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Archive for the ‘Hormone Clinic’ Category

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

Joy Victory is Deputy Managing Editor of 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 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 -

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 –

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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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& For more information, visit

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

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

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,, 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,

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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

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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.


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 –

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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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& For more information, visit

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

Surprise Period Hormones Don’t Scramble Your Brain –

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Its hard to get away from stereotypes connected to our periods. The trope of women being angry, emotional and even less able to perform on the job during that time of the month is old and tired, but it persists. Even the president of the United States cant seem to stop bringing up blood in connection with prominent women he wants to disparage. Now, a first-of-its-kind study published July 4 in Frontiers in Behavioral Neuroscience provides some scientific proof for what most people with periods already know: Our hormones dont keep our brains from properly functioning.

More:What's happening to your body each day of your menstrual cycle

Researchers at University Hospital Zrich, led by Dr. Brigitte Leeners, monitored the estrogen levels of 68 women of varying ages throughout two menstrual cycles. During their periods, the subjects participated in neuropsychological tests to measure their visual memory, attention and cognitive bias. The researchers didn't take into account things like food cravings, emotions, or sexual stimuli for this study, because those measures "do not assess prefrontal cognitive abilities." They found no meaningful connection between estrogen levels and cognitive function. The biggest takeaway came from comparing the two cycles: Even when a person experienced some cognitive discomfort during one cycle, that same person often did not experience the same thing during the next period.

More:Periods don't stop women from becoming leaders negative stereotypes do

Previous studies looked at only one menstrual cycle, introducing bias and ultimately fueling stereotypes, according to Leeners.

They resulted in false positive associations and the false conclusion that womens cognitive performance is hormone regulated, she said. Such an assumption is the background of the myth that womens cognitive performance is strongly influenced by the menstrual cycle and any resulting prejudice toward womens abilities in private and professional life.

More:Premenstrual Dysphoric Disorder May Be Linked to How Cells Process Sex Hormones

These findings are great for science because they answer a big question that many researchers have blamed for a lack of research into womens health issues the difficulty of controlling for menstruation when studying pretty much anything else about the body or mind. Much medical research, for example, is done on men in part because researchers are reluctant to have to control for periods and because especially in the U.S. digging into potential gender differences in the body and brain is often controversial.

Dr. Louann Brizendine, a neuropsychiatrist and author of the books The Female Brain and The Male Brain, said the results seem to confirm decades of experience. She has found that about 80 percent of women report feeling more uncomfortable physical and mood symptoms during some cycles than during others, but only about 8 percent report debilitating noticeable discomfort during every period. That 8 percent is typically the group that makes its way to Brizendines clinic, the Womens Mood and Hormone Clinic at the University of California San Francisco. Brizendine opened the clinic in 1988 and says she hoped that by now there would be copycats around the country. Thats not yet the case, but she is hopeful that increased interest and funding for womens health will change that.

Dr. Mary Jane Minkin, an OB-GYN and professor at Yale University School of Medicine, cautions that this new research shouldnt keep doctors from taking menstruation-related health complaints seriously. Premenstrual dysphoric disorder, which causes significant and life-affecting mood shifts before ones period, affects about 5 percent of women and is often misdiagnosed. But the good news is that those symptoms and others such as cramping can usually be addressed with birth control, an SSRI or in some cases over-the-counter medication.

Ive been in practice since 1979, and I can honestly say I dont think Ive ever taken care of a patient in my life who was significantly impaired by one part of her cycle that she couldnt put her finger on the atomic button, Minkin told SheKnows. There are hormones at play with memory and cognition, but I dont think its anything that cant be overcome. Do some women feel depressed? Yes. Debilitated? No.

Next, Leeners team in Zrich plans to look into the science behind hormonal cravings. But for now, let's stop discounting the mental capacity of people who menstruate, OK?

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Surprise Period Hormones Don't Scramble Your Brain -

Does Having My Thyroid Removed Affect My Heart? – Health Essentials from Cleveland Clinic (blog)

Q: Does having my thyroid removed affect my heart?

A: The thyroid is really important because thyroid levels control your energy level and heart rate, your bowel function and your concentration. When you have your thyroid removed, its really important to replace the thyroid hormone to the appropriate amount so you can still function normally. Your endocrinologist, primary care doctor or your cardiologist should be checking your thyroid hormones level, which is called the TSH, to make sure its where it needs to be. With too much thyroid hormone, your heart may be racing. If you have too little, your heart pumping function may be reduced. In extreme situations, you may even have very low energy and have something called myxedema coma. These are just a few examples of the effects of thyroid hormone on the heart.

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

Preventive cardiologistHaitham Ahmed, MD, MPH

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Does Having My Thyroid Removed Affect My Heart? - Health Essentials from Cleveland Clinic (blog)

On a midnight stroll, activists reach out to Hollywood’s transgender and homeless population – Los Angeles Times

It was close to midnight Friday when the volunteers got off an MTA bus and began their two-hour walk through Hollywoods streets.

Starting at Western Avenue and armed with clothing vouchers, granola bars and condoms, they headed down Santa Monica Boulevard in groups, turning onto side streets and peering into alleys.

Less than five minutes in, Teanna Herrera who works as an advocate for transgender people at St. Johns Health Center in Santa Monica was encouraging two people on a bus bench to visit the clinic to learn about hormone therapy.

Ive done what theyre doing, said Herrera, 49, explaining that she had been a prostitute on those same streets at age 16. [I want] to let them know: I know what its like to be out here and theres hope for every one of us.

Several dozen volunteers have met five times since January for the Midnight Stroll an initiative organized by various LGBTQ groups and Los Angeles city agencies that reaches out to those on the street, including transgender sex workers and the homeless population.

