Archive for the ‘Hormone Physician’ Category

It is normal for females to experience fluctuations in sexual desire throughout life. However, a substantial or total loss of interest in sex, or difficulty responding to stimulation, may indicate female sexual interest/arousal disorder (FSIAD).

FSIAD is a type of sexual dysfunction. A person with the condition may experience a lack of sexual desire, a lack of physical arousal, or both.

As with other types of sexual dysfunction, FSIAD can be distressing. It can affect a persons self-esteem, relationships, and overall well-being.

In this article, we explore FSIAD and its symptoms, causes, and treatments.

FSIAD describes a loss or significant reduction in sexual desire or physical arousal in females. It is a relatively new term that first appeared in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).

Previously, FSIAD was split into two separate disorders:

FSAD used to refer to a lack of lubrication and swelling in the female genitals, which researchers focused on as a cause for sexual dysfunction.

However, some experts argue that this is a flawed concept, as low levels of lubrication does not necessarily indicate female arousal, nor does it always prevent sex.

There is a close link between sexual desire and physical arousal. As a result, the DSM-5 combined the two conditions.

It is unclear how many people experience FSIAD specifically. However, sexual dysfunction is highly common in males and females.

A 2016 meta-analysis suggests that around 40.9% of premenopausal women worldwide experience at least one type of sexual dysfunction. Of those, 28% reported low sexual desire.

However, compared to some types of sexual dysfunction in males, such as erectile dysfunction, FSIAD is far less well-known.

According to the DSM-5, a person must have three of the following symptoms to have FSIAD:

They must also have:

In addition to this, people with FSIAD can experience symptoms in different ways. The condition may be:

Partners may notice that a person with FSIAD does not want to engage in sex most of the time and that they talk about it less, or not at all.

It is important to note that FSIAD is different from asexuality.

Asexuality is an umbrella term for sexual orientations that involve varying degrees of sexual and romantic attraction towards others. It is not a medical condition.

Some asexual people have lifelong preferences for nonsexual relationships. While a lifelong lack of interest in sex can occur due to sexual dysfunction, this is not always the case.

According to the DSM-5, for an FSIAD diagnosis to apply, a person must show signs of clinically significant distress about their lack of desire.

A person who identifies as asexual, does not feel distressed by it, and has no problem developing close relationships, does not meet the criteria for FSIAD.

Sexual desire and arousal are complex. Many factors influence the amount and type of sexual desire a person has and how their body responds to intimacy.

While a single cause is often difficult to identify, the DSM-5 notes that people with FSIAD often have other sexual or emotional difficulties, some of which are explored below.

A 2018 review found that relationship dissatisfaction was a risk factor for sexual dysfunction in females. This may be the result of communication problems, a lack of emotional intimacy, or unresolved conflict.

The mental and physical health of partners may also have an impact. If a person desires sex more often than their partner or partners, or they have sexual dysfunction themselves, this may influence the development of FSIAD.

A negative self-image, lack of confidence in ones body or appearance, and mood disorders are also associated with FSIAD.

Negative body image, or body dysmorphic disorder, may make the prospect of removing clothes or sexual activity stressful. Stress, anxiety, and depression can also reduce a persons desire to have sex.

However, it is important to note that low self-esteem, stress, and mental health conditions can occur as a result of FSIAD, and may not be the direct cause.

Some people with FSIAD have previously experienced emotional or sexual abuse. A 2020 study suggests that sexual trauma, such as childhood sexual abuse, can lead to shame surrounding sex, which may then contribute to sexual dysfunction.

Personal, cultural, and religious beliefs can play a role in FSIAD.

People who believe in traditional gender roles may feel they should not play an active role in sex or that they should not enjoy it. This may create feelings of shame surrounding sex.

If a person does not have much experience or knowledge about sex, they may have unrealistic ideas about what is normal in terms of sexual desire. They may also struggle to explain what they like or dislike, or be unaware of different sexual techniques.

It is important that people have access to quality sex education that normalizes sexual desire, and teaches that sex has a positive role in a persons well-being.

The 2018 review notes that sex education and feeling that sex is important in a relationship are both protective factors against sexual dysfunction.

Many people with FSIAD may also experience other types of sexual difficulties, such as:

Treating these conditions may help with improving a persons FSIAD symptoms.

Learn about the causes of pain during sex.

Other factors that may cause changes to a persons sexual desire and arousal include:

There are several ways to approach treatment for FSIAD. These include:

Talking with a sex therapist, psychotherapist, or counselor specializing in female sexual health can help someone identify factors contributing to their FSIAD.

A sex therapist or psychotherapist can help someone:

If relationship difficulties contribute to FSIAD, a therapist may also recommend relationship counseling sessions, where the persons partner also attends.

Medication options for FSIAD include Vyleesi (bremelanotide), which activates receptors in the brain that influence sexual behavior and desire.

Hormone therapy may help treat low sexual desire in people going through menopause or who have hormone imbalances.

These medications will not be appropriate for everyone. It is important to discuss the safety, interactions, and side effects of these treatments with a doctor before trying them.

If a persons sexual desire or physical response to sexual stimulation has changed since they developed a mental or physical health condition, or since they began taking a certain medication, this may be a factor.

A person can discuss the following options with a doctor:

If a person notices they have lower sexual desire than usual, or do not seem to respond to sexual stimulation as they used to, they can seek help from a physician or healthcare professional specializing in sexual function.

It can be difficult to talk about sexual dysfunction, but there is no shame in doing so. It is a medical condition, which can get better with treatment.

Being specific about any concerns or changes in desire or arousal will help a doctor advise on the next steps.

FSIAD is a type of sexual dysfunction that occurs when a persons sexual desire or arousal is much lower than usual. It can cause significant distress. However, sexual dysfunction is prevalent in females, and it is treatable.

Many factors may contribute to FSIAD, so a person may benefit from trying several treatment approaches. Options include individual therapy, trauma therapy, relationship counseling, or medication.

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What is female arousal disorder? Symptoms and treatment - Medical News Today

ALBANY Monique and Fred Wilson are lovingly known as the King and Queen of Phoebe, Fred as the familiar friendly face who greets visitors to the hospital and gives them rides through the massive parking lot and Monique as, among other duties, the face-to-face coordinator for the regions Young Survivors Coalition.

Its fitting, then, for the thousands of hospital employees and patients whove been treated there that Monique Wilson has been honored as the tree-lighter for the Phoebe Foundations annual Lights of Love celebration. And while the annual heart-felt ceremony was altered to a virtual celebration this year in deference to the coronavirus pandemic, that does little to dampen the enthusiasm of the woman chosen to represent the cancer survivors as the tree-lighter.

Even though we pre-recorded the (tree-lighting) event as a safety precaution and will show the ceremony later, it was still very moving for me, Monique Wilson, who is the survivorship data coordinator at Phoebe, said. Even filming it ahead of time, I was very nervous at first. But it was such a beautiful ceremony even with the social distancing that I got caught up in it. Ill never forget it.

Wilson was selected as the tree-lighter for the Lights of Love celebration, which is sponsored annually by the Phoebe Foundation and raises funds for cancer-related projects, as a breast cancer survivor. She was diagnosed in June of 2016 and is today cancer-free.

My husband and I were coming back from a trip to New Jersey, when I felt something strange (in my breast), she said. When we got home to Georgia, I rechecked the spot, and it was still there. No one on either side of my family has ever had breast cancer, so one of the things Ive learned from all this is that cancer does not discriminate ... it will impact anyone.

I called my family physician the next day, and she scheduled a mammogram. I got the phone call on June 26 that it was breast cancer. On the same day, the Carlton Breast Center called and said I needed to come in immediately for an ultrasound and biopsy. I told them I was going away for a birthday weekend, and the person who called said, Did you hear what I just said? I told her, Yes, and did you hear what I just said? I had my weekend but scheduled an appointment for the ultrasound and biopsy the next Monday.

Wilsons cancer was detected early (Stage 1) but was found to be invasive, so she began a series of 33 radiation treatments. Shes in the midst of a 10-year regimen of hormone blockers, but she is now cancer-free.

Sure, there was some depression and anxiety during the treatment, but I never lost faith, Wilson said.

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Now, her experience allows her to give a first-hand accounting to young cancer patients as they face their own battle.

We have women as young as 27 and as old as 49, and my having been through this gives me an opportunity to give them some honest answers that often comforts them, she said of the Young Survivors Coalition.

In addition, both Fred and Monique Wilson participate in their Tour de Pink, an annual 200-mile bike ride they take part in in New Jersey to raise funds to support and increase awareness of breast cancer treatment and prevention.

We do the Tour de Pink to raise funds for other women and even men who will be diagnosed with breast cancer and for those who have passed on, Monique Wilson said.

This years virtual tree-lighting ceremony will be unveiled on Phoebes Facebook and YouTube channels Thursday at 7 p.m. And, since the annual Lights of Love event is a fundraiser for the Phoebe Foundation, that groups Mandy Tedder said the broadcast will include an opportunity for the community to donate to the foundation.

Tedder said she doesnt think the pandemic will stop supporters from giving.

I believe people are going to come across, she said. This is their opportunity to be part of something extra special. This is the 37th year for Lights of Love, and while people know they cant come out for the celebration, they can gather with their immediate family and still be a part of this community tradition.

Funds raised through Lights of Love have been used to purchase a van that has taken cancer patients to and from treatments and to purchase radiation equipment. Tedder said this years funds will top off efforts to re-open the Light House, which was destroyed by straight-line winds in January of 2017. The newly built Light House, which provides respite opportunities for families of cancer patients, will be opened early next year at the corner of Second Avenue and Monroe Street.

More here:
Monique Wilson tree-lighter for Phoebe's virtual Lights of Love - The Albany Herald

Amcenestrant (SAR439859), a new oral form of endocrine therapy that has shown early signs of efficacy, is being evaluated against the current standards of care in patients with estrogen receptor (ER) positive, HER2-negative locally advanced or metastatic breast cancer.

The agent, a selective estrogen receptor degrader (SERD), is being compared with physicians choice of endocrine therapy in the open label, phase 2 trial AMEERA-3 trial (NCT04059484). The control treatment involves choosing monotherapy from a list of agents with different mechanisms of action: anastrozole, letrozole, or exemestane, which are aromatase inhibitors; tamoxifen, a selective estrogen receptor modulator; or fulvestrant (Faslodex), a SERD (Figure).1

Figure. SAR439859 in Locally Advanced or Metastatic Breast Cancer

Amcenestrant is a next-generation SERD that, in preclinical studies, has demonstrated antitumor efficacy and regression in ER-positive breast cancer models and can be administered as an oral therapy because of its favorable pharmacokinetic profile.2 Fulvestrant, which has been available since 2002, must be administered via intramuscular injection because of limitations including low solubility and weak permeation.3

Its exciting to have a potential SERD that is oral and has potentially better bioavailability than fulvestrant. So many of us wondered whether these [novel] agents could substitute for fulvestrant in the future and potentially be a better option, said Sara M. Tolaney, MD, MPH, principal investigator for the AMEERA-3 trial, in an interview with OncLive.

SERDs work by serving as competitive antagonists to the ER, inducing conformational changes that lead to degradation of the receptors. They have dual functions. I think this accounts for their ability to block the signaling in ER-dependent tumors that may be potentially resistant to other endocrine therapies, said Tolaney, who is associate director of the Susan F. Smith Center for Womens Cancers and director of Clinical Trials in Breast Oncology at Dana-Farber Cancer Institute in Boston, Massachusetts.

Amcenestrant has shown activity in patients regardless of ESR1 mutation status, which makes it very intriguing, added Tolaney, who also is an associate professor of medicine at Harvard Medical School in Boston. It is blocking the estradiol and binding to the estrogen receptor, which promotes inactivation and degradation. Its thought to do so more potently than fulvestrant does.

The goal of AMEERA-3 is to demonstrate that amcenestrant is superior to the endocrine therapy of physicians choice in patients who are refractory to endocrine therapy and have metastatic hormone receptor (HR)positive breast cancer, Tolaney said. The primary end point is progression-free survival (PFS). Secondary end points include overall survival (OS), objective response rate (ORR), disease control rate, clinical benefit rate (CBR), and duration of response (DOR).

Tolaney said the trial design takes into account the options available to patients with HR-driven breast cancer. In the first-line setting for metastatic hormonal receptorpositive disease, patients get a different endocrine backbone. Some patients are getting an aromatase inhibitor with CDK4/6 inhibition; some are getting fulvestrant with CDK4/6 inhibition. This trial allows for the flexibility for the physician to choose what is most appropriate for the patient based on their prior exposure to endocrine treatment, Tolaney said.

Amcenestrant is being administered at 400 mg daily in 28-day cycles until unacceptable toxicity, progression, death, investigator decision, or patient request.3 The comparators are being given based on approved labeling.4

In terms of eligibility requirements, the trial limits participants to 1 prior targeted therapy with a CDK4/6 inhibitor or 1 prior treatment with chemotherapy for advanced or metastatic disease. The criteria also require patients outside of China to receive a prior CDK4/6 inhibitor if they can get reimbursed for it; the number of participants without previous CDK4/6 inhibitor therapy will be capped at 20%. It has become standard of care to use CDK4/6 inhibitors with endocrine treatment in the first-line setting for metastatic, hormone receptorpositive disease, Tolaney noted.

Additionally, eligible patients are required to have progressed after 6 or more months of continuous endocrine therapy for advanced disease or to have relapsed while on adjuvant endocrine treatment for 2 or more years or within 12 months of receiving that therapy. Patients with brain metastases are excluded, as well those who previously received an mTOR inhibitor or a SERD other than fulvestrant, which must be stopped at least 3 months before randomization.

The trial seeks to enroll 282 patients through 126 worldwide locations. An extension is planned with an additional 90 Chinese participants expected to be enrolled. Tolaney said the trial is more than halfway accrued. It was a little delayed because of COVID [coronavirus disease 2019], but it has been doing well otherwise, she said. She anticipates enrollment will be completed early in 2021.

The rationale for AMEERA-3 stems from findings from an ongoing first-in human phase 1/2 study (NCT03284957) testing amcenestrant as monotherapy and in combination with other agents in postmenopausal women with ER-positive, HER2-negative metastatic breast cancer.

Investigators presented results for patients who received amcenestrant monotherapy in 2 cohorts of the study at the 2020 American Society of Clinical Oncology Virtual Scientific Program. The pooled data included women who received from 150 mg to 600 mg daily in part A of the study and those who took 400 mg daily in part B of the study. The primary end point in part B was ORR, documented by RECIST v1.1 criteria; secondary end points included overall safety profile; ORR based on ESR1 status (mutated or wild type); and CBR defined as complete and partial responses plus stable disease for 24 weeks or more.5

All patients in the study (N = 62) had received prior endocrine therapy in the advanced setting; 48.4% had 3 or more previous lines of therapy. Among 59 evaluable patients, the ORR was 6.8% (90% CI, 2.3%-14.8%), all partial responses. The CBR was 35.6% (90% CI, 25.1%-47.1%), which study investigators said was similar to that of fulvestrant in less heavily pretreated patients. Patients with wild-type ESR1 (n = 30) had better responses than those with mutant ESR1 (n = 28) for ORR (10.0% vs 3.6%, respectively) and CBR (40.0% vs 32.1%).

In a subset of women without prior treatment with a SERD, CDK4/6 inhibitor, or mTOR inhibitor (n = 14), the antitumor activity of amcenestrant was substantially greater and compared favorably with historical results for fulvestrant. The ORR was 21.4% (90% CI, 6.1%-46.6%) and the CBR was 64.3% (90% CI, 39.0%-84.7%).

Amcenestrant had a favorable safety profile with limited treatment-related adverse effects (TRAEs); 61.3% of women in the study had adverse effects, and all were grade 1 or 2, most commonly hot flush (16.1%); constipation (9.7%); and arthralgia (9.7); decreased appetite, vomiting, diarrhea, nausea and decreased appetite (all 8.1%); and fatigue (6.5%). No patients discontinued because of TRAEs.

Amcenestrant has the potential to become the best-in-class endocrine backbone across treatment lines in HR-positive breast cancer, according to Paul Hudson, chief executive officer of Sanofi, the company developing the drug.6

Amcenestrant also is being evaluated in comparison with letrozole in an ongoing phase 2 window of opportunity study (NCT04191382) in newly diagnosed ER-positive, HER2-negative breast cancer.7 In this study, patients are being randomized to receive amcenestrant at 400 mg or 200 mg daily, or to receive letrozole at 2.5 mg daily for 14 days prior to surgery. Biopsies will be taken before and after therapy to assess tumor biomarkers.

The primary end point is a change in Ki-67 after a 14-treatment period compared with baselines levels via immunohistochemistry assessment in tumor tissue. Secondary end points include the proportion of patients with relative decrease from baseline in Ki-67 of 50% or more, change in ER expression compared with baseline, and safety and tolerability. Ki-67 is a biomarker of cellular proliferation, and expression of Ki-67 in 14% or more of tumor nuclei is associated with poor prognosis in early breast cancer, investigators noted. This study began enrolling patients in December 2019 and is being conducted at 16 sites worldwide.7

Another study, AMEERA-5 (NCT04478266)8, is testing amcenestrant in combination with palbociclib (Ibrance), a CDK4/6 inhibitor, versus letrozole plus palbociclib as a firstline therapy for patients with ER- positive, HER2-negative breast cancer. The study, which aims to recruit 810 patients, has a primary end point of PFS and secondary end points of OS, ORR, DOR, and CBR.

Additionally, the Quantum Leap Healthcare Collaborative announced in June 2020 that amcenestrant was selected to be part of a new I-SPY 2 study arm.7 The study, known as the I-SPY 2 Endocrine Optimization Protocol (EOP), is focused on patients with molecularly low-risk, clinically high-risk, HR-positive, HER2-negative clinical stage II or III invasive breast cancer. Amcenestrant will be tested as a monotherapy and in combination with up to 3 other agents.

The I-SPY program was designed to identify therapies that are most effective in specific patient subgroups based on biomarker signatures. Sanofi is supplying the drug and providing financial support.9

See the article here:
Next-Generation Endocrine Therapy Moves Forward in Breast Cancer Trial - OncLive

The human endocrine system consists of a number of glands, which release hormones to control many different functions.

When the hormones leave the glands, they enter the bloodstream and are transported to organs and tissues in every part of the body.

The adrenal, or suprarenal, glands are located on top of the kidneys. They are divided into two regions. The right gland is triangular, and the left is crescent-shaped.

The adrenal glands secrete:

Both men and women have some androgen, but men have higher levels. Androgens control the development of characteristics associated with males, like facial hair and a deeper voice.

The hypothalamus is located just above the brain stem and below the thalamus.

This gland activates and controls involuntary body functions, including respiration, heart rate, appetite, sleep, temperature, and the circadian cycles, or daily rhythms.

The hypothalamus links the nervous system to the endocrine system via the attached pituitary gland.

The ovaries are located on either side of the uterus in females. They secrete the hormones estrogen and progesterone.

These hormones promote sexual development, fertility, and menstruation.

The testicles are located in the scrotum, below the penis in males. They secrete androgens, mainly testosterone.

Androgens control sexual development, puberty, facial hair, sexual behavior, libido, erectile function, and the formation of sperm cells.

Located in the abdomen, the pancreas is both an endocrine gland and a digestive organ.

It releases:

Diabetes and digestive issues can result if there are problems with the pancreas.

