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Archive for the ‘Hormone Physician’ Category

Heres why Bill Maher is wrong about fat-shaming – AlterNet

On a recent episode of his Friday evening talk show, Bill Maher proposed that society combat obesity by body-shaming overweight individuals. He argued that fat shaming doesnt need to end, it needs to make a comeback to deter people from overeating.

Obesity is a national epidemic that is placing a significant burden on our health care system. Nearly 40% of Americans are considered obese, costing upwards of US$150 billion dollars per year in health costs, according to the Centers for Disease Control and Prevention.

To individuals who are not obese, it can be easy to assume that overeating is strictly a failure of willpower and discipline. However, evidence shows that body-shaming and weight discrimination are misguided approaches, and often make the problem worse. Moreover, there are multiple biological forces underlying appetite and metabolism that may be beyond a persons full control.

I am a molecular biologist with interests in the root causes of human behavior. As the author of the book, Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are, I have done extensive research into the biological forces that conspire to shape human personality and behavior, including the factors influencing our diet and tendency to overeat.

Maher tried to support his argument with the claim that being fat isnt a birth defect. This is not necessarily true. Some people are born with genetic variations in hormonal systems that regulate hunger and satiety. Leptin, for instance, is a hormone that tells the brain when the stomach is full. People born with leptin deficiency cannot sense when they are full and frequently overeat. Other genes linked to energy metabolism, food cravings and the brains reward response have been found to be driving factors in overeating and weight gain.

There is also growing evidence that several health conditions, including obesity, may arise from how the environment in the uterus affects the development of the fetus. A 2014 study at the University of Denver showed that prenatal maternal stress influences childhood obesity. Why should children be shamed for their mothers stress during pregnancy?

There is compelling data that the microbes in our intestines, part of our microbiome, may influence our food cravings and the tendency to overeat. Microbiologist Jeffrey Gordon at Washington University has conducted pioneering studies charting differences in the bacterial species inhabiting the guts of lean versus obese people.

Gordon and his team also transplanted intestinal bacteria from lean or obese people into the guts of mice. For the study, the intestinal bacteria were harvested from identical twins in which one was obese and the other lean. The result: While gut bacteria from the lean twin kept mice lean, gut bacteria from the obese twin led to obesity in the mouse. These findings provide evidence that the types of microbes in our gut influence our metabolism and contribute to our weight.

It is also well-established that certain medications, like steroids, alter metabolism and fat deposition, leading to weight gain. Brain injury and tumors can also induce overeating and obesity. While these causes of obesity are less common, I think it is unfair to make assumptions that obese individuals are in full control of their behavior.

Body-shaming is not only ineffective but frequently backfires. In a 2013 study, researchers at Florida State University revealed that people subjected to weight discrimination were three times more likely to remain obese. A year later, researchers at University College London added more supporting evidence; rather than helping people lose weight, weight discrimination promotes weight gain.

Most recently, a 2019 study showed that weight discrimination significantly contributed to an overall health decline in all participants. In addition to weight gain, multiple studies have shown that body-shaming also harms psychological health, frequently leading to depression.

There are more effective, not to mention more compassionate, ways to help those struggling with obesity. As British physician Stephen ORahilly has written, The growing evidence that humans can be genetically hardwired to become severely obese should eventually lead to a more widespread realization that morbid obesity is a disease requiring further scientific research, rather than a failure of willpower requiring sanctimonious moral opprobrium.

Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University.

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Heres why Bill Maher is wrong about fat-shaming - AlterNet

Longtime St. Louis nurse says Good Karma is about ‘healthier alternatives’ – Greenway

Dr. Patricia Coughlin, sole owner of Good Karma Dispensary, has applied for a dispensary facility license in Brentwood, Missouri. Like the other 2,300 applications, she awaits licensing results from the state. Coughlin is one of over 1,000 applicants applying to open a medical marijuana dispensary in Missouri.

The 83-year-old has lived in St. Louis her entire life. She was a registered nurse for 44 years and a social worker for 39 years. She has her doctorate in social work. Dr. Coughlin is a captain in the United States Army Nurse Corps; a former professor at Washington University, University of Missouri-St. Louis, and Maryville University; and even formerly hosted a local radio show.

I believe that my unique background, combined with my extensive knowledge in the area of medical marijuana will be to serve my dispensary clients well, Dr. Coughlin told Greenway Magazine. As a senior, I intend to focus quite a bit on the more mature population that does not feel comfortable with many of the stereotypical associations of marijuana. I believe it is important to promote the message that medical marijuana is an acceptable alternative to traditional pharmacology, and I hope my messages will help to de-stigmatize medical marijuana.

She said her reason for applying for a facility license comes down to her first-hand accounts of the needs of the aging community and a need for alternative treatment options.

My main reason for applying for a dispensary license is that I see first hand every day the significant need in the aging community for a healthier alternative to dangerous prescription medications to treat: sleep problems and insomnia, loss of appetite, chronic pain from age-related conditions, depression, and the agitation and other symptoms related to Alzheimers, Dr. Coughlin said. The aging population, in my opinion, is the most needlessly over-medicated and is in dire need of alternatives.

A way she plans for her dispensary to serve aging patients better is by offering a VIP Service where her or another nurse will meet in-home with families and patients to discuss treatment.

I will work in conjunction with the patients physician and healthcare team to determine the best course of medical marijuana treatment, Dr. Coughlin said. I will follow up weekly with family members to assess progress, changes, and any concerns as well as to personally deliver the product to the family/patient and assist with teaching and training on side effects, symptoms, etc.

Dr. Coughlins dispensary also plans to make specific offerings for fellow veterans, including discounts and outreach. She will be providing lectures and visiting support groups touting the benefits of medical marijuana to treat post-traumatic stress disorder and other conditions unique to veterans.

Her outreach will further extend into the healthcare industry, where she plans to capitalize on her almost 50 years of nursing experience. She will also be providing workshops and seminars for counselors, social workers, therapists, psychologists, and psychiatrists to increase regional education for medical marijuana treatment for mental illness.

Her experience and multi-faceted outreach strategy is one that Dr. Coughlin hopes will make her application stand out.

Outside of her care experience, Dr. Coughlin founded the Magdala Foundation, the first halfway house for female offenders in the United States, for which former St. Louis Mayor A.J. Cervantes awarded her the key to the City.

Additionally, she co-founded The PMS Center, one of the first facilities of its kind in the country to treat women suffering from PMS and other hormone-related conditions. She emerged early on as an expert in PMS and bio-identical hormones, appearing on several national television shows. She volunteers as a counselor at Birthright Crisis Pregnancy Counseling and she is on the Board of Missouri Right to Life.

Her dispensary proposal, of which she is the sole owner and funder, has been welcomed by the City of Brentwood and local residents.

Dr. Coughlin is an active longtime member of the St. Louis Arch Diocese and a longtime serial entrepreneur. She is the mother of five professional adults and grandmother to 15, all living in the St. Louis area.

Continued here:
Longtime St. Louis nurse says Good Karma is about 'healthier alternatives' - Greenway

How much weight can you lose on the HCG diet? – VIVA GLAM MAGAZINE – vivaglammagazine.com

HCG (Human chorionic gonadotropin) is one of the fastest andeasiest ways to lose weight up to 3lbs per day for the first week. Nowadays,this protocol of weight loss has become popular among those who search for thequickest weight loss products out there in the market. HCG is a kind of hormonethat can be found in the placenta of pregnant women. In her pregnant period,the production of this hormone increases at its highest level. It sends themessage of a woman not to menstruate.

In comparison to other weight loss products in the market, HCG works faster. Thats why; its demand is on the rise at present. It is available as a form of sprays, drops, and injections. By eliminating cravings and controlling hunger for foods, HCG drops help you to lose weight according to your need.

It is also called an ultra-low-calorie diet which allows itsuser to consume only 500 calories per day as long as he or she is on this dietplan. As HCG helps to boost metabolism in your body, it works as a weight-losssupplement all without making you hungry.

If somebody takes the HGC diet plan and can keep stickduring this plan, he or she can lose 5 to 40 pounds or more. In the first week,you may end up losing nearly 3 to 4 pounds if it is your first time. And youhave to continue this diet plan (3 or 6 weeks) until it finishes following thediet plan. If you think that you have already burnt enough fat and fail tofollow the extreme diet plan, you will end up gaining more weight.

HCG, a very low-calorie diet comes up with three main stages you need to follow strictly. These include loading phase, weight loss phase, and maintenance phase. All three stages are equally important to observe. If you fail to maintain any of them, you will end up gaining some extra weight.

This is the phase where you are permitted to takehigh-calorie and high-fat foods just for two days after starting the HCG dietplan to lose weight.

This is the most crucial phase you have to followappropriately without making any mistake. Along with taking HCG, it will allowyou to choose only 500 calories each day for 3 to 6 weeks. You can have twomeals per day- lunch and dinner. You may think that this extreme diet plan willleave you to make hungry. HCG diet plan will not allow you to crave or make youhungry for foods.

In this phase, you can increase food intake and stopconsuming HCG. It does not mean that you can eat as much as you wish. For thenext three weeks, you have to avoid sugar and starch to maintain the phase.Otherwise, you will gain weight fast indeed.

Phase 3 should be the most crucial part of the HCG diet plan. Some people regain their weight during phase 3 because they start consuming sugar and starch randomly. To maintain the weight you have achieved during the diet plan, you have to eat foods that are recommended for phase 3. You should also be aware of including new food items into your diet. Instead, you can gain 2 pounds of weight more if you do not follow the instruction during this phase.

If you aim to lose weight within the shortest possible time,there is no alternative to HCG. Yes, it is a solid diet plan because itsinstructions are rigorous but concise. If you can follow all itsrecommendations while taking this extreme diet plan, you are sure to burn yourextra fat up to 40 pounds or even more.

Its beginning is faster than the later phases. At thebeginning of any diet plan for weight loss, all you lose is water from yourbody. You can eat fats as well as healthy foods you like once you have finishedthe diet plan. But you have to make sure that you are not overeating.

Losing extra weight is beneficial for your body. It iseasier to perform actions of your day to day life if you are not too bulky.Everyone under the sun wants to have a good appearance. But doing things toofast also leave you with some side effects.

So, it would be wise to consult with your physician beforetaking any diet plan. Your doctor knows it very well whether your body is up tothe mark to continue with the extreme-low diet plan, HCG. If it does not suityou, you will have some health conditions including headaches, depression, orfatigue.

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How much weight can you lose on the HCG diet? - VIVA GLAM MAGAZINE - vivaglammagazine.com

What Are Steroids and Are They Legal? – The Vistek

Steroids can be defined as a kind of natural or synthetic chemical compounds that can be produced naturally in the body as well as artificially in the laboratories.

Steroids help the cells, tissues, and organs to function properly and they are also used to treat various medical conditions. The two primary sorts of steroids are corticosteroids and anabolic-androgenic steroids which is also called anabolic steroids.

To decide which steroids are legal is a tricky one. The term legal steroids is a catch-all for muscle-gaining supplements that are not considered illegal. Legal steroids are also called Multi Ingredient Pre-Exercise Supplements (MIPS) and Over-The-Counter (OTC) health supplements.

These health supplements are intended to help with weight-lifting, developing muscles, and improve performance and stamina of athletes. Anabolic-androgenic steroids are engineered (artificial) renditions of the male sex hormone testosterone.

Medical practitioners prescribe these hormone enhancing steroids to individuals who have muscle atrophy or problems in producing enough testosterone. However, numerous reports and cases have come to light where athletes and bodybuilders have been found to use these steroids unlawfully to boost performance or grow muscles.

There are two sorts of steroids present inside the body. The adrenal organ situated over the kidney in our body produces corticosteroids. These hormones comprise of aldosterone, which plays a vital role in controlling the concentration of sodium in the body, and cortisol, which acts as the bodys stress reaction framework to reduce inflammation.

Corticosteroids are prescribed by medical practitioners to treat illnesses like asthma, bowel ailment, rheumatoid joint inflammation, and a number of ailments.

Anabolic or anabolic-androgenic steroids are produced artificially that copies characteristics of the male hormone testosterone in its capacity to build muscle tissue and in the development of the features of male secondary sex. Different types of medical conditions such as hypogonadism, osteoporosis, malnutrition, anemia, HIV (Human Immunodeficiency Virus), and breast cancer.