City Councilman Mitch OFarrell participated in Fridays walk, which started with an orientation at Blanks 2nd Stage Theatre. On the walk back from Western Avenue, the volunteers invited those they met on the streets to come back to the theater for food; a mobile HIV testing unit was parked nearby.

We really want to get them on a different path, said Jazzmun Crayton, an HIV testing counselor with the Asian Pacific AIDS Intervention Team. Once you have a record, its very difficult to continue to navigate through the various systems that are in place.

The Midnight Stroll grew out of discussions between the LAPD and transgender community leaders, two groups whose relationship has improved significantly in recent years, said Karina Samala, chair of the Transgender Advisory Council. Community leaders have assisted in training police on how to interact with transgender individuals, including respecting their preferred gender identity.

Habib Munoz, a sergeant in the LAPDs Hollywood Division, said the department receives complaints about transgender prostitution especially on Santa Monica between Western and La Brea avenues.

By providing some kinds of outreach services, hopefully were able to get people out of that lifestyle, Munoz said. We do have a group of people that need help and we want to help them but at the same time, there are crimes being committed. And those crimes are affecting the community.

Brian van der Brug / Los Angeles Times

Jazzmun Crayton rides an MTA bus to begin Friday's Midnight Stroll walk at Santa Monica Boulevard and Western Avenue.

Jazzmun Crayton rides an MTA bus to begin Friday's Midnight Stroll walk at Santa Monica Boulevard and Western Avenue. (Brian van der Brug / Los Angeles Times)

Many of the transgender people the volunteers encounter are homeless. According to a survey by the city this year, 1% of the homeless respondents identified as transgender.

When our communities are not accepted by their own families theyre finding themselves homeless, said Jim Wen, who heads the Transgender Advisory Councils housing and homelessness committee.

About an hour into Fridays stroll, some of the volunteers stopped in front of a homeless encampment, calling out offers of free food and clothing.

Gia Olaes, who works with incarcerated transgender individuals with the Center for Health Justice, talked with Kay a 20-year-old she knew from seeing him at the Los Angeles LGBT Center.

Some of them have temporary housing, but they relapse, said Olaes, who once was homeless herself. Its about letting them know that this is a time to change.

About an hour later, Olaes came across Mimi, a 23-year-old transgender woman who said she dreams of helping others by opening a transgender homeless shelter.

Mimi who wore a black dress and red Converse sneakers said she had been on a waiting list at the LGBT Center for two months and planned to visit other shelters next week. In public shelters, she said, its difficult to be housed according to her gender identity.

Thats why I want my own shelter, she said. Because I know what its like.

Olaes offered encouragement.

Come see me, she told Mimi.

Twitter: @leilamillersays

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On a midnight stroll, activists reach out to Hollywood's transgender and homeless population - Los Angeles Times

Bio-Identical Hormone Therapy – Z Med Clinic

Natural -BioIdentical -Hormone Replacement Therapy

Many of the most common signs of aging includingfatigue,weight gain, joint pain, and poor libidoare a direct result of a loss of hormones in our bodies. As we grow older our hormone production slowly decreases, leaving us feeling much different than we did in our youth. As a solution, natural hormone replacement therapy can be used to help replenish hormone levels and reverse the effects of aging.


At Z Med Clinics(Internet Medical Clinics ) we have a unique approach to hormone replacement therapy as a part of our anti-aging program:


Hormone levels are optimized for each individual on a bell curve, very much like the way the bell curve is used in school grading. For example, when you take a test in school your grade depends on where your score fell along the bell curve. Although the students who were on the low end of the bell curve passed, they didn't do as well those who were at the upper end.

This works very much the same way with hormone levels. When you are tested for hormones most laboratories look at whether or not you fall within a "normal rage". However, these ranges are not scaled based on a patient's age, race, sex, or other underlying medical factors. Therefore, they most often are an inaccurate representation of how well your hormones are working in your body.

When we are younger we tend to have hormone levels at the upper end of the bell curve. However, as we age our levels begin to decline, sliding us further and further down the curve. At Z Med Clinic (Internet Medical Clinics ) our healthcare providers help replace patient hormone levels until they are back up to the upper end of the curve, just like when you were younger.

For example:A patient may present with symptoms of of thyroid hormone deficiency such as weight gain, fatigue, depression and fluid retention, but have a thyroid hormone level within a "normal range". In most cases this patient would not be treated with thyroid hormone replacement, but rather with medications to combat the symptoms such as anti-depressants. However, at Internet Medical Clinics our specialists recognize that although this patient hormone was within normal ranges, it was at the low end of the bell curve and needed hormone replacement to bring it back up to the upper end. This sort of hormone optimization would alleviate all of those symptoms due to a decrease in thyroid hormone production.

Click hereto learn more about menopause hormonal optimization in women.


Estrogens are hormones that cause feminizing effects in the body. There are hundreds of different types of estrogens available in nature and created synthetically; however there are only two that are made naturally in women: Estriol and Estradiol. According to a large research study conducted on women and hormones, these are the only two that can be safely used in replacement therapy. Other synthetic or plant estrogens such as Premarin, Premphase and Prempro can cause significant health risks when used in women.

At Internet Medical Clinics we use bio-identical hormone replacement, which means natural estrogen and progesterone, in order to ease symptoms of pre-menstrual syndrome, hot flashes, night sweats, vaginal dryness, mood swings, fatigue, poor energy, slow metabolism, weight gain, an inability to focus and concentrate and other discomforts associated with menopause. Natural bio-identical estrogen and progesterone can be taken as a cream or capsule or through the insertion of a timed-released pellet under the skin placed three to four times a year.