This is a small endocrine gland located deep in the brain. It secretes melatonin and helps control the bodys sleep patterns and moderate levels of reproductive hormones.

An endocrine gland attached to the hypothalamus at the base of the brain.

It is sometimes called the main endocrine master gland because it secretes hormones that regulate the functions of other glands, as well as growth and several other bodily functions.

The anterior, or front, pituitary secretes hormones that affect sexual development, thyroid function, growth, skin pigmentation, and adrenocortical function.

If the anterior pituitary is underactive, it can lead to stunted growth in childhood and underactivity in other endocrine glands.

The posterior, or rear, pituitary secretes oxytocin, a hormone that increases contractions of the uterus and antidiuretic hormone (ADH) which encourages the kidneys to reabsorb water.

The thymus is an endocrine gland located beneath the breastbone, or sternum.

T lymphocytes, a type of immune cell, mature and multiply in the thymus gland early in life. After puberty, the gland shrinks.

The thymus gland plays a role in the immune system, which protects the body against disease and infection.

A butterfly-shaped gland located just below the Adams apple in the neck, the thyroid produces hormones that play a key role in regulating blood pressure, body temperature, heart rate, metabolism, and how the body reacts to other hormones.

The thyroid gland uses iodine to create hormones.

The two main hormones it produces are thyroxine and triiodothyronine.

It also produces calcitonin, which helps strengthen bones and regulates the metabolism of calcium.

Below is a 3-D model of the endocrine system, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about the endocrine system.

During the first visit, the doctor will ask the patient a series of questions to help reach a diagnosis.

These might cover:

It can help to list any existing symptoms before the visit.

The endocrinologist might ask about symptoms that do not seem to be related, or that seem unnecessary.

This is because hormone levels affect so many different systems in the body that just small changes in one gland can impact parts of the body far from the site of the glands themselves.

They will check the patients heart rate and blood pressure, and look at the condition of their skin, hair, teeth, and mouth.

Blood and urine samples may be taken.

Following diagnosis, the endocrinologist will suggest a treatment plan. This will depend on which underlying condition is causing the symptoms.

Link:
Endocrinologist: Why would I visit and what can I expect?

by Dr. Elizabeth Lee Vliet

SARS-CoV-2 virus was virtually unknown when it hit in early 2020. COVID-19, as the disease is known, now has more than 60,000 National Library of Medicine citations, as the internet disseminates information at the speed of light. Recently President Trump was treated early for COVID-19, with rapid success.

What are the lessons learned from the scientific research?

Lesson 1: COVID-19 is not the death sentence we had at first thought. For healthy 74-year-olds who do not smoke tobacco, dont drink alcohol, and have no serious medical conditions such as heart disease, lung disease, diabetes, kidney disease, or morbid obesity, recovery rate is better than 95%.

Lesson 2: Early treatment at first sign of symptoms is critical. Thousands of frontline physicians in the US and around the world have been saying this from the beginning. Early treatment is the principle that guides almost all medical practicefrom heart disease to diabetes to cancer. In viral diseases, early treatment is critical. Patients need antiviral medicines, vitamins, minerals, known immune boosters, fresh air, and sunshine.

Studies confirm early treatment for COVID-19. In more than 130 studies compiled at c19study.com, the early-treatment studies using hydroxychloroquine (HCQ) showed a favorable effect of HCQ with other antivirals, with a median improvement of 64 percent. We accept 30-40 percent as a success with flu vaccine. Why wouldnt 64 percent improvement with antiviral medicines be considered a huge success? Even the majority of late treatment studies in very sick hospitalized patients showed around 25% improvement with HCQ.

Lesson 3: Doctors have now learned what medicines work, and when to use them. Many physicians across Americamyself included--are using a combination approach to early treatment for COVID, keeping patients at home for treatment with family and loved ones around them helping to implement the physicians recommendations.

A peer-reviewed algorithm by lead author Baylor cardiologist Peter McCullough, M.D. and colleagues from major US and Italian medical centers shows the widely available, safe medicines targeted for each stage of COVID-19 illness. Doctors already use these generic medicines day in and day out for many conditions. They now show impressive success with COVID-19.

Dr. McCulloughs team of experts recommend cheap, safe, FDA-approved medicineshydroxychloroquine (HCQ) with azithromycin or doxycycline, possibly ivermectin or colchicine, inhaled budesonide or the more potent oral prednisone, anticoagulants, supplemental zinc, vitamin C and vitamin D, and home oxygen concentrators.

With the possible exception of mechanical ventilation, almost all the treatment modalities treatment used in hospitals can be implemented at homefaster, better tailored to the individual, at lower risk of other infections common in hospitals, and at dramatically lower cost.

Lesson 4: LATE stage treatment of COVID carries a high risk of ICU admission, mechanical ventilation and death. The failed Fauci model telling patients to go home, self quarantine, do nothing, and go to the ER if they sickerexacerbated by the FDAs statements discouraging HCQ use, has caused the US COVID death rate to be in the worlds top ten.

Lesson 5: Widespread use of home therapy could prevent thousands of deaths and hospitalizations. The pathophysiological rationale and protocol published in the prestigious American Journal of Medicine gives much needed hope for physicians and patients around the world. Dr. McCullough is not just theorizing. He is actually treating COVID patients who remain in their own homes.

This is not just theory for me either. I have personally collaborated with Dr. McCullough using this home-based model of care for my own seriously ill COVID patients who live in other states. TeleHealth allows visually checking the patient, remote access to vital signs, and electronic ordering of medications and medical equipment such as oxygen concentrators when needed. In my experience, early aggressive outpatient treatment can usually be handled with oral medicines, but home health services can provide intravenous medicines if necessary. One of my seriously ill COVID patients in Virginia, a 63-year-old health care worker, is alive today and avoided hospitalization because of early treatment at home following Dr. McCulloughs algorithm.

But patients and physicians suffer as the FDA continues to erect barriers to early home-based treatment for COVID-19. FDA refuses to retract its negative statements on HCQ or release the national stockpile of HCQ donated by Big Pharma to help save American lives.

In a letter delivered August 19 to FDA Commissioner Stephen Hahn, Sen. Ron Johnson (R-Wis.), Chairman of the Senate Oversight Committee on Government Affairs and National Security, with Sen. Ted Cruz (R-Tex.) and Sen. Mike Lee (R-Utah) requested the FDAs data used to claim HCQ given within the first seven days of COVID symptoms might be harmful in outpatients. The FDAs reply deadline was August 25.

The FDA stonewalled until October 6, when the Senators finally received a response letter that completely ignored the questions asked by the Senators. FDA failed to produce any data at all that showed use of HCQ for early outpatients had no clinical effect or caused harm.

Whom is the FDA protecting by stonewalling, using a false narrative of outpatient harm with HCQthat even the FDA itself cannot support with its data? Are they preserving profits for Big Pharma with new high-cost medicines still on patentfor example, Gileads costly experimental drug remdesivir, or Regeneron, another high cost experimental drug given to President Trump?

Americans have the right to know why low-cost medicine, widely used for other conditions for decades, are suddenly too dangerous to be used for COVID-9 so people can stay at home to be treated and get well quickly.

Enormous financial conflicts exist within NIH, CDC and FDAand all receive payments from pharmaceutical companies and vaccine manufacturers, as well as income from patents on new vaccine adjuvants and processes. Dr. McCulloughs editorial, The Great Gamble of Covid-19 Vaccine Development, explained this multibillion-dollar financial incentive to preserve vaccine windfall profits in wealthy countries.

Print Dr. McCulloughs article. This can save your life. Learn your options before you get sick. Make a copy for your doctor. This entire model of care can be implemented by your local physician, in your own home, with minimal cost, and gives you the best chance of rapid recovery.

I know these doctors are right from my own experience treating patients. If you get admitted to hospital, you will likely be a prisoner with no visits from family, clergy, or the doctor of your choiceand at high risk of complications and death. For most patients, hospitalization is unnecessary.

Patients and physicians must take the initiative from the start, use the home-based methods that work, instead of trusting in FDA-promoted no-treatment standard of care, waiting in fear for a vaccine magic bullet.

(Dr. Vliet has been a leader in patient centered, individualized medical care. Since 1986, she has practiced medicine independent of insurance contracts that interfere with patient-physician relationships and decision-making. Dr. Vliet focus is medical freedom and free market approaches to healthcare. Dr. Vliet is the founder of Vive Life Center and Hormone Health Strategies with medical practices in Tucson AZ and Dallas TX, specializing in preventive and climacteric medicine with an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems from puberty to late life.)

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There is hope and help for treating COVID-19 at home - Gasconade County Republican

Hanne Hoffmann, assistant professor in the College of Agriculture and Natural Resources, and her colleagues in the Hoffmann Lab, study how light regulates our physiology, affects our overall well-being and mood and induces changes in brain function. As winter approaches, Hoffmann answers questions about light and seasonal affective disorder, or SAD.

What is SAD?

Seasonal affective disorder is a type of depression that is related to changes in seasons. It usually begins with less hours of sunlight in the fall and eases in spring when days gets longer. Interestingly, a small proportion of people do experience SAD in the summer. Due to the seasonality of SAD, it is commonly known as seasonal depression. Although anyone can get SAD, women experience it four times more frequently than men. At this point, its unclear why women are more at risk for SAD than men. Since the disorder is caused by changes in day length, the further away from the equator you live, the higher the risk of experiencing it.

How many people have it?

Studies indicate that as many as 20% to 40% of people living at approximately the same latitude as Michigan experience some degree of SAD in the winter. However, this number could easily be reduced through lifestyle adaptations, including spending more time outside and using light therapy.

Hanne Hoffmann, assistant professor in the College of Agriculture and Natural Resources.

What does lack of light do to your body and how does it affect health?

Light matters because it boosts your mood and energy. To regulate your mood and physiology, light-sensing cells send light information to the brain through the optic nerve in your eye. From here, neurons in the brain further relay the light information to regulate mood and hormone release, changing physiological functions depending on the season of the year. The impact on physiological changes in response to light is more pronounced when exposed to blue and green light wavelengths than red light wavelengths. The exact mechanisms happening in the brain for light to regulate mood is poorly understood, but evidence supports that light can regulate the mood-enhancing neurotransmitter serotonin as well as the sleep-promoting hormone melatonin.

In the summer, when most people get a lot of natural light, this promotes changes in the body allowing an increased sense of well-being, more energy and good mood. In the fall, when most people spend less time outside, combined with days with less hours of sunlight, many do not get enough natural light to maintain the feeling happy brain signals, and start to feel sad. The onset of SAD is progressive and is therefore often overlooked.

Common signs of SAD include lack of energy, reduced motivation, trouble concentrating and feeling down as well as being grumpy, moody or anxious. You might eat more and gain weight. Your sleep quality often is reduced, and you might sleep more but still feel tired when you get up. To be appropriately diagnosed, you should see your primary care physician.

Will it be harder to deal with SAD this winter?

This is an unusual year with the COVID-19 pandemic causing increased isolation, more time indoors and increased stress. These are all risk factors for depression and SAD, which is supported by recent research evaluating depression in the summer of 2020 and found an increase in depression by more than three times. Due to the continued changes in lifestyle, increased work, family stressors and reduced social interactions, we can expect to see a significant increase in SAD this winter.

Does light therapy really work?

Yes, the good news is that light therapy works for almost everyone to prevent or reverse SAD.

The general rule is to imitate the natural light cycle of the outdoors: bright (blue rich) light during the day and dimmer (with little to no blue light, and more red light) in the evening. Today, there are many affordable light boxes, also known as SAD lamps, which can be purchased and used to help prevent the disorder.

To reverse SAD, start light treatment as soon as possible. The benefit of light treatment will take days to weeks to happen, so be patient. Heres how to use a light box:

Use daily if possible, but at least five days per week.

Use early after waking, preferably between 7 and 8 a.m. or during the middle of the day. These are the times of day when the body is the most sensitive to the mood-enhancing properties of light. Most importantly, just get some light.

You do not need to use the light box at the same time of day every day.

Avoid extensive use in the late afternoon, and do not use it in the evening or after sunset. In the evening, you want to avoid bright light to promote melatonin release, which will help you sleep.

Use the lightbox at least one to one and a half hours per day. This can be broken down into two or three sittings. You can use it less, 30 to 40 minutes, if you use it in the morning right after waking up.

Do you have recommendations on what to look for in a light box?

These are some general recommendations, and many different light boxes exist. The important criteria is bright intensity (light brightness is measured in lux). On average, a light box with the below criteria cost is approximately $60 to $140.

Use a light box with 10,000 lux at 12 inches or more from your face.

Some of the more expensive light box models, which cost more than $150, will allow you to be up to two feet away and still get the recommended amount of light.

Make sure the light has a UV filter to avoid the risk of retinal damage to the eyes.

Do not look straight into the light box. For example, place it at an angle next to your computer screen or on the table next to where you are reading a book. If you love cooking, hang it on the wall in the part of the kitchen where you spend the most time.

In addition to light therapy, is there anything else we can do to prevent or reduce SAD symptoms?

Yes, there are other things to combine with light therapy that will help.

Consider talk therapy. Twice a week talk therapy sessions with a friend have been shown to be effective at reducing the symptoms of SAD, and it works well in combination with light therapy.

Consider antidepressants. If you suspect you have SAD or are at risk of developing SAD, see your physician, who may prescribe antidepressants. Antidepressants are, in most cases, effective at treating SAD.

Take vitamin D. Vitamin D deficiency is very common and more pronounced in the winter due to reduced natural sunlight, and studies indicate it can improve depression. Before starting supplements, its best to have your Vitamin D levels evaluated by your primary care physician to help determine the best dosage.

Get outside regularly during the day. Natural light is a great prevention and treatment strategy for SAD.

Try to reduce your stress level in the afternoon because stress and too much light will impair your sleep.

Increasing your sleep quality by sleeping through the night and getting at least seven and a half hours, which is beneficial for your overall mental and physical well-being.

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Ask the expert: Light, seasonal affective disorder and COVID-19 - MSUToday

Maintaining a good quality of life with the disease requires early detection and appropriate treatment

Let's start before prostate cancer is even detected. Maintaining a well-balanced diet, keeping one's weight in check, reducing alcohol consumption and avoiding smoking, are all key to an overall healthy lifestyle. Regular exercise, while also a part of any wellness regime, has a specific benefit for prostate health. Prostate cancer reacts strongly to steroids in the body, and regular exercise helps to stabilize steroid levels by counterbalancing the 'everyday' stresses that flood the body with adrenaline.

However, despite maintaining a healthy lifestyle, genetics also play a role that should be considered. Men who have a first-degree relative (e.g. a father or brother) with prostate cancer are twice as likely to develop the disease, and there is also a generally heightened risk if a mother or sister has been diagnosed with breast cancer.

Understanding the warning signs is key. For example, any urinary disfunction exhibited after the age of 50 should be a signal to have a clinical visit with a urologist - these specialists are very adept at detection.

Normally, a clinical exam by way of a digital rectal examination should suffice to provide everything required for an initial diagnosis. Combining this exam with a simple blood test to detect PSA (prostate-specific antigen) can confirm the diagnosis and determine the extent of tumor growth. Given the low mortality risk of prostate cancer, doctors tend to monitor the aggressivity of the tumor with frequent PSA testing and ultrasounds, etc., before undertaking specific treatment. Depending on the progression of the disease and the age of the patient, several treatments are available to maintain quality of life.

So, what does it mean to prioritize 'quality of life' or 'living better' with prostate cancer? Unfortunately, several of the treatment options have consequences that, while effective at removing the cancer, have negative impacts on the day-to-day life of a patient, including erectile dysfunction and urinary difficulties. Consequently, depending on the age of the patient and the progression of the disease, the 'eradication' of the cancer through full or partial removal of the prostate (prostatectomy) may leave a relatively young, early-stage patient with negative side effects that could last a lifetime. It could be said that the most recent 'breakthrough' in the treatment of prostate cancer is managing the medical mindset to spare patients from systematic surgery, by taking into account their day-to-day holistic quality of life and considering the full array of treatment options.

In the early stages, frequent monitoring for tumor progression using PSA testing and ultrasound may be all that doctors advise. This offers the patient a longer 'normal/functional' window before other interventions are advised. Unlike other cancers, where eradication is the immediate priority, the objective of most prostate cancer treatments is to delay the progression of the disease and offer the patient the best life possible.

In the later stages, the introduction of hormone therapy may be advised. This involves suppressing the level of testosterone on which the cancer cells feed. Steroid levels are quite important in this disease - the higher the levels, the worse the potential prognosis. So, if testosterone levels are very high, reducing them through treatment may have a positive patient impact. This treatment is effective at stopping growth and 'choking off' the cancer cells and offers the patient an ongoing good quality of life. Depending upon the extent of such treatment, which at the extreme includes full blockage of testosterone production (temporary chemical castration), there will be an impact on libido and erectile function, but neither side effect is permanent and will only exist during the period of treatment. This offers a patient with advanced disease windows of 'normal life' between treatments. One lasting side effect of hormone suppression therapy is a reduction in BMD (bone mass density), known as osteoporosis, often seen in women during menopause, yet this too is treatable.

In cases where the cancer has not spread beyond the prostate, or has spread only slightly, radiation therapy is quite effective at targeting and killing cancer cells. While a long-term side effect of this therapy is erectile disfunction, the impact is not immediate, and the patient can continue to have years of normal sexual function.

The debate on removing the prostate (prostatectomy)versuspreserving the organ function stands as a major issue that is decided patient by patient, depending on the prognosis of the disease. Thanks to advances in robotic surgery, the procedure is now more precise, which reduces the risk of erectile and urologic disfunction. Other treatments such as radiotherapy may also be advised, when applicable to the patient's level of cancer and taking into account the objective of preserving a 'good life' with the disease.

Insurance providers likewise need to take into account all the treatment options, as well as the general prognosis of a normal life expectancy in prostate cancer patients. The insured will be more likely to file claims related to reduced earning capacity due to working less, increased treatment expenses, and so forth. This is not, in most cases, a serious condition impacting life insurance claims.

In conclusion, given that most diagnosed prostate cancer patients will have a normal life expectancy, both the patient and the treating physician need to focus on how well the patient can live his life. Men need to pay attention to potential signals and visit their urologist if symptoms present themselves, especially after the age of 50. If a prostate cancer diagnosis is confirmed, it is important that the 'stress' of the word 'cancer' be tempered against what is likely to be a long life with the disease rather than a life cut short because of it.

Disclaimer

SCOR SE published this content on 19 November 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 19 November 2020 11:54:03 UTC

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Natural vaginal lubrication is largely driven by the hormone estrogen and plays a crucial role in both sexual intercourse and vaginal health. When estrogen levels are low, it can cause the vaginal tissue to become thin, fragile, and dry making sex painful.

You can use store-bought lube to help with vaginal dryness, however, some lubes can actually pull natural moisture and worsen dryness. So, it's important to look for lubes that promote vaginal hydration.

Another option is vitamins and supplements that can help increase female lubrication naturally by boosting estrogen levels. But keep in mind that you should always consult a doctor before beginning any vitamin or supplement regimen to avoid dangerously high doses.

Here's what you need to know about vaginal dryness and how to boost your body's natural ability to self-lubricate.

People of all age groups can experience vaginal dryness, but it is more common in those who are menopausal. Other causes of vaginal dryness include:

Vitamin A: This vitamin is important in the development of mucous membranes, which include the lining of the vagina. "It is helpful in terms of moisture and collagen production," says Anita Sadaty, MD, attending physician in obstetrics and gynecology at Northwell Health System in New York.