Corticosteroids are used as medicines that help combat inflammation in our body. These steroids are made in laboratories and perform just like the cortisol hormone that is produced inside our body. Cortisol or corticosteroids like the drug prednisone prevent our immune system from producing inflammation-causing substances.

Corticosteroids medically help treat conditions that cause swelling and irritation. They also help ease side effects of asthma, multiple sclerosis, rheumatoid inflammation of joints, skin conditions like dermatitis, short-term treatment of allergic reactions like poison ivy rash, lupus vulgaris or lupus erythematosus, chronic obstructive pulmonary disorder (COPD).

Regular intake of high doses of corticosteroids for quite a while can cause severe symptoms like osteoporosis, impedes the development in children, and also cause adrenal deficiency which is a deadly condition where the bodys stress reaction capacity stops it can no longer respond to illnesses or surgical procedures.

Other long-term effects of taking corticosteroids include eye problems like cataract, loss of muscle strength, and also a higher possibility of suffering from diabetes.

The anabolic or androgenic steroids are artificially composed to mimic the characteristics of testosterone hormone that is produced in the testicles and ovaries.

The androgenic compound of the testosterone hormone is associated with building up the male sex attributes, while the anabolic part is engaged with expanding the volume of body tissue by accelerating protein generation. The pituitary organ, situated at the base of the cerebrum, manages testosterone generation and hormone discharge.

Medical practitioners might advise the use of anabolic and androgenic steroids as prescription drugs for individuals whose body is not capable of producing enough hormone which is why they might need hormone supplements.

The anabolic steroids are recommended by medicinal services providers as legal prescription drugs, yet this type of medications is frequently mishandled and illegally consumed escalate performance of athletes and also develop physical appearance like muscle building.

At the point when utilized in a well-sustained body, anabolic steroids will cause weight gain to encourage an expansion in muscular tissues.

While anabolic steroids may have positive impacts when taken under the supervision of a physician, they have numerous severe and at times irreversible reactions. These reactions are caused because of the unusually abnormal accumulation of testosterone in the body and may result in hypertension, raised cholesterol levels, liver ailments, cardiovascular illness, skin inflammation, hair loss, and certain behavioral syndrome. The anabolic steroids are available in many different types.

Some copy the activities of testosterone, while others cause the body to create abundance testosterone by meddling with the typical hormone-producing system in the body.

No matter what the purpose of these steroids are, the excessive amount of testosterone-induced in the body always ends up in affecting the normal functioning of cells and organs in the body.

Anabolic steroids are usually prescribed to be taken orally or injected in the muscles, especially for individuals whose body does not produce enough testosterone. Medical practitioners also recommend them to individuals who have lost muscle strength due to chronic health conditions like cancer and AIDS. AIDS, and other wellbeing conditions.

High doses of anabolic steroids taken for a long time can harm our liver, kidneys, and heart. It can also cause heart failure and swelling of the heart because of extreme fluid retention. These medications can likewise raise the level of LDL cholesterol, which can cause strokes or heart attacks in individuals of any age.

Conclusion

It is safe to say that steroids irrespective of their legalities are never the best answer for growing muscles or keeping the body fit. They can cause many harmful reactions that may compromise the state of our wellbeing in the long haul.

Steroids are drugs that cause strong reactions in the body, and they can cause cataracts or illnesses of bones like osteopenia. Therefore, it is always ideal to concentrate on manageable, sound approaches to build muscles and remain fit.

This will not only prevent any additional physical and mental damage due to the dependence on synthetic chemicals to enhance physical stamina but also allow the cells and organs of our body to function normally.

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What Are Steroids and Are They Legal? - The Vistek

MD Anderson Breast Cancer Pilot Shows Promising Results for Neoadjuvant Use of Pfizer PARP Inhibitor – Precision Oncology News

NEW YORK A recent pilot study of Pfizer's PARP inhibitor talazoparib (Talzenna) suggests that it might work as a neoadjuvant treatment for women with triple negative breast cancer and BRCA germline mutations.

Pfizer is conducting its own Phase II trial, results of which are still likely more than a year away, but the pilot, conducted by researchers from MD Anderson Cancer Center, showed promising results.

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Postmenopausal Hormone Therapy Market to Surge at a Robust Pace by 2024 – Market Reporter

Post menopause is the period occurred after menopause followed by various syndromes like vaginal dryness, hot flashes, etc. During this period level of estrogen and progestin falls significantly leading to even serious complications like osteoporosis. The worldwide market for Postmenopausal Hormone Therapy is gaining moment substantially. This rising demand for Postmenopausal Hormone Therapy is due to increasing level of awareness about menopausal symptoms and its treatment. Another factor is growing population of post-menopausal women. Postmenopausal Hormone Therapy includes replenishment of body level of estrogen and progestin hormones in women through external intake of hormones. Thus, it help in treating the menopausal symptoms. It decreases the symptoms like vaginal dryness, hot flashes, disturbed sleep, night sweats and etc. The Postmenopausal Hormone Therapy helps in prevention of osteoporosis and hot flashes caused due to depletion of estrogen and progestin level in body. The Postmenopausal Hormone Therapy comprises of natural as well as synthetic estrogens. In order to enhance the menopausal treatment, it is also given in combination with progesterone.

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The treatment for post menopausal syndrome is generally treated with sequential or continuous schedules through various doses of estrogen, progestin or combination of both. Despite of existing controversy and confusion about the safety profile of the postmenopausal hormone therapy, the market for the postmenopausal hormone therapy has recorded positive inclining growth due to growing demand. The development of postmenopausal hormone therapy with respect to driving demand leads to introduction of highly safe treatment options to patients which include development of novel drug delivery system like vaginal estrogen drugs and transdermal estrogen patches. Low dose postmenopausal hormone therapy are used in order to address the backdrop caused due to safety issues. The non-hormonal treatment has comparatively least efficacy to produce optimum results, hence the postmenopausal hormone therapy market is observed to grow significantly.

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However, the major retarding factors to the market include the affordability to the therapy. The cost for postmenopausal hormone therapy approximately revolves around US$ 10,000 per annum, and thus incurring a major burden on the patients pocket. Thus the population from developing and under developed countries faces a challenge of affordability for the postmenopausal hormone therapy. The post treatment risk of cervical cancer and coronary disease are another restraining factors for the market. Approved recognition of the products related to postmenopausal hormone therapy in compounding pharmacies particularly from developed countries is another deterring factor. However the opportunity for the market is the introduction of the product targeting the cardiovascular disease prevention.

The Postmenopausal Hormone Therapy market can be segmented by product, by therapy, by dosage form, by route of administration, by end-user and by geography. In the terms of product, the postmenopausal hormone therapy is classified into patches, tablets, creams, suppositories, and injections. The tablet formulation comprises the largest market share of the total postmenopausal hormone therapy market. However, due to growing concern of safety and long-term therapy the market for the patches are growing at much faster compound annual growth rate. Based on the therapy, the market is segmented into individual progestin, estrogen and combination therapies. The majority of market is occupied by estrogen therapy across the world.

Based on the route of administration, the postmenopausal hormone therapy market is classified into oral, topical and subcutaneous implants. Due to high safety, oral administration has been the preferred choice of option for the patient. However, introduction of novel drug delivery system has driven the market for topical and subcutaneous products as well. In the terms of end-user, the target population are the women suffering from menopause. However, the treatment is influenced by the physician/ gynecologist, the target end-users are hospitals and specialty clinics.

Geographically, North America occupies the largest market share followed by other developed region like Europe. The United States accounts for a major share of the global market. The high awareness level and high purchasing power in this region led the market of postmenopausal hormone therapy for expansion significantly. However, the same factor of affordability has restrained the markets in developing regions. Despite of this, Asia Pacific has shown striking increase in its growth rate for the postmenopausal hormone therapy market. Rising population, increase in disposable income, and increase in awareness level are some key factors driving the Asia Pacific Market. Due to this factors, the Asian market is observing high number of new entrants compared to those in developed regions.

The Major players reported in the market include Abbott Laboratories, AbbVie, Inc., Bayer Pharma AG, Hisamitsu Pharmaceutical Co., Inc., Novartis AG, Novo Nordisk A/S, Orion Pharma AB, Pfizer, Inc., Meda pharmaceuticals, Teva Pharmaceutical Industries Ltd. and TherapeuticsMD, Inc., etc

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Postmenopausal Hormone Therapy Market to Surge at a Robust Pace by 2024 - Market Reporter

Endocrine Testing Market Report 2019 to 2024 With Top Countries Data : Growth, Provides Analysis on Supply, Market Size, Import and Export,…

Report Title: 2019-2024 Global and Regional Endocrine Testing Industry Production, Sales and Consumption Status and Prospects Professional Market Research Report

Endocrine Testing Market research report gives detailed information of major players like manufacturers, suppliers, distributors, traders, customers, investors and etc. Endocrine Testing market Report presents a professional and deep analysis on the present state of Endocrine Testing Market that Includes major types, major applications, Data type include capacity, production, market share, price, revenue, cost, gross, gross margin, growth rate, consumption, import, export and etc. Industry chain, manufacturing process, cost structure, marketing channel are also analyzed in this report.

Overview Of Endocrine Testing Market:

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Report further studies the Endocrine Testing market development status and future trend across the world. Also, it splits Endocrine Testing market by type and by applications to fully and deeply research and reveal market profile and prospects.

Segmentations Analysis:

Top Key Players:Abbott Laboratories, AdnaGen, Beckman Coulter/Danaher, Biomedical Diagnostics, BioMerieux, Bio-Rad, Dako, DiaSorin, Eiken, Fujirebio, Instrumentation Laboratory, Kyowa Medex, Matritech, Ortho-Clinical Diagnostics, Roche, Siemens, Sysmex, Thermo Fisher, Tosoh, Wako, Wallac/PE

By TestEstradiol (E2) Test, Follicle Stimulating Hormone (FSH) Test, Human Chorionic Gonadotropin (hCG) Test, Luteinizing Hormone (LH) Test, Dehydroepiandrosterone sulfate (DHEAS) Test, Progesterone Test, Testosterone Test, Thyroid Stimulating Hormone (TSH) Test, Others (Gastrin, Thymosin, Secretin, etc.)

By TechnologyTandem Mass spectrometry, Immunoassay (Enzyme immunoassays, Radioimmunoassays (RIA)) Technologies, Monoclonal and Polyclonal Antibody Technologies, Sensor (Electrochemical, Biosensors, etc.) Technologies, Clinical Chemistry Technologies, Others (Liquid Chromatography + Mass Spectrometry (LC-MS)

By End UserHospitals, Commercial Laboratories, Ambulatory Care Centers, Home Based Tests, Physician Offices.

Inquire more and share questions if any before the purchase on this report at https://www.360researchreports.com/enquiry/pre-order-enquiry/12885744

Endocrine Testing Market report covers the manufacturers data, including: shipment, price, revenue, gross profit, interview record, business distribution etc., these data help the consumer know about the competitors better. This report also covers all the regions and countries of the world, which shows a regional development status, including market size, volume and value, as well as price data.

Geographically, this report is segmented into severalkey regions, with sales, revenue, market share and growth Rate of Endocrine Testing in these regions, from 2014 to 2024, covering

The Endocrine Testing market report provides answers to the following key questions:

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Detailed TOC of 2019-2024Global and Regional Endocrine Testing Industry Production, Sales and Consumption Status and Prospects Professional Market Research Report

Chapter 1 Industry Overview

Chapter 2 Production Market Analysis

Chapter 3 Sales Market Analysis

Chapter 4 Consumption Market Analysis

Chapter 5 Production, Sales and Consumption Market Comparison Analysis

Chapter 6 Major Manufacturers Production and Sales Market Comparison Analysis

Chapter 7 Major Type Analysis

Chapter 8 Major Application Analysis

Chapter 9 Industry Chain Analysis

9.2 Manufacturing Analysis

9.3 Industry Chain Structure Analysis

Chapter 10 Global and Regional Market Forecast

10.2 Sales Market Forecast

10.3 Consumption Market Forecast

Chapter 11 Major Manufacturers Analysis

11.1 Company 3

11.2 Company 2

11.3 Company 3

Chapter 12 New Project Investment Feasibility Analysis

Continued.