Humans make 2 kinds of thyroid hormones: Thyroxine 3 and Triiodothyronine 4. When a patient is suffering from insufficient thyroid hormone he or she may experience weight gain, poor energy levels, hair loss and hair thinning, swelling, cold extremities, depression and sleep disturbances. Natural thyroid replacement given twice daily as an oral tablet can help alleviate these uncomfortable symptoms.

Testosterone and DHEA are two types of hormones known as androgens, which cause masculinizing effects on the body. Both plants and animals make many types of androgens as well as scientists can make unique synthetic androgens. However, men and women only make two major androgens: testosterone and dihydroepiandosterone (DHEA). These are the only two that should be used in humans for hormone replacement. For men and women testosterone and DHEA replacement helps significantly with decreased libido, loss of muscle and bone strength, decreased exercise tolerance, mental sharpness and recovery from injury. The preferred route of administration of testosterone is as an insertion of a timed released pellet under the skin twice a year. It may also be used as a cream-used twice daily or as an intramuscular injection every 7-10 days.

Click hereto learn more about our Low Testosterone Treatments for men.

As we get age our adrenal glands, located on top of the kidneys, can burn out and cease to produce appropriate levels of the hormone called cortisol. This causes what is called "adrenal fatigue", or a general feeling of tiredness in many patients. Cortisol is usually supplemented as a capsule taken in the morning and titrated to a level that gets the patient feeling his or her best.

Anti-oxidants are small substances found in food that are very important in neutralizing harmful chemicals that damage our cells and tissues. We encourage our patients to take a daily natural anti-oxidant regimen which can help protect the organs which produce hormones and prevent further decline in production levels. It is recommended that you eat six servings of raw fruits and vegetables a day in order to maintain healthy antioxidant levels.

The society we live in today makes us exposed to many substances that are alien for the body. The environmental changes and our stressful lifestyle brings a shift in the hormonal balance in our body, and as we start to age, all of this adds up to impact the ability of our body to work towards attaining the optimum hormone level. Common symptoms associated with hormonal imbalance and the inability of our body to produce the required levels of hormones include fatigue, memory loss, weight gain, insomnia, poor libido, confusion, joint pain, and irritability to name a few. These hormone imbalances make both men and women suffer, especially the latter in their pre and post menopausal years. Men and women should both understand that natural (bio-identical) hormone therapy can optimize hormone naturally in the body, which can help in improving the quality of life.

Z Med Clinic has the resources and expertise to provide bio-identical hormone replacement therapy to men and women who have noticed a dip in their energy levels, and other symptoms common with hormonal imbalance.

Whether its estrogen and progesterone replacement, natural thyroid replacement, natural cortisol replacement, or natural testosterone hormone therapy for men, we can help you with advanced treatments to overcome the symptoms and enable you to lead a better and more fulfilling life.

We use bio-identical hormones that are similar in structure to hormones that are naturally produced inside our body. Once you are diagnosed with hormonal imbalance, we will make sure that it is corrected, and all the signs and symptoms associated with this condition are completely eliminated.

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The Struggles Of A Transgender Arkansan Looking For Healthcare – KUAR

Gender confirmation surgery is becoming more mainstream among surgeons, as doctors learn more about the role surgery plays in caring for transgender individuals.

It was a little over a year ago when, for the first time in its 89-year history, a conference hosted by the American Society of Plastic Surgeonsheld a session on the topic.

Arkansans searching for trans-related healthcare, including surgery, currently have limited options to do so in-state. There is uncertainty over where to find qualified providers.

In 2009, Dr. Janet Cathey, an OBGYN who specializes in the field, opened the states first gender clinic at the University of Arkansas for Medical Sciences (UAMS) because she says she saw a need for healthcare within the community.

"The first trans patient I had, I had an endocrinologist in Little Rock call and say Ive got a patient thats male, hes on hormones, hes a genetic female and he wants a hysterectomy and I cant find anyone that will do it. Will you take care of them? and its like, why would I not?" Cathey said.

Though services for transgender patients are on the rise, some treatments are not yet available in Arkansas, especially gender reassignment surgery.

"Weve got some options close for doing trans female, male-to-female reassignment surgery. Its kind of new to the area, but weve got someone whos willing to do it," Cathey said.

"Right now as far as what we say the bottom surgery for both, its an out-of-state sort of thing. Most of them go out-of-state."

Her clinic provides hormone therapy for men and women who want to transition. Also hysterectomies and breast reduction surgery for men.

But, she says, the demand for gender reassignment surgery remains greater than the options available.

"There is a big need for qualified people that do gender reassignment surgery,"Cathey said.

Kendra Johnson is the Arkansas director for the Human Rights Campaign, an advocacy group for the transgender community. She says she thinks with the community becoming more visible in recent years, options for healthcare are growing.

"There were no providers who were out saying these are the services that I offer. For example, UAMS and Arkansas Childrens Hospital and some other private doctors have started to state that they may have some services," Johnson said.

Dr. Cathey with the gender clinic says the endpoint for some of those transitioning is hormone therapy, which she can provide, and not necessarily a surgical procedure. It's a spectrum, she explains.

"When they get that sense of wellbeing, sometimes theyre fine with that, thats all they want. Some people want surgery, some trans males only want top surgery,"Cathey said.

Krystopher Stephens, 30, with the Arkansas Transgender Equality Coalition is currently on hormone therapy under the supervision of his primary care doctor. He says he's been on a waiting list to see Dr. Cathey for over six months.

"Shes amazing, and the doctors around here that are affirming, for the most part, the quality of their care has been great," Stephens said.