Vitamin A can be taken orally, she says, but should not be taken in excess. "If vitamin A becomes extremely high there can be liver injury, but it's honestly pretty hard to overdose."

Vitamin B: Vaginal secretionscan be altered by both hormonal and dietary factors. Proper immune function is important when it comes to vaginal health, and vitamin B complex a supplement that includes all eight types of vitamin B boosts immune function.

It can be taken as a supplement or absorbed through food sources including poultry, fish, potatoes, and bananas. But too much can be dangerous. It can lead to a lack of muscle control, stomach issues, and painful lesions.

Beta-carotene: Beta-carotene is a provitamin, meaning your body uses it to make another vitamin, in this case, vitamin A. As stated above, vitamin A helps fend off vaginal dryness.

Beta-carotene is found in foods includingcarrots, dark-green leafy vegetables, sweet potatoes, broccoli, cantaloupe, and winter squash. Though it is not toxic in high doses, too much can cause the skin to take on a yellow-orange hue among other side effects.

Omega-3 fatty acids: "In general, essential fatty acids will help improve the architecture of the vaginal mucosa," Sadaty says. A 2012 study found omega-3 to significantly reduce vaginal dryness for six months among postmenopausal breast cancer survivors with vaginal atrophy(atrophic vaginitis), which is a thinning, drying, and inflammation of the vaginal walls.

Sadaty says although there have been concerns that high levels of omega-3s may lead to blood-thinning or excess bleeding, research does not support that claim.

Vitamin E: This is another vitamin that can help promote vaginal lubrication. A small 2016 study of 52 postmenopausal women showed vitamin E vaginal suppositories helped the majority of subjects with symptoms of vaginal atrophy, including dryness. Vitamin E can also be ingested from various foods, including plant-based oils, nuts, seeds, fruits, and vegetables.

"Foods like pumpkin and sunflower seeds are all good for dryness," Sadaty says. When sourced naturally through food, vitamin E carries no risk. But in supplement form, high doses of vitamin E might increase the risk of bleeding by interfering with the blood's ability to clot. This could potentially lead to a hemorrhagic stroke, or bleeding in the brain, though this is rare.

Vaginal DHEA: Your body produces the hormone dehydroepiandrosterone (DHEA), which in turn, helps produce other hormones including estrogen. DHEA levels peak in early adulthood and decrease with age. For vaginal dryness, a doctor may prescribe a synthetic version of DHEA as an oral treatment or a topical cream.

A 2016 study spanning 12 weeks found vaginal secretions improved in participants by 86% to 121% over the placebo effect. However, DHEA treatments may have some risks, including an increase in the risk of hormone-sensitive cancers, such as breast and ovarian cancers. It should also be avoided if you have high cholesterol.

Low-dose estrogen/estrogen cream: There are two types of estrogen treatments for vaginal dryness:

Hyaluronic acid: Hyaluronic acid is a molecule that exists naturally in your skin and is key to keeping it moist. However, you can also get hyaluronic acid as a topical gel, which multiple studies have found can help vaginal dryness in postmenopausal women.

One of the most important factors in balancing your hormones is a low level of stress, Sadaty says. Research is still limited, but stress, anxiety, and depression are thought to make vaginal dryness worse.

To combat this, Sadaty recommends the "big three": exercise, balanced diet, and sufficient sleep. Research shows exercise plays a key role in happiness and emotional resilience. Studies have also found that sleep not only reduces stress by recharging and restoring the body but leads to greater life satisfaction.

And while a particular diet can be an important stress-management tool, there are also foods rich in the previously mentioned vitamins that can drastically reduce dryness, including vegetables, nuts, seeds, and healthy fats.

If you are experiencing vaginal dryness, it should be dealt with as soon as possible, Sadaty says. Seek out medical support if dryness is persistent or painful.

"If you allow dryness and vaginal thinning to go on long enough, sometimes it's harder to fix it," Sadaty says. "At some point, it's difficult to restore the anatomy."

Vaginal lubrication is a key aspect of overall health and sexual satisfaction. Those who have issues with it may have estrogen deficiencies, which can be treated with vitamins, supplements, hormone treatments, and creams.

People who experience vaginal lubrication issues should seek medical counsel as soon as possible. Always consult a medical professional before taking supplements or medications.

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How to boost vaginal lubrication naturally, according to an OB-GYN - Insider - INSIDER

USA Gymnastics policy changes allowing trans athletes to compete in disciplines aligning with gender identity without sex reassignment surgery or hormone treatment is a disgusting violation of womens rights to appease a minority.

In a familiar tale of the perennial battle to establish super-inclusive safe spaces at the expense of logic orthe safety and rights of others, USA Gymnastics (USAG) on Tuesday pledged to remove surgical sex reassignment, legal gender recognition, and hormone therapy requirements as requirements for transgender athletes to compete in disciplines they consider align with their gender identity.

The new policy changes effectively gives any athlete born male but identifying as a transgender woman free reign to campaign alongside women without having to forego the inconvenience of anything that might give their claim to be a member of the opposite sex any shred of credibility.

Also on rt.comFeminists infuriated but gay gamers rejoice at Dua Lipa as FIFAs cheap attempt to sell sex takes unexpected turn

And just why has USAG decided to become part ofthe woke mob inclusive indoctrination process? You guessed it: feelings.

The emotional and psychological safety of transgender gymnasts or of anyone who might be offended at medical procedures, legal documents, logic or, heaven forbid, common sense, was ludicriously equated to the physical, emotional and psychological safety of other gymnasts by USAG CEO Li Li Leung in a statement released announcing the policy changes.

Our top priority is and must always be the safety of our athletes, including their emotional and psychological safety, Leung babbled in the press release. Inclusivity plays an important role in creating safe and welcoming environments for our community members, and this policy will help ensure athletes who identify as transgender or non-binary feel at home in our sport.

Leung may attempt to dress the matter up as implementing one big, cosy, marshmellow-walled haven impenetrable by the voice of reason for transgender gymnasts, but in reality, the announcement is nothing more than gender politics point-scoring to play up to the perpetually-offended progressive movement.

A closer look reveals that the timing of the USA Gymnastics woke faux-pas flex press release on Wednesday came slap bang in the middle of Transgender Awareness Week which, for those notaware, is typically celebrated in the second week of November.

Only USAG arent definitely unaware that their cuddling up to the endlessly principled teachings of the progressive gospel isnt safe, but rather a serious violation of the rights and dignity of the women and young girls in their care.

The full and frankly mind-boggling manifesto reads that USAG intends to promote an inclusive environment for athletes of all gender identities, while protecting the privacy of trans and non-binary athletes.

Protecting privacy!? Has it not occurred to USAG that not only will female gymnasts be forced to welcome a legally-recognized male into the team in the name of inclusivity, but the new policy would potentiallyexpose them to contact with a gymnast with the physical and hormonal attributes of a male in changing rooms, when rooming in hotels, or in showers, whether they like it or not, seriously compromising their privacy and dignity.

And for what? So a transgender gymnast who couldnt be bothered to go through paperwork or muster the effort to undergo a medical procedure to at least adequately fit into a leotard can feel safe and included at the expense of the feelings ofthose around them?

Is compromising the comfort and safety of young female gymnasts really acceptable procedure for an institution still reeling from one of the largest sexual abuse scandals in sporting history?

READ MORE: Scandal-hit USA Gymnastics chief to resign in the wake of horrific events of Nassar sexual abuse

In 2018, USAG filed forbankrupcy owing in part toa stream of lawsuits targetingthe organizations alleged negligence over the sexual abuse of dozens of national team members committed by disgraced former team physician and convicted pedophile Larry Nassar, some claiming the organization attempted to cover up years of serious assaultsand encouraged or coerced his victims to remain silent on their suffering.

Nassar, who servedan 18-year tenure as USAGnational medical coordinator from 1996 to 2014, was sentenced to 175 years in jail after being found guilty on numerous child sex charges dating back to 1992.

It is effortlessly ironic that USAG should take a course of action to create safe spaces for the gymnasts under their care by allowing practically all of themto be further exposed to contemporaries legally and scientifically recognized as men.

In gymnastic eventswherephysical strengthplays a significant role in the chances of success, afemale gymnast could theoretically dedicate her entire lifeto the sportonly to be pipped at the post for a place on the podium by someone significantly stronger, but who just fancied competing in that discipline, and whose word were obliged to take so as not to hurt anyones feelings other than the poor girl prevented from achieving her dreams because of strong-arm inclusivity tactics. How veryprogressive.

Such arbitrary rule making,which USAGvaguely claims isbased on current medical science and consistent with unnamed anti-discrimination legislation, despite not providing any further evidence, should be stamped out before the spurious spread of ultra-inclusivity affects other sports where womens records and achievementscould potentially be wiped out and its competitors seriously hurt by the inclusion of transgender athletes benefitting from hormonal and physical advantages over their peers.

READ MORE: Who thought Dua Lipa in FIFA was a good idea?! Gamers red-faced as pop star GROPED by players during goal celebrations

Perhaps the most laughable line of the entire shambles of a statement came fromKim Kranz, USAGsChief of Athlete Wellness, when trying to explain theircommitment to help create an inclusive environment within the sport.

Everyone should have the opportunity to participate in gymnastics with the knowledge that they will be safe and have their dignity respected, Kranz claimed.

It seems USAGs respect for dignity, safety and comfort is a luxury afforded only to thosethat campaign to be accepted and treated just as everyone else, but whose plan to achieve such is by beingtreated as an exception, all at the expense of the rights of the very young girls and women they purport to protect.

By Danny Armstrong

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USA Gymnastics' 'safe space' policy to allow trans athletes to compete WITHOUT surgery is disgusting violation of women's rights NY Pilot Sport News...

(CNN) -- For the transgender people who seek it, gender-affirming hormone therapy can be lifesaving. But if they're uninsured or their insurance won't cover it, some bypass the health care system entirely to get the care they need.

Around 75,000 transgender Americans are likely using hormones that weren't prescribed -- close to 1 in 10 of the estimated 1.4 million transgender adults in the US -- says a study published this month in the Annals of Family Medicine.

Beyond the health risks of using nonprescription hormones, the findings indicate extensive barriers to care transgender Americans face, lead author Dr. Daphna Stroumsa told CNN.

"Trans people face a multitude of cultural and structural hurdles in staying safe and healthy," said Stroumsa, a clinical lecturer in the University of Michigan's Department of Obstetrics and Gynecology who specializes in LGBTQ health care. "We need to streamline care. We don't need to put barriers between patients and providers."

Using data from the US Transgender Survey, a sample of almost 28,000 trans Americans from the National Center for Transgender Equality, the study focused on two groups: Uninsured trans people and trans people whose insurance company denied their claims for gender-affirming hormones. Both groups were more likely to seek out nonprescription hormones than insured transgender people, according to the study.

Trans Americans are more likely to be uninsured than the general population -- about 15.5% of respondents in the US Transgender Survey compared to 12.8% of US adults. And among uninsured respondents, around 21% said their insurance claims for gender-affirming care had been denied, according to the study.

About 84% of respondents to the US Transgender Survey said they wanted gender-affirming hormones, but around 55% of them were actually taking hormones. Among all respondents taking hormones, more than 9% of them said they were using nonprescribed hormones.

On one hand, the fact that some trans people circumvent the healthcare system to access gender-affirming care shows their "resilience," Stroumsa said. But from a physician's perspective, that's a sign of failure, they said.

"This indicates that we have a problem in getting trans people lifesaving medication," they said.

Hormone therapy can be expensive out of pocket -- often around $30 a month, according to a 2013 CNN piece, though that amount can vary. It can also be dangerous when not regulated by a physician, Stroumsa said. Some hormone therapies can increase risk of heart problems or stroke. And without a doctor to monitor the dosage and components of the hormones they're receiving, trans patients may experience unforeseen health issues.

Mounting evidence shows that accessing gender-affirming health care can be lifesaving for trans people who seek it. UCLA's Williams Institute, a think tank that focuses on LGBTQ legal issues, reported that a lack of gender-affirming care likely contributed to high percentages of suicidal thoughts among transgender Americans.

And though it's illegal for most insurance companies to discriminate against trans Americans, 30 states permit health insurance plans to exclude some trans health services, NPR reported in 2019.

Stroumsa said insurance companies that cover such procedures often ask patients to provide proof that procedures or treatments are necessary. For example, a trans man's insurers may require him to provide two signed letters from mental health care providers when he seeks a gender-affirming hysterectomy, they said.

Insurance is just one hurdle trans people face in getting care. There's the discrimination they often face from physicians and health care providers who refuse them care or misstate their gender, and higher rates of homelessness and joblessness -- all likely reasons why some trans people bypass the health care system altogether.

"Health care systems and physicians and health care providers have so often failed trans people, either with direct discrimination or ignorance of trans people's health care needs," Stroumsa said. "We need to fix that."

One of the ways physicians can start to mend those gaps, they said, is by including trans people in the agenda-setting process and taking their needs into account when setting insurance policies. Some major medical associations, including the American Academy of Family Physicians, have announced their support for insurance coverage of gender-affirming care. More voices in support of gender-affirming health care coverage could remove at least one obstacle.

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Almost 1 in 10 transgender Americans use nonprescribed hormones because they're uninsured or insurance won't cover the cost - CBS46 News Atlanta

Dr. Cherie Worford speaks about the resources available to the transgender community through the Colorado State University Health Network. (Matt Tackett | The Collegian)

Medical care for transgender and gender nonbinary people varies in accessibility and practice throughout the country.

At Colorado State Universitys Health Network, its become more mainstream.

Dr. Cherie Worford is the clinical supervisor of the Womens and Gender Care Clinic at CSUs Health Network and a medical physician subtrained in obstetrics and gynecology.

One of Worfords primary duties is to aid transgender and gender nonbinary people interested in medically transitioning via hormone injections.

Medical transition is for patients who are identifying as transgender and are looking to take medications to potentially cause some external changes, aligning internal gender identity with external gender (appearance), Worford said.

We try to be as straightforward as possible. Its available, were here to do it, were happy to see you. Let us know how we can help, all without making it an overly medicalized situation.Dr. Cherie Worford, CSU Womens and Gender Care Clinic clinical supervisor, medical physician

According to Worford, the general process begins with an introductory meeting in which the doctor and patient go over the patients general health history and things that could potentially affect them being on medications.

This is followed by a discussion of the patients history with gender dysphoria, internal distress caused when an individuals gender identity differs from the sex they were assigned at birth, she explained.

During this conversation, the doctor and patient discuss what aspects of their gender identity they find dysphoric and what the patient hopes to gain from being prescribed hormones, Worford said.

This includes short- and long-term goals, where on the gender spectrum the patient wants to transition toward and what they may want to accomplish overall by medically transitioning, she said.

CSU in general, as most clinics now which is good run on whats called the informed consent model, Worford said.

This model requires medical professionals to educate their patients on what medical procedures are and the benefits and the risks involved, according to Worford.

Due to this practice, patients know what it is they want and the effects the medical practices can have prior to consenting to taking medications, she said.

I essentially talk to patients about what this (process) is, what hormones are, this is what they do, these are the benefits we see, these are the potential risks (and seeing if people are) still interested in doing it, Worford said.

According to Worford, medical professionals dont have to be involved in counseling nor do hormone suppliers require the approval of a mental health provider for a patient to qualify for hormones.

Before the implementation of the Health Networks current practices, a patient had to pass certain criteria to be approved for any method of medical transitioning. They had to live as their desired and identified gender for a year before they could get approved to transition. This came with a lot of psychological and social safety issues associated with it, Worford said.

According to Worford, some patients come in the first day, and they know exactly what they want. For others, it takes a couple appointments and consultations for them to think things through and decide if they want to proceed toward a hormone treatment or if they arent ready to take that step yet.

We try to be as straightforward as possible, Worford said. Its available, were here to do it, were happy to see you. Let us know how we can help, all without making it an overly medicalized situation.

For a full gender transition, from start to finish, the process can take up to three to five years depending on how far into the transition the patient would like to go, according to Worford.

In transgender women, breast development may take a long time, while in transgender men, their voice may deepen quickly but their facial and body hair growth can take longer, she said.

For gender nonbinary individuals or those whod like an androgynous appearance, it may take less time in total, Worford explained.

We dont question their motives. Its a legitimate procedure, and we are providing a service without judgement. -Dr. Paul Steinwald, Denver plastic surgeon

Prescribed hormone doses vary for each person and where on the gender spectrum theyd like to be. An increase in dosage doesnt necessarily speed up the process. For some, it simply increases the symptoms, Worford said.

It can be a slow process, Worford said. I tell people its a similar concept to puberty. For a majority of us, puberty does not happen overnight. Most of us didnt really enjoy it. Its like a second puberty.

Jill Vesty is a family nurse practitioner who works alongside Worford at the CSU Health Network. She aids in educating patients on the process of taking hormones, helping them decide what steps to take on their journey through transitioning.

Vesty has worked with the Health Network for 10 years and was on staff when it started to implement transgender health care.

I care about people, I care about society, Vesty said. I think everybody deserves health care, and I want to help people access it.

According to Vesty, the CSU Health Network has largely mirrored the type of care that has become more normalized throughout the United States for this community.

A type of health care that was once thought to be specialized, transgender care has become more incorporated into general, primary care, Vesty explained.

I think its great when a transgender student can come in with any number of medical issues, and the same clinician can manage all of those medical issues, Vesty said. It increases access if you have more general family practitioners to provide this care as part of their routine.

According to Vesty, this improves awareness across the spectrum and makes resources more widely known. This allows individuals who are on their way to transitioning to become aware of what is available, she said.

Vesty said the Health Network does not provide specialty care like plastic surgery. However, they are always able to recommend services that are both financially and regionally accessible for their patients.

Dr. Paul Steinwald is a plastic surgeon with the Center for Cosmetic Surgery, located in Denver. A specialty to his practice is his chest masculinization procedure, otherwise known as top surgery.

According to Steinwald, he is one of the few plastic surgeons that, when removing breasts, will try to keep the breast attached, specifically the nipple.

While this is considered to be a more difficult procedure that has risks, Steinwald said it is more likely to retain sensation in the area.

While other surgeons generally take the nipple off and graft it back on, Steinwald prefers to only do that for individuals with larger breasts, size DD or higher.

It heals better than a graft ever would, Steinwald said. And you can adjust it or revise it later with everything still attached, versus grafting.

According to Steinwald, its really about how the patient will scar. If the nipple looks good two weeks after the procedure, then the patient is in a good place. Otherwise, the need for revision would be considered.

Overall, its a very well-tolerated procedure with a 95% success rate for nipple survival, and thats key, Steinwald said.

Steinwald has been working with the transgender community for the majority of his career, his first experience occurring in 2002.

Its a very wonderful population of patients, Steinwald said. I think they should be treated like everyone else, with good, safe care and respect.

His staff has reported positively when working with individuals within the community.

We dont question their motives, Steinwald said. Its a legitimate procedure, and we are providing a service without judgement.

Dorina Vida can be reached at news@collegian.com or on Twitter @simply_she_.

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Transgender health care: Shifting to the conventional The Rocky Mountain Collegian - Rocky Mountain Collegian

With more than 11 million cases of COVID-19 in the United States and few treatments available, its no wonder that a study suggesting melatonin may treat or even prevent the coronavirus has gained attention. But alluring as it is to think that a sleep aid sold at most drugstores can cure this virus, experts tell Yahoo Life that those believing its a silver bullet are significantly off the mark.