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Ultrasound: Sonogram – American Pregnancy Association

An ultrasound exam is a procedure that uses high-frequency soundwaves to scan a womans abdomen and pelvic cavity, creating a picture(sonogram) of the baby and placenta. Although the terms ultrasoundand sonogram are technically different, they are used interchangeablyand reference the same exam.

There are basically seven different ultrasound exams, but the basic process is the same.

The different types of procedures include:

Transvaginal Scans Specially designed probe transducersare used inside the vagina to generate sonogram images. Most oftenused during the early stages of pregnancy.

Standard Ultrasound Traditional ultrasound examwhich uses a transducer over the abdomen to generate 2-D images ofthe developing fetus.

Advanced Ultrasound This exam is similar to thestandard ultrasound, but the exam targets a suspected problem anduses more sophisticated equipment.

Doppler Ultrasound This imaging procedure measuresslight changes in the frequency of the ultrasound waves as they bounceoff moving objects, such as blood cells.

3-D Ultrasound Uses specially designed probes andsoftware to generate 3-D images of the developing fetus.

4-D or Dynamic 3-D Ultrasound Uses specially designedscanners to look at the face and movements of the baby prior to delivery.

Fetal Echocardiography Uses ultrasound waves toassess the babys heart anatomy and function. This is used to helpassess suspected congenital heart defects.

The traditional ultrasound procedure involves placing gel on yourabdomen to work as a conductor for the sound waves. Your healthcareprovider uses a transducer to produce sound waves into the uterus.The sound waves bounce off bones and tissue returning back to thetransducer to generate black and white images of the fetus.

Ultrasounds may be performed at any point during pregnancy, and theresults are seen immediately on a monitor during the procedure. Transvaginalscans may be used early in pregnancy to diagnose potential ectopicor molar pregnancies.

There is not a recommended number of ultrasounds that should be performedduring routine prenatal care. Because ultrasound should only be usedwhen medically indicated, many healthy pregnancies will not require an ultrasound. The average number of ultrasounds varies with each healthcareprovider.

Additional ultrasounds might be ordered separately if yourhealthcare provider suspects a complication or problem related toyour pregnancy.

Ultrasounds are diagnostic procedures that detect or aid in the detectionof abnormalities and conditions related to pregnancy. Ultrasoundsare usually combined with other tests, such as tripletests, amniocentesis,or chorionic villus sampling,to validate a diagnosis.

An ultrasound exam may be performedthroughout pregnancy for the following medically-necessary reasons:

First Trimester:

Second Trimester:

Third Trimester:

The ultrasound is a noninvasive procedure which, when used properly,has not demonstrated fetal harm. The long-term effects of repeatedultrasound exposures on the fetus are not fully known. It is recommendedthat ultrasound only be used if medically indicated.

No, itdoes not mean there is a problem. The heartbeat may not be detectedfor reasons that include: tipped uterus, larger abdomen, or inaccuratedating with last menstrual period. Heartbeats are best detected withtransvaginal ultrasounds early in pregnancy.

Concern typically developsif there is no fetal heart activity in an embryo with a crown-rumplength greater than 5mm. If you receive an ultrasound exam after week6, your healthcare provider will begin to be concerned, if there isno gestational sac.

Your healthcare provider will use hormone levels in yourblood, the date of your last menstrual period and, in some cases,results from an ultrasound to generate an estimated gestational age.However, variations in each womans cycle and each pregnancy may hinderthe accuracy of the gestational age calculation.

If your healthcareprovider uses an ultrasound to get an estimated delivery date to basethe timing of your prenatal care, the original estimated gestationalage will not be changed.

If there are any questions regarding gestational age, placenta location,or possible complications then more ultrasounds may be scheduled.Because ultrasound should only be used when medically indicated, manyhealthy pregnancies will not require an ultrasound. The average numberof ultrasounds varies with each healthcare provider.

Your healthcare provider willuse hormone levels in your blood, the date of your last menstrualperiod and, in some cases, results from an ultrasound to generatean expected date of conception. However, many differences in eachwomans cycle may hinder the accuracy of the conception date calculation.

The viability of sperm varies as well, which means intercoursethree to five days prior to ovulation may result in conception. Ultrasounddating of conception is not reliable for determining paternity becausethe ultrasound can be off by at least 5-7 days in early pregnancy.

Youmay have an ultrasound between 18 to 20 weeks to evaluate dates, amultiples pregnancy, placenta location or complications. It may alsobe possible to determine the gender of your baby during this ultrasound.Several factors, such as the stage of pregnancy and position of the fetus,will influence the accuracy of the gender prediction.

To be 100% sureyou will have an anxious wait until the birth!

Ultrasoundsare only necessary if there is a medical concern. As noted above,ultrasounds enable your healthcare provider to evaluate the babyswell being as well as diagnose potential problems. For women withan uncomplicated pregnancy, an ultrasound is not a necessary partof prenatal care.

Last updated: November 3, 2017 at 14:29 pm

Compiled using information from the following sources:

1. Williams Obstetrics Twenty-Second Ed. Cunningham,F. Gary, et al, Ch. 16.

2. American Institute of Ultrasound in Medicine

https://www.aium.org

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Ultrasound: Sonogram - American Pregnancy Association

Hyperparathyroidism – Symptoms and causes – Mayo Clinic

Overview

Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. These glands are about the size of a grain of rice and are located in your neck.

The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.

Two types of hyperparathyroidism exist. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone, resulting in high levels of calcium in the blood (hypercalcemia), which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.

Secondary hyperparathyroidism occurs as a result of another disease that initially causes low levels of calcium in the body and over time, increased parathyroid hormone levels occur.

Hyperparathyroidism is often diagnosed before signs or symptoms of the disorder are apparent. When symptoms do occur, they're the result of damage or dysfunction in other organs or tissues due to high calcium levels circulating in the blood and urine or too little calcium in bones.

Symptoms may be so mild and nonspecific that they don't seem at all related to parathyroid function, or they may be severe. The range of signs and symptoms include:

See your doctor if you have any signs or symptoms of hyperparathyroidism. These symptoms could be caused by any number of disorders, including some with serious complications. It's important to get a prompt, accurate diagnosis and appropriate treatment.

Hyperparathyroidism is caused by factors that increase the production of parathyroid hormone.

The parathyroid glands maintain proper levels of both calcium and phosphorus in your body by turning the secretion of parathyroid hormone (PTH) off or on, much like a thermostat controls a heating system to maintain a constant air temperature. Vitamin D also is involved in regulating the amount of calcium in your blood.

Normally, this balancing act works well. When calcium levels in your blood fall too low, your parathyroid glands secrete enough PTH to restore the balance. PTH raises calcium levels by releasing calcium from your bones and increasing the amount of calcium absorbed from your small intestine.

When blood-calcium levels are too high, the parathyroid glands produce less PTH. But sometimes one or more of these glands produce too much hormone, leading to abnormally high levels of calcium (hypercalcemia) and low levels of phosphorus in your blood.

The mineral calcium is best known for its role in keeping your teeth and bones healthy. But calcium has other functions. It aids in the transmission of signals in nerve cells, and it's involved in muscle contraction. Phosphorus, another mineral, works in conjunction with calcium in these areas.

The disorder can generally be divided into two types based on the cause. Hyperparathyroidism may occur because of a problem with the parathyroid glands themselves (primary hyperparathyroidism) or because of another disease that affects the glands' function (secondary hyperparathyroidism).

Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands:

Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.

Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. Therefore, your parathyroid glands overwork to compensate for the loss of calcium. Factors that may contribute to secondary hyperparathyroidism include:

Severe vitamin D deficiency. Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps your digestive system absorb calcium from your food.

Your body produces vitamin D when your skin is exposed to sunlight, and you consume some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.

You may be at an increased risk of primary hyperparathyroidism if you:

Complications of hyperparathyroidism are primarily related to the long-term effect of too little calcium in your bones and too much calcium circulating in your bloodstream. Common complications include:

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Hyperparathyroidism - Symptoms and causes - Mayo Clinic

melatonin | Description, Hormone, & Effects | Britannica.com

Melatonin, hormone secreted by the pineal gland, a tiny endocrine gland situated at the centre of the brain. Melatonin was first isolated in 1958 by American physician Aaron B. Lerner and his colleagues at Yale University School of Medicine. They gave the substance its name on the basis of its ability to lighten skin colour in frogs by reversing the skin-darkening effects of melanocyte-stimulating hormone. Melatonin, a derivative of the amino acid tryptophan, is produced in humans, other mammals, birds, reptiles, and amphibians.

In humans, melatonin plays an important role in the regulation of sleep cycles (i.e., circadian rhythm). Its production is influenced by the detection of light and dark by the retina of the eye. For example, the production of melatonin is inhibited when the retina detects light and is stimulated in the absence of light. Special photoreceptor cells in the retina send signals about light status to the suprachiasmatic nucleus (SCN) in the hypothalamus of the brain. These signals are then transmitted to the pineal gland. Melatonin generation by the pineal gland, which peaks during the nighttime hours, induces physiological changes that promote sleep, such as decreased body temperature and respiration rate. During the day, melatonin levels are low because large amounts of light are detected by the retina. Light inhibition of melatonin production is central to stimulating wakefulness in the morning and to maintaining alertness throughout the day.

Melatonin receptors are found in the SCN and the pituitary gland of the brain, as well as in the ovaries, blood vessels, and intestinal tract. There is a high concentration of receptors in the SCN because this is where melatonin mediates the majority of its affects on circadian rhythm. The binding of melatonin to its receptors on the pituitary gland and the ovaries appears to play a role in regulating the release of reproductive hormones in females. For example, the timing, length, and frequency of menstrual cycles in women are influenced by melatonin. In addition, in certain mammals (other than humans), such as horses and sheep, melatonin acts as a breeding and mating cue, since it is produced in greater amounts in response to the longer nights of winter and less so during summer. Animals who time their mating or breeding to coincide with favourable seasons (such as spring) may depend on melatonin production as a kind of biological clock that regulates their reproductive cycles on the basis of the length of the solar day.

Melatonin has antiaging properties. For example, it acts as an antioxidant, neutralizing harmful oxidative radicals, and it is capable of activating certain antioxidant enzymes. Melatonin production gradually declines with age, and its loss is associated with several age-related diseases. Melatonin also plays a role in modulating certain functions of the immune system.

Synthetic melatonin is available in pill form and can be used to treat insomnia and other sleep disorders, to adjust sleep schedules following jet lag or other major disruptions, and to help blind people establish night and day cycles. Melatonin supplements may also help lower blood pressure and aid in withdrawal from benzodiazepines, though further research is needed.

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melatonin | Description, Hormone, & Effects | Britannica.com

Supplements Archives – Dr. Jolene Brighten

This web site offers health, wellness, fitness and nutritional information and is provided for informational purposes only. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment, Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this web site. The use of any information provided on this web site is solely at your own risk. Nothing stated or posted on this web site or available through any services offered by Dr. Jolene Brighten, ND and Brighten Wellness, LLC, are intended to be, and must not be taken to be, the practice of medicine. Information provided on this web site DOES NOT create a doctor-patient relationship between you and any doctor affiliated with our web site. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

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Thyroid Hormone Treatment | American Thyroid Association

Thyroid hormone is easy to take. Because it stays in your system for a long time, it can be taken just once a day, and this results in very stable levels of thyroid hormone in the blood stream. When thyroid hormone is used to treat hypothyroidism, the goal of treatment is to keep thyroid function within the same range as people without thyroid problems. Keeping the TSH level in the normal range does this. The best time to take thyroid hormone is probably first thing in the morning on an empty stomach. This is because food in the stomach can affect the absorption of thyroid hormone. However, the most important thing is to be consistent, and take your thyroid hormone at the same time, and in the same way, every day. If you are taking several other medications, you should discuss the timing of your thyroid hormone dose with your physician. Sometimes taking your thyroid hormone at night can make it simpler to prevent your thyroid hormone from interacting with food or other medications.

Do not stop your thyroid hormone without discussing this with your physician. Most thyroid problems are permanent, and therefore most patients require thyroid hormone for life. If you miss a dose of thyroid hormone, it is usually best to take the missed dose as soon as you remember. It is also safe to take two pills the next day; one in the morning and one in the evening. It is very important that your thyroid hormone and TSH levels are checked periodically, even if you are feeling fine, so that your dose of thyroid hormone can be adjusted if needed.