"As far as the nation as a whole or even the state as a whole outside of Little Rock, quantity and quality arent necessarily the same just because theres a lot doesnt mean theyre all great."

Stephens says the Transgender Coalition received a grant about two years ago to work with UAMS to educate doctors about the trans experience.

"Education is definitely the biggest problem, just staff being culturally competent and being informed on trans issues, and it could be as simple as using the right pronoun," Stephens said.

"Some things are complicated but some things are simple, but if you dont know what to do, it just builds up. Especially on the patient, thats put on them, your misunderstanding or your misinformed opinion, youve projected that onto the patient when you refuse to take care of them or you refuse to acknowledge they are trans."

Cathey says the grant is allowing UAMS to work with its centers around the state to provide this type of education outside of central Arkansas as well. The University is also incorporating LGBTQ care into its course curriculum for med students. Some dont have experience with patients from the community.

Kendra Johnson with the Human Rights Campaign says while trans healthcare is limited for now, the growth shes seen makes her hopeful for the future.

"I think we could get to a point where theres a safety net in the medical community for people who are transitioning and to me thats really exciting because I never thought, given all the prejudice and all the work that we still have to do in this state, that we would have this response from the medical community as seeing it absolutely necessary," Johnson said.

Disclaimer: Kendra Johnson of the Human Rights Campaign is also on the fundraising board for KUAR and KLRE.

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The Struggles Of A Transgender Arkansan Looking For Healthcare - KUAR

Doctors to offer stem cell treatments – The News (subscription)

Dr. Ren Halverson can emphasize with his patients. Like many of those who walk through his doors at Advanced Chiropractic in Brunswick, he has also experienced injuries and the pain they cause.

I had a torn labrum in my right shoulder, a torn rotator cuff in my left shoulder and and torn meniscus in my right knee. I already had two surgeries on my knees, he said. It was a daily challenge treating patients.

In order to help his patients and himself find relief, the chiropractor is always on the lookout for the latest in scientific health developments that might help. He spends countless hours studying the latest in medical innovations. Not too long ago, Halversons research paid off when he came across amniotic stem cells.

Of course, Halverson was already familiar with stem cells and the long term research concerning some for joint treatment. But the new data, methods and results were something he simply couldnt ignore.

World-wide the results with stem cells are off the charts. There are different types of stem cells ... blood marrow, which is best used for blood diseases. Amniotic, which is the membrane surrounding the placenta and is the safeguard between the mothers blood flow and the babys. That is what we are talking about here, he said. It has proven to be best for joint and tendon repair.

Amniotic arent, however, the same as the controversial fetal stem cells that gained so much attention over the past decade. Halverson says these types of stem cells raise no moral or ethical questions. They are also more effective than other types of stem cells in healing musklo-skeletal injuries.

These are offered by willing, cesarean donors. The FDA has approved the process and it is very strictly regulated. The hosts, the mothers who donate, are screened for all blood born pathogens before they are able to donate.

The regenerative field of medicine is something that has proven itself invaluable over the past few decades. It has convinced Halverson to open that door to his patients. After all, he has experienced the positive effects of the treatment first hand.

I wanted to try the stem cell treatment first. I did it about three months ago and the results are just incredible, he said, moving his arms to illustrate his range of motion.

It takes about eight months for the full effects to set in but Im swimming again. I couldnt do that before. In many cases worldwide, patients have been able to fully heal arthritic joints and tendons or cartilage tears without having to have surgery.

He feels the statistics truly speak for themselves. The company Halverson uses has conducted more than 100,000 similar treatments.

Stem cells contain Hyaluronic Acid which provides a scaffold for mesenchymal growth cells to begin the rebuilding process. They also contain natural anti inflammatory agents known as Cytokines.

Halverson says there is not one documented case of a side effect reported.

There has never been a negative reaction. Patient satisfaction is/over 98 percent ... thats just in the U.S. They are doing this heavily in Europe and Israel, he said. The results are unbelievable. Pre- and post -X-rays show remarkable results.

He will however bring on new faces who will run the expanded medical clinic.

Our medical director is Dr. Theresa Cezar, who is a great internist but has extensive experience in physical medicine. We also have Cynthia White who is our nurse practitioner. They are both excellent, he said. We have a really exceptional staff here.

In addition to the stem cell treatments, Halverson is offering an expanded line of medical services, designed to treat musklo-skeletal patients with a cutting edge integrated approach. Those include trigger point injections, state of the art spinal bracing, biomechanics as well as the regeneration therapy, which includes stem cell and Hormone Replacement Therapy.

Halverson is excited about the opportunity to bring these innovative techniques to the Golden Isles. He sees these treatments as a significant building blocks in the future of healthcare, a departure from relying on medication, dangerous opioids and other invasive options.

Ive experienced it and I know it works. Even Medicare says integration with medicine, chiropractic and therapies together are the wave of the future. We are combining what weve already been doing ... the chiropractic and rehabilitation to really take this to the next level, Halverson said.

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Doctor Makes California Pain Clinic a Special Place Pain News … – Pain News Network

Dr. Tennant always has some new diagnostic test or research study up his sleeve. Recently, he asked patients to participate in a new DNA study of genetic indicators not previously studied in rare diseases that involve chronic pain. Every new test and diagnostic tool reveals important information hormone panels, nerve conduction studies, blood tests for inflammatory biomarkers, and MRI images that may reveal the presence of adhesive arachnoiditis.

All of these diagnostic research efforts produce new insights. For example, in a study of over 100 intractable pain patients who require relatively high opioid doses, Dr. Tennant found that 91% of them had genetic defects that impacted their ability to metabolize medications, suggesting why they need higher doses for effective pain relief.