Its a gigantic leap, says Dr. Ryan Marino, an emergency room physician and medical toxicologist in Ohio. This finding may certainly be worth studying further, but it will not change how I treat my patients or myself, and I would urge everyone caution in interpreting these headlines.

The study was published in the journal PLOS Biology this week, accompanied by a press release from the Cleveland Clinic, where it was conducted, that said that researchers had used data to identify melatonin as a possible treatment for COVID-19. The studys authors utilized electronic records to analyze the link between the two, concluding that melatonin usage was associated with a nearly 30 percent reduced likelihood of testing positive for SARS-CoV-2 after adjusting for age, race, smoking history and various disease comorbidities.

Marino describes the press release as irresponsible and factually unsupportable and says that while it is an interesting finding, its one that may be giving people false hope.

Melatonin is defined by the National Institutes of Health as a hormone that your brain produces in response to darkness. Classified as a dietary supplement by the Food & Drug Administration, it is one of the most widely used sleep aids in the U.S. While it is not regulated like a drug, many doctors have come to embrace melatonin, with the Mayo Clinic describing it as safe for short-term use, saying there is evidence showing that it provides some insomnia relief.

When used under doctors supervision, the supplement can be useful for alleviating sleep issues. But as a treatment for COVID-19, Marino says, its not a good idea. He elaborates on what he calls major problems within the study. One, the finding is an association only and, given the lack of any plausible mechanism, should not be mistaken for true cause and effect, says Marino. While I would not dismiss it outright, it would certainly be much easier to explain this through unidentified confounding factors for example, people who take melatonin are more likely to practice other interventions to try to protect their health.

Story continues

There are many reasons those taking melatonin may be experiencing COVID-19 in lower numbers, including improved sleep, better overall health and a more significant commitment to safety precautions.

On top of that, he suggests that only a randomized trial would be able to establish a causal connection. Observational studies like this are usually not able to show us whether anything truly prevents or treats a condition but just can identify correlations that then can be further studied, says Marino. The studys lead author, Feixiong Cheng, assistant staff in the Genomic Medicine Institute, seems to agree. In the press release on Cleveland Clinics site, Cheng advised against running out to buy the supplement.

It is very important to note these findings do not suggest people should start to take melatonin without consulting their physician, said Cheng. Large-scale observational studies and randomized controlled trials are critical to validate the clinical benefit of melatonin for patients with COVID-19, but we are excited about the associations put forth in this study and the opportunity to further explore them.

The Cleveland Clinic, in response to a request for comment, noted that the study was peer-reviewed and that the headline of the press release reflects the papers findings, adding the summary on Lerners web site emphasizes that this is a potential drug candidate for COVID-19 and further research is needed to validate theses initial findings.

After Marino tweeted about the study, other doctors expressed similar fears about the way it has been framed. It is simultaneously not at all surprising and incredibly disappointing that @ClevelandClinic is peddling bulls*** like this, and in so doing further eroding societal scientific literacy by spurring on predatory, clinical-evidence-not-required bandwagon fueling supplement sales, tweeted Dr. Yoni Freedhoff, an associate professor of family medicine at the University of Ottawa.

Like other experts, Marino emphasizes that the Centers for Disease Control and Preventions guidelines for staying safe remain the most important. As of right now there are no good treatment options for COVID-19, and the best way to prevent it is to practice distancing, masking and good hand hygiene, says Marino. A sure way to prevent disease spread is to avoid gathering in groups this Thanksgiving, as we are currently seeing uncontrolled virus spread in every part of the country.

For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDCs and WHOs resource guides.

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No evidence that melatonin can be a treatment for COVID-19 - Yahoo Sports

Coronavirus research found a potential compound that can be found in foods.

Highlights

Health experts all over the world are in constant search for viable means to prevent and treat Coronavirus. Every day, we see a glimmer of hope in the numerous researches making headway in unravelling measures to combat the pandemic. One such recently-conducted research led by Cleveland Clinic found a new compound that is being seen as a promising drug against Coronavirus. Melatonin, a sleep-regulating hormone, was noted as the potential prevention and treatment of COVID-19. Humans naturally produce the hormone but in its absence, over-the-counter supplements and foods containing melatonin can be taken to overcome the deficiency.

The researchers analysed patient data from its COVID-19 registry and found that melatonin usage was associated with a nearly 30 percent reduced likelihood of testing positive for SARS-CoV-2 after adjusting for age, race, smoking history, and various disease comorbidities.

However, the researchers warned against starting taking melatonin supplements until further studies corroborate their findings that were published in the journal PLOS Biology. "It is very important to note these findings do not suggest people should start to take melatonin without consulting their physician," said Feixiong Cheng, PhD, assistant staff in the Genomic Medicine Institute and lead author on the study.

While we wait for validation on melatonin to reduce the risk of Coronavirus, you may consider consuming foods that are a natural source of melatonin. National Center for Biotechnology Information listed down the following foods that contain a good amount of melatonin.

(Also Read:Vitamin D Deficiency Found In 80% COVID-19 Patients; Diet Sources)

Melatonin is a sleep-regulating hormone.

Eggs are highly rich in proteins and can be consumed in abundance through breakfast diet. Boiled eggs, omelette, baked eggs, scrambled eggs, and more such egg-based recipes can be easily tried.

Another animal-based source of melatonin, fish is generally considered very healthy food to have, which provides many other nutrients as well.

3. Nuts

Out of all the plant-based sources, nuts have the highest amount of melatonin. Make it a habit to have a handful of different kinds of nuts every day.

This vegetable can be easily incorporated into our diet. Many Indian sabzis like mushroom matar and international dishes like mushroom pasta, can be made with mushrooms.

Try to consume different kinds of cereals to maximise nutrient-intake from this melatonin-rich food.

Promoted

Beans, lentils, chickpeas, peanuts - there's a whole range of legumes you can add to your regular diet. Thankfully, most of us already consume it in adequate quantities.

Note: These foods are not part of the study.

(This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.)

About Neha GroverLove for reading roused her writing instincts. Neha is guilty of having a deep-set fixation with anything caffeinated. When she is not pouring out her nest of thoughts onto the screen, you can see her reading while sipping on coffee.

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Experts Discover New Compound That May Fight Coronavirus; These Foods Are Natural Sources - NDTV Food

(HealthDay News) Patients with multiple primary melanomas have worse overall survival than those with a single primary melanoma, according to a study published online June 26 in JAMA Dermatology.

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Five-Year Survival Less Than 40 Percent in Seniors With DLBCL

FRIDAY, June 28, 2019 (HealthDay News) Overall survival among older adults with diffuse large B-cell lymphoma (DLBCL) has improved over time, but five-year survival is less than 40 percent, according to a study published online June 12 in Leukemia & Lymphoma.

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FRIDAY, June 28, 2019 (HealthDay News) Morning preference seems to have a protective effect on breast cancer risk, according to a study published online June 26 in The BMJ.

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Use of 3-D Mammography Rapidly Expanded 2015 to 2017

FRIDAY, June 28, 2019 (HealthDay News) Adoption of 3-D mammography expanded rapidly in the United States in just a few years, particularly in areas with greater socioeconomic resources, according to a research letter published online June 24 in JAMA Internal Medicine.

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Review: HPV Vaccination Program Has Considerable Impact

FRIDAY, June 28, 2019 (HealthDay News) The human papillomavirus (HPV) vaccination program has had a considerable impact, according to a study published online June 26 in The Lancet.

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Infections Tied to Subsequent Risk for Acute Ischemic Stroke

FRIDAY, June 28, 2019 (HealthDay News) Different infection types, especially urinary tract infection (UTI), are associated with subsequent acute ischemic stroke, according to a study published online June 27 in Stroke.

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USPSTF Lung Cancer Screening Too Conservative for Blacks

THURSDAY, June 27, 2019 (HealthDay News) Current U.S. Preventive Services Task Force (USPSTF) guidelines for lung cancer screening eligibility may be too conservative for African American smokers, according to a study published online June 27 in JAMA Oncology.

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Five-Year Overall Survival for Glioblastoma Persistently Low

THURSDAY, June 27, 2019 (HealthDay News) The percentage of patients achieving five-year survival following a glioblastoma diagnosis remains both steady and low, according to a study published online June 19 in Mayo Clinic Proceedings.

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MSSP ACOs May Not Improve Spending, Quality of Care

WEDNESDAY, June 26, 2019 (HealthDay News) After adjustment for the nonrandom exit of clinicians, the Medicare Shared Savings Program (MSSP) is not associated with improvements in spending or quality, according to a study published online June 18 in the Annals of Internal Medicine.

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Americans Concerned About Clinician Burnout

WEDNESDAY, June 26, 2019 (HealthDay News) Nearly three-quarters of Americans are concerned about burnout among their clinicians, according to a survey released June 17 by the American Society of Health-System Pharmacists (ASHP).

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Combination Biopsy Strategy May Identify More Prostate Cancers

WEDNESDAY, June 26, 2019 (HealthDay News) A lesion visible on magnetic resonance imaging (MRI) identifies a heightened risk for clinically significant prostate cancer in men undergoing first-time prostate biopsy, and a combination of targeted and systematic biopsy may improve the chances of detecting cancer, according to a study published online June 12 in JAMA Surgery.

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Mortality Not Higher With Transfusions From Female Donors

TUESDAY, June 25, 2019 (HealthDay News) There is no increased risk for mortality among patients receiving red blood cell transfusions from female, previously pregnant, or sex-discordant donors, according to a study published in the June 11 issue of the Journal of the American Medical Association.

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Anesthesia Tied to Neurocognitive Impairment in Childhood ALL Survivors

TUESDAY, June 25, 2019 (HealthDay News) Multiple exposures to general anesthesia may be associated with neurocognitive impairment and brain imaging abnormalities in long-term survivors of childhood acute lymphoblastic leukemia (ALL), according to a study published online June 20 in JAMA Oncology.

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Voxelotor Improves Hemoglobin Levels in Sickle Cell Disease

TUESDAY, June 25, 2019 (HealthDay News) For individuals with sickle cell disease, 1,500 mg of voxelotor increases hemoglobin levels and reduces the incidence of worsening anemia compared with placebo, according to a study published in the June 14 issue of the New England Journal of Medicine.

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Cancer Survivors Have High Prevalence of Chronic Pain

TUESDAY, June 25, 2019 (HealthDay News) Cancer survivors have a high prevalence of chronic pain, according to a research letter published online June 20 in JAMA Oncology.

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Nonchromosomal Birth Defects May Up Childhood Cancer Risk

MONDAY, June 24, 2019 (HealthDay News) Children with nonchromosomal birth defects have a higher relative risk for cancer, though the absolute risk is still low, according to a study published online June 20 in JAMA Oncology.

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Adrenal Incidentalomas Rarely Grow, Change Hormone Function

MONDAY, June 24, 2019 (HealthDay News) Nonfunctioning adrenal tumors (NFATs) or adenomas causing mild autonomous cortisol excess (MACE) rarely show clinically relevant changes in size or hormone function, according to research published online June 25 in the Annals of Internal Medicine.

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Drug Combo Slows Progression in Advanced Breast Cancer

MONDAY, June 24, 2019 (HealthDay News) Treatment with a combination of alpelisib and fulvestrant prolongs progression-free survival among patients with PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, according to a phase 3 study recently published in the New England Journal of Medicine.

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Transfusion Dose Density Affects Myelodysplastic Syndrome Survival

MONDAY, June 24, 2019 (HealthDay News) Transfusion dose density is an independent prognostic factor for progression-free survival (PFS) in patients with myelodysplastic syndromes treated with red blood cell transfusions (RBCTs), according to a study published online June 6 in Haematologica.

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Poor Oral Health Not Linked to Gastrointestinal Cancer Risk

FRIDAY, June 21, 2019 (HealthDay News) Self-reported poor oral health is not associated with gastrointestinal cancer risk, although it may be associated with hepatobiliary cancer, specifically hepatocellular carcinoma, according to a study published online June 8 in the United European Gastroenterology Journal.

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Seniors Who Develop Cancer Have Better Memory, Slower Decline

FRIDAY, June 21, 2019 (HealthDay News) Older individuals who develop cancer have better memory and slower memory decline than those who remain cancer-free, according to a study published online June 21 in JAMA Network Open.

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Study Reveals Lower Predictive Ability for Renal Cancer Models

FRIDAY, June 21, 2019 (HealthDay News) Prospective validation of existing renal cell carcinoma (RCC) prediction models demonstrates a decrease in their predictive ability, according to a study published online June 19 in the Journal of Clinical Oncology.

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No Change Seen in Processed Meat Consumption by U.S. Adults

FRIDAY, June 21, 2019 (HealthDay News) During the last 18 years, there has been no change in consumption of processed meats among U.S. adults, according to a study published online June 21 in the Journal of the Academy of Nutrition and Dietetics.

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First States to Expand Medicaid Had Largest Bump in Cancer Screening

FRIDAY, June 21, 2019 (HealthDay News) The first states to expand Medicaid under the Affordable Care Act saw the largest increases in colorectal cancer (CRC) screening from 2012 to 2016, according to a study published in the July issue of the American Journal of Preventive Medicine.

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Restricting Blood Transfusions OK in Cardiac Surgery

THURSDAY, June 20, 2019 (HealthDay News) For high-risk patients undergoing cardiac surgery with cardiopulmonary bypass, a restrictive approach to red blood cell transfusions leads to fewer transfusions than a liberal approach, with no increase in the risk for acute kidney injury (AKI), according to a study published online June 20 in the Journal of the American Society of Nephrology.

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Most Women Unaware Alcohol Poses Breast Cancer Risk

THURSDAY, June 20, 2019 (HealthDay News) Women have poor awareness of alcohols role in breast cancer risk, according to a study published online June 17 in BMJ Open.

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New England Journal of Medicine Picks New Editor-in-Chief

THURSDAY, June 20, 2019 (HealthDay News) The new editor-in-chief of the prestigious New England Journal of Medicine is Eric J. Rubin, M.D., Ph.D., who was selected after a worldwide search and plans to start in September, according to the Massachusetts Medical Society, which publishes the journal.

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Health Care Workers With ARIs Often Work While Symptomatic

THURSDAY, June 20, 2019 (HealthDay News) Almost all health care workers (HCWs) with acute respiratory illness (ARI) report working at least one day while symptomatic, according to a study published online June 18 in Infection Control & Hospital Epidemiology.

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High Response Seen for Chemo in Seniors With High-Risk AML

THURSDAY, June 20, 2019 (HealthDay News) A substantial proportion of older patients with high-risk acute myeloid leukemia (AML) treated with chemotherapy are long-term survivors, according to research published online June 7 in Cancer Medicine.

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Computer-Assisted Diagnosis Aids Detection of Glioma Growth

THURSDAY, June 20, 2019 (HealthDay News) Computer-assisted diagnosis (CAD) can help physicians detect growth of low-grade gliomas, according to a study published online May 28 in PLOS Medicine.

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San Francisco Considering Banning Sales of E-Cigarettes

WEDNESDAY, June 19, 2019 (HealthDay News) A ban on the sale and distribution of electronic cigarettes is being considered by San Francisco supervisors. If passed, it would be the first such ban by any city in the United States.

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Gout Linked to Increased Length of Hospital Stay in Patients With Heart Failure Exacerbation - Renal and Urology News

Transparency Market Research (TMR) () has published a new report titled,Endocrine Testing Market Global Industry Analysis, Size, Share, Growth, Trends, and Forecast, 20192027. According to the report, the globalendocrine testing marketwas valued atUS$ 5.5Bnin2018and is projected to expand at a CAGR of6.4%from2019to2027.

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Endocrine Testing Market projected to expand at a CAGR of 6.4% from 2019 to 2027 - Eurowire

Cardiovascular (CV) mortality is now the most common cause of death in men with prostate cancer, even exceeding prostate cancer mortality.1Several studies have shown androgen deprivation therapy, which is still the cornerstone of treatment for men with hormone-dependent prostate cancer, is associated with an increased risk of cardiovascular disease (CVD).2,3However, recent evidence suggests it is now time to consider which androgen deprivation therapy (ADT) modality is most suitable for patients with cardiovascular risk factors.4

The aim of this study was to use real-world data from a UK primary care database (Optimum patient care database) to clarify whether CV risk in prostate cancer patients was lower in those treated with GnRH antagonists vs. LHRH agonists. A total of 9,081 patients were identified from the database as patents with a diagnosis for prostate cancer and new users of degarelix, leuprorelin, triptorelin, or goserelin. We found patients receiving degarelix had a higher baseline prostate-specific antigen (PSA), indicating more advanced prostate cancer than those initiating therapy with a GnRH agonist. Further, more patients receiving degarelix had pre-existing CVD compared with patients receiving GnRH agonists. Despite this, the relative risk of experiencing any cardiac event was lower with degarelix than all GnRH agonists (Table 1; risk ratio [RR] 6.9% vs. 17.7%; 0.39 [95% confidence interval [CI] 0.191, 0.799]; p = 0.01).

Our data support findings from previously published studies showing GnRH antagonists are associated with a lower cardiac risk than LHRH agonists. In a retrospective pooled analysis of six prospective clinical trials in men with pre-existing CVD (2328), initiating degarelix compared with GnRH agonist therapy resulted in an absolute risk reduction of 8.2% (NNT=12).5Further, in a prospective randomized controlled trial of 80 patients with pre-existing CV disease, 20% on the agonist developed a major adverse cardiovascular event (MACE) compared to 3% on the antagonist.6Recent publications of similar real-world studies also reflect our findings. An analysis of Italian health records showed the incidence rate of CV events was significantly higher in patients treated with GnRH agonists rather than degarelix (8.80 vs. 6.24 per 100 person-year, p-value 0.002).7Further, pharmacovigilance data (VigiBase) showed increased odds of cardiac events (driven by myocardial infarction [MI] and heart failure [HF]), for GnRH agonists but not for GnRH antagonists.8Finally, a Phase III randomized controlled trial of an oral antagonist (relugolix) showed in pre-specified safety analysis, the incidence of major adverse cardiovascular events (MACE) was lower in the relugolix group than in the leuprolide group (2.9% vs. 6.2%, respectively).9

Our study, along with this recently published data highlights the importance of raising awareness of the CV risks for prostate cancer patients. A careful CV assessment should be considered in all patients undergoing hormonal therapy to identify those patients at high, intermediate, and low risk (Figure 1) and the optimal ADT identified to reduce the risk of future CV events. Further, is there a possibility that patients on long-term ADT initially considered intermediate risk may progress to high risk? This may be particularly important in patients with metastatic prostate cancer on a combination of ADT plus novel hormonal therapies such as enzalutamide and abiraterone, which have also been associated with increased cardiovascular mortality.10Those at high risk should receive appropriate lifestyle advice, regarding smoking cessation, healthy diet, weight control, and daily exercise and should be managed appropriately with European Association of Urology (EAU) guidelines recommending a cardiology consultation in men with a history of cardiovascular disease and men older than 65 prior to staring ADT1. American Urological Association (AUA) guidelines recommend patients on ADT are referred to their primary care physician for a periodic follow-up evaluation with appropriate secondary preventative measures in place for those patients with cardiac disease such as lipid-lowering therapy, antihypertensive therapy, glucose-lowering therapy, and antiplatelet therapy.11It is therefore important to consider personalized treatment for prostate cancer patients on hormonal therapies to optimize treatment options and reduce CV events.

