such as by assigning female officers if necessary.

Regarding the hormone treatment, the bureau said it is not the states responsibility to allow it unless there would be irreparable damage and the bureau determines there is a necessity to do so.

Mikiya Nakatsuka, professor at Okayama University and a specialist on transgender issues, said the government should be more flexible regardless of whether an inmate has undergone surgery.

Hormone therapy is crucial for maintaining health, so the government should seek the opinions of doctors (working with) gender identity disorder, Nakatsuka said.

According to research led by Katsuki Harima, a doctor at Harima Mental Clinic, about 22,000 people consulted medical institutions due to GID as of the end of 2015.

Requests from around 6,000 people to change their sex on their family registries had been accepted as of 2015. A special law came into force in 2004 permitting such changes if one applies to a family court.

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Transgender convict in Hokkaido asks to be treated as female inmate - The Japan Times

New clinic to offer range of health care to help transgender children – St. Louis Public Radio

A group of St. Louis doctors is working to make sure transgender kids get the medical care they need.

When the Washington University and St. Louis Childrens Hospital Transgender Center of Excellence opens today, it will be the first of its kind in a 250-mile radius. The clinic aims to provide transgender children with comprehensive health care including pediatric medicine, endocrinology, and mental health counseling.

Staff members will include people equipped to help transgender patients navigate hormone therapy and understand their identities.

This is really a vulnerable group of kids who need specialty expertise and people whove really spent the time to learn more about these issues and concerns, clinic co-founder Dr. Sarah Garwood said. Theres a problem with access to health care for transgender kids and adults and clinics like this can help mitigate that.

Willis Ryder Arnold reports on the Washington University and St. Louis Children's Hospital Transgender Center of Excellence and the role it will play in young people's lives.

The clinics staff members will see patients at St. Louis Childrens Hospital and the St. Louis Childrens Specialty Care Center.

Such services have been long anticipated by St. Louis area parents like Peter Seay, whose child was long considered a girl but in middle school decided to identify as a boy.

Aiming to be supportive, Seay looked for a doctor to provide appropriate care. But finding one isnt easy. Some doctors think being transgender is a problem.

And I mean some doctors we called were like, sure we can fix your kid, recalled Seay, who said that was a terrible thing to hear.

Dr. Garwood and Dr. Chris Lewis developed the clinic with help from Washington University Medical School, St. Louis Childrens Hospital and a growing network of similar clinics located throughout the country.

Families with transgender childrenface a number of hurdles when seeking care, among them insurance obstacles, Garwood said. Many doctors remain ignorant of proper care for transgender individuals and available support systems. Some patients face outright discrimination.

Garwood helped set up the clinic, motivated by an exponential increase of referrals over recent years. She said early intervention is necessary to ensure transgender kids lead the healthiest happiest lives possible.

Follow Willis on Twitter: @WillisRArnold

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New clinic to offer range of health care to help transgender children - St. Louis Public Radio

Couple and a new partner share love of Ahwatukee, better health – Ahwatukee Foothills News

Todd and Jen Winton have a clear vision of why Ahwatukee is the perfect place for their practice.

The husband-wife doctors he a naturopath and she a chiropractor consider it a community of people who are as committed to healthy living as they are to helping people achieve it.

Ahwatukee has a very friendly community, said Jen. People are genuinely interested in their health and are continuously looking for natural alternatives to drugs and surgery. They find many answers in our clinic to get healthy and stay active.

Jen Winton opened the practice, Active Lifestyle Clinic, at 16515 S. 40th St., Ahwatukee, not long before they married about six years ago, having met on the online dating site eharmony.com.

Now theyve added a partner, Dr. Keith Smith, who is returning to Ahwatukee eight years after he sold his 10-year-old Ahwatukee Life Center.

The Wintons take healthy living seriously even when theyre not at work.

Theyve marched in demonstrations against genetically modified food, and load their website, activelivingcenter.com, with tips and products aimed at helping people live a healthier life.

Smith shares that philosophy, even though he had never met the couple until he began working with them, motivated by a desire to get back into chiropracty.

He had sold his business to open a wellness practice that concentrated on nutrition and weight loss.

Many people are hungry for information on vitamins, nutrition and eating healthy but dont know where to start, he said. I am passionate about sharing this information and helping people get back to basics with food.

The Wintons, parents of two boys ages 3 and 5, have both been practicing for more than 15 years.

She graduated from Palmer West College of Chiropractic Smiths alma mater as well in 2003 and also holds a bachelors degree in psychology from the University of Washington.

Her husband attended Southwest College of Naturopathic Medicine, graduating in 1999.

Jen Winton practices chiropractic with a focus on family care.

