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Category Archives: Testosterone
Anti-trans sports bills: Protecting women or discrimination? – The Current – The Student-Run Newspaper of Nova Southeastern University.
Posted: November 19, 2021 at 1:59 am
In June, Gov. Ron Desantis signed into lawthe Fairnessin Womens SportsAct, a bill that makesathletesinK-12womenssportsineligible to compete if they were not assignedfemale at birth. Atitssigning, Desantis said,In Florida, girls are going to play girl sports and boys are going toplay boysports, echoing age-old transphobic rhetoric.Texas State Rep. Valoree Swanson, who introduced House Bill 25,which works ina similar wayto the Florida bill and was recently passed by Gov. Greg Abbottsaid,House Bill 25 is one of the greatest victories for equality for girls since Title IX passed 50 years ago.
But do these laws actuallyguaranteesome sort of fairness in sports and is there any biological advantage for trans women to begin with?
Valerie Starrattisa professor in thedepartment ofpsychology andneuroscienceat Nova Southeastern Universityandspecializesin evolutionary psychology and sexual conflict.
The things that people say are the reason why they implement these bills, I dont think always necessarily coincides with the real motivation behind it, and I dont think, always necessarily coincides, Starratt said.
Although thelaws are advertised to be about fairness, thereal issue regarding trans women in sports is all about hormonesand how they affect the human body.
From the biological perspective, the issue is not actually male, female or otherwise. The issue is people who live in bodies that have been affected by testosterone and people who live in bodies that have not been affected by testosterone,saidStarratt.The developmental effects of testosterone cannot just be undone.
There are certainreportedadvantages that fully developed trans women who transition later in life have asopposedto those who transitionprepubescentlyorcisgenderwomen.According tothe academic journalCurrent Sports MedicineReports 2016 article titled Beyond Fairness:The Biology of Inclusion for Transgender and Intersex Athletes.
There are a number of sports where anatomical and biological features, such as size, muscle mass, and even lung capacity would be an obvious advantage,the article states.
However,according toa studyperformedby Louis J G Gooren and Mathijs C M Bunck in 2004,going on hormone replacement therapy for about a year puts testosterone and hemoglobin levels for trans womenat around the same level for cisgender women.A 2019 study from Endocrine Reviews found thatMTF trans people reported a loss of muscle mass, an increase in fat mass, and a decrease in bone mineral density.
Potentially due to datasimilar tothis, in2015the International Olympic Committee allowed transgender athletes to compete in the Olympics afteronlyone year of hormone replacementtherapy.
Even though the dataright nowshows that biological differences in adult trans athletes are minimal,these bills are targeted at trans children and teenagers, who have had little to noeffectsof long-term testosterone.
Ifweretalking about prepubescent athletes,theresno effect of testosterone.Theresno differenceofadvantage or disadvantage, its irrelevant. It only becomes relevant when you see the effects of testosterone or not. said Starratt.
This raises questions about if these bills willfacilitateanti-trans discrimination, something thatZachary Scalzo,adjunct professor of gender studies at NSU,saidhas already begun.
If you start on a gender affirmative path like hormone therapy early or prepubescent then it mitigates a lot of the physiological changes that a lot of these laws are focusing on as the clear biological advantage, said Scalzo, adding that, regarding discrimination, We also have totake into accountthings like school environments have often facilitated lots of anti-trans bullying and behavior and aggression.
The focus on sex assigned at birth instead of gender also encourages a dangerous discourse for public schools.
Researchfromthe University of Oxford in 2018 found thatwhen132 college studentsarepresented withinformationthat either bases gender on sex or social terms, the students who receiveda social view of genderwere more opentoviewing trans women as women but students who received thesex-based information were more likely to see trans women as men, saying that, ultimately, The findings suggest that essentialist claims that ground the male/female binary in biology may lead to more transprejudice.
According to Scalzo, these bills are insisting that in some way trans women are not real women and just shouldnt be able to engage in public forum practices,adding that we are also now expanding this to be an act of aggression on gender variant minors.
According toCurrent Sports Medicine Report, when discussing the concept of gender, a surveys respondentsoverwhelmingly agreed thatan athlete gender wasa suitable replacement for male/female binary sports. For those who disagreedwith the proposal, their main argument was that biological differences between males and females remained even after the transition.
As for now, the bills stand in the states previously mentionedand other, but the debate surrounding transathleticsis far from over.
I think the billsare further confusing what gender actually is,said Scalzo.
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Codoxo, Platinum Sponsor, to Present at the NHCAA Institute for Health Care Fraud Prevention’s Annual Training Conference – WFMZ Allentown
Posted: November 19, 2021 at 1:59 am
ATLANTA, Nov. 16, 2021 /PRNewswire-PRWeb/ -- Codoxo, a trusted provider of healthcare artificial intelligence solutions for healthcare payers and agencies, will be presenting at the NHCAA Institute for Health Care Fraud Preventions's Annual Training Conference on Thursday, November 18 at 2:30 p.m. Eastern Time. Codoxo, a Platinum Sponsor for the virtual event, is thrilled to support one of the industry's most important healthcare anti-fraud events, as it serves to provide attendees training, industry trends, emerging schemes, and critical investigative skills.