Another example is the growing understanding of the impact of pain on hormone levels. Severe chronic pain initially elevates hormones, but if uncontrolled for too long, hormone levels become depleted. Hormone levels that are too high or too low are biomarkers of uncontrolled pain, and indicate that higher doses of pain medications or hormone replacement may be necessary. Ongoing clinical research is a key element of Dr. Tennants approach to pain care.

In my visits with Louis to numerous pain doctors prior to finding Dr. Tennant, almost all of them said, The goal is to get you off those pain medications.

I was shocked when I first heard Dr. Tennant say, The goal is to relieve your pain.

Dr. Tennant has the expertise to see a patients pain and to ask the right questions. His discerning eye can distinguish between intractable pain patients and the few who come to the clinic seeking drugs for the wrong reasons.

Dr. Tennant understands that most patients have already tried and failed at many different pain treatments. When that is the case, he tries to determine what will work. The goal is to relieve pain so that the patient has a chance at meaningful improvement of function and quality of life. There is no demeaning treatment, there are no words said that convey doubt or suspicion, there are no looks that say, You must be a drug seeker. Dr. Tennants clinic is one of very few medical facilities I have visited where there was no evidence of stigma toward pain patients.

An important piece of Dr. Tennants philosophy is that if you effectively treat the pain, improvements in function and quality of life will follow. Dr. Tennant prescribes medication as needed to enable patients to effectively manage their pain, which in turn helps to stabilize their overall condition, while the underlying causes are identified and treatments are attempted. If a patients pain remains undertreated, the likelihood of successfully treating the underlying causes is greatly reduced.

The Institute of Medicines 2011 report,Relieving Pain in America,called for a cultural transformation in the way pain is understood, assessed, and treated. The characteristics I would seek in such a transformation of pain care are visible every day in Dr. Tennants clinic. I wish that other doctors who treat chronic pain could get outside the bounds of their particular specialties and professional societies to view their patients differently.

As Dr. Tennants research has moved forward, he has found that the majority of chronic pain patients who go to his clinic have 4 or 5 rare disease conditions: adhesive arachnoiditis, post-viral autoimmune disease, Reflex Sympathetic Dystrophy (also called Complex Regional Pain Syndrome), and connective tissue disorders such as Ehlers-Danlos Syndrome. All of these conditions are often accompanied by very severe, constant pain.

In the last few years, Dr. Tennant has made great advances in identifying and treating the underlying causes of intractable pain. He credits two recent scientific advances for enabling him to treat the causes rather than just the symptoms of pain. First, we now know that microglial cells within the central nervous system, once activated by a painful injury, disease or trauma, cause inflammation inside the brain and spinal cord. This neuro-inflammation causes chronic pain to centralize in the spinal cord and brain, resulting in severe pain that is constant.

Second, we now know that nerve cells may regrow, a process called neurogenesis. Certain neuro-hormones in the brain and spinal cord can promote neurogenesis when neuro-inflammation is reduced. Dr. Tennants approach is to reduce neuro-inflammation while simultaneously promoting neurogenesis. His protocols for treatment of neuro-inflammation are in their early stage, but they are already providing disease regression, enhanced pain relief, less suffering, and, for some patients, reduction in the use of opioids.

It is a true privilege to work as a volunteer in Dr. Tennants clinic. When I asked him in 2014 if I could be a volunteer, I had two specific reasons: to learn more so I could fight back against our insurance provider (who had suddenly decided to reduce the reimbursement for my husbands pain medications), and to educate myself so that I could become an effective advocate for chronic pain patients. We lost the battle with the insurance company, but I have certainly received an education that very few people have a chance to experience.

Dr. Tennants methods and approaches are not proprietary -- he's eager to share them.There are many good doctors out there who could learn to do what he does, instead of focusing solely on the treatment of pain as a symptom. It doesnt require a fancy clinic, lots of money, and corporate or university infrastructures. What it takes is a doctor who is truly committed to relieving pain and practicing the art of healing.

It is possible to manage pain with medicine instead of injecting the spine, inserting stimulators and pumps, or using other invasive procedures. Instead of treating pain with these modalities, treat and relieve the pain with medication, stabilize the patient, and search for the underlying causes so that they can be addressed.

At age 76, Dr. Tennant could have retired and given up his practice many years ago. Why does he put up with the many challenges of operating a pain clinic? Because he truly cares about helping people who are suffering.

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Testicular Cancer: 5 Things Every Man Needs to Know – Health Essentials from Cleveland Clinic (blog)

Cure rate for testis cancer is 90-plus percent Share Facebook Linkedin Pinterest Email

Cancer isnt something anyone wants to spend a lot of time thinking about, yet knowledge is power. When it comes to testicular cancer, acting early has huge implications.

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

Here are five things every man needs to know:

A cancer diagnosis is never a feel-good moment. But its important that you know that testicular cancer is one of the most treatable cancers out there.

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

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Testicular Cancer: 5 Things Every Man Needs to Know - Health Essentials from Cleveland Clinic (blog)

Docs Call Hormone Therapy for Kids Risky – – Newsmax

Using hormones to treat transgender children who feel that they are members of the opposite sex, which is becoming commonplace in medicine, could have serious long-term effects on children, doctors are warning in a new report.

In a paper published in the journal The New Atlantis this week, Paul Hruz of the Washington University Medical School and Lawrence Mayer and Paul McHugh of Johns Hopkins Medical School say such treatments could have serious health implications, the New York Post reports.

The paper, called Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria, notes a recent analysis by UCLA found that about 1.4 million people in the United States identify as transgender, a growing number of whom are children.