Figure 1. Cardiovascular risk assessment

Table 1.Baseline characteristics and cardiovascular events in patients with prostate cancer treated with degarelix, leuprorelin, goserelin, or triptorelin

Written by: Patrick Davey, MD, PhD,Consultant Cardiologist, Northampton General Hospital, Northampton, UK;and Michael Kirby, MBBS, LRCP, MRCS, FRCP, Professor, University of Hertfordshire, Hatfield, England, United Kingdom

References:

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Cardiovascular Risk Profiles of GnRH Agonists and Antagonists: Real-World Analysis from UK General Practice - Beyond the Abstract - UroToday

From aches and pains to hormonal disorders, depression, anxiety and even immunity-related disorders, these non-invasive, alternative therapies promise to heal from within, slowly but surely, minus the side-effects of allopathic medicines. Heres more on three popular therapies.

This ancient eastern practice that originated in China found itself in the spotlight a decade ago when singers Celine Dion and Mariah Carey claimed it played a vital role in helping them conceive. Both gave birth to twinsafter much struggle due to their respective health issueswithout having to resort to IVF. But while the western world may have just recently woken up to the benefits of acupuncture, the Japanese and the Chinese have been using this therapy for decades now, treating everything from aches and pains to allergies, migraines, anxiety and even various hormonal disorders.

So what exactly is this form of treatment? Traditionally used to balance energy flow, acupuncture involves inserting very thin needles at strategic points of your body. Its essentially a drugless, natural treatment with no side effects, which works on the concept of Yin and Yang. Energy blockages are identified and worked upon, and balance in the body is restored for its optimal functioning, says Mumbai-based Dr Santosh Pandey, a PhD in alternative medicine. It is particularly helpful for inflammation or pain, as inserting a needle into a specific location can cause a release of endorphins, which are chemicals that your body produces to promote self-healing. Since it activates pain-killing hormones, it can treat acute or chronic pain.

Acupuncture sessions usually require anywhere from two sessions to 30 and more to show results, depending on the severity of the mental and/or physical issue being treated. If you suffer from chronic liver problems or issues with clotting, its best to avoid this therapy, cautions Dr Pandey.

Naturopathy, says Arizona-based Naturopathy physician Dr Meghna Thacker, believes in the healing power of nature. The body has an inherent capacity to heal itself and in many cases, without any treatment at all. With an increasing number of people preferring a holistic approach to health and wellness, this alternative and now broadly integrative medicinal practice is fast gaining traction.

So whats the basic tenet behind it? The aim, says Dr Thacker, is to first do no harm. The idea is to try healing the patient with natural and non-invasive therapies. For example, if a patient is dealing with an infection, if I can treat him or her with botanical or microbial medicines, that would be my preference over antibiotics, she adds.

In her recent book, Amazon bestseller, Seven Steps To Heal Your Thyroid, Dr Thacker explains in depth the science behind naturopathy. We treat the patient as a whole and not just that one particular issue. We identify the root cause and underlying reasons. The focus on this kind of therapy is also to prevent diseasesthere a so many factors that need to be looked at to ensure overall good health, she says.

Among the popular treatments is the bio-identical hormone replacement therapy (BHRT), which is different from the standard hormone therapies offered by modern medicine. In BHRT, we use natural plant-based prescription medicines to help patients transition from perimenopausal to postmenopausal years, explains Dr Thacker, who also specialises in thyroid treatment, adrenal support, nutrient IV therapy in addition to emotional wellness.

Several celebrities, including Kate Hudson, Gwyneth Paltrow and Cameron Diaz, have taken to social media to tout the benefits of this Japanese healing technique. And, despite the bad press it often receives for having little scientific data to back up the results, youll find many, especially in India, swearing by it. Reiki uses the bodys chakras to transfer healing energy to a recipient, working on the not just the body, but the mind and soul as well, says Mumbai-based Reiki grandmaster, certified numerologist and multi-modality Vannee Jaising, It can help you solve mental, physical as well as emotional issues, provided the recipient is open to receiving the healing energy."

Jaising, a conduit of this healing energyhas seen a surge in clients over the last few months, with COVID-19 and the consequent lockdowns and economic crisis pushing people on the brink of a meltdown. Reiki does not require physical touch. I can administer this healing to anyone, in any part of the world, and it will work, she explains, adding that this healing energy practice is free of side effects, making it safe for all. There are, of course, newer and more powerful modalities available nowReconnective Healing, Merkaba, Lama Fera, Humkara with Haleem, to name a few.

"Reiki can easily be your go-to first aid kitinstead of popping in a crocin to cure that headache, try this practice first to heal yourself. The benefits of spiritual healing are aplenty and much needed in this pandemic era, says Jaising.

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From reiki to acupuncture: How alternative therapies can help you manage pain and balance your mood - VOGUE India

Abstract

Objective To evaluate the association between pregravid use of a variety of contraceptive methods and subsequent fecundability.

Design Prospective cohort study.

Setting Denmark and North America, 2007-19.

Participants 17954 women who had tried to conceive for up to six menstrual cycles at study entry. At baseline, participants reported their contraceptive histories, and personal, medical, and lifestyle characteristics.

Main outcome measures Pregnancy, determined by bimonthly follow-up questionnaires for up to 12 months.

Results Approximately 38% (n=6735) of participants had recently used oral contraceptives, 13% (n=2398) had used long acting reversible contraceptive methods, and 31% (n=5497) had used barrier methods. Women who had recently stopped using oral contraceptives, the contraceptive ring, and some long acting reversible contraceptive methods experienced short term delays in return of fertility compared with users of barrier methods. Use of injectable contraceptives was associated with decreased fecundability compared with use of barrier methods (fecundability ratio 0.65; 95% confidence interval 0.47 to 0.89). Users of injectable contraceptives had the longest delay in return of normal fertility (five to eight menstrual cycles), followed by users of patch contraceptives (four cycles), users of oral and ring contraceptives (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles). Lifetime length of use of hormonal contraceptive methods was not associated with fecundability.

Conclusions Use of some hormonal contraceptive methods was associated with delays in return of fertility, with injectable contraceptives showing the longest delay. The findings indicated little or no lasting effect of long term use of these methods on fecundability.

Worldwide, about 22% of women of reproductive age used hormonal contraception in 2019.1 In the United States, 35% of women of reproductive age used hormonal contraception in 2015-17.2 Although male condoms and oral contraceptives remain the most commonly used methods in North America and Europe,1 long acting reversible contraceptive methods have become increasingly popular.2 Long acting reversible contraceptive methods include intrauterine devices, implants, and injectable contraceptives.3 In the US, 2% of women aged 25-34 used long acting reversible contraceptive methods in 1995 compared with 13% of similarly aged women in 2015-17.23 In Europe, 9% of women of reproductive age reported that they used long acting reversible contraceptive methods in 2019.1

Most research on the use of contraceptives and fertility has focused on the effect of oral contraceptives on fecundability; the average probability of pregnancy during one menstrual cycle for a couple engaging in regular intercourse without contraception. Several studies reported delays of about three months in return of fertility after stopping oral contraceptives.456 In some57 but not all studies,4 women who used oral contraceptives for long periods had greater fecundability than women who used oral contraceptives for shorter periods. Less is known about the association between the use of other methods of contraception and fertility, however. Recent use of intrauterine devices (copper and hormonal methods combined) was associated with a slightly longer time to conception than use of barrier methods.68 The results are conflicting,49 however, and could be confounded by parity or underlying fecundity because previous indicators of fertility could affect the choice of contraceptive and the probability of conception in the future. One study indicated that recent use of injectable contraceptives might be associated with delayed conception.4 Most studies examining less common contraceptive methods have been small489 or retrospective in design, with a risk of recall bias.68 Given the increasing popularity of long acting reversible contraceptive methods and other alternatives to oral contraceptives, more research into their short and long term effects on fertility is needed.

This investigation was designed to examine fecundability in relation to recency and length of use of various hormonal and non-hormonal contraceptive methods, in three large preconception cohorts. The cohorts were from three prospective studies from North America and Denmark of women and men planning pregnancies.

We pooled data from three prospective cohort studies of participants planning pregnancies: Snart Gravid, a Danish study of women planning pregnancies, aged 18-49 (2007-11); Snart Foraeldre, an extension of Snart Gravid that included male partners (2011-19); and Pregnancy Study Online (PRESTO), a North American study of women planning pregnancies, aged 21-45, and their male partners (2013-19). Recruitment for Snart Foraeldre and PRESTO is ongoing. Participants in all studies were recruited mainly by advertisements on social media and health related websites, such as Facebook and Netdoktor (www.netdoktor.dk, a well known Danish health related website).1011 For example, we used the following advertisement on Facebook to recruit participants for PRESTO: Trying to conceive? Help scientists learn more about fertility. Enroll in an online research study. The recruitment methods for the study have been described in detail elsewhere.101112

Enrollment and primary data collection were done by email and through the study website. Eligible women were not pregnant, did not use contraceptives, were not receiving fertility treatment, and were trying to conceive. We excluded participants if they reported insufficient or implausible information on their menstrual cycle (Snart Gravid 5%, Snart Foraeldre 8%, PRESTO 2%). We also excluded participants who had been trying to conceive for more than six menstrual cycles at study entry; excluding these participants reduced potential recall bias (that is, differential recall and reporting of exposures and covariates resulting from reduced fertility) and possible confounder misclassification, which might arise if women who had been trying to conceive for longer than six cycles changed their behavior as a result of not conceiving before entering the study. The proportions of women excluded because they had been trying to conceive for more than six cycles were 22% in Snart Gravid, 25% in Snart Foraeldre, and 20% in PRESTO. Participants whose last method of contraception was not included in the present analysis (sterilization that was subsequently reversed, emergency contraception, and douching) were also excluded (<1% of participants). A total of 17954 participants were included in the pooled analyses: 4435 from the Snart Gravid study, 4768 from the Snart Foraeldre study, and 8751 from PRESTO (fig 1).

Flowchart of enrolment and exclusions in the Snart Gravid, Snart Foraeldre, and PRESTO studies (n=17954), 2007-19

All questionnaires were completed online. At baseline, participants reported exposure and covariate information, including personal characteristics, lifestyle factors, and medical history. Follow-up questionnaires were done every two months for 12 months or until a pregnancy was reported, whichever came first. More than 80% of participants completed at least one follow-up questionnaire.All participants provided online informed consent.

At baseline, participants reported the contraceptive method used most recently before they tried to conceive (Which birth control method did you use most recently?). Categories included barrier methods (condoms, diaphragm, sponge, foam (Snart Gravid and Snart Foraeldre studies only), jellies, creams, and suppositories), oral contraceptives (progestin only and combined), hormonal intrauterine devices, copper intrauterine devices, patches, injectable contraceptives, vaginal rings, implants, and natural methods (withdrawal, avoiding sex when fertile, calendar methods, and monitoring cervical mucus or basal body temperature). Those who used hormonal methods recently were asked if they waited for a period of time after stopping hormonal contraception before trying to conceive (Did you wait a few months after stopping hormonal contraception before trying to get pregnant? If yes, For how many months did you wait between stopping hormonal contraception and trying to get pregnant?).

To evaluate the potential effects of recent use of hormonal contraceptives, participants who reported waiting longer than one month before trying to conceive after stopping hormonal contraception were categorized as users of barrier or natural methods based on their questionnaire responses. Participants in the Snart Foraeldre and Snart Gravid studies selected only one most recent contraceptive method, but participants in PRESTO could select more than one method. Those who reported that they used both hormonal and barrier methods were categorized as users of the hormonal method, and those who reported that they used both barrier and natural methods were categorized as users of barrier methods. Participants who selected more than one hormonal method were categorized based on their reported ages when they stopped.

In PRESTO, participants reported the total number of hormonal contraceptive types they had used in their lifetime (oral contraceptives, rings, implants, injectable contraceptives, patches, hormonal intrauterine devices), the name of each method, and their ages when they started and stopped each method. Length of use (years) was calculated separately for each type of hormonal contraceptive. In the Snart Gravid and Snart Foraeldre studies, a detailed history of length of use was collected only for oral contraceptives.

We collected data on menstrual cycle dates and pregnancy status from the baseline and follow-up questionnaires. At baseline, participants reported the typical length of their menstrual cycle, the date of their last menstrual period, and the number of menstrual periods they had since they began trying to conceive. At each follow-up, women reported the date of their last menstrual period, whether they were pregnant, and whether they had started fertility treatment. In the PRESTO cohort, we also identified pregnancies in participants lost to follow-up by linking to birth registries, searching for baby gift registries and birth announcements online, and contacting the participants directly. We calculated pregnancy attempt time, rounded to the nearest whole cycle, as: (number of menstrual cycles participants had been trying to conceive at baseline)+[(date of last menstrual period from most recent follow-up questionnairedate of baseline questionnaire)/cycle length]+1.

At baseline, participants reported their age, height, weight, smoking history, education, household income, and frequency of intercourse; length of their relationship; whether they were trying to improve the chances of conception (eg, timing intercourse to their fertile period); length of the menstrual cycle and regularity; parity; history of infertility (previously tried to conceive for 12 months); history of physician diagnosed endometriosis, uterine leiomyomata, polycystic ovarian syndrome, or type 2 diabetes; and whether they had ever been pregnant, the outcome of each pregnancy (miscarriage, induced abortion, livebirth), and whether the pregnancy had been planned. We calculated body mass index. In PRESTO, participants also reported their race and ethnicity at baseline. Education and household income were determined differently in the Danish and North American cohorts. To pool the data, we developed similar categories for each cohort by dichotomizing household income at $50000 (Danish Kr313 845; 38 250; 42 172) per year for the PRESTO cohort and Kr300000 (6092; $7963; 6717) per year for the Snart Foraeldre and Snart Gravid studies. Education was reported as years of education after compulsory schooling in the Snart Foraeldre and Snart Gravid studies and as overall years of schooling in PRESTO, and categorized accordingly.

Women contributed at risk cycles to the analysis from study entry until they reported a pregnancy, started fertility treatment, withdrew from the study, stopped trying to conceive, were lost to follow-up, or had 12 cycles of trying to conceive, whichever occurred first. We used life table methods to calculate the percentage of couples who conceived during six and 12 cycles of follow-up, accounting for censoring events.13 We used proportional probability regression models to calculate fecundability ratios with 95% confidence intervals.14 The fecundability ratio is a measure of the average probability of conception per cycle comparing users of a specific contraceptive method with a reference group. Proportional probability models adjust for cycle at risk, taking into account the average decline in fecundability as fertile couples conceive and are removed from the population at risk over time.14 We used the Andersen-Gill data structure to account for left truncation bias that might result from women entering the study after at least one cycle of trying to conceive.1516 For example, participants that entered the study after one cycle of trying to conceive, and conceived during the fifth cycle, contributed cycles two to five to the analysis.

We first examined the association between fecundabilitythe probability of conception per cycleand use of oral contraceptives (combined and progestin only), hormonal intrauterine devices, copper intrauterine devices, rings, implants, patches, injectable contraceptives, and natural methods as the last method of contraception compared with barrier methods. We selected barrier methods as the reference group because: use of barrier methods would not be expected to cause changes in the vaginal environment or hormone concentrations, offering a well defined contrast with the use of hormonal methods; a large proportion of couples in our study used barrier methods; and we could compare our findings with previous studies that used the same reference category. We then examined fecundability after the use of hormonal intrauterine devices compared with copper intrauterine devices. To quantify delay in return of fertility for each method of contraception, we examined fecundability in each menstrual cycle when participants were trying to conceive. We considered the return of fertility to occur during the cycle in which fecundability for users of a specific method was not meaningfully lower than that for users of barrier methods (that is, adjusted fecundability ratio >0.90). Lastly, we examined the total length of use of each hormonal method. Total length of contraceptive use was divided into two year categories and compared with less than two years of use. In the Snart Foraeldre and Snart Gravid studies, this analysis was conducted only for oral contraceptives because of limited data on length of use.

Models were adjusted for potential confounders measured in the three studies and selected a priori based on the literature and a directed acyclic graph. Potential confounders included cohort (Snart Gravid, Snart Foraeldre, PRESTO); age (<25, 25-29, 30-34, 35); education (12, 13-15, 16, or 17 years in North America or fundamental education, technical education or less than three years of higher education, three to four years of higher education, or greater than four years of higher education in Denmark); non-Hispanic white race and ethnicity (yes v no); household income (

We also considered adjustment for possible indicators of underlying fertility because women with a previous pregnancy might be more likely to use a long acting reversible contraceptive method to avoid pregnancy if they believe it is more effective. Also, women with reproductive disorders associated with infertility might make contraceptive choices based on treatment recommendations (eg, use of oral contraceptives to treat polycystic ovarian syndrome17). In this analysis, we adjusted for history of unplanned pregnancy (yes v no); history of induced abortion (yes v no); history of infertility (yes v no); menstrual cycle characteristics (irregular cycles, regular cycles of <26 days, regular cycles of 2630 days, and regular cycles of 31 days); parity (parous v nulliparous); and physician diagnosed endometriosis (yes v no), uterine leiomyomata (yes v no), or polycystic ovarian syndrome (yes v no). To examine effect measure modification, results for the most recent type of contraception were examined separately by cohort (Denmark v North America), age (<30 v 30), attempt time at study entry (<3 v 3-6 menstrual cycles), body mass index (<30 v 30), history of infertility (yes v no), parity (parous v nulliparous), and menstrual cycle regularity (regular v irregular).

We conducted two sensitivity analyses to evaluate potential bias as a result of misclassification of exposure. We excluded women who stopped hormonal methods of contraception for one or more months before trying to conceive. These women could have switched from hormonal to barrier methods because of concerns that it would take time for the menstrual cycle to normalize after using hormonal contraceptives. Also, we separated progestin only from combined oral contraceptives to consider the potential extent of bias because of analyzing all oral contraceptives in one group. We conducted this analysis in the PRESTO cohort and evaluated the proportion of women who used progestin only oral contraceptives. We also examined the association between recent use of oral contraceptives and fecundability for progestin only and combined oral contraceptives separately.

In each cohort, we used PROC MI to impute missing exposure and covariate values, with over 100 variables in the imputation model to create five datasets. Last method of contraception was imputed for 0.7% of participants in PRESTO and for 0.5% of participants in the Snart Foraeldre and Snart Gravid studies. We also imputed missing outcome data for participants who did not complete any follow-up questionnaires (16% in PRESTO and 13% in Snart Gravid and Snart Foraeldre) to minimize potential selection bias. We assigned these participants one cycle of follow-up and imputed their pregnancy status (pregnant v not pregnant) for that cycle. We used PROC MIANALYZE to combine coefficient and standard error estimates across imputed datasets.18

No patients were involved in developing the research question, study design, or outcome measures, or in the implementation of this study.

Overall, 17954 women contributed a total of 10729 pregnancies during 66759 menstrual cycles of observation to the analysis. With life table methods, about 56% and 77% of women conceived within six and 12 cycles of follow-up, respectively. After recategorizing participants who reported waiting longer than one month after stopping hormonal contraception, the most commonly reported last method of contraception was oral contraceptives (37.5%), followed by barrier (30.6%) and natural (15.4%) methods (table 1). About 13.3% of women used long acting reversible contraceptive methods, and the most frequently used were intrauterine devices: 7.8% of women used the hormonal intrauterine device and 4.0% of women used the copper intrauterine device as their last method of contraception. The average number of pregnancy attempts before study entry was similar for all contraceptive methods (two menstrual cycles). Users of injectable contraceptives had a higher body mass index on average and were more likely to be current smokers, to report a history of infertility, to have irregular menstrual cycles, and to have type 2 diabetes than users of all other methods of contraception, but were less likely to report trying to improve their chances of conceiving. On average, users of implant, patch, and injectable contraceptives reported fewer years of education and lower household income than users of other methods. Users of intrauterine devices were more likely to be parous and to report a history of unplanned pregnancy than users of other contraceptive methods.