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Thyroid Hormone Treatment | American Thyroid Association

Thyroid Disorders | Hormone Health Network

The thyroid is a small butterfly-shaped gland inside the neck, located in front of the trachea (windpipe) and below the larynx (voicebox). It produces two thyroid hormonestriiodothyronine (T3) and thyroxine (T4)that travel through the blood to all tissues of the body.

Thyroid hormones regulate how the body breaks down food and either uses that energy immediately or stores it for the future. In other words, our thyroid hormones regulate our body's metabolism.

Another gland, called the pituitary gland, controls how well the thyroid works. The pituitary gland is located at the base of the brain and produces thyroid-stimulating hormone (TSH). The bloodstream carries TSH to the thyroid gland, where it tells the thyroid to produce more thyroid hormones, as needed.

Thyroid hormones influence virtually every organ system in the body. They tell organs how fast or slow they should work. Thyroid hormones also regulate the consumption of oxygen and the production of heat.

Endocrinologistsphysicians and scientists who study and care for patients with endocrine gland and hormone problemsstudy and treat several major disorders of the thyroid gland. The following is a list of some common thyroid disorders.

Too much thyroid hormone from an overactive thyroid gland is called hyperthyroidism, because it speeds up the body's metabolism. This hormone imbalance occurs in about 1 percent of all women, who get hyperthyroidism more often than men. One of the most common forms of hyperthyroidism is known as Graves' disease. This autoimmune disorder (when your bodys defense system attacks your own cells) tends to run in families. Because the thyroid gland is producing too much hormone in hyperthyroidism, the body develops an increased metabolic state, with many body systems developing abnormal function.

Too little thyroid hormone from an underactive thyroid gland is called hypothyroidism. In hypothyroidism, the body's metabolism is slowed. Several causes for this condition exist, most of which affect the thyroid gland directly, impairing its ability to make enough hormone. More rarely, there may be a pituitary gland tumor, which blocks the pituitary from producing TSH. Whether the problem is caused by the thyroid or by the pituitary gland, the result is that the thyroid is producing too few hormones, causing many physical and mental processes to become sluggish. The body consumes less oxygen and produces less body heat.

A thyroid nodule is a small lump in the thyroid gland. Thyroid nodules are common. These nodules can be either a growth of thyroid tissue or a fluid-filled cyst, which forms a lump in the thyroid gland. Almost half of the population will have tiny thyroid nodules at some point in their lives but, typically, these are not noticeable until they become large and affect normal thyroid size. About 5% of people develop large nodules, more than a half inch across (about 1 centimeter).

Although most nodules are not cancerous, people who have them should seek medical attention to rule out cancer. Also, some thyroid nodules may produce too much thyroid hormone and cause hyperthyroidism, or become too large, interfering with breathing or swallowing or causing neck discomfort.

Other thyroid problems include cancer, thyroiditis (swelling of the thyroid gland), or a goiter, which is an enlargement of the thyroid gland.

July 2018

Editors

Bryan Haugen, MD

Leonard Wartofsky, MD, MACP

Ramon Martinez, MD

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Thyroid Disorders | Hormone Health Network

Unwanted side effects of (bioidentical) hormone …

The use of bioidentical hormones got a lot of press after Suzanne Somers (Threes Company cast member and promoter of the ThighMaster) began touting them as an alternative to synthetic hormone replacement. I wholeheartedly agree that bioidentical hormones are preferable to synthetic hormone replacement therapy (HRT). Recall the large experiment on the female population known as the Womens Health Initiative Postmenopausal Hormone Therapy Trials. If you arent familiar with the results of that study, here is a summary provided by the National Institutes of Health:

Compared with the placebo, estrogen plus progestin resulted in:

Increased risk of heart attackIncreased risk of strokeIncreased risk of blood clotsIncreased risk of breast cancerReduced risk of colorectal cancerFewer fracturesNo protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, estrogen alone resulted in:

No difference in risk for heart attackIncreased risk of strokeIncreased risk of blood clotsUncertain effect for breast cancerNo difference in risk for colorectal cancerReduced risk of fracture(Findings about memory and cognitive function are not yet available.)

Just because synthetic hormones come with proven risk, it seems that people have decided bioidentical hormones are totally fine to take. Bioidentical hormones are crafted to be the exact molecular structure of the hormone(s) your body produces. Synthetic hormones, on the other hand are not. Synthetic hormones are typically a bit different from the exact structure that your body makes because that way it can be patented by the manufacturer.

The purpose of this article is not necessarily to compare and contrast synthetic from bioidentical HRT; but to alert you as to how the body responds when bioidentical (and synthetic) hormones are taken. Well, really to alert you on the downside consequences of taking ANY hormones. The physiology is simple and logical. It can be more in depth, but Ill focus on the basics. By the way, Im referring to the pathways of the most commonly replaced hormones, steroid (e.g.: estrogen, testosterone, progesterone, cortisol, DHEA, etc.) and thyroid hormones.

Most hormones work in the body via a negative feedback loop. This means that as the level of a hormone rises, a signal is mediated that ceases that hormones production and release; in order to prevent the production of the hormone from getting out of control. Lets begin with an example using thyroid hormone.

The three main glands involved in thyroid hormone production are the hypothalamus, pituitary and thyroid. The hypothalamus releases thyroid releasing hormone (TRH), which stimulates the pituitary gland to release thyroid stimulating hormone (TSH), which in turn stimulates the thyroid gland to manufacture and release thyroid hormones (thyroxine or T4 and triiodothyronine or T3). Once the thyroid hormone begins to do its job throughout the body, production begins to decline, so as not to produce too many hormones. So, as the level of thyroid hormone increases, the levels of TRH and TSH decrease. Its called a negative feedback loop because the rise in hormone levels results in a decreased production; as opposed to a positive feedback loop where a rise in hormone levels would produce an even greater rise in the level of that same hormone. The only example of a hormone that works on a positive feedback loop that I can think of is oxytocin.

Because these hormones work this way, you may be able to guess what happens when you are exposed to (i.e.: ingest) exogenous hormones. Exogenous (as opposed to endogenous) refers to those taken in from outside the body, and can be any type of hormone. So, if you take a hormone, you can be sure that those negative feedback loops will still function as usual. The resultyour body stops (or significantly slows) its own production of these hormones. Whats wrong with that? Eventually, youll be dependent on these hormones as your glands have gone to sleep, because someone else is doing their job. Its simply not necessary for the glands to have to do anything.

So if you stop taking them, it may be extremely difficult to get your bodys own production back up to par. Now, considering people often take hormones because theyre not producing enough on their own in the first place, you can imagine how difficult it would be to begin the production process after taking exogenous hormones and suppressing your hormone production even further. Therefore, people usually become completely dependent on hormones, bioidentical or not. In general, as long as youre okay with taking a hormone for the rest of your life, there is no need to worry. However, most (if not all) of my patients shun that idea.

The next issue is that of hormone receptor insensitivity. Generally speaking, each hormone docks into a receptor on its target cell. Its as if the receptor is the lock and the hormone is the key. Once the cell door opens, the hormone goes on to carry out its function (usually turning on or off genes). The problem with bombarding the cells with large doses of a hormone is that eventually its as if the cell decides to change the lock on the door. The result is that it is harder and harder for the hormone to open the cell door, and therefore more and more of the hormone is needed each successive time you want to make an effect on the cell/genes. Its almost as if you need enough hormone to knock the cell door down, because it doesnt want to open. This is especially prevalent with the use of hormone creams (usu. progesterone). However, if you make no lifestyle changes it typically happens with any hormone. Thats why people on thyroid hormone often have to continue increasing the dose to get the same effect; the same goes for those who take insulin. Have you ever known of diabetic or person with hypothyroidism (except for autoimmune thyroid disease/Hashimotos) that had to decrease their dose, without making lifestyle changes? So, taking a hormone for the rest of your life may not even do the trick, especially insulin. You may be familiar with how well diabetics fare without changing their lifestyle, and continually increasing their doses of insulin. By the way, hormone receptor sites often run out of the vitamin and minerals that are necessary to allow them to function properly, due to the constant bombardment of hormones they are subject to in these cases.

This is not to say that no one should be on HRT, bioidentical or synthetic. There is a time and place for everything. And when these hormones are necessary, they can be miraculous. The big question is: When are they necessary? Thats a debatable issue and can certainly vary between individuals. So I am not absolutely against HRT, though I definitely prefer bioidentical over synthetic when possible.

The point Im trying to get across is that I wouldnt recommend anyone start with HRT, unless they are in a very unmanageable state. In these instances, one option may be to start with HRT to prime the pump and then eventually wean off them. Unfortunately, with all the books written about HRT and the attention it gets these days, many people (and doctors) go straight for hormones (with or without lab tests). Dont get me wrong, chances are youll feel like a million bucks if you take hormones that you are deficient in, or insensitive to. But dont forget to ask the million dollar question just because you feel like a million bucks: How long does that last? Well, there is no single answer to that question because everybodys condition and lifestyle is a bit different. But, from what Ive seen, it lasts about six months at best, before they have to adjust the dose upward. You may eventually find yourself always having to increase the dose to get the same effect. And finally, your cells just may not respond adequately, despite the dose. Thats not say there is no hope though.

Im currently working with a patient who had low testosterone and used testosterone replacement therapy for over a year. Sure enough, he had to continually increase the dose, until it eventually stopped giving him the results he needed (i.e.: absence of musculoskeletal pain, strength, libido, and an erection). In this case (and others), I determine if the hypothalamus, pituitary, gonads (when it comes to testosterone), and/or cell receptors need support. Fortunately, in the above mentioned case, the patient got immediate results that according to him, showed via the number of plates he kept adding on the machines at the gym.

In some cases, it may not be easy to get everything back up and running like new. But with the proper nutritional support and lifestyle improvements, it certainly is an attainable goal. The willingness of the patient to change their lifestyle and the length of time the person has been on hormones are two very important factors that will help to determine the outcome. Fortunately, I havent seen a lost cause yet; but I sure have seen people feeling miserable after the hormones stop giving the desired effect. Remember, theres no such thing as a free lunch!

Not to go into politicsbut Im a big advocate of being able to buy supplements over-the-counter. Although I truly believe that hormones should only be dispensed through licensed health care practitioners who know how to use them.

PS: There are more problems associated with HRT (bioidentical or not) than what I mentioned above. For example, many men who take testosterone can eventually wind up converting it into estrogen (just about the opposite effect they are looking for)thats enough on that for now.

PSS: Im not saying that bioidentical hormones are never necessary. They certainly can be in some instancesjust consider the potential side-effects and work with a licensed, competent, qualified health care professional who knows how to use them appropriately. They can be very useful to prime the pump when other lifestyle changes are implemented.

Dr. Robert DAquila NYC Chiropractor Applied Kinesiology

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Unwanted side effects of (bioidentical) hormone ...

Bioidentical Hormone Doctors

NOTE: Forever Health provides a directory where people like you can connect with BHRT and other physicians and innovative health practitioners. We do not provide medical advice or services directly. While BHRT and prevention are important to the physicians and health practitioners listed, each has his or her own approach to practicing medicine. So when scheduling your appointment, be sure to clarify the reason for your visit, as well as your goals for seeking out such treatment.

NOTE on Insurance: Innovative practitioners and insurance companies have long debated the importance of preventive medicine and services such as BHRT. Due to variations in coverage for novel treatment options, many practitioners will resolve this issue by providing their services on a cash-only basis. Forever Health encourages you to contact the practitioner to determine if any alternative payment options or post-visit reimbursements exist.

DISCLAIMER: Inclusion in this directory is free to practitioners and does not constitute endorsement by Forever Health. All health practitioners who appear on this list do so on the sole basis of their own expression of interest in the fields of BHRT or other integrative medicine. Forever Health does not verify the competence, professional credentials, business practices or validity of the expressed interests of these health practitioners. Forever Health makes no recommendation of any health practitioner on this list and makes no suggestion that any such health practitioner will cure, treat, or prevent any disease or condition.