The number of children diagnosed with gender dysphoria described by clinicians as incongruence between ones experienced/expressed gender and assigned gender has been on the rise.

A gender identity clinic for children in the United Kingdom, for instance, reported a 2,000 percent increase in referrals since 2009, with those for children under the age of 6 going from six to 32 in the same time period.

Well-meaning parents have been increasingly trying hormone suppression, which prevents sex organs in boys and girls from developing in the usual way, Hruz, Mayer, and McHugh note.

While that may allow children to postpone decisions about actual sex-reassignment surgery, the authors argue that this therapy may have real and long-term effects on childrens physical and psychological development.

Whether blocking puberty is the best way to treat gender dysphoria remains far from settled, they write, and it should be considered ... a drastic and experimental measure.

2017 NewsmaxHealth. All rights reserved.

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Advanced Cancer Drug Study Highlights Need for Novel Approaches – Technology Networks

Mohammad Alyamani, Ph.D., with lab technician Yoon-Mi Chung. Credit: Cleveland Clinic

Cleveland Clinic researchers have shown for the first time how a class of advanced prostate cancer drugs are processed in the body and how their anti-tumor activity might change depending on how they are metabolized. Their pre-clinical findings, just published in Cell Chemical Biology, may lay the foundation for improving therapies for treatment-resistant, aggressive prostate cancer.

Next-generation anti-androgens are potent drugs that work by cutting off the prostate tumors supply of androgens (male hormones), which fuel prostate cancer. The drugs, used in patients whose cancer has become resistant to hormone deprivation therapy, have been shown to improve survival in men with metastatic disease. Unfortunately, prostate tumors eventually become resistant to these drugs, highlighting the need for new therapies.

Despite an array of improved treatment options that have become available over the past decade, prostate cancer remains the second leading cause of cancer mortality in men in the United States. There are few therapeutic options for men whose cancer has become resistant to all therapies, said Nima Sharifi, M.D., lead author on the study. Our goal is to improve the use and role of these existing drugs and hopefully design new therapies that work better and longer.

Galeterone is a steroidal anti-androgen that was recently studied in a clinical trial. Dr. Sharifis team in the Cleveland Clinic Lerner Research Institutes Department of Cancer Biology has shown that when galeterone is metabolized, it is converted to the intermediate molecule D4G, which blocks androgen synthesis and reduces the amount of androgens available to cancer cells. A pitfall is that galeterone is also converted to another molecule that may stimulate the tumor.

Dr. Sharifi previously found that another steroidal anti-androgen drug, abiraterone, is metabolized in a similar manner. He went on to show in landmark studies that abiraterones metabolite D4A has greater anti-tumor activity than abiraterone alone and that other molecules stimulate tumor growth, suggesting that the drug should be fine-tuned to improve efficacy.

Dr. Sharifis new findings suggest that effective steroidal anti-androgens share common metabolic activities and that their metabolites should be closely examined for their effects on tumor survival. The findings may also guide medical decision making in the use of steroidal vs. nonsteroidal drugs for advanced prostate cancer.

New agents and a clearer understanding of drug mechanisms are both urgently required to improve outcomes for treatment-resistant advanced prostate cancer, said Dr. Sharifi. This work provides an important foundation that hopefully will lead to better treatment strategies for this disease.

This article has been republished frommaterialsprovided by Cleveland Clinic. Note: material may have been edited for length and content. For further information, please contact the cited source.


Alyamani, M., Li, Z., Berk, M., Li, J., Tang, J., Upadhyay, S., . . . Sharifi, N. (2017). Steroidogenic Metabolism of Galeterone Reveals a Diversity of Biochemical Activities. Cell Chemical Biology. doi:10.1016/j.chembiol.2017.05.020

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Important hormones for your health – Meridian Star

OK, today I want to talk about hormones which ones are important and why. Hormones have just as much impact on your health as the three other big pieces of the puzzle physical health, mental health and nutrition. Dont believe me? Well, you will by the end of this, so keep reading! This will be a very broad overview and I havent included all hormones, just what I call the big hitters. In later columns, well dive deeper into individual hormones.

Vitamin D

Vitamin D is technically a pro-hormone that we get mainly from being out in the sun. Other sources include cod liver oil, calcium-rich foods, egg yolk and supplementation. Almost everyone is deficient in Vitamin D. I take a Vitamin D. The biggest areas of benefit include significantly decreasing risk of cancer (by blocking progression of pre-cancerous cells) and lowering heart disease rates. It can also improve testosterone levels, calcium absorption, bone health, blood pressure control and lower autoimmune disease rates. Its one of the first areas I recommend for a quick improved health intervention in most of my patients.


Your thyroid is important, and low levels of thyroid hormones can significantly impact health. Your thyroid regulates metabolism, energy and body temperature. When its healthy, it increases protein synthesis, lowers cholesterol, increases fat breakdown and improves cognition. When its low, there are over 200 symptoms you could have. The most significant include fatigue, depression, weight gain, dry skin, brittle nails, thin hair, brain fog, constipation and high cholesterol. Women, especially those ages 40-60, are more prone to low thyroid levels compared to men although we do see it in men as well.


Another common area impacting health is your adrenals (you have two of them they rest just above your kidneys). When you are startled and have that body shock feeling, thats the adrenals releasing adrenaline. When there is longer term stress, the adrenals release cortisol. When stress continues and cortisol gets depleted, you move towards what we call adrenal fatigue. Unfortunately, due to our inherent culture of go-go-go, adrenal fatigue syndrome is very common. Also, it usually takes a long time (4-12 months) to resolve once addressed. Stress management is a key to reducing your risk for adrenal fatigue and improving your health. Well discuss stress management techniques in a later column.