Her husband focuses on the most conservative treatments, specializing in male and female hormone balance using bio-identical hormones, natural pain relief using prolotherapy and ozone injections and weight loss.

The naturopathic aspect is very intriguing to most folks since male and female hormone imbalance is so rampant, she said, adding that her husbands natural pain injections and his other treatments are very effective at healing joints and preventing surgery."

Before she had met her husband, Jen Winton had bought a small practice from Dr. Janelle Perkins in Ahwatukee at Ray Road and Ranch Circle, and soon found it grew exponentially to where she needed more space.

She relocated to the 40th Street location off Frye Road and by that time picked up her new partner in life as her partner in the practice.

Over time, they have found that one of their biggest challenges has involved the insurance industry.

We used to rely on insurance sending us patients through their network listings, she explained. Insurance in Arizona has changed so much in the world of chiropractic that most do not cover it anymore.

So theyve developed a program offering low rates such as $25 for an adjustment and $65 for naturopathic care to counter the effects of those changes.

Jen Winton and Smith also have teamed up with local restaurants, such as Pita Jungle, Hillside Spot and Pomegranate Caf, to offer health-related lunch workshops to businesses in Ahwatukee and the surrounding area.

Smith said hes glad hes hitched up with the Wintons because they share his commitment to helping people live healthier lives and because of their location.

We all have a very similar philosophy, care for patients and make care affordable, he said. Plus, I have practiced in Ahwaukee for years and really enjoy the community.

Information: 480-704-1050, ActiveLifestyleClinic.com

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Couple and a new partner share love of Ahwatukee, better health - Ahwatukee Foothills News

Is clomid a hormone drug – Side effects of medicines are always the same for everyone – Van Wert independent

Submitted information

OHIO CITY The Ohio City Park Association and the Lambert Days Committee has finalized plans for the 2017 festival.

Lambert Days is always the third full weekend in July. This years dates are July 21-23. This is also the 50th anniversary of Ohio Citys celebration of the life of John W. Lambert and his invention of Americas first automobile.

This years edition of Lambert Days will feature a communitywide garage sale. For more information, contact Laura Morgan at 419.965.2515. There will also be food all weekend in the newly renovated Community Building on Ohio 118.

Friday, July 21

Festivities start off with a steak dinner (carryout is available), starting at 4 p.m. Friday. Ohio Citys American LegionHarvey Lewis Post 346 will have aflag-raising ceremony at 5 Friday evening, while kids games and inflatables will also open at 5. At 6 p.m., the Lambert Days Wiffleball Homerun Derby will take place. For more information, contactLorenzo Frye 419.771.7037.

There will also be entertainment at 6 p.m. featuring Cass Blue. At 7, there will be a adult Wiffleball tournament. For more information, contact Brian Bassett419.203.8203. A Texas Hold em Tournament will begin at 7 p.m. Friday, along with Monte Carlo Night, which begins at 8 p.m. For more information, contact Jeff Agler at 419.513.0580.

Entertainment for Friday night starts at 8 and will be the band Colt & Crew. There will also be a fireworks display at 10:15 p.m. Friday (Saturday night is the rain date).

Saturday, July 22

Saturday morning begins with a softball tournament at 8. For more information, contact Brian Bassettat 419.203.8203. There will also be a coed volleyball tournament that starts at 9 a.m. Saturday. For more information, contact Tim Matthews at 419.203.2976. The Lambert Days Kids Wiffleball Tournament starts at 10 a.m. Saturday. For more information, contact Lorenzo Frye at 419.771.7037.

Kids games and Inflatables continue at 11 Saturday morning. Cornhole tournament registration and 3-on-3 basketball tournament registration start at noon, while both tournaments begin at 1 p.m. For more information on cornhole, contact Josh Agler at 567.259.9941 and for 3-on-3 basketball, contact Scott Bigham at 419.953.9511.

The Hog Roast Dinner starts at 4 p.m. Saturday and carryout is available. There will also be music under the tent by Jeff Unterbrink at 4. Bingo will start at 5 p.m., and the night ends with entertainment by Megan White and Cadillac Ranch.

(more)

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Is clomid a hormone drug - Side effects of medicines are always the same for everyone - Van Wert independent

Number of children being referred to gender identity clinics has quadrupled in five years – Telegraph.co.uk

Research suggests that just one per cent of the population experience gender issues. Although the number of transgender children is small, it is growing rapidly, she told the Telegraph Festival of Education last month.

Children - encouraged by their experiences at school - are beginning to question their gender identity at ever younger ages.

"In doing more than just supporting transgender children, and instead sowing confusion about gender identity, schools do neither boys nor girls any favours."

Dr Williams added that the growing number of young children being referred for gender counselling stemmed from new policies being adopted by schools, adding that schools were now encouraging even the youngest children to question whether they are really a boy or a girl.