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Bioidentical Hormone Doctors

Adrenal gland – Wikipedia

The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol.[1][2] They are found above the kidneys. Each gland has an outer cortex which produces steroid hormones and an inner medulla. The adrenal cortex itself is divided into three zones: the zona glomerulosa, the zona fasciculata and the zona reticularis.[3]

The adrenal cortex produces three main types of steroid hormones: mineralocorticoids, glucocorticoids, and androgens. Mineralocorticoids (such as aldosterone) produced in the zona glomerulosa help in the regulation of blood pressure and electrolyte balance. The glucocorticoids cortisol and corticosterone are synthesized in the zona fasciculata; their functions include the regulation of metabolism and immune system suppression. The innermost layer of the cortex, the zona reticularis, produces androgens that are converted to fully functional sex hormones in the gonads and other target organs.[4] The production of steroid hormones is called steroidogenesis, and involves a number of reactions and processes that take place in cortical cells.[5] The medulla produces the catecholamines adrenaline and noradrenaline, which function to produce a rapid response throughout the body in stress situations.[4]

A number of endocrine diseases involve dysfunctions of the adrenal gland. Overproduction of cortisol leads to Cushing's syndrome, whereas insufficient production is associated with Addison's disease. Congenital adrenal hyperplasia is a genetic disease produced by dysregulation of endocrine control mechanisms.[4][6] A variety of tumors can arise from adrenal tissue and are commonly found in medical imaging when searching for other diseases.[7]

The adrenal glands are located on both sides of the body in the retroperitoneum, above and slightly medial to the kidneys. In humans, the right adrenal gland is pyramidal in shape, whereas the left is semilunar or crescent shaped and somewhat larger.[8] The adrenal glands measure approximately 3cm in width, 5.0cm in length, and up to 1.0cm in thickness.[9] Their combined weight in an adult human ranges from 7 to 10grams.[10] The glands are yellowish in colour.[8]

The adrenal glands are surrounded by a fatty capsule and lie within the renal fascia, which also surrounds the kidneys. A weak septum (wall) of connective tissue separates the glands from the kidneys.[11] The adrenal glands are directly below the diaphragm, and are attached to the crura of the diaphragm by the renal fascia.[11]

Each adrenal gland has two distinct parts, each with a unique function, the outer adrenal cortex and the inner medulla, both of which produce hormones.[12]

The adrenal cortex is the outermost layer of the adrenal gland. Within the cortex are three layers, called "zones". When viewed under a microscope each layer has a distinct appearance, and each has a different function.[13] The adrenal cortex is devoted to production of hormones, namely aldosterone, cortisol, and androgens.[14]

The outermost zone of the adrenal cortex is the zona glomerulosa. It lies immediately under the fibrous capsule of the gland. Cells in this layer form oval groups, separated by thin strands of connective tissue from the fibrous capsule of the gland and carry wide capillaries.[15]

This layer is the main site for production of aldosterone, a mineralocorticoid, by the action of the enzyme aldosterone synthase.[16][17] Aldosterone plays an important role in the long-term regulation of blood pressure.[18]

The zona fasciculata is situated between the zona glomerulosa and zona reticularis. Cells in this layer are responsible for producing glucocorticoids such as cortisol.[19] It is the largest of the three layers, accounting for nearly 80% of the volume of the cortex.[3] In the zona fasciculata, cells are arranged in columns radially oriented towards the medulla. Cells contain numerous lipid droplets, abundant mitochondria and a complex smooth endoplasmic reticulum.[15]

The innermost cortical layer, the zona reticularis, lies directly adjacent to the medulla. It produces androgens, mainly dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), and androstenedione (the precursor to testosterone) in humans.[19] Its small cells form irregular cords and clusters, separated by capillaries and connective tissue. The cells contain relatively small quantities of cytoplasm and lipid droplets, and sometimes display brown lipofuscin pigment.[15]

The adrenal medulla is at the centre of each adrenal gland, and is surrounded by the adrenal cortex. The chromaffin cells of the medulla are the body's main source of the catecholamines adrenaline and noradrenaline, released by the medulla. Approximately 20% noradrenaline (norepinephrine) and 80% adrenaline (epinephrine) are secreted here.[19]

The adrenal medulla is driven by the sympathetic nervous system via preganglionic fibers originating in the thoracic spinal cord, from vertebrae T5T11.[20] Because it is innervated by preganglionic nerve fibers, the adrenal medulla can be considered as a specialized sympathetic ganglion.[20] Unlike other sympathetic ganglia, however, the adrenal medulla lacks distinct synapses and releases its secretions directly into the blood.

The adrenal glands have one of the greatest blood supply rates per gram of tissue of any organ: up to 60 small arteries may enter each gland.[21] Three arteries usually supply each adrenal gland:[8]

These blood vessels supply a network of small arteries within the capsule of the adrenal glands. Thin strands of the capsule enter the glands, carrying blood to them.[8]

Venous blood is drained from the glands by the suprarenal veins, usually one for each gland:[8]

The central adrenomedullary vein, in the adrenal medulla, is an unusual type of blood vessel. Its structure is different from the other veins in that the smooth muscle in its tunica media (the middle layer of the vessel) is arranged in conspicuous, longitudinally oriented bundles.[3]

The adrenal glands may not develop at all, or may be fused in the midline behind the aorta.[12] These are associated with other congenital abnormalities, such as failure of the kidneys to develop, or fused kidneys.[12] The gland may develop with a partial or complete absence of the cortex, or may develop in an unusual location.[12]

The adrenal gland secretes a number of different hormones which are metabolised by enzymes either within the gland or in other parts of the body. These hormones are involved in a number of essential biological functions.[23]

Corticosteroids are a group of steroid hormones produced from the cortex of the adrenal gland, from which they are named.[24] Corticosteroids are named according to their actions:

The adrenal gland produces aldosterone, a mineralocorticoid, which is important in the regulation of salt ("mineral") balance and blood volume. In the kidneys, aldosterone acts on the distal convoluted tubules and the collecting ducts by increasing the reabsorption of sodium and the excretion of both potassium and hydrogen ions.[18] Aldosterone is responsible for the reabsorption of about 2% of filtered glomerular filtration rates.[27] Sodium retention is also a response of the distal colon and sweat glands to aldosterone receptor stimulation. Angiotensin II and extracellular potassium are the two main regulators of aldosterone production.[19] The amount of sodium present in the body affects the extracellular volume, which in turn influences blood pressure. Therefore, the effects of aldosterone in sodium retention are important for the regulation of blood pressure.[28]

Cortisol is the main glucocorticoid in humans. In species that do not create cortisol, this role is played by corticosterone instead. Glucocorticoids have many effects on metabolism. As their name suggests, they increase the circulating level of glucose. This is the result of an increase in the mobilization of amino acids from protein and the stimulation of synthesis of glucose from these amino acids in the liver. In addition, they increase the levels of free fatty acids, which cells can use as an alternative to glucose to obtain energy. Glucocorticoids also have effects unrelated to the regulation of blood sugar levels, including the suppression of the immune system and a potent anti-inflammatory effect. Cortisol reduces the capacity of osteoblasts to produce new bone tissue and decreases the absorption of calcium in the gastrointestinal tract.[28]

The adrenal gland secretes a basal level of cortisol but can also produce bursts of the hormone in response to adrenocorticotropic hormone (ACTH) from the anterior pituitary. Cortisol is not evenly released during the day its concentrations in the blood are highest in the early morning and lowest in the evening as a result of the circadian rhythm of ACTH secretion.[28] Cortisone is an inactive product of the action of the enzyme 11-HSD on cortisol. The reaction catalyzed by 11-HSD is reversible, which means that it can turn administered cortisone into cortisol, the biologically active hormone.[28]

All corticosteroid hormones share cholesterol as a common precursor. Therefore, the first step in steroidogenesis is cholesterol uptake or synthesis. Cells that produce steroid hormones can acquire cholesterol through two paths. The main source is through dietary cholesterol transported via the blood as cholesterol esters within low density lipoproteins (LDL). LDL enters the cells through receptor-mediated endocytosis. The other source of cholesterol is synthesis in the cell's endoplasmic reticulum. Synthesis can compensate when LDL levels are abnormally low.[4] In the lysosome, cholesterol esters are converted to free cholesterol, which is then used for steroidogenesis or stored in the cell.[29]

The initial part of conversion of cholesterol into steroid hormones involves a number of enzymes of the cytochrome P450 family that are located in the inner membrane of mitochondria. Transport of cholesterol from the outer to the inner membrane is facilitated by steroidogenic acute regulatory protein and is the rate-limiting step of steroid synthesis.[29]

The layers of the adrenal gland differ by function, with each layer having distinct enzymes that produce different hormones from a common precursor.[4] The first enzymatic step in the production of all steroid hormones is cleavage of the cholesterol side chain, a reaction that forms pregnenolone as a product and is catalyzed by the enzyme P450scc, also known as cholesterol desmolase. After the production of pregnenolone, specific enzymes of each cortical layer further modify it. Enzymes involved in this process include both mitochondrial and microsomal P450s and hydroxysteroid dehydrogenases. Usually a number of intermediate steps in which pregnenolone is modified several times are required to form the functional hormones.[5] Enzymes that catalyze reactions in these metabolic pathways are involved in a number of endocrine diseases. For example, the most common form of congenital adrenal hyperplasia develops as a result of deficiency of 21-hydroxylase, an enzyme involved in an intermediate step of cortisol production.[30]

Glucocorticoids are under the regulatory influence of the hypothalamus-pituitary-adrenal (HPA) axis. Glucocorticoid synthesis is stimulated by adrenocorticotropic hormone (ACTH), a hormone released into the bloodstream by the anterior pituitary. In turn, production of ACTH is stimulated by the presence of corticotropin-releasing hormone (CRH), which is released by neurons of the hypothalamus. ACTH acts on the adrenal cells first by increasing the levels of StAR within the cells, and then of all steroidogenic P450 enzymes. The HPA axis is an example of a negative feedback system, in which cortisol itself acts as a direct inhibitor of both CRH and ACTH synthesis. The HPA axis also interacts with the immune system through increased secretion of ACTH at the presence of certain molecules of the inflammatory response.[4]

Mineralocorticoid secretion is regulated mainly by the reninangiotensinaldosterone system (RAAS), the concentration of potassium, and to a lesser extent the concentration of ACTH.[4] Sensors of blood pressure in the juxtaglomerular apparatus of the kidneys release the enzyme renin into the blood, which starts a cascade of reactions that lead to formation of angiotensin II. Angiotensin receptors in cells of the zona glomerulosa recognize the substance, and upon binding they stimulate the release of aldosterone.[31]

Primarily referred to in the United States as epinephrine and norepinephrine, adrenaline and noradrenaline are catecholamines, water-soluble compounds that have a structure made of a catechol group and an amine group. The adrenal glands are responsible for most of the adrenaline that circulates in the body, but only for a small amount of circulating noradrenaline.[23] These hormones are released by the adrenal medulla, which contains a dense network of blood vessels. Adrenaline and noradrenaline act at adrenoreceptors throughout the body, with effects that include an increase in blood pressure and heart rate.[23] actions of adrenaline and noradrenaline are responsible for the fight or flight response, characterised by a quickening of breathing and heart rate, an increase in blood pressure, and constriction of blood vessels in many parts of the body.[32]

Catecholamines are produced in chromaffin cells in the medulla of the adrenal gland, from tyrosine, a non-essential amino acid derived from food or produced from phenylalanine in the liver. The enzyme tyrosine hydroxylase converts tyrosine to L-DOPA in the first step of catecholamine synthesis. L-DOPA is then converted to dopamine before it can be turned into noradrenaline. In the cytosol, noradrenaline is converted to epinephrine by the enzyme phenylethanolamine N-methyltransferase (PNMT) and stored in granules. Glucocorticoids produced in the adrenal cortex stimulate the synthesis of catecholamines by increasing the levels of tyrosine hydroxylase and PNMT.[4][13]

Catecholamine release is stimulated by the activation of the sympathetic nervous system. Splanchnic nerves of the sympathetic nervous system innervate the medulla of the adrenal gland. When activated, it evokes the release of catecholamines from the storage granules by stimulating the opening of calcium channels in the cell membrane.[33]