Sex hormones

Testosterone, estrogen, and progesterone are all considered sex hormones. The name is misleading as these hormones are definitely not just about sex. Thats not even how the word sex is meant here. Anyway, I could go on for many moons on this subject as Im passionate about it but well hit some highlights here. In general, women need estrogen, progesterone and testosterone. Men need testosterone and estrogen. People usually think of testosterone as only for men and estrogen as only for women but thats not the case. Men and women need estrogen and testosterone to benefit their health but the levels needed are different. As an aside, sex hormone optimization is complex and you need a healthcare provider who specializes in this to address and manage it properly as there are risks to mismanagement. Testosterone helps your body with sex drive, erections (in men), muscle strength, mood, energy, bone strength, as well as decreasing heart disease, cholesterol and diabetes risks to name a few benefits. Estrogen and progesterone can affect mood, sex drive, breast growth (particularly in women), urinary tract infection risk, cholesterol, bone strength, cognition, Alzheimers risk, skin health and sleep...again, to name just a few areas. Progesterone, in particular, is good at helping with sleep.

For women, these sex hormones can be deficient before menopause, but definitely deficient after. Ten to 15 years ago, there was concern for hormone replacement after menopause and several post-menopausal women abruptly stopped hormone replacement. We now know that likely put them in a higher health risk category than if theyd stayed on them. Also, since then, weve learned more and really see where theres a benefit in maintaining these hormone levels with appropriate surveillance by a qualified healthcare provider.

For men, testosterone, in particular, got a bad rap 4-8 years ago with a concern for worsening heart disease risk, and historically there has been a concern for prostate cancer risk. We will address these individually at length in upcoming columns but the short of it is this: there does not appear to be an increased risk for prostate cancer with normal compared to low testosterone levels (the data actually shows an increasing incidence in the low testosterone groups) and, in most patients, theres an improvement in heart health and lowering of heart disease risk with normal testosterone levels compared to low (similar to above, the data points towards increased heart disease risk at low testosterone levels compared to normal).

I know I threw a lot at you here, but thats a super-high bird's eye look at the impact of hormones on health. Keeping hormone levels optimized naturally, or if needed through supplementation, improves your chance for more functional years and an improved quality of life!

Dr. Thomas is a board-certified physician who operates Complete Health Integrative Wellness Clinic and Thomas Urology Clinic in Starkville, Mississippi.

This newspaper column is for informational purposes only and is, under no circumstances, intended to constitute medical advice or to create or continue a physician-patient relationship. If you have a medical emergency, you should immediately seek care from your nearest emergency room, and if you have specific health questions, you should consult your own physician.

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Augusta Pride kicks off eighth annual celebration – WJBF-TV

AUGUSTA, Ga. (WJBF)-Augusta Pride Weekend 2017 has arrived.

This is the eighth annual pride celebration in Augusta, and this year, organizers are hoping between 12,000 and 15,000 people attend the weekend of celebration.

Alyssa Fredericks of Thomson came to Beats on Broad, the Friday night celebration at the common, with her girlfriend, andshe says she feels the CSRA is a pretty welcoming place for the LGBTQ community.

Its good to be out here with everybody, Fredericks said. Its like a community as one.

Even though its a party, some groups are taking advantage of the celebration to offer important health services, includingfree HIV testing.

We caught up with a volunteer from the Equality Clinic of Augusta, which is a free student-run clinic for uninsured and underinsured people.

A lot of our patients are from the LGBTQ population, said Matthew Luo, who is treasurer of the Equality Clinic of Augusta.

Luo says about 70 percent of their patients are transgender people seeking hormone replacement therapy. He says they are one of the only clinics in the region that provides that service to those in need.

We have people coming from Charleston, from Mississippi from like Kentuckyall over the Southeast to come, he said. They drive hours and hours to come to our clinic because were one of the only people that offers this service.

Its a reflection of what Augusta pride is trying to dooffering people in the CSRA and beyond a chance to be themselves.

Its about love, respect, tolerance, being able to live your most authentic life, said Augusta Pride President Lonzo Smith.

The pride parade kicks off on Broad Street at 10:30 a.m. Saturday.After that the pride festival will be at the Augusta Common till 5 p.m.

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How doctors in Texas are trying to protect transgender patients from a persistent threat: HIV – Los Angeles Times

When the Kind Clinic began offering free or low-cost hormone therapy for transgender people in March, word spread quickly here. Within days, the service was booked up until the end of June. Now the next available appointment is in December.

For the patients flocking to the clinic north of downtown the first of its kind in central Texas its a chance to begin a transition many thought they could not afford. But for the doctors, the rush is a chance to start addressing another major health problem facing the transgender community: the staggering rates of HIV.

By offering hormone therapy, the clinic aims to earn the trust of a population that often feels alienated by mainstream medicine and persuade those at high risk of exposure to the virus to start on a drug regimen that can prevent infection.

The U.S. Food and Drug Administration approved a regimen marketed as Truvada for use as a pre-exposure prophylaxis against HIV in 2012, but it is not widely prescribed.

Katie Falkenberg / Los Angeles Times

Dr. Cynthia Brinson, medical director at the Kind Clinic, consults with a transgender patient, Peter Haley.

Dr. Cynthia Brinson, medical director at the Kind Clinic, consults with a transgender patient, Peter Haley. (Katie Falkenberg / Los Angeles Times)

Is that just available to anyone? Peter Haley, a 27-year-old transgender patient, asked a Kind Clinic doctor when she told him about Truvada.

The doctor, Cynthia Brinson, explained that the clinic would first want to provide counseling about the medicine and do a series of tests to rule out a preexisting HIV infection and other potential complications. But if everything checked out, she said, the clinic would provide a prescription and help filling it at little or no cost.