Baseline characteristics of participants planning pregnancies by last method of contraception in the Snart Gravid, Snart Foraeldre, and PRESTO studies (n=17954), 2007-19

Use of injectable contraceptives as the last method of contraception was associated with decreased fecundability compared with use of barrier methods (fecundability ratio 0.65, 95% confidence interval 0.47 to 0.89) after adjusting for personal factors, lifestyle characteristics, and medical history (table 2). This association remained after further adjustment for indicators of underlying fertility (fecundability ratio 0.65, 95% confidence interval 0.47 to 0.89). Users of hormonal intrauterine devices had an increase in fecundability compared with users of barrier methods (fecundability ratio 1.23, 95% confidence interval 1.15 to 1.31) and users of copper intrauterine devices (fecundability ratio 1.19, 95% confidence interval 1.07 to 1.33). These associations were slightly reduced after further adjustment for indicators of underlying fertility. The fully adjusted fecundability ratio was 1.14 (95% confidence interval 1.07 to 1.22) comparing users of hormonal intrauterine devices with users of barrier methods, and 1.18 (95% confidence interval 1.05 to 1.33) comparing users of hormonal intrauterine devices with users of copper intrauterine devices. On average, use of oral contraceptives, copper intrauterine devices, rings, implants, patches, or natural methods as the last method of contraception was not meaningfully associated with fecundability compared with the use of barrier methods as the last method of contraception.

Last method of contraception and fecundability in participants planning pregnancies in the Snart Gravid, Snart Foraeldre, and PRESTO studies (n=17954), 2007-19

Figure 2 and table 3 show the cycle specific probability of conception and fecundability ratios, respectively, for recent users of different methods of contraception. Compared with users of barrier methods, we found varying delays in return of fertility for recent users of alternative methods. On average, users of injectable contraceptives had the longest delay in return of normal fertility (five to eight cycles), followed by users of patch contraceptives (four cycles), users of oral and ring contraceptives (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles) (table 3). Our results were imprecise for these analyses, however. Because of the small numbers of women who used less common methods, we grouped cycles five to eight and nine to 12 for this analysis.

Per cycle probability of conception for common contraceptive methods in the Snart Gravid, Snart Foraeldre, and PRESTO studies (n=17954), 2007-19. Results are shown for barrier methods and the four most common methods of hormonal contraception. IUD=intrauterine device

Last method of contraception and fecundability in participants planning pregnancies by cycle of attempted pregnancy in the Snart Gravid, Snart Foraeldre, and PRESTO studies (n=17954), 2007-19

Overall, associations between last method of contraception and fecundability did not differ widely across cohorts (Denmark v North America), age (<30 v 30), or body mass index (<30 v 30) (table 4). The results varied by the number of menstrual cycles couples had been trying to conceive at study entry, however: relative to barrier methods, use of oral contraceptives, the patch, and injectable contraceptives was associated with decreased fecundability in women who had been trying to conceive for less than three cycles at study entry, but was associated with improved fecundability in women who had been trying to conceive for three to six cycles. This pattern is consistent with a short term delay in return of fertility. Results were similar across groups when we stratified by history of infertility, parity, and regularity of the menstrual cycle (table 4).

Last method of contraception and fecundability in participants planning pregnancies stratified by cohort, age, body mass index, attempt time at study entry, history of infertility, parity, and menstrual cycle regularity in the Snart Gravid, Snart Foraeldre, and PRESTO studies (n=17954), 2007-19

In the PRESTO cohort, no evidence was found of decreased fecundability with longer total lifetime use of oral contraceptives, rings, injectable contraceptives, hormonal intrauterine devices, implants, or patches (eTable 1). In Snart Gravid and Snart Foraeldre, we found a trend of increasing fecundability with longer lifetime use of oral contraceptives. The adjusted fecundability ratio comparing participants who used oral contraceptives for four to five years with those who used oral contraceptives for less than two years was 1.20 (95% confidence interval 1.05 to 1.36).

About 18.5% of participants stopped using hormonal methods of contraception and used natural or barrier methods for one or more months before attempting to conceive. The results were consistent when we excluded these women from the main analyses (eTable 2). In PRESTO, about 3.7% of women reported ever having used a progestin only oral contraceptive, and 1.0% of women (n=89) used the progestin only oral contraceptive as their last method of contraception. The adjusted fecundability ratio comparing users of a progestin only oral contraceptive with users of barrier methods was 1.09 (95% confidence interval 0.87 to 1.37). Excluding users of progestin only oral contraceptives from the main analyses did not change our results substantially. The adjusted fecundability ratio comparing users of combined oral contraceptives with users of barrier methods was 0.99 (95% confidence interval 0.92 to 1.07).

In this large prospective cohort study of couples planning pregnancies and residing in Denmark, Canada, and the US, users of oral contraceptives and some long acting reversible contraceptive methods experienced short term delays in return of fertility compared with users of barrier methods. On average, users of injectable contraceptives had the longest delay in return of normal fertility whereas users of hormonal intrauterine devices, copper intrauterine devices, and implant contraceptives had the shortest delays. Long term use of these methods did not appear to be detrimental to fertility. About 13% of women reported that they used a long acting reversible contraceptive as their last method of contraception, which is consistent with previous descriptions of use of long acting reversible contraceptives in the US.23 Our findings for use of barrier methods were also consistent with previous studies that reported that 28% of women in the US of reproductive age who are cohabiting, engaged, or married use condoms.19

The delay in return of fertility that we found was consistent with our previous study examining the use of oral contraceptives in a subset of the present Snart Gravid cohort.5 Our results were also consistent with several studies that reported slight delays in return of fertility after use of oral contraceptives,6 intrauterine devices,68 and implants,4 and longer delays after use of injectable contraceptives.420 We found little association between length of use and fecundability in the PRESTO cohort, but improved fecundability after long term use of oral contraceptives in the Snart Gravid and Snart Foraeldre studies. Our finding in the Snart Gravid and Snart Foraeldre studies is consistent with a retrospective study conducted in 8497 pregnant women in southwest England.7 This higher fecundability has been attributed to the prevention of ovulation that occurs with use of oral contraceptives,21 which might help to maintain ovarian reserve.2223 Research on this question has shown inconsistent results, however, and potential mechanisms (eg, reduced rates of atresia) have not been fully explained.24252627

Recent use of hormonal contraceptives could influence the return of fecundability by several mechanisms. Combined oral contraceptives contain estrogen and progestin, which block the normal release of gonadotropin releasing hormone by the hypothalamus, suppressing production of follicle stimulating hormone and luteinizing hormone, and ultimately suppressing ovulation.21 Although oral contraceptives have a short half-life, prevention of ovulation, changes in cervical mucus, and thinning of the endometrium could persist after stopping oral contraceptives. The vaginal ring and transdermal patch act by a similar mechanism2829 and might continue to suppress ovarian function immediately after stopping use of these contraceptives.30 Progestin only injectable, implant, and oral contraceptives also act at the pituitary and hypothalamic levels to suppress ovulation and have effects on cervical mucus and endometrial thickness.21 Also, injectable contraceptives contain substantially higher dosages of progestin than other contraceptive methods as they are designed to prevent pregnancy for at least 90 days after injection.3132 The most common type of injectable contraceptive is depot medroxyprogesterone acetate (DMPA), which is given intramuscularly in a 150 mg dose and has a half-life of 50 days. Levels of DMPA are detectable (<100 pg/mL) for 120-200 days after injection.33 The longer half-life of DMPA could explain the overall reduced fecundability and longer delay in return of fertility in users of injectable contraceptives. Our findings also agree with a previous study that reported a threefold longer time to pregnancy for users of injectable contraceptives than users of condoms after stopping contraception.4 The characteristics of users of injectable contraceptives differed from those of users of barrier method in our study, however. Residual confounding by unmeasured factors, such as overall health condition and knowledge of reproductive health, might explain part of the association seen.

The average per cycle probability of conception was about 20% higher in women who used the hormonal intrauterine device than in those who used barrier methods. We expected that women with proven fertility (that is, women with previous pregnancies) would be more likely to use intrauterine devices and to have greater fecundability than women who used barrier methods. Although users of intrauterine devices were more likely to be parous than users of other methods, adjustment for parity and other indicators of underlying fertility did not explain our findings. Also, the fecundability ratio comparing users of hormonal intrauterine devices with users of barrier methods (1.14; 95% confidence interval 1.07 to 1.22) was similar to the fecundability ratio comparing users of hormonal intrauterine devices with users of copper intrauterine devices (1.18; 95% confidence interval 1.05 to 1.33). This finding suggests that users of hormonal intrauterine devices have improved fecundability relative to users of barrier methods and copper intrauterine devices, and that this effect is not confounded by underlying fertility.

Hormonal intrauterine devices release levonorgestrel, a progestin that creates a spermicidal environment and prevents fertilization or implantation. Unlike other hormonal methods, the hormonal intrauterine device does not suppress ovulation.34 Similarly, the copper intrauterine device prevents fertilization and implantation but has no effect on ovulation. The mechanisms by which copper intrauterine devices prevent pregnancy are not fully understood, however. Most research on intrauterine devices and fecundability has not examined intrauterine devices separately by type,689 with the exception of one randomized trial conducted in 1993.35 In the randomized trial, the investigators evaluated fecundability after removal of the intrauterine device and found slightly higher pregnancy rates in women assigned to the levonorgestrel intrauterine device compared with the copper intrauterine device.

This study had several limitations. First, some misclassification of cycles was likely because our calculation of time-to-pregnancy relied on reported length of the menstrual cycle36 and date of the last menstrual period.11 Misclassification could also have arisen if participants interpreted the question, Did you wait a few months after stopping hormonal contraception before trying to get pregnant? as asking about two or three months specifically. The extent of misclassification is likely to be small, however, because 45% of participants who reported waiting indicated that they waited more than three months, and 16% reported having waited less than 2 months. Second, confidence intervals were wide in the analyses of less commonly used contraceptive methods, limiting our ability to identify the timing of return of fertility. Third, we did not collect data on the date of the last injection for women who used injectable contraceptives. This lack of data limited our ability to determine the recency of use in women who used injectable contraceptives continuously and to evaluate potential misclassification of wait time in women who reported stopping injectable contraceptives a few months before trying to conceive.

In this study, two potential sources of selection bias were identified. Study cohorts were based on self-selection and were volunteers. Women who volunteer to participate in research might differ from those who decline. We believe that our findings are internally valid and externally applicable to those planning pregnancies, however, because the physiological mechanisms underlying the effects that we examined are unlikely to vary substantially between women who did and did not participate. Also, women who conceive immediately after stopping contraception might be less likely to enroll in the study. About 50% of study participants reported that the number of attempts at conceiving was less than two menstrual cycles at study entry, however. This finding indicates that we were successful in recruiting couples at the beginning of their attempts to conceive. We also found minimal evidence of bias in a previous empirical evaluation of the potential for selection bias in Snart Gravid.37 Overall, we expect any potential selection bias to be minimal.

For our analysis of length of use, two limitations were identified. Precision was limited because a detailed history of use of all types of hormonal contraceptives was available only for participants in PRESTO. Also, reporting of contraceptive methods is likely to be less accurate for methods used in the distant past than those used recently. Given the prospective cohort design, any errors in recall of contraception are expected to be unrelated to outcome, leading to reduced associations for extreme categories of length of contraception use.

In this large prospective investigation, we examined the association between pregravid use of contraceptives and subsequent fecundability. We considered several less studied long acting reversible contraceptive methods, including implants and injectable contraceptives, and also individual intrauterine device types. Our findings suggested that return of normal fertility varies substantially by contraceptive method. Overall, we found that use of intrauterine devices and implant contraceptives was associated with short delays in the return of fertility, with injectable contraceptives showing the longest delay (about five to eight menstrual cycles). Our results, although imprecise, indicate little or no lasting effect of long term use of these methods on fecundability. As the use of long acting reversible contraceptive methods becomes more common worldwide, these findings might inform clinical recommendations on contraceptive decision making. Understanding the comparative effects of different contraceptives on fecundity is essential for family planning, counselling for contraception, and management of infertility.

Use of long acting reversible contraceptives has become increasingly common but epidemiologic studies of their effect on return of fertility have been small and inconsistent

Research on use of contraceptives and fertility has focused mainly on the effects of oral contraceptives, with most studies showing short delays in the return of fertility after stopping oral contraceptives

This study quantified the delay in return of fertility after use of a variety of contraceptive methods

On average, users of injectable contraceptives had the longest delay in return of normal fertility (five to eight menstrual cycles) and users of hormonal and copper intrauterine devices and implant contraceptives had the shortest delays (two menstrual cycles)

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Pregravid contraceptive use and fecundability: prospective cohort study - The BMJ

When visiting your doctor, whether its for your annual physical or to address a specific health issue, its reasonable to expect your practitioner to listen to your concerns, take them seriously, and do their best to give you the treatment that you need. But for folks in larger-sized bodies, that expectation rarely lives up to reality. All too often, your doctor might just prescribe one thing, regardless of your symptoms or lab results: weight loss.

This isnt theoretical. People (particularly women) have been outspoken for years about the mistreatment theyve experienced in medical settings because of their weightit was a theme in Roxane Gays 2017 memoir, Hunger, as well as the focus of a viral 2018 Self article from the columnist Your Fat Friend. Multiple studies have found that the bias doctors, nurses, and other practitioners have about weight leads to worse care and poorer health outcomes for people in larger-sized bodies. It also makes them less likely to seek health care in the first place.

Weight stigma is a huge problem in the health-care industry. But a revolutionary framework for understanding health called Health at Every Size (HAES) is seeking to provide better care for people of all sizes.

Officially, Health at Every Size is a registered trademark of the Association for Size Diversity and Health (ASDAH), formed in 2003. ASDAH defines HAES as a social justice framework that respects the diversity of body shapes and sizes, supports inclusive health care, and rejects weight discrimination and stigma against larger bodies.

Essentially, HAES is a weight-neutral approach to health. HAES-informed health-care providers focus on addressing each patients medical conditions in evidence-based ways (like medication, surgical intervention, behavior change, and therapy), without focusing on weight or encouraging weight loss.They promote the idea that it is possible to be healthy or to pursue better health without changing the size of your body.

The origins of HAES are decades-old. In 1967, writer Lew Louderback published an article in The Saturday Evening Post titled More People Should Be Fat! He outlined ideas central to the later HAES movement: that intentional weight loss is not typically sustainable long-term, that dieting can lead to food obsession and other destructive behaviors, that eating intuitively (aka listening to your bodys cues and cravings, tuning out rules about what you should or shouldnt eat, and letting go of intentional restriction) instead of dieting can improve well-being, and that Americas fear of fatness is actually about cultural aesthetics, not about health.

Louderbacks article, and the ideas it put forward, contributed to what came to be known as the fat acceptance (or size acceptance) movement. HAES is one piece of this movement.

Researcher Lindo Bacon, PhD, helped bring more widespread attention to HAES with the 2008 book Health at Every Size. In it, Dr. Bacon goes into detail about a randomized clinical trial they co-authored which found that people are actually more likely to adopt health-promoting behaviorseating nutritious foods, engaging in regular movement, etc.if they arent trying to lose weight.

Instead of using the traditional diet model, we were just supporting people in appreciating their bodies and learning how to trust their bodies and take good care of them, Dr. Bacon says. Instead of trying to control and restrict their calories, it was about learning what their bodies were asking for. Paying attention to things like hunger and fullness. And instead of using exercise as a way of punishing themselves or of burning calories, we helped people to connect with the joy of being in their bodies and moving.

The study found that while people in the traditional diet program did initially lose weight and see improvements in health markers like blood pressure, almost none of them maintained the weight loss or the health benefits after two years. Meanwhile, the HAES group saw sustained improvements in health markers over the two years. Whats more, the HAES group experienced improvements in levels of depression and self-esteem; the traditional diet group did not.

Studies have also supported Louderbacks assertion that weight loss is difficult to maintain long-term.In a 2011 review published in Nutrition Journal, Dr. Bacon and co-author Lucy Aphramor looked at existing weight loss studies and found that almost no one was able to sustain significant weight loss for more than five years. They found that dieting and intentional weight loss often led to weight cycling (the continual gaining and losing of weight), which has also proven to havenegative effects on health. Many of these findings were supported by an April 2020 meta-analysis published in The BMJ, which looked at 121 clinical trials (with nearly 22,000 total participants) and found that while most diets lead to weight loss and lowered risk of cardiovascular disease after six months, both of these effects largely disappear at the twelve-month mark.

The why of all this isnt perfectly understood, but rest assured that it isnt lack of willpower. A 2015 review found that intentional weight loss leads to physiological adaptations like a decrease in energy expenditure (calories burned), fat oxidation (using fat for energy), and leptin (a hormone that signals fullness), and an increase in appetite and ghrelin (a hormone that signals hunger). Basically, trying to lose weight may force the body to adjust in various ways to maintain its existing fat levelsmaking it harder to lose said weight or keep it off.

The HAES philosophy has been met with some skepticism in mainstream health circles. Research has long connected being at a higher weight with an increased risk of serious health conditions like heart disease, diabetes, and stroke; some experts worry that HAES could worsen those outcomes. David Katz, MD, a doctor and public health professor at Yale University, argued in 2012 that ignoring weight and the obesity epidemic will just lead to continued increases in chronic disease.

But proponents of HAES argue that our current view of weight is harmful, not helpful, to those in larger-sized bodies. By labeling it an obesity epidemic, [you] are problematizing weight, Dr. Bacon says. As soon as you problematize weight, what happens is its going to lead to people feeling bad about their bodies; its going to lead to bullying, to weight-based discrimination.

Regardless of what your weight is, we can all make good choices to support health. Lindo Bacon, PhD

Like any form of discrimination, weight stigmanegative bias and attitudes towards people at higher weightshas health consequences. A 2018 review published in BMC Medicine found that weight stigma is linked to poor metabolic health, higher levels of stress hormones, exercise avoidance, and poor mental health. HAES, on the other hand, is about making people feel empowered and respected in health-care settings, no matter their weight.

Despite this evidence, many health-care professionals continue to emphasize the importance of weight loss for health. Part of the disconnect is that HAES is a relatively new framework, and not commonly taught in most standard health-care curriculums. [HAES] is not the medical model that people are taught in school, whether theyre training to be a nurse, dietitian, doctor, or something else, says Christyna Johnson, RDN, a dietitian who practices within the HAES framework. Many providers find the HAES framework years into their clinical practice, often after seeing their patients try and fail to lose weight, she says.

Yes, and taking a HAES approach doesnt mean denying that theres some relationship between weight and health. Yes, weight is causally linked to certain medical outcomes, like diabetes, says Jennifer Gaudiani, MD, an internal medicine physician and certified eating disorder specialist. Im a completely passionate HAES supporter, and yet as an internist, scientifically, [weight and certain health outcomes] are causally linked.

The HAES movement takes this reality into account. Health at Every Sizeis not suggesting that everybody is at their healthiest best at every weight, Dr. Bacon says. What it is suggesting, though, is that regardless of what your weight is, we can all make good choices to support health, and thats all we want to do.