Cells in zona reticularis of the adrenal glands produce male sex hormones, or androgens, the most important of which is DHEA. In general, these hormones do not have an overall effect in the male body, and are converted to more potent androgens such as testosterone and DHT or to estrogens (female sex hormones) in the gonads, acting in this way as a metabolic intermediate.[34]

Thehuman genomeincludes approximately 20,000 protein coding genes and 70% of thesegenes are expressedin the normal, adult adrenal glands.[35][36]Only some 250 genes are more specifically expressed in the adrenal glands compared to other organs and tissues.The adrenal gland specific genes with highest level of expression include members of the cytochrome P450 superfamily of enzymes. Corresponding proteins are expressed in the different compartments of the adrenal gland, such as CYP11A1, HSD3B2 and FDX1 involved in steroid hormone synthesis and expressed in cortical cell layers, and PNMT and DBH involved in noradrenalin and adrenalin synthesis and expressed in the medulla.[37]

The adrenal glands are composed of two heterogenous types of tissue. In the center is the adrenal medulla, which produces adrenaline and noradrenaline and releases them into the bloodstream, as part of the sympathetic nervous system. Surrounding the medulla is the cortex, which produces a variety of steroid hormones. These tissues come from different embryological precursors and have distinct prenatal development paths. The cortex of the adrenal gland is derived from mesoderm, whereas the medulla is derived from the neural crest, which is of ectodermal origin.[12]

The adrenal glands in a newborn baby are much larger as a proportion of the body size than in an adult.[38] For example, at age three months the glands are four times the size of the kidneys. The size of the glands decreases relatively after birth, mainly because of shrinkage of the cortex. The cortex, which almost completely disappears by age 1, develops again from age 45. The glands weigh about 1 g at birth[12] and develop to an adult weight of about 4 grams each.[28] In a fetus the glands are first detectable after the sixth week of development.[12]

Adrenal cortex tissue is derived from the intermediate mesoderm. It first appears 33 days after fertilisation, shows steroid hormone production capabilities by the eighth week and undergoes rapid growth during the first trimester of pregnancy. The fetal adrenal cortex is different from its adult counterpart, as it is composed of two distinct zones: the inner "fetal" zone, which carries most of the hormone-producing activity, and the outer "definitive" zone, which is in a proliferative phase. The fetal zone produces large amounts of adrenal androgens (male sex hormones) that are used by the placenta for estrogen biosynthesis.[39] Cortical development of the adrenal gland is regulated mostly by ACTH, a hormone produced by the pituitary gland that stimulates cortisol synthesis.[40] During midgestation, the fetal zone occupies most of the cortical volume and produces 100200mg/day of DHEA-S, an androgen and precursor of both androgens and estrogens (female sex hormones).[41] Adrenal hormones, especially glucocorticoids such as cortisol, are essential for prenatal development of organs, particularly for the maturation of the lungs. The adrenal gland decreases in size after birth because of the rapid disappearance of the fetal zone, with a corresponding decrease in androgen secretion.[39]

During early childhood androgen synthesis and secretion remain low, but several years before puberty (from 68 years of age) changes occur in both anatomical and functional aspects of cortical androgen production that lead to increased secretion of the steroids DHEA and DHEA-S. These changes are part of a process called adrenarche, which has only been described in humans and some other primates. Adrenarche is independent of ACTH or gonadotropins and correlates with a progressive thickening of the zona reticularis layer of the cortex. Functionally, adrenarche provides a source of androgens for the development of axillary and pubic hair before the beginning of puberty.[42][43]

The adrenal medulla is derived from neural crest cells, which come from the ectoderm layer of the embryo. These cells migrate from their initial position and aggregate in the vicinity of the dorsal aorta, a primitive blood vessel, which activates the differentiation of these cells through the release of proteins known as BMPs. These cells then undergo a second migration from the dorsal aorta to form the adrenal medulla and other organs of the sympathetic nervous system.[44] Cells of the adrenal medulla are called chromaffin cells because they contain granules that stain with chromium salts, a characteristic not present in all sympathetic organs. Glucocorticoids produced in the adrenal cortex were once thought to be responsible for the differentiation of chromaffin cells. More recent research suggests that BMP-4 secreted in adrenal tissue is the main responsible for this, and that glucocorticoids only play a role in the subsequent development of the cells.[45]

The normal function of the adrenal gland may be impaired by conditions such as infections, tumors, genetic disorders and autoimmune diseases, or as a side effect of medical therapy. These disorders affect the gland either directly (as with infections or autoimmune diseases) or as a result of the dysregulation of hormone production (as in some types of Cushing's syndrome) leading to an excess or insufficiency of adrenal hormones and the related symptoms.

Cushing's syndrome is the manifestation of glucocorticoid excess. It can be the result of a prolonged treatment with glucocorticoids or be caused by an underlying disease which produces alterations in the HPA axis or the production of cortisol. Causes can be further classified into ACTH-dependent or ACTH-independent. The most common cause of endogenous Cushing's syndrome is a pituitary adenoma which causes an excessive production of ACTH. The disease produces a wide variety of signs and symptoms which include obesity, diabetes, increased blood pressure, excessive body hair (hirsutism), osteoporosis, depression, and most distinctively, stretch marks in the skin, caused by its progressive thinning.[4][6]

When the zona glomerulosa produces excess aldosterone, the result is primary aldosteronism. Causes for this condition are bilateral hyperplasia (excessive tissue growth) of the glands, or aldosterone-producing adenomas (a condition called Conn's syndrome). Primary aldosteronism produces hypertension and electrolyte imbalance, increasing potassium depletion and sodium retention.[6]

Adrenal insufficiency (the deficiency of glucocorticoids) occurs in about 5 in 10,000 in the general population.[6] Diseases classified as primary adrenal insufficiency (including Addison's disease and genetic causes) directly affect the adrenal cortex. If a problem that affects the hypothalamic-pituitary-adrenal axis arises outside the gland, it is a secondary adrenal insufficiency.

Addison's disease refers to primary hypoadrenalism, which is a deficiency in glucocorticoid and mineralocorticoid production by the adrenal gland. In the Western world, Addison's disease is most commonly an autoimmune condition, in which the body produces antibodies against cells of the adrenal cortex. Worldwide, the disease is more frequently caused by infection, especially from tuberculosis. A distinctive feature of Addison's disease is hyperpigmentation of the skin, which presents with other nonspecific symptoms such as fatigue.[4]

A complication seen in untreated Addison's disease and other types of primary adrenal insufficiency is the adrenal crisis, a medical emergency in which low glucocorticoid and mineralocorticoid levels result in hypovolemic shock and symptoms such as vomiting and fever. An adrenal crisis can progressively lead to stupor and coma.[4] The management of adrenal crises includes the application of hydrocortisone injections.[46]

In secondary adrenal insufficiency, a dysfunction of the hypothalamic-pituitary-adrenal axis leads to decreased stimulation of the adrenal cortex. Apart from suppression of the axis by glucocorticoid therapy, the most common cause of secondary adrenal insufficiency are tumors that affect the production of adrenocorticotropic hormone (ACTH) by the pituitary gland.[6] This type of adrenal insufficiency usually does not affect the production of mineralocorticoids, which are under regulation of the reninangiotensin system instead.[4]

Congenital adrenal hyperplasia is a congenital disease in which mutations of enzymes that produce steroid hormones result in a glucocorticoid deficiency and malfunction of the negative feedback loop of the HPA axis. In the HPA axis, cortisol (a glucocorticoid) inhibits the release of CRH and ACTH, hormones that in turn stimulate corticosteroid synthesis. As cortisol cannot be synthesized, these hormones are released in high quantities and stimulate production of other adrenal steroids instead. The most common form of congenital adrenal hyperplasia is due to 21-hydroxylase deficiency. 21-hydroxylase is necessary for production of both mineralocorticoids and glucocorticoids, but not androgens. Therefore, ACTH stimulation of the adrenal cortex induces the release of excessive amounts of adrenal androgens, which can lead to the development of ambiguous genitalia and secondary sex characteristics.[30]

Adrenal tumors are commonly found as incidentalomas, unexpected asymptomatic tumors found during medical imaging. They are seen in around 3.4% of CT scans,[7] and in most cases they are benign adenomas.[47] Adrenal carcinomas are very rare, with an incidence of 1 case per million per year.[4]

Pheochromocytomas are tumors of the adrenal medulla that arise from chromaffin cells. They can produce a variety of nonspecific symptoms, which include headaches, sweating, anxiety and palpitations. Common signs include hypertension and tachycardia. Surgery, especially adrenal laparoscopy, is the most common treatment for small pheochromocytomas.[48]

Bartolomeo Eustachi, an Italian anatomist, is credited with the first description of the adrenal glands in 1563-4.[49][50] However, these publications were part of the papal library and did not receive public attention, which was first received with Caspar Bartholin the Elder's illustrations in 1611.[50]

The adrenal glands are named for their location relative to the kidneys. The term "adrenal" comes from ad- (Latin, "near") and renes (Latin, "kidney").[51] Similarly, "suprarenal", as termed by Jean Riolan the Younger in 1629, is derived from the Latin supra (Latin: "above") and renes (Latin: kidney). The suprarenal nature of the glands was not truly accepted until the 19th century, as anatomists clarified the ductless nature of the glands and their likely secretory role prior to this, there was some debate as to whether the glands were indeed suprarenal or part of the kidney.[50]

One of the most recognized works on the adrenal glands came in 1855 with the publication of On the Constitutional and Local Effects of Disease of the Suprarenal Capsule, by the English physician Thomas Addison. In his monography, Addison described what the French physician George Trousseau would later name Addison's disease, an eponym still used today for a condition of adrenal insufficiency and its related clinical manifestations.[52] In 1894, English physiologists George Oliver and Edward Schafer studied the action of adrenal extracts and observed their pressor effects. In the following decades several physicians experimented with extracts from the adrenal cortex to treat Addison's disease.[49] Edward Calvin Kendall, Philip Hench and Tadeusz Reichstein were then awarded the 1950 Nobel Prize in Physiology or Medicine for their discoveries on the structure and effects of the adrenal hormones.[53]

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Nocturia or Frequent Urination at Night – National Sleep …

A frequent need to get up and go to the bathroom to urinate at night is called nocturia. It differs from enuresis, or bedwetting, in which the person does not arouse from sleep, but the bladder empties anyway. Nocturia is a common cause of sleep loss, especially among older adults.

Most people without nocturia can sleep for 6 to 8 hours without having to urinate. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with daytime tiredness. Patients with severe nocturia may get up five or six times during the night to go to the bathroom.

Nocturia is often a symptom of other medical conditions including urological infection, a tumor of the bladder or prostate, a condition called bladder prolapse, or disorders affecting sphincter control. It is also common in people with heart failure, liver failure, poorly controlled diabetes mellitus, or diabetes insipidus. Diabetes, pregnancy and diuretic medications are also associated with nocturia.

Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of sleep apnea.

Nocturia becomes more common as we age. As we get older, our bodies produce less of an anti-diuretic hormone that enables us to retain fluid. With decreased concentrations of this hormone, we produce more urine at night. Another reason for nocturia among the elderly is that the bladder tends to lose holding capacity as we age. Finally, older people are more likely to suffer from medical problems that may have an effect on the bladder.

In fact, nearly two-thirds (65%) of those responding to NSF's 2003 Sleep in America poll of adults between the ages of 55 and 84 reported this disturbance at least a few nights per week.

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Get Paid to be an Apartment Mystery Shopper – Ellis Partners

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Ellis contracts with individuals to conduct over 8,000 apartment mystery shops monthly. Were fair to our shoppers, and our staff is available to answer questions and help with challenges.

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BEWARE of Email Shopping ScamsEllis has been made aware of an email scam regarding shop contracts for our company. Please be advised you can verify the legitimacy of ALL Ellis shop contracts that are available by logging into your Ellis shopper account or contacting us by email or phone. Ellis does not offer apartment shop contract opportunities by mail. If you have reason to believe you have received a fraudulent email or other type of communication involving Ellis shop contract opportunities (especially for any type of assignment other than a multifamily housing mystery shop), please notify us immediately so we can take proper action.