Haley had come to the clinic because he was no longer covered by his mothers insurance and couldn't afford the $100-a-month prescription for testosterone injections or routine visits to the doctor.

Recently married, he didnt think he was in any immediate danger from HIV. But he left the clinic with a stack of leaflets about pre-exposure prophylaxis, or PrEP.

I have a lot of friends who probably should know about it, he told the doctor.

A 2013 review of the limited research estimated that as many as 22% of transgender women in the U.S. were living with the AIDS-causing virus a rate 27 times higher than for the general population of reproductive age (15 to 49). More than half of African American transgender women could be infected, according to one study. The risk to transgender men is believed to be lower, although there is even less data about them.

The population is so vulnerable because the stigmatized place that transgender people occupy in society translates into extremely high rates of poverty, substance abuse, mental health difficulties, homelessness and incarceration all of which increase the odds of having sex without condoms or sharing needles, the two most common ways that HIV is spread in the U.S.

Finding a job can be especially difficult for some transgender women, so they may turn to sex work, which puts them in even greater danger. Many clients dont want to use condoms, they say, and assaults are common.

Katie Falkenberg / Los Angeles Times

Kelly Kline, one of the Kind Clinic's first transgender patients, takes a pill once a day to protect herself from HIV.

Kelly Kline, one of the Kind Clinic's first transgender patients, takes a pill once a day to protect herself from HIV. (Katie Falkenberg / Los Angeles Times)

Many of those living with HIV refuse to get tested or treated because of bad experiences at mainstream medical facilities.

A survey by the National Center for Transgender Equality in 2015 found that 23% of the nearly 28,000 respondents hadnt seen a doctor when they needed one in the last year, because they were afraid of being mistreated. A third couldnt afford to see one.

Of those who had consulted a healthcare provider, a third reported being refused treatment, verbally harassed, assaulted or subjected to some other mistreatment.

You go to the doctor to seek help, but they act like theyre disgusted by you sometimes, said Kelly Kline, 42, one of the Kind Clinics first transgender patients.

She recalled the New Years Eve that she came down with pneumonia and had to go to the emergency room.

Everyone was so nice, until they asked for my ID, she said. Then the receptionist, in front of everybody, asked, So, youre a man?!

The doctor did a double take when he saw her and checked her chart.

Im so sorry, she recalled him saying. They told me there was supposed to be a man on my table.

Kline, a community activist who hosts a popular drag show at an Austin nightclub, said she has lost count of the number of friends who have died of AIDS-related complications so many people. Some refuse to get tested because they cant face the possibility of an HIV diagnosis. But others are afraid of how they will be received.

Because transgender people feel so unwelcome at many medical facilities, opportunities for preventing the spread of HIV the best hope for containing the virus short of a cure or a vaccine are being missed.

The Austin clinic began in 2015 with the aim of making Truvada more easily available to those at high risk of contracting the virus. That includes anyone who is in a relationship with an HIV-positive person, gay and bisexual men who do not regularly use condoms with partners whose HIV status they dont know, and anyone who sometimes shares equipment to inject drugs or hormones.

Taken daily, the medicine has been shown to reduce the risk of infection by more than 90%.

Though public health officials in Texas and across the nation have made it a component of their strategies against the virus, the U.S. Centers for Disease Control and Prevention has said that many primary care doctors and nurses remain unaware of it.

The medicine has also faced opposition from some doctors and AIDS activists who argue that offering people another way to block HIV transmission would undermine long-standing efforts to promote the use of condoms, a method that is also effective against other sexually transmitted infections. The CDC issued guidelines in 2013 stipulating that PrEP should be used with condoms.

Some doctors in Texas which sees 4,000 new infections each year also object to the medicine on moral grounds, arguing it encourages promiscuity and intravenous drug use.

Brinson, who in addition to being the clinics medical director provides care at the county jail, recalled having to break the news to an inmate that he was HIV-positive. The man was stunned because he had tested negative just three months prior.

Well, did they offer you PrEP? she asked him. No, he had never heard of the regimen.

Just having people continually come in to be tested but not offering them a prevention seemed ludicrous, she said.

Most of the people who work at the clinic are volunteers, and the care is free, thanks to a combination of public and private funding. The clinic can also help patients cover the prescription costs for Truvada, which run over $1,600 a month without insurance.

By the end of last year, the clinic was providing the medicine to 800 patients, most of them gay or bisexual men, who account for the majority of new HIV infections in the U.S.

But the doctors worried about how few transgender people were coming in. So they reached out to community representatives, who pointed out that for many transgender people, HIV is a secondary concern to obtaining the hormones they need to transition. The observation was borne out by recent studies that recommend combining HIV and gender care services for these patients.

And so the clinic began offering hormone therapy.

Our strategy is around getting to zero [new infections], and you cant do that without addressing the needs of the transgender community in a way that makes sense to them, said Joe McAdams, the Kind Clinics executive director.

At first, the clinic offered gender care appointments one evening each week. To meet the growing demand, it recently added weekend hours and is planning to move to larger premises in August.

More than a quarter of the transgender patients decide to try Truvada, said McAdams, who has been living with HIV himself for 30 years.

One of them is Kline. She now takes a blue pill every morning with her allergy medicine.

She loves coming to the clinic. On her first visit, she was offered a questionnaire that asked about her gender identity, the sex she was assigned at birth and what pronouns she prefers.

Other doctors have never, ever asked about it, she said.

Twitter: @alexzavis

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How doctors in Texas are trying to protect transgender patients from a persistent threat: HIV - Los Angeles Times