HAES also challenges the idea that fat people are unhealthy, and that people who take care of themselves are thin, Dr. Gaudiani says. In reality, its much more complicated than that. (Just look at the Body Mass Index, which has been shown to be inaccurate for many people.) Many people at higher weights can be metabolically healthymeaning they have medically ideal levels of blood glucose, cholesterol,and other biomarkers. Plus, a 2015 study of over 100,000 Danish adults found that those in the overweight category (with a BMI range of 25-30) actually lived the longest, on average, compared to people in other weight categories. Thats not to say that havinga larger-sized body automatically translates to longevity, but its proof that the relationship between weight and health is complex.

Some experts question the plausibility of metabolically healthy obesity. However, most studies on the subjectlike a 2019 review, which found that people with larger-sized bodies and who are metabolically healthy still are at a higher risk for chronic diseases like type 2 diabetes and heart disease than their lower-weight counterpartsdont control for the effects of experienced weight stigma or weight cycling, both of which are very common among higher-weight people and have been shown to worsen health outcomes and increase risk of diabetes, heart disease, stroke, and even early mortality.

Again, none of the evidence above denies that there is some relationship between weight and health. But HAES practitioners (and research) argue that just because weight is causally linked to certain conditions doesnt mean that all higher weight people have or will have those conditions. Thus, Health at Every Size makes health more accessible to people in larger bodies by acknowledging that weight isnt as modifiable as weve traditionally believed, and encouraging people to improve health in other ways.

Its also about meeting people where they are. Johnson explains that within the HAES framework, the relationship between a health-care provider and their patient is collaborative and takes individual circumstances into account. Is this person living at or below the poverty level? Is this person in a non-binary or trans body? Is this person in a disabled body? Is this person living with a mental illness or a chronic illness? Does this person have generational trauma? All these intersections can affect a persons health, she says, and can inform what type of care they need.

The HAES approach might also make people in larger bodies more likely to seek care. Lesley Williams, MD, a family medicine physician and certified eating disorder specialist who practices HAES, says that many patients in larger bodies come to her because they feel like their previous doctor wasnt listening to them. The patient would come in with a specific problemor for a routine checkup, with no problems at alland the doctor would invariably tell them to lose weight, minimizing whatever underlying problem was at hand. Many would then avoid the doctors office going forward, for fear of being stigmatized or feeling disrespected.

Although there is a peer-reviewed HAES curriculum available online for providers and others who are interested, theres no credential or certification required. [HAES] is an inclusive and compassionate health-care model that allows people to seek and define health for themselves, Johnson says. In other words, it will look different for everyone, because its about honoring each persons unique body and unique needs.

If youre looking for a HAES-informed health-care provider, theres an online database that you can search by area or specialty. But its also something that you can implement in your own life by vowing to stop fixating on weight and instead focusing on healthy behaviors.

And, look, if youre not on board with every aspect of the HAES movement, thats okay. Its a huge paradigm shift that goes against what most of us have been taught. But no matter your current beliefs on weight and health, its worth acknowledging the fact that weight loss isnt actually possible for everyone, and that dieting and restriction can actually cause physical harm. The underlying goal of HAES is to make health and quality health care accessible to more people, which is hard to argue with.

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The Health at Every Size Philosophy Aims To Make Health Care More Inclusive of Larger-Sized Bodies - Well+Good

Feminizing hormone therapy is a common way for transfeminine or gender non-binary individuals to achieve traditionally female characteristics and feel more comfortable in their own bodies. Here's how it works, what you can expect from the procedure, and important health risks to know.

Feminizing hormone therapy can involve taking estrogen and anti-androgen hormones. An anti-androgen is any drug that blocks the production of male sex hormones, mainly testosterone.

"We're increasing estrogen levels while also decreasing testosterone levels," says Ravi Iyengar, MD, an endocrinologist at Rush University Medical Center with a clinical expertise in transgender medicine.

Ultimately, the target is to lower the patient's testosterone levels to that of the typical cis female range, which is around 30 to 100 ng/dl. The following medications are usually used:

"I usually talk to most of my patients that, in general, hormone therapy is not quick to act. It's a process and it does take a couple of years," Iyengar says.

Here is a general timeline and description of the changes you might expect from feminizing hormone therapy:

Shayanne Gal/Insider

To develop the right individualized treatment plan, you should talk with your doctor about what you'd like to gain from feminizing hormone therapy and your preferred timetable, as you can adjust your dosage accordingly.

The lower your dose of feminizing hormones, the slower the changes you'll see in your body. However, this doesn't necessarily mean that higher doses cause faster changes, and they may even endanger your health.

In fact, high doses of estrogen can increase the risk of blood clots, stroke, and estrogen-related tumors, according to a 2018 study. That's why preliminary blood tests are important for those seeking to go on feminizing hormone therapy.

"Every person is unique based on their own health factors and their family history," says Amy Weimer, MD, a primary care physician with a clinical interest in transgender care at UCLA Health. "But at the very baseline, we typically check blood count and a liver and kidney panel, then may check tests for cholesterol or diabetes or occasionally hormone levels as well."

Blood clots are the best characterized risks for estrogen therapies, says Joshua Safer, MD, an endocrinologist at the Center for Transgender Medicine and Surgery at Mount Sinai Hospital. However, they're not common. A 2017 study found that blood clots form within roughly two of 1,000 people on feminizing hormone therapy.

Those taking spironolactone must also know their baseline potassium levels. Spironolactone is known as a potassium-sparing diuretic, meaning it prevents the body from having low potassium levels. The drug blocks the hormone aldosterone, which causes the kidneys to pass fluid while keeping potassium.

In some cases, potassium could build up to higher than normal levels in a condition called hyperkalemia, though it is also rare.You should check in with your doctor if you experience the following symptoms of hyperkalemia:

Weimer also says there are a few medical cases where feminizing hormone therapy may be more harmful to your health, such as having signs of breast cancer, colorectal cancer, or any cancer sensitive to estrogen.

While feminizing hormone therapy comes with some health risks, for some people, not receiving this treatment can be even more harmful. "It is, for many people, a life-threatening condition to continue without access to hormone therapy," Weimer says. "It carries its own very high health risk."

To find an expert well-versed in transgender care, try to find a WPATH provider near you. WPATH stands for World Professional Association for Transgender Health and aims to promote evidence-based care, education, research, public policy, and respect in transgender health. Other good places to look for a provider include LGBT centers, community health centers, or community clinics, says Weimer.

See original here:
Feminizing hormone therapy: Medications, effects, and risks - Insider - INSIDER

Studies have advised avoiding strenuous exercise at least one hour before bedtime.

Staying awake in bed

Weve all experienced it at one point or another: lying awake in bed at night staring at the wall. Experts say doing that can be harmful down the road.

If you dont fall asleep within 20 minutes of going to bed, get up, go to another room and do a calming activity, then go back to bed," Dr. Guy Leschziner, a consultant neurologist at the sleep disorder center, Guys and St. Thomas' hospitals in London told The Guardian. "If you are lying in bed unable to sleep, your brain will soon start associating lying in bed with being awake.

Drinking alcohol

You may have heard of sipping a nightcap before bed, but experts warn against having one containing alcohol.

Some people end up self-medicating with a nightcap, because it does help them to fall asleep more easily at the beginning of the night," Stacey Gunn, sleep medicine physician at the Insomnia and Sleep Institute of Arizona, told HuffPost. "But I recommend against it because it causes the sleep architecture to be disrupted later on, resulting in poor quality sleep.

Consuming caffine

Much like drinking alcohol before bed, experts dont consume the stimulating drug before getting some shut-eye.

If you have caffeine later in the day, it can actually predispose you to develop insomnia or make it worse if you already have it, Dr. Rachel Salas, an associate professor of neurology at Johns Hopkins Medicine who specializes in sleep medicine, told Self magazine.

Still, its important to note that recent studies have indicated that drinking coffee before bed may not be as bad as other pre-sleep habits, such as using nicotine or drinking alcholic beverges.

Using their phones or laptops sans blue light filter

Researchers have noted that blue light from cellphones and TV screens can delay the production of melatonin the hormone that regulates the sleep-wake cycle in the body.

Checking your phone stimulates the brain so we are more active and awake, Cleveland Clinic sleep disorder specialist Dr. Harneet Walia told Health Essnetials. Even just a quick check can engage your brain and prolong sleep.

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Experts say they avoid these 5 things before bed - Atlanta Journal Constitution

A study presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting identified sexual dysfunction as a treatment side effect experienced by the majority of cancer survivors that is not currently well addressed.1

Further, female survivors were significantly less likely to have their sexual dysfunction addressed. Researchers suggested that these collective findings demonstrate the utility of using validated sexual health questionnaires for both male and female cancer survivors to improve physician engagement and facilitate open discussion between patients and providers to improve the quality of life of cancer survivors.

Sexual dysfunction is an unfortunately common side effect of cancer treatment, and there appears to be a large gender disparity in how physicians discuss sexual health with their patients, lead author James Taylor, MD, MPH, chief resident in radiation oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, said in a press release.2 "Our results show that we are asking men about sexual dysfunction caused by cancer treatment, but we are not asking women as frequently. We should be asking everyone, to determine how we can help."

An IRB-approved questionnaire developed with input from radiation oncologists, medical oncologists, and surgeons was administered from 2017 to 2019 on social media and in clinic using an iPad. The survey was compromised of more than 25 questions and was directed specifically to cancer survivors. However, patients with missing data were excluded from the study analysis.

In total, 405 cancer survivors responded to the survey and 391 (96.5%) were included in the analysis. The majority of respondents were female (n = 313; 81.0%), between the ages of 41 and 50 years old (n = 115; 30.0%), and typically had cancer types such as breast (66.8%) or pelvic tumors including prostate (16.3%), endometrial (6.1%), bladder (3.8%), and rectal (1.8%) cancer. In total, 47.4% of patients received anti-hormone therapy, 78.1% received chemotherapy, and 54.2% received radiation therapy.

Overall, 44% of respondents reported they were preemptively told that sexual health could be affected. Moreover, the majority (n = 337; 87%) of respondents indicated that cancer treatment impacted their sexual function or desire, with 53.8% reporting body image distortion, 73.4% with dyspareunia, and 42.3% unable to achieve orgasm.

Only 27.9% of respondents stated they had been formally asked about their sexual health from a provider. Additionally, male patients were significantly more likely to have been asked than female patients (53% vs. 22%, P < .001). Specifically, standardized sexual health questionnaires were administered to 31.5% of male cancer survivors and only 5.4% of female cancer survivors (P = .001), though 51% of all patients reported that they would be most comfortable with the conversation about sexual health to be initiated by their provider after being given a questionnaire to stimulate that conversation.

"Patients seem to prefer completing a survey or questions about their sexual health in clinic and then reviewing this information with their provider, rather than the physician directly asking the patient or the patient driving the discussion," Taylor explained. "A questionnaire administered to all patients can reduce uncomfortable feelings and make bridging the discussion much easier. We know that validated instruments exist, and it is time to put them into practice."

Of note, response bias may have influenced the high rates of sexual side effects observed in this study. Moving forward, the investigators intend to collect additional responses to validate their findings and include a wider variety of cancer types, combining their results with a companion survey of oncologists that asks similar questions on sexual health discussions from the provider perspective. The researchers also plan to conduct pilot studies that implement existing questionnaires in the clinic to determine where additional tools are needed.

References:

1. Taylor J, Ruggiero M, Maity A, et al. Sexual Health Toxicity in Cancer Survivors: Is There a Gender Disparity in Physician Evaluation and Intervention? Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting. Abstract #: 1042.

2. Sexual health often overlooked in cancer survivorship care, especially for female patients [news release]. Arlington, Virginia. Published October 27, 2020. Accessed November 2, 2020. https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2020/Sexual-health-often-overlooked-in-cancer-survivors

More here:
Sexual Dysfunction Not Well Addressed in Female Cancer Survivors - Cancer Network

About the Authors:Ian Chiangis aprincipal atFlare Capital Partners, a healthcare technology and services-focused VC firm. Prior to joining Flare, he was the SVP of product and innovation and a founding member of Cignas CareAllies. Previously, he was a digital health entrepreneur and a former management consultant at McKinsey & Company.

Poorwa Godbole is an MBA candidate at the Wharton School concentrating in Health Care Management and a Flare Capital Scholar. Prior to Wharton, she was a management consultant at McKinsey & Company focused on health systems and services and a member of the Health & Life Sciences team at Gates Ventures. She is a graduate of Stanford University.

Disclaimer:Flare Capital Partners is an investor inBright Health, Eden Health and Iora Health.

HIMSS20 Digital

Healthcare delivery has undergone unprecedented changes in the past decade. Over the past five to 10years, healthcare's digitization has accelerated exponentially due to innovative government policies, changes in consumer preferences, an influx of venture capital, a growing number of digital health entrepreneurs and continued investments by industry incumbents.

The COVID-19 crisis has highlighted some of the challenges in our healthcare system and presented unique opportunities for the U.S. healthcare system to innovate in real time. Across the board, we have seen healthcare providers adopt telehealth at an unprecedented rate. While the last chapter of COVID-19s impact on the evolution of our healthcare delivery system is far from being written, we would like to highlight 10 major care-delivery trends accelerated by COVID-19.

Telemedicine (or telehealth) is not a novel concept. (See thehistory.)Yet adoption was slow for both patients and providers in the early years. The COVID-19 crisis has ushered in unprecedented changes and made virtual health more mainstream. During the early days of COVID-19, numerous primary care providers across the U.S. were forced to shut down their physical facilities. As a result of this sudden shock, many aggressively adopted and rolled out telehealth. In some cases, advanced primary care groups, such as Iora Health, converted almost all care to a virtual setting.

Because of our value-based payment model and team-based delivery model, we were able to do the right thing when [COVID-19]hit quickly pivot to doing over 90% of our encounters by phone and video, and proactively reach out all of our patients over the first few weeks and many times thereafter, reminding them to stay distanced and wear masks, Rushikia Fernandopulle, Iora Healths CEO, said.

Similarly, Privia Health, a network of 650 provider practices, quickly scaled its existing telehealth capabilities.

Telehealth was a priority at Privia even before COVID-19, Shawn Morris, CEO at Privia Health, said. We invested in building our own solutions. We did 400,000 plus virtual visits in the early days of COVID-19, including 60,000+ unique senior visits. About 20% of our patient encounters are done virtually, and we can certainly do more.

Most health systems have also observed a surge in virtual visits (e.g., Ochsner sees nearly 1000% increase in virtual visits in March 2020).

While not all primary care practices were equipped with internally developed technologies to scale telemedicine operations rapidly, many were able to adopt SaaS platforms, such as doxy.me. Despite the range in readiness found across providers, Bain & Company reports that by April 2020, 97% of primary care physicians were using telemedicine to treat patients, primarily for non-COVID-19 or nonurgent care.

Its likely no coincidence that this acceleration in demand for virtual health closely preceded a new annual record for digital health funding led by mega deals in virtual care delivery (e.g., AmWells nearly $194M Series C round in May and eventual IPO in September). Though the huge jump in demand for virtual care dropped in recent months as the country opened up, many care delivery organizations are still seeing significant utilization of virtual health and expect at least one-fifth to a quarter of patient encounters to be done virtually going forward (See John Halamkas interview).

For providers, Telehealth is a great tool to help doctors provide better care, enhance the patient experience and expand panel size and access, Morris said.

While virtual primary care will not replace 100% of in-person care visits, we believe that the primary care delivery landscape will be profoundly changed going forward,due to the increased adoption of virtual health and acceleration toward value-based reimbursement.

Because of Ioras value-based business model, when the pandemic hit, our revenue did not change one bit due to the shift to virtual care, Fernandopulle said. For years traditional practices have claimed they have been trying to operate in both the fee-for-service and value worlds at the same time with one foot on the dock and the other in the canoe. What [COVID-19] has shown is that the dock is now on fire so its time to get both feet in the canoe and start paddling!

Like primary care, a large portion of specialty care has also shifted to virtual delivery during the COVID-19 pandemic. However, the expected permanence of these virtual models will vary by specialty.

On one end of the spectrum, there are procedure-based specialties that cannot exist solely digitally. (See Telehealth usage as percent of total visits by specialty)For instance, many procedures in specialties like ophthalmology and orthopedics have been delayed due to a temporary ban on elective surgeries during the early months of COVID-19 (e.g., one study estimated a backlog of one million-plus cases for spinal fusions and joint replacements in the field of orthopedic surgery alone).

These surgical procedures will return in the post-pandemic world, and while we do not anticipate procedures being done virtually, we foresee a shift towards increasingly virtual preoperative and postoperative consultations.

On the other end of the spectrum, we saw an accelerated movement of some specialties or subspecialties into the virtual world. In recent months, we have seen many digital health companies that offer ongoing care and management of specific conditions or diseases (e.g., hair loss, sexual health, migraine, sleep andbehavioral health conditions) enjoy rapid growth.

For example, Thirty Madison has a full process in place for diagnosing a patients hair-loss condition, creating a treatment planand sending a treatment supply directly to the patient without any in-person interaction. AbleTo, Talkspace, Lyra Health, Octave Health, Mindstrong and others offer virtual therapy, coaching and digital measurement for mental health support. During COVID-19, these companies have provided patients with much-needed specialty care, while their brick-and-mortar peers were forced to shut down temporarily.

Reliance on virtual care solutions for behavioral health continues to be high as of October 10, when in-person visits to behavioral health providers were still 14% below pre-pandemic levels. On top of their commercial traction, these virtual specialty care providers have shown that they can raise mega-funding rounds during the height of COVID-19 (See:Mindstrong announces$100 million funding, Lyra raised $110 million Series D fundingandCerebal lands $35M). We believe these strong commercial and financial tailwinds will lead to the creation of a new generation of virtual specialty care providers.

Additionally, we see a rise in uptake of virtual specialty care-enablement platforms. For example, Heartbeat Health is the developer of a telemedicine and virtual care platform for cardiologists. Technology platforms like Heartbeat Health were vital during the pandemic, which caused 75% of cardiology outpatient encounters to shift to telehealth within just two weeks.

The use of these tools across the country has demonstrated how virtual delivery can increase access to care, improve efficiency and patient satisfaction, and provide a more personalized and coordinated experience. Virtual health-enablement platforms in other specialties (e.g., Babyscripts in OBGYN) have also flourished.

"Payers and ACOs are looking closely at radically reducing costs in high-prevalence, high-cost conditions like [cardiovascular disease]. Many will seek Virtual First players who are willing to go at sub-risk," Dr. Jeff Wessler, CEO of Heartbeat Health, said.

The movement from fee-for-service to fee-for-value will also serve as a tailwind for the rise of virtual specialty care providers or enablement platforms.

Furthermore, the emergence and incorporation of virtual specialty care will likely be hyper-charged in the post-pandemic world. Digital health behemoths, like Teladoc and Livongo, are joining forces to accelerate the development of an integrated, full-stack specialty care platform. In itsS4 filing, Livongo highlighted the potential for the merged company to create the next generation of specialist care offering both medical specialty care and chronic-condition-management services in a combined, remote solution that augments standard care.

Across primary care and specialty care, we see providers beginning to use an increasing mix of synchronous and asynchronous delivery. Some types of asynchronous care (e.g., forwarded X-rays or MRIs to be interpreted by a radiologist) are well established. But with the shift towards more virtual care, other types of asynchronous communication, such as text and media messages, are increasing in utilization, both for patients to consult with their physicians and forphysicians to consult with other specialists.