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Physician Assistant Studies (masters degree) | University …

What is a Physician Assistant?Physician assistants (PA) are health professionals who practice medicine as members of a team with their supervising physicians. PAs deliver a broad range of medical and surgical services to diverse populations in rural and urban settings. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and prescribe medications. PAs promote quality, cost effective medical care to all members of society. Physician assistants are certified by the National Commission on Certification of Physician Assistants (NCCPA) and state-licensed.

How do PA graduates become eligible to practice?Physician Assistant Studiesgraduates are eligible to take the Physician Assistant National Certifying Examination. After successful completion of the examination, they are eligible for state certification and licensure to practice as certified physician assistants.

Program LocationsThe University of Kentucky PAS Program has two campuses: the Lexington campus is located in the Charles T. Wethington Building at the University of Kentucky and the Morehead Campus, which is housed in the Center for Health Education and Research (CHER Building) at Morehead State University.

AccreditationAt its 2017 March meeting, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) placed the University of Kentucky Physician Assistant program sponsored by University of Kentucky on Accreditation-Probation status until its next review in 2019 March.Probation is a temporary status of accreditation conferred when a program does not meet the Standards and when the capability of the program to provide an acceptable educational experience for its students is threatened.Once placed on probation, programs that still fail to comply with accreditation requirements in a timely manner, as specified by the ARC-PA, may be scheduled for a focused site visit and/or risk having their accreditation withdrawn.Specific questions regarding the Program and its plans should be directed to the Program Director and/or the appropriate institutional official(s).

Program Director's Response to Accreditation Status

UKPAS Program PANCE PerformanceUKPA Program PANCE Pass Rates please click here for the full report: UKPA PANCE Results

This document is subject to change due to changing tuition costs each academic year. You may check the University of Kentucky Registrar'swebsitefor the current tuition fees of the academic year. TheUKPAprogram will update the tuition and fee document for each new incoming cohort before matriculation in January.

Contact UsPhysician Assistant ProgramCollege of Health Sciences900 S. LimestoneLexington, KY 40536-0200

General InquiriesLexington 859- 218-0567Morehead 606-783-2051

Admissions AdvisementLexington 859-257-5001Morehead 606-783-2558

Transfer Credit859-218-0473

Clinical Placement859-218-0498

Program Information Sheet(pdf)

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Hormone Questions? Ask Your Doctor These 6 Things | Sara …

If you read my blog or follow my work, you know that my mission is to help women weed through the myths and mysteries to uncover the truth: how to eat, how to move and how to live so you thrive in that powerful place of physical, mental and emotional well-being.

But at the end of the day, many of you still have health issues you have to address with conventional medicine. If youre lucky, you have a caring and committed physician who is willing to guide you in the process. If youre not so lucky? You can end up feeling frustrated and alone when your doctor doesnt listen to your concerns or when youre thrown yet another prescription for something that may or may not help you get better.

If you suspect you have a hormonal imbalance but youre concerned about how to approach your doctor, youre not alone. While I specialize in these types of issues, many general physicians may not investigate this area as a first plan of attack to treat health problems.

So what do you do when youre ready to broach the subject? How can you get the right answers, take the right tests and know that your doctor is on your side?

If youre willing to be candid, a little preparation can help you open the lines of communication and hopefully lead you to better health outcomes.

Doctors are no different from other working professionals who see clients or patients. Their time is usually limited, so its important to make the most of your appointment. A good step for initial preparation is to take my hormone quiz (you can access it online or in my book, The Hormone Cure). The results of this assessment should give both you and your doctor a general idea of what hormonal imbalances might be at play. With a few follow-up questions, your physician should be able to determine what tests might be needed to investigate the problem further.

It never hurts to present a physician with your own research on the topic that concerns you. If youve done your homework, feel free to bring along books, studies or other materials on the subject. This can help start the conversation, letting your doctor know that youre informed and serious about getting answers. Another research step you can take is to complete a comprehensive hormonal profile test at home (which can be purchased through the Canary Club) and take the results to your appointment.

If youve taken preliminary tests, done your research or have some other reason to suspect a problem (maybe you have a family history of low thyroid or an autoimmune condition, for example), dont be afraid to ask for specific tests. If, on the other hand, youre going into the conversation with little information, bring along a list of specific questions. You can then compare your doctors answers to your own research or you can get a second opinion.

If youre not confident in your physicians ability to help you address your concerns, its always OK to ask for a referral to an endocrinologist or someone who has more experience treating hormonal imbalance. You may also need to simply shop around for a doctor with whom you feel comfortable and supported.

While some physicians are great at blending traditional medicine with more holistic approaches, you might need to turn elsewhere for support in areas like nutrition, herbal medicine or natural hormone balance. It may be possible to work with your doctor but also to get support from a health coach, a nutritionist or some other type of practitioner who has the necessary qualifications. This might require a more proactive stance on your end youll need to make sure youre communicating important information with both the doctor and the practitioner (like your health history, supplements or herbs youre taking, etc.) But this type of combined approach can work if youre doing it safely and consulting both parties about the treatment youre receiving.

Finding a good doctor is like finding a good therapist, a good friend or a good job it can take some time and effort. Do your research, read patient reviews and study a physicians background, qualifications and approach before you even have a consultation. Like any other relationship, when its right, youll know.

Lastly, remember that the biggest advocate for your own treatment and care should be you. Ask the tough questions, be assertive and follow up your health may depend on it.

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Oxandrolone – Wikipedia

OxandroloneClinical dataTrade namesOxandrin, Anavar, othersSynonymsVar; CB-8075; NSC-67068; SC-11585; Protivar; 17-Methyl-2-oxa-4,5-dihydrotestosterone; 17-Methyl-2-oxa-DHT; 17-Methyl-2-oxa-5-androstan-17-ol-3-oneAHFS/Drugs.comMonographMedlinePlusa604024PregnancycategoryRoutes ofadministrationBy mouthDrug classAndrogen; Anabolic steroidATC codeLegal statusLegal statusPharmacokinetic dataBioavailability97%[2]Protein binding9497%[2]MetabolismKidneys (primarily), liver[1][2]Elimination half-lifeAdults: 9.410.4 hours[2][3]Elderly: 13.3 hours[3]ExcretionUrine: 28% (unchanged)[3]Feces: 3%[3]Identifiers

O=C3OC[C@@]2([C@H]1CC[C@@]4(C)[C@H]([C@@H]1CC[C@H]2C3)CC[C@@]4(O)C)C

Oxandrolone, sold under the brand names Oxandrin and Anavar among others, is an androgen and anabolic steroid (AAS) medication which is used to help promote weight gain in various situations, to help offset protein catabolism caused by long-term corticosteroid therapy, to support recovery from severe burns, to treat bone pain associated with osteoporosis, to aid in the development of girls with Turner syndrome, and for other indications.[4][5][6] It is taken by mouth.[4]

Side effects of oxandrolone include symptoms of masculinization like acne, increased hair growth, voice changes, and increased sexual desire.[4] Uniquely among most AAS that are active by mouth, it seems to have little risk of liver damage.[4][7] The drug is a synthetic androgen and anabolic steroid and hence is an agonist of the androgen receptor (AR), the biological target of androgens like testosterone and dihydrotestosterone (DHT).[4][8] It has strong anabolic effects and weak androgenic effects, which give it a mild side effect profile and make it especially suitable for use in women.[4]

Oxandrolone was first described in 1962 and was introduced for medical use in 1964.[4] It is used mostly in the United States.[4][9] In addition to its medical use, oxandrolone is used to improve physique and performance.[4][10] The drug is a controlled substance in many countries and so non-medical use is generally illicit.[4][11][12][13]

Oxandrolone has been researched and prescribed as a treatment for a wide variety of conditions. It is FDA-approved for treating bone pain associated with osteoporosis, aiding weight gain following surgery or physical trauma, during chronic infection, or in the context of unexplained weight loss, and counteracting the catabolic effect of long-term corticosteroid therapy.[14][15] As of 2016[update], it is often prescribed off-label to quicken recovery from severe burns, aid the development of girls with Turner syndrome, and counteract HIV/AIDS-induced wasting. Oxandrolone improves both short-term and long-term outcomes in people recovering from severe burns and is well-established as a safe treatment for this indication.[5][6] It is also used in the treatment of idiopathic short stature, anemia, hereditary angioedema, alcoholic hepatitis, and hypogonadism.[16][17]

Medical research has established the effectiveness of oxandrolone in aiding the development of girls with Turner syndrome. Although oxandrolone has long been used to accelerate growth in children with idiopathic short stature, it is unlikely to increase adult height, and in some cases may even decrease it. Oxandrolone has, therefore, largely been replaced by growth hormone for this use.[18] Children with idiopathic short stature or Turner syndrome are given doses of oxandrolone far smaller than those given to people with burns in order to minimize the likelihood of virilization and premature maturation.[18][19]

Many bodybuilders and athletes use oxandrolone for its muscle-building effects.[4] It is much more anabolic than androgenic, so women and those seeking less intense steroid regimens use it particularly often.[4] Many also value oxandrolone's low hepatotoxicity relative to most other orally active AAS.[4]

Like other AAS, oxandrolone may worsen hypercalcemia by increasing osteolytic bone resorption.[14] When taken by pregnant women, oxandrolone may have unintended effects such as masculinization on the fetus.[14]

Women who are administered oxandrolone may experience virilization, irreversible development of masculine features such as voice deepening, hirsutism, menstruation abnormalities, male-pattern hair loss, and clitoral enlargement.[18][14][19] Oxandrolone may disrupt growth in children, reducing their adult height.[20][bettersourceneeded] Because of these side effects, doses given to women and children are minimized and people are usually monitored for virilization and growth abnormalities.[18][19] Like other androgens, oxandrolone can cause or worsen acne and priapism (unwanted or prolonged erections).[14][20] Oxandrolone can also reduce males' fertility, another side effect common among androgens.[20] In an attempt to compensate for the exogenous increase in androgens, the body may reduce testosterone production via testicular atrophy and inhibition of gonadotropic activity.[14]

Unlike some AAS, oxandrolone does not generally cause gynecomastia because it is not aromatized into estrogenic metabolites.[21] However, although no reports of gynecomastia were made in spite of widespread use, oxandrolone was reported in a publication in 1991 to have been associated with 33cases of gynecomastia in adolescent boys treated with it for short stature.[22][23] The gynecomastia developed during oxandrolone therapy in 19 of the boys and after the therapy was completed in 14 of the boys, and 10 of the boys had transient gynecomastia, while 23 had persistent gynecomastia that necessitated mastectomy.[22][23] Though transient gynecomastia is a natural and common occurrence in pubertal boys, the gynecomastia associated with oxandrolone was of a late/delayed onset and was persistent in a high percentage of the cases.[22][23] As such, the researchers stated, "although oxandrolone cannot be implicated as stimulatory [in] gynecomastia", a possible relationship should be considered in clinicians using oxandrolone in adolescents for growth stimulation.[22][23]

Uniquely among 17-alkylated AAS, oxandrolone shows little to no hepatotoxicity, even at high doses.[7][unreliable medical source?][24] No cases of severe hepatotoxicity have been singularly attributed to oxandrolone.[24] However, elevated liver enzymes have been observed in some people, particularly with high doses and/or prolonged treatment, although they return to normal ranges following discontinuation.[24] In any case, oxandrolone may be among the safest 17-alkylated AAS in terms of hepatotoxicity.[7][unreliable medical source?]