Dr Polly Carmichael, a leading NHS psychologist and director of the GIDS, defended the teaching of transgender issues in schools.

She told The Sunday Telegraph: It is good that schools are putting it on the agenda. It can never be negative if schools are being thoughtful and offering opportunities to discuss topical issues.

She added that gender is a complex subject, and children should only be taught about it in schools in an age appropriate manner.

Children can only be referred to GIDS by their GP or by the child and adolescent mental health service.

After six months of psycho-social assessment by a clinician, an action plan would be drawn up, which could be continuing with counselling, or it could be a physical intervention.

Children who have started puberty, from around the age of 12, can be referred on to an endocrinology clinic which can prescribe a course of hormone blockers, which postpones puberty.

Children aged 16 and over could be given cross-sex hormones, which would enable them to take on the physical characteristics of the opposite sex.

More than double the number of teenage girls compared to boys are referred to the GIDS, while in the younger age groups it is more common for boys to be referred.

Dr Carmichael said one possible explanation is that young girls who display more male attributes are seen as tomboys and so are less likely to be seen as a cause for concern among parents.

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Number of children being referred to gender identity clinics has quadrupled in five years - Telegraph.co.uk

Prostate cancer that spreads typically occurs in lymph nodes and bones – Post-Bulletin

DEAR MAYO CLINIC: I am 63 and was diagnosed with prostate cancer two years ago. I had my prostate removed shortly after the diagnosis. I found out recently the cancer is now in my lymph nodes. What can I do to prevent it from spreading further?

When prostate cancer spreads out of the prostate gland, the most common places for it to occur are in the lymph nodes and bones. Although prostate cancer that has spread can be difficult to cure, treatment is available that may help slow or stop further spread of the cancer.

Prostate cancer is cancer that occurs in a man's prostate gland a small walnut-shaped gland that makes fluid to nourish and transport sperm. Prostate cancer is one of the most common types of cancer in men. It often grows slowly and remains confined to the prostate gland in its early stages. But the cancer may spread if cancer cells break away from the tumor in the prostate and travel to other areas of the body through the lymph system or the bloodstream.

When prostate cancer spreads to the lymph nodes, as in your case, treatment often includes hormone therapy. Radiation therapy or surgery may be necessary in some people, too, depending on an individual's circumstances.

Hormone therapy stops your body from making the male hormone testosterone or blocks the effects of testosterone on prostate cancer. This is useful, because prostate cancer cells rely on testosterone to help them grow. Cutting off the hormone supply may cause the cancer to shrink or help to slow its growth.

Hormone therapy for prostate cancer often includes taking medication that prevents the testicles from receiving messages to make testosterone. Those medications are called luteinizing hormone-releasing hormone, or LH-RH, agonists and antagonists. Examples of these drugs include leuprolide, goserelin and degarelix.

Other medications that block testosterone from reaching cancer cells may be given along with a luteinizing hormone-releasing hormone agonist or given before taking a luteinizing hormone-releasing hormone agonist. These medications are called anti-androgens. Examples include bicalutamide, enzalutamide, flutamide and nilutamide.

Hormone therapy usually is continued for as long as the treatment works. Over time, prostate cancer may adapt to hormone therapy and begin growing despite treatment. If that happens, your doctor may suggest a different combination of hormone therapy drugs to see if the cancer responds.

Depending on where the cancer has spread, along with other factors, radiation therapy may be combined with hormone therapy to treat prostate cancer that affects the lymph nodes. Radiation therapy uses high-powered beams of energy, such as X-rays or protons, to kill cancer cells.

The kind of radiation used to combat prostate cancer that has spread is called external-beam radiation. It uses a large machine that moves around your body to direct energy beams at the areas affected by cancer. External beam radiation treatments typically are given five days a week for several weeks or more.

In addition to hormone therapy and radiation therapy, in some cases, chemotherapy also may be recommended to treat advanced prostate cancer. Immunotherapy, which uses the body's immune system to kill cancer cells, also may be useful in certain situations.

Your specific treatment likely will be based on how fast the cancer is growing and how much it has spread, as well as your medical history, overall health and other treatment you've received. Your doctor can talk with you in detail about possible treatment options, as well as their risks and benefits. Working together, you and your doctor can create a treatment plan that best fits your needs. J. Fernando Quevedo, M.D., Medical Oncology, Mayo Clinic, Rochester.

Mayo Clinic Q & A is an educational resource and doesnt replace regular medical care. Email a question to MayoClinicQ&A@mayo.edu. For more information, visit http://www.mayoclinic.org.

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Prostate cancer that spreads typically occurs in lymph nodes and bones - Post-Bulletin

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