Asynchronous care delivery amplifies telemedicine's benefits and increases patients access to low-cost, high-value care. For instance, a patient requiring non-emergent care for a skin rash can now send a photo to her primary care provider. Instead of commuting to the doctor's office, spending time in the waiting roomand only getting a few minutes with the physician, the patient can now go about their day at home and take the appropriate steps when the provider replies asynchronously.

The use of asynchronous care also increases provider efficiency. Physicians can now see a full panel of patients in person without limiting their ability to provide virtual care. The asynchronous nature of the visit allows physicians to respond to requests at their convenience.

This also creates opportunities for quality improvement. Physicians have more time to gather a patients full history and data, research hypotheses and consult with others before responding to a patient. Providers can also see all the patient data in a structured, standardized format, allowing them to potentially complete three to six visits in the time it would take to do one synchronous visit. Companies likeZipnosisare taking advantage of asynchronous care and "store-and-forward"solutions to improve both the patient and the provider experience.

While asynchronous care delivery is growing, a synchronous chat or text is simultaneously emerging as a dominant model. Some synchronous chat applications (e.g., KHealthand98point6) combine artificial intelligence with physician expertise. Patients begin by chatting with a bot to discuss symptoms and get an initial diagnosis.

If needed, a physician will then chat with the patient live to discuss next steps or prescribe a care plan. These synchronous chat applications are becoming more and more popular (e.g., 98point6 raises $118 million) and integrated with other providers. In September, Sams Club announced a collaboration with 98point6 to provide members discounted subscriptions to the text-based app and virtual visits for just $1.

While some pundits are concerned about the quality of synchronous text/chat-based and asynchronous care, a study at Stanford Health Care has shown asynchronous teledermatology to be effective in increasing access and maintaining high-quality care. Companies like hims, Alpha Medical and Thirty Madison are already putting these results to use and creating a physician-patient experience that is centered on chat or text.

Eden Health, which offers virtual-first primary care and onsite clinics to employers, is experiencing the rise in demand for asynchronous and synchronous virtual care during the pandemic.

Medical problems are rarely solved in a single experience, so we see messaging interactions continuing to increase as patients get exposure to its ease and effectiveness, Matt McCambridge, CEO at Eden Health, said. Combining the convenience of messaging with the power of face-to-face video appointments in a single application creates a seamless and positive experience for our patients,

As millennials and Generation Z become more engaged healthcare consumers, we believe that synchronous and asynchronous interactions will continue to gain prominence as the preferred mode of engagement, especially in primary and low-acuity specialty care.

According to a PWC Health Research Institute survey, 38% of large employers offered an onsite health clinic in 2019, up from 27% in 2014. Just as these numbers are rising, the COVID-19 pandemic has caused many companies to operate with a primarily remote workforce. Though working from home may become part of the new normal, employees will still expect easily accessible and affordable care from employers.

Healthcare is no longer viewed only as an employee benefit.Its now a necessity for maintaining a strong workforce, McCambridge said. With a large percentage of employers now embracing liberal work-from-home policies, access to healthcare for distributed workforces is critical. This mindset shift has accelerated demand for virtual primary care, and interest in our telemedicine solution from employers has surged by more than 500% since the beginning of the outbreak in March.

To meet this demand, employers will need to explore virtual care delivery options. Incumbent employer/work-site health providers (e.g., Marathon Health, Premise HealthandCigna Onsite Health) have adopted or expanded virtual health during COVID-19. Other well-known employer-focused medical groups with 24/7 virtual capabilities have seen significant growth in membership. (One Medical saw a 25% increase in year-over-year membership growth in Q2 2020.)In addition to virtual-first solutions, employers and commercial health plans are actively exploring ways to extend care, especially urgent and emergency care, to employee/members homes. (See Trend 8.)

Whether partnering with a virtual-first employer health-solution provider, expanding telehealth benefits or adding home-based care delivery options, employers across the U.S. (and around the world) are actively looking to meet their employees healthcare needs in a multimodal fashion.

In the wake of the pandemic, many prominent hospital systems are using virtual encounters to provide safer and timely care. For instance, at theUniversity of Pennsylvania Health System, telehealth is being used across the board to understand a patients symptoms and let them know if they need to visit the ER, reduce ICU interaction and provide therapy over the phone.Systems and government agencies have rapidly adopted AI symptom checkers (e.g.,GYANT,Ada,BabylonandBuoy Health) to improve patient experience and to handle increased volume in a cost-effective manner.

For example, Intermountain Healthcarejointly developeda COVID-19 Screener and Emergency Response Assistant (COVID-19 SERA) with GYANT and rolled it out in April of 2020. Intermountain has seen a30% decreasein call center volume, which frees up patient-clinician communications for those who need it most. Other health systems have also adopted similar tools.(See:Montefiore using HyroandSyllable.AI powering New York Presbyterians COVID-19 web bot.)

While we are still in the early innings of AI-based triage, and more complex clinical algorithms will need to be developed to facilitate smarter triage, there is no doubt that AI-based triage tools will play a significant role in changing the way healthcare providers will evaluate and direct patients to the most appropriate site of care going forward.

Providing healthcare in rural areas is challenging on multiple dimensions large elderly populations with multiple comorbid conditions, many uninsured patients and lack of specialists. Many providers already operate at a loss, which has deepened during the pandemic when elective procedures (which typically make up half of a hospitals revenue) were canceled or delayed.

According to the Texas Commissioner of Rural Health, 60 of the 163 rural hospitals have less than 30 days of cash on hand. Some of these facilities are looking to telehealth solutions to stay connected to patients during this time. (See:Ballad Health announces major expansion of virtual health program to lower cost and improve urgent care access.)

As we look forward to the role that telehealth will play in primary care in rural areas, we believe the adoption of virtual health will be further accelerated by innovative funding models (e.g.,CHART) from the Centers for Medicare & Medicaid Services (CMS) Innovation Center.

COVID-19 will also have a lasting impact on access to specialty care. Platforms like RubiconMD and AristaMD that connect primary care doctors with specialists for eConsults help to improve access to specialty care in rural areas, where wait times for referrals to see a specialist could be exceedingly long.

Rural medicine is facing a shortage of over 20,000 physicians, a resource strain that has only intensified with the global pandemic, CEO of RubiconMD Gil Addo said. It's more important than ever to empower PCPs in rural areas to provide the most comprehensive care possible. eConsults through RubiconMD allow these doctors to receive same-day insights from specialists across the country, improving care and saving patients unnecessary appointments and the often long, burdensome and costly trips that go along with them."

Going forward, we believe there will be an increased demand for eConsults in both outpatient and inpatient settings, especially at rural facilities where access to specialists is limited.(See:Avail raises $100Mfor telemedicine in the operating room.)We also believe that virtual primary care will be more ubiquitous in rural areas.

While there is still a digital divide between rural and urban areas, the Federal Communication Commission (FCC) has moved aggressively to expand broadband access across America. We anticipate that additional funding will increase broadband and high-speed wireless Internet access in rural America in the post-COVID-19 world and further accelerate the adoption of innovative virtual health services.

With healthcare facilities reaching capacity, patients fearing contracting illness from entering a doctors office, and with high-risk patients needing to stay away from others, COVID-19 has everyone thinking about the future of care delivery in the home. Though providing care virtually removes the human touch from medicine, it also enables a physician to see a patients home environment and potentially discover factors affecting a patients health that may not be obvious when examining the patient in the office.

In addition to basic virtual visits, RPM technologies (e.g., TytoCare, Current Health, Vivify Health, Harmonize Health, AliveCorandEko) and home-based point-of-care diagnostic (POC Dx) tools (e.g., Scanwell Health) allow clinicians to actively examine or passively monitor their patients.

Prior to COVID-19, CMS expanded the reimbursement of RPM services in its final rule on Chronic Care Remote Physiologic Monitoring in November 2019. Increased adoption of value-based care, and providers taking on the financial risk of managing chronically ill patients, haveled to increased investment in RPM solutions. According to one study from 2019, 88% of providers surveyed have invested or are evaluating investments in RPM technologies. Even telecom giants like Comcast are riding these tailwinds. (See:Comcast's launch of Quil Health for RPM for aging seniors.)

Payment reforms, adoption of value-based care payment and COVID-19 subsidies will undoubtedly usher in integration of traditional telemedicine, RPM and home-based POC Dx. In a podcast conversation with Senator Bill First, Dr. Eric Topol a renowned cardiologist and author predicts we will soon be in a Telemedicine 2.0 world where patients can actually collect and share health data with their physicians in order to receive care at home. The merger between Teladoc and Livongo may foreshadow what is yet to come.

During the height of the COVID-19 crisis in many states, we witnessed an overwhelming demand for hospital beds for critically ill patients, and many hospitals converted various wards into ICUs. As a result of an actual or anticipated surge in need forhospital beds for COVID-19 and other severely ill patients, many health systems around the country have accelerated their efforts to stand up hospital-at-home (HaH) programs to provide hospital-level care in the patients home. (See:Intermountains Castell launched its HaH programMayo launched advanced care at home model of care.)

In the post COVID-19 world, it is more important than ever to provide hospital-level care to high-risk patients directly from advanced primary care settings.

The hospitals of the future will expand virtually into homes to provide appropriate acute-level care, Rajesh Shrestha, Castell president and CEO and Intermountain VP and COO for community-based care, said. Intermountain Healthcare and Castell Health launched this new service to support patients who are at risk for hospitalization or complications.

Additionally, COVID-19 has exposed the downside of relying on fee-for-service revenue for many health systems. In the aftermath of COVID-19, we anticipate health systems to take on a more aggressive approach when it comes to value-based contracts and securing more reliable payments from health plans (e.g., Allina, BCBS of Minnesota announced a six-year value-based contract in August of 2020).

As hospitals are beginning to invest more in HaH programs, we are also seeing elevated demand from patients for receiving healthcare services in the comfort and safety of their homes in a post-COVID-19 world. While we have seen the rapid adoption of telehealth by providers and patients, telehealth is undoubtedly not the be-all and end-all solution to comprehensive care. Invariably, there are true urgent or emergent cases that would require a clinician to provide an in-person examination of patients.

House call companies (e.g., DispatchHealth, RemedyandHeal) that equip mobile care teams with equipment needed to perform high-acuity medical care will see an increase in demand from patients. Health plans and risk-bearing entities (e.g., self-insured employers) will look to accelerate rolling out of house calls to prevent unnecessary ER utilization, which could often lead to in-patient admissions. Many of these new house call companies are also integrating telemedicine services to shorten turnaround time and improve the patient experience.

Furthermore, COVID-19 will have a lasting impact on some of the most chronically ill patients' willingness to receive in-person care. Anecdotally, we have heard many primary care physicians, including ones from advanced primary care groups, highlight that some Medicare Advantage (MA) or Medicaid patients refused office-based visits even as states opened up. Home-based care delivery or home-based primary care will become even more important going forward for MA health plans and risk-bearing providers to close care gaps.

In 2013, Cigna acquired Alegis Care, a Chicago-based house call company, to provide chronic care management for severely ill, homebound Medicare and Medicaid patients. Humana recently made a $100 million investment in Heal, and highlighted the investment and partnership as part of their efforts to build a broader set of offerings across the spectrum of home-based care. Similarly, Landmark Health has provided home-based primary care, house call, and telemedicine services since 2013.

COVID-19 will accelerate home-based care delivery and drive integration of various home-based care delivery services across the acuity continuum.

The crisis has demonstrated how health disparities and risk-levels for a disease are impacted by income, geography, race and other factors. Experts have been pointing out the importance of acknowledging and addressing social determinants like food or housing insecurity as part of a patients care plan for years, but social spending in the U.S. is still low. Now, with entire cities needing to take steps like finding housing for homeless populations, awareness of social determinants of health (SDoH) is rising.

We have seen organizations rapidly ramp up their efforts in providing holistic care to patients and helping risk-bearing providers integrate SDoH screening, coordinationand tracking as part of their workflows. Companies like UniteUs, Healthify, NowPow, AuntBertha and others have seen an elevated demand from payers and providers.

Integrated delivery networks have long been champions of SDoH. (See:Intermountain pours $12M into social determinants of health efforts in 2018, Geisingers Fresh Food FarmacyandKaiser Permanente launched initiatives that will improve health outcomes by creating stable housing for vulnerable populations.)Health plans are also ramping up on their SDoH efforts. (See:Centene makes investments to combat hunger, improve connectivity and provide key health and educational products to those in need during COVID-19.)We continue to be hopeful that this elevated awareness will be durable post-COVID-19.

The COVID-19 pandemic has increased public awareness of the inequality that exists in the U.S. healthcare system and the differences in healthcare access and outcomes across population groups. Astudy of telemedicine cardiology careat the University of Pennsylvania found that patients who completed video visits with their providers "were slightly older, more likely to be male, less likely to be Black, and had a higher median household income than patients who completed telephone-only visits."

For marginalized groups like racial and ethnic minorities, studiesshowmistrust of providers may be amplified in virtual settings due to limited communication and providers being less mindful of implicit bias. For other groups, like transgender people, especially those in rural areas, virtual care may be the solution to raising the quality of and access to gender-affirming care.

While today's brick-and-mortar healthcare system has often underinvested in care-delivery solutions for historically overlooked communities, we see digital health companies leading the way to creating population-specific solutions for underserved groups (e.g., Medicaid, women, BIPOC, LGBTQ andrural communities).

Maternal health innovators (e.g., Quilted HealthandBabyscripts) are working to provide much-needed services to women who have inadequate prenatal care access. On the BIPOC side, companies like Cityblock Health are bringing interdisciplinary teams including primary care providers, behavioral health specialists, pharmacists, nurse care managers and social workers to communities where they are needed most. Other early-stage innovators, such as Juno Medical, are looking to build next-generation primary care providers in neighborhoods overlooked by One Medical and other commercially focused providers.

Ethnically focused next-generation primary care and multi-specialty care providers (e.g., Asian-focused andLatino-focused) and Independent Physician Associations (IPAs) partnering with next-generation health plans with ethnically-focused care programs (e.g., Bright HealthandClever Care) will emerge in years to comeas many ethnically-focused care-delivery entities have delivered superior quality and outcomes. (See:LEON Medical Centers Health Plans awarded a five-star rating by Medicare for the third time in 2020.)

Another historically overlooked community with population- and sub-population-specific health needs is the LGBTQ community. Over the past few years, we have seen advancements led by digital health companies. Companies such as Plume Health are expanding access to gender-affirming hormone therapy.

Others, like Queerly Health and Included Health, help match LGBTQ patients with healthcare providers. Other platforms are emerging (e.g., Folx Health, which raised venture funding in August 2020).

As healthcare delivery is becoming more population-specific and personalized, we predict that there will be a proliferation of population-specific in-person and/or virtual care innovators focusing on the needs of historically underserved communities.

Originally posted here:
Zooming into the next phase of care delivery: 10 emerging trends in a post-COVID-19 world - Mobihealth News

Dopamine and serotonin are both neurotransmitters chemical messengers that transmit signals between cells which regulate bodily functions like mood, sleep, and digestion.

While dopamine and serotonin have similar effects on the body, they work a bit differently. Here's what you need to know about the similarities and differences between dopamine and serotonin.

"While it does not precipitate the pleasurable experience, dopamine does serve to reinforce the pleasurable experience," says Kristin M. Stover, PsyD, a licensed psychologist in Florida and telehealth specialist with AristaMD, a telehealth provider.

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Because dopamine is related to the reward system and reinforces pleasurable experiences, it is thought to play a role in addiction and compulsive gambling, though researchers aren't yet sure of the exact link between dopamine and these behaviors.

Meanwhile, low levels of serotonin can have the opposite effect and negatively impact your mood. Low levels of serotonin have been linked to depression as well as sleep and appetite disturbances, Stover says.

Serotonin also regulates important bodily functions. For example, your gut, which houses 90% of the body's total serotonin, releases chemicals when you eat to stimulate your intestines and move food through your digestive system. Blood platelets also release serotonin when you get a cut or scrape to heal wounds.

Serotonin and dopamine do not function independently of one another. Instead, they work together to create complex patterns of behavior.

"When one neurotransmitter is altered, there is a change in the function or prevalence of the other substance," Stover says. "Increased levels of serotonin can lead to decreased dopamine activity and vice versa."

Because both dopamine and serotonin affect mood, they are thought to play a role in mood disorders like depression. For example, researchers have observed decreased levels of serotonin in people with depression and other types of mental illness, like anxiety and attention deficit hyperactivity disorder (ADHD).

"Because serotonin is responsible for sleep, mood, and digestion, we often see symptoms of depression that reflect that imbalance, such as sleeping too much or too little, having no appetite or overeating," Stover says.

Long-term or chronic stress can also lead to elevated cortisol levels a hormone released as a stress response. High levels of cortisol reduce the production of both serotonin and dopamine and have been linked to depression, says Nicole Avena, PhD, an assistant professor of neuroscience at Mount Sinai Medical School and a visiting professor of health psychology at Princeton University.

"Targeting the dopamine system is one of the ways in which we can look at potential mechanisms and treatments for depressive behaviors," Avena says.

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Serotonin vs. dopamine: A guide to the two mood-regulating hormones and how they can affect your health - Business Insider India

Its been a very challenging time. The coronavirus. The election. Now winter is coming. White Plains Hospital has some tips for navigating Seasonal Affective Disorder.

For many, the shortening, colderdays can signify many months of depression. If you feel despondent the same time every year, you could be suffering from Seasonal Affective Disorder (SAD).

There is more to SAD than the acronym implies. Seasonal Affective Disorder is a form of depression that lasts for four or five months until the days become longer again. This disorderaffects an estimated 10 million Americansand women are four times more likely to be diagnosed with it than men.

Researchers have found that people with SAD produce too much melatonin, a hormone that regulates sleep. A persons circadian rhythm, or body clock helps determine their sleep patterns, says Dr. Christopher Robles, a Family Medicine and Primary Care physician at White Plains Hospital. When theres less lightand particularly when the seasons change your body clock signals to the brain to make more melatonin so you get drowsy. Body clocks that run fast or slow can disrupt your sleep.

SAD signs

People with Seasonal Affective Disorder often develop a predictable set of signs and symptoms, which may include:

How to stop feeling SAD

There is evidence thatthe amount and quality of sleep we get is associated with the amount of vitamin D our bodies absorb, particularly in the colder months. Fortunately, Dr. Robles says, a natural source of this vitamin is readily available. You can get vitamin D from sunlight, so go outside, even if its just during your lunch break, she says It can have a positive effect on your mood.

A healthy diet can also help chase away that SAD feeling. Dr. Robles recommends eating natural foods like egg yolks, mushrooms, fatty fish and liver because theyre full of vitamin D and nutrients.

Finally, staying active can help your body and mind settle into a more restful routine. Exercising for 30 minutes three times a week can help boost your mood and relieve stress and anxiety.

Nearly everyone has days when they feel lethargic or down, and thats normal. But if you feel down for days at a time and you cant get motivated to do activities you normally enjoy, see your primary care physician. They will be able to analyze your symptoms and help you get back to a healthier state.

Dr. Christopher Roblesspecializes in Family Medicine and Primary Care and sees patients at the Somers and White Plains practices. To make an appointment, call914-849-7075.

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How to Fight SAD in Challenging Times - theLoop