Oxandrolone greatly increases warfarin's blood-thinning effect, sometimes dangerously so.[25] In April 2004, Savient Pharmaceuticals published a safety alert through the FDA warning healthcare professionals of this.[26] Oxandrolone can also inhibit the metabolism of oral hypoglycemic agents.[14] It may worsen edema when taken alongside corticosteroids or adrenocorticotropic hormone.[14]

Like other AAS, oxandrolone is an agonist of the androgen receptor (AR), similarly to androgens like testosterone and DHT.[4] This increases protein synthesis, which increases muscle growth, lean body mass, and bone mineral density.[6]

Compared to testosterone and many other AAS, oxandrolone is less androgenic relative to its strength as an anabolic.[4][27] Oxandrolone has about 322 to 633% of the anabolic potency and 24% of the androgenic potency of methyltestosterone.[4] Similarly, oxandrolone has as much as 6times the anabolic potency of testosterone and has significantly reduced androgenic potency in comparison.[4] The reduced ratio of anabolic to androgenic activity of oxandrolone often motivates its medical use in children and women because less androgenic effect implies less risk of virilization.[4] The bodybuilding community also considers this fact when choosing between AAS.[4]

As oxandrolone is already 5-reduced, it is not a substrate for 5-reductase and hence is not potentiated in androgenic tissues such as the skin, hair follicles, and prostate gland.[4] This is involved in its reduced ratio of anabolic to androgenic activity.[4] Due to the substitution of one of the carbon atoms with an oxygen atom at the C2 position in the A ring, oxandrolone is resistant to inactivation by 3-hydroxysteroid dehydrogenase in skeletal muscle.[4] This is in contrast to DHT and is thought to underlie the preserved anabolic potency with oxandrolone.[4] Because it is 5-reduced, oxandrolone is not a substrate for aromatase and hence cannot be aromatized into metabolites with estrogenic activity.[4] Oxandrolone similarly possesses no progestogenic activity.[4]

Oxandrolone is, uniquely, far less hepatotoxic than other 17-alkylated AAS, which may be due to differences in metabolism.[24][4][1][3]

The oral bioavailability of oxandrolone is 97%.[2] Its plasma protein binding is 94 to 97%.[2] The drug is metabolized primarily by the kidneys and to a lesser extent by the liver.[1][2] Oxandrolone is the only AAS that is not primarily or extensively metabolized by the liver, and this is thought to be related to its diminished hepatotoxicity relative to other AAS.[1][3] Its elimination half-life is reported as 9.4 to 10.4hours but is extended to 13.3hours in the elderly.[2][3] Approximately 28% of an oral dose of oxandrolone is eliminated unchanged in the urine and 3% is excreted in the feces.[3]

Oxandrolone is a synthetic androstane steroid and a 17-alkylated derivative of DHT.[28][29][4] It is also known as 2-oxa-17-methyl-5-dihydrotestosterone (2-oxa-17-methyl-DHT) or as 2-oxa-17-methyl-5-androstan-17-ol-3-one, and is DHT with a methyl group at the C17 position and the C2 carbon replaced with an oxygen atom.[28][29][4] Closely related AAS include the marketed AAS mestanolone (17-methyl-DHT), oxymetholone (2-hydroxymethylene-17-methyl-DHT), and stanozolol (a 2,3-pyrazole A ring-fused derivative of 17-methyl-DHT) and the never-marketed/designer AAS desoxymethyltestosterone (3-deketo-17-methyl-2-DHT), methasterone (2,17-dimethyl-DHT), methyl-1-testosterone (17-methyl-1-DHT), and methylstenbolone (2,17-dimethyl-1-DHT).[28][29][4]

Oxandrolone was first made by Raphael Pappo and Christopher J. Jung while at Searle Laboratories (now part of Pfizer). The researchers first described the drug in 1962.[4][30][31] They were immediately interested in oxandrolone's very weak androgenic effects relative to its anabolic effects.[30][4] It was introduced as a pharmaceutical drug in the United States in 1964.[4]

The drug was prescribed to promote muscle regrowth in disorders which cause involuntary weight loss, and is used as part of treatment for HIV/AIDS.[4] It had also been shown to be partially successful in treating cases of osteoporosis.[4] However, in part due to bad publicity from its illicit use by bodybuilders, production of Anavar was discontinued by Searle Laboratories in 1989.[4] It was picked up by Bio-Technology General Corporation, which changed its name to Savient Pharmaceuticals, which following successful clinical trials in 1995, released it under the brand name Oxandrin.[4] BTG subsequently won approvals for orphan drug status by the Food and Drug Administration for treating alcoholic hepatitis, Turner syndrome, and HIV-induced weight loss.[4] It is also indicated as an offset to protein catabolism caused by long-term administration of corticosteroids.[4]

Oxandrolone is the generic name of the drug and its INN, USAN, USP, BAN, DCF, DCIT, and JAN, while ossandrolone is or was formerly the DCIT.[28][29][32][9][33]

The original brand name of oxandrolone was Anavar, which was marketed in the United States and the Netherlands.[4][34] This product was eventually discontinued and replaced in the United States with a new product named Oxandrin, which is the sole remaining brand name for oxandrolone in the United States.[4][35] Oxandrolone has also been sold under the brand names Antitriol (Spain), Anatrophill (France), Lipidex (Brazil), Lonavar (Argentina, Australia, Italy), Protivar, and Vasorome (Japan) among others.[4][29][34][36] Additional brand names exist for products that are manufactured for the steroid black market.[4]

Among those using oxandrolone for non-medical purposes, it is often referred to colloquially as "Var", a shortened form of the brand name Anavar.[37][38][39][self-published source]

Oxandrolone is one of the few AAS that remains available for medical use in the United States.[35] The others (as of November 2017) are testosterone, testosterone cypionate, testosterone enanthate, testosterone undecanoate, methyltestosterone, fluoxymesterone, nandrolone decanoate, and oxymetholone.[35]

Outside of the United States, the availability of oxandrolone is quite limited.[4][9] With the exception of Moldova, it is no longer available in Europe.[4] Oxandrolone is available in some less regulated markets in Asia such as Malaysia.[4] It is also available in Mexico.[4] Historically, oxandrolone has been marketed in Argentina, Australia, Brazil, France, Italy, Japan, and Spain, but it appears to no longer be available in these countries.[4][29][34][9]

In the United States, oxandrolone is categorized as a Schedule III controlled substance under the Controlled Substances Act along with many other AAS.[11] It is a Schedule IV controlled substance in Canada,[12] and a Schedule 4 Controlled Drug in the United Kingdom.[13]

Oxandrolone is sometimes used as a doping agent in sports. There are known cases of doping in sports with oxandrolone by professional athletes.

Read more:
Oxandrolone - Wikipedia

Hormone Health Course – 6 Month Program

Convenient, Flexible Online Learning Platform

24-7 access to course materials, so you can study when its convenient for you and learn from anywhere with a Wi-Fi connection.

These online trainings start with the fundamentals and go beyond the basics of hormonal health to give you a comprehensive education on the entire endocrine system, specific health issues associated with hormone imbalances, and strategies to address hormonal issues from a bio-individual perspective.

Ask our moderators all your questions and connect with other students in the course through this exclusive Facebook group. Youll receive ongoing support and motivation as you complete the program so you never feel stuck or alone.

Easily guide clients through plans designed to support the health and balance of the thyroid, adrenals, liver, and gut, so you can help them achieve the good health they desire.

Supplemental materials in every module including handouts, skill building activities, and reference materials help you refer back to important concepts, apply what you learn to real life experiences, test your knowledge, and get the most out of this essential course.

Easily guide clients through plans designed to support the health and balance of the thyroid, adrenals, liver, and gut, so you can help them achieve the good health they desire.

Supplemental materials in every module including handouts, skill building activities, and reference materials help you refer back to important concepts, apply what you learn to real life experiences, test your knowledge, and get the most out of this essential course.

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Hormone Health Course - 6 Month Program

BioTE Medical – Official Site

A simpler question is how do you know if your hormones aren't balanced? You will likely feel unwell and not be able to figure out why. The practitioners certified by BioTE Medical have seen the life-changing results time and time again; balanced hormones can change your life.

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Studies have shown that balanced hormones are necessary for good health and disease prevention for women and men throughout the entire life cycle. However, balanced hormones become even more critical for health as we grow older and more susceptible to disease.

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BioTE Medical optimizes hormone levels with bio-identical hormone pellets. Hormone optimization is a process by which levels of hormones throughout the body are equalized through continual absorption of BHRT pellets, leading to peak levels of health and wellbeing.

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Hormone pellets release bio-identical hormones into the bloodstream continuously. These are tiny pellets just under the skin, typically placed in the upper hip. BHRT pellets are smaller than a grain of rice and are consistently effective for between 3 and 6 months.

Learn More

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BioTE Medical - Official Site

The Hormone Center – Alternative Medicine | Holistic …

A Doctor's Journey

I started to realize something was wrong when I saw a patient who was on 10 medications. The first five dealt with ailments while the second five were for the side effects of the first five. Despite the medications, the patient didn't feel any better. This was the beginning of my inquiry into another way to practice medicine.

Sometimes our practice gets lumped into the alternative medicine category. And while we are open to additional ways to treat illness, our protocols are based on science and deduction.

The Hormone Center is much more than a hormone treatment center or just a hormone physician. We practice integrativemedicine, which is sometimes confused with functionalmedicine.

We believe that medications are not always the answer and can often mask the true underlying conditions and imbalances. Even my kids chuckle when they see drug commercials that spend 15 seconds on the benefits and 45 seconds on the side effects.

And unfortunately 'healthcare in the U.S. is mistitled. It should be called sick-care because most people only engage the medical system when theyre sick, not when theyre healthy.

Our "hormone specialists" believe the following:

We believe that most people dont want to be on medications or live a sub-standard life but they often don't know what else to do.

At our core, we believe that from an evolutionary standpoint, the body is built to heal itself. Our job is to clear the obstacles and support the body, before resorting to more invasive measures. If this belief makes us alternative medicine doctors, then so be it.

We look forward to meeting you!

- Lauren D. Loya, M.D.

Founder and Medical Director of The Hormone Center

At The Hormone Center, we put an underlying focus on the cause, not the symptom. We are an integrative medicine practice and put our clients first. Some of our most sought-after services include:

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The Hormone Center - Alternative Medicine | Holistic ...

Good Hormone Health | Become a Healthier You

Does this sound like you? Too tired to function during the day, but cant sleep at night. Keep gaining weight in spite of eating clean and working out with a personal trainer. Becoming depressed, moody and irritable. Achy. Sweating. Bloated. Ever thought you had a hormonal disorder or wanted to have your thyroid thoroughly checked. You may want to look over the information on the Goodhormonehealth.com website and see if making an appointment with Dr. Friedman is appropriate.

The key to getting your life back starts with getting the right information from an expert Endocrinologist who is dedicated to educating and treating patients with all types of hormonal disorders. Goodhormonehealth is dedicated to providing just that. Check out our collection of articles backed by research, provided by Theodore C. Friedman, MD, PhD on the detection and treatment of hormone imbalances, pituitary, thyroid, adrenal disorders, low testosterone, menopause and Cushings disease/syndrome. You can then decide if you want to make an appointment with Dr. Friedman.

So many of us believe that fatigue, weight gain, loss of libido and other problems are just symptoms we must learn to live with. What if these symptoms are not the result of stress, diet, or aging, but are actually caused by a hormonal disorder? Symptoms of hormone deficiency or excess may be subtle and difficult to diagnose. Many hormonal problems are misdiagnosed as depression, especially in women.You know your own body better than anyone else, and you know when something is wrong. Dr. Friedman is a compassionate, caring physician who will listen carefully to your concerns and work with you to establish a diagnosis and treatment plan. As an experienced, board-certified endocrinologist and researcher, he has the capabilities to diagnose and treat even the most difficult hormonal problems. Dr. Friedman has found that many of his patients suffer from undiagnosed pituitary, thyroid or adrenal problems or are improperly treated for these conditions. These include many people with Cushings disease, which can present with a baffling array of symptoms and is frequently misdiagnosed. Other patients may have pituitary, thyroid or adrenal insufficiency, each of which have numerous symptoms and are equally hard to diagnose. Menopause is a challenging time and Dr. Friedman specializing in treating women with menopause. Dr. Friedman is a world-renown expert in these difficult-to-diagnose diseases and is happy to see patients from around the country (and around the world) who need a straight answer to their hormone problems. Dr. Friedman is a take action doctor who wont delay treatment and just tell you to come back in 3 months. He thinks out of the box (yet is well-grounded in conventional Endocrinology) and often diagnoses hormonal problems where other doctors have failed. Dr. Friedman is not an anti-aging doctor and works to return low hormones levels to normal unlike anti-aging doctors who give high doses of hormones often to those with normal levels. Dr. Friedman listens to symptoms and uses reliable laboratories for testing.

Dr. Friedman appeared as an expert Endocrinologist (along with his patient Kate) in a program called Science of Obesity, which was produced for and aired on the National Geographic Channel.

Find out more on pertinent endocrine issues. Dr. Friedman give tips to readers about how they can improve or augment actions in their life to have ahealthylifestyle.

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Good Hormone Health | Become a Healthier You

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