Codoxo's Derik Ciccarelli, Healthcare Fraud Analyst will present "Detect the Undetected: Using AI & Data Analytics to Identify Previously Unknown FWA Schemes." The session will highlight the journey one non-profit health payer took to AI-based fraud detection and how they leveraged Codoxo's AI platform to identify and investigate previously unknown fraud schemes, including testosterone replacement therapy (TRT). Attendees will learn how this particular FWA scheme significantly impacted patient safety and created a projected risk exposure of over $2.2M over an 18-month period. Ciccarelli will provide practical insights into the data, codes, and analytics that helped to detect this outlier provider behavior and the investigation process that followed for rapid intervention.
"Codoxo is working very closely with its health payer and agency clients each day to execute some of the most innovative AI solutions available to the industry and we are pleased to share that story with NHCAA attendees and spotlight the stellar work of this special investigations unit," stated Musheer Ahmed, Codoxo's Chief Executive Officer.
Codoxo is a member of NHCAA and has a stated mission "To make healthcare more affordable and effective for everyone." Through it's Forensic AI Platform and Healthcare Integrity Suite, it is disrupting the cost containment and payment integrity space by implementing the most innovative AI available to reduce fraud, waste, and abuse for health payers and agencies.
To find out more about Codoxo and its presence at the annual NHCAA Institute for Health Care Fraud Preventions's Annual Training Conference, please visit https://www.codoxo.com.
About Codoxo
Codoxo is the premier provider of artificial intelligence-driven applications that help healthcare companies and agencies identify and act to reduce risks from fraud, waste, and abuse. Codoxo's Healthcare Integrity Suite helps clients reduce risks and costs across network management, clinical care, provider education, payment integrity, and special investigation units. Our software-as-a-service applications are built on our Forensic AI Platform, which uses a patented algorithm to identify problems and suspicious behavior earlier than traditional techniques. Our solutions are HIPAA-compliant and operate in a HITRUST-certified environment. For additional information, visit http://www.codoxo.com.
Media Contact
Ronda Duncan, Codoxo, 8472549782, rduncan@springmarketinggroup.com
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Kim Jong-kook truly unnatural? What does science say? – The Korea Herald
Posted: November 19, 2021 at 1:59 am
Singer and entertainer Kim Jong-kook has enjoyed over two decades of success in TV and music. But the 45-year-old recently made headlines for something other than his voice: his workout routine.
Controversy broke out one faithful Halloween to spook fans of the beloved TV personality, when a fitness YouTuber named Greg Doucette called him out for likely not being natural when working out to build his body.
Is he natural? Of course not! Doucette said in his video. He added that he thought it was not likely that Kim was using performance-enhancing drugs like anabolic steroids, but rather hormone replacement therapy like Doucette himself. HRT has been found to be effective at reversing the aging effects on muscles.
Doucette, a bodybuilder and powerlifter, appears to know what he is talking about when it comes to workouts with PEDs. In 2014, it was reported that Doucette was fined by the Canada Border Services Agency $50,000 for smuggling and distributing anabolic steroids, and that a 2010 search of his Halifax home found $250,000 worth of steroids and steroid distribution materials, along with 56 envelopes containing raw testosterone powder.
The Canadian bodybuilder admitted on Instagram in 2020 to using steroids in the past and said he was on HRT, both then and now. And now, he is accusing Kim, one year his junior, of doing the same as he is doing to compensate for his aging body -- that he is not natural.
In bodybuilding, being natural generally refers to not having been enhanced by any means other than working out, eating right, getting sufficient rest and protein supplements. A lot of the times it refers to not adding male hormones via artificial means. Obviously, this rules out PEDs and HRT, although the implications of using the two methods are not the same among bodybuilders.
The focal point of the dispute is simple: Is it feasible for a 45-year-old man to have a body like Kims without taking a shortcut?
Kims bodyThere can hardly be any dispute that Kim has a phenomenal body. In 2018, Kim -- one of the main cast members of SBS My Little Old Boy -- took an InBody scan as part of a routine health checkup. He stood 177.4 centimeters tall, weighed 81 kilograms and his body fat was 8.5 percent.
To put that into perspective, the American Council on Exercise says athletes are normally in the 6-13 percent range, fit people are 14-17 percent and 18-24 percent is considered acceptable. It was reported in 2018 that then 33-year-old Cristiano Ronaldo, one of the biggest soccer superstars in the world, had 7 percent body fat.
Kims skeletal muscle mass was measured to be 42.8 kilograms. In short, Kim has an athlete-level body by any standards.
The controversy stems from Doucettes argument that it is highly doubtful Kim is a natural athlete, based on the fact that the body does not keep growing with age and that male hormones decrease over time.
Nobody beats Father Time, but for how long can he be hoodwinked?
Deterioration of body over time
There have been amazing individuals in sports world who seemingly defy the test of time. Tom Brady, arguably the greatest quarterback of all time, was Super Bowl MVP in 2020, six months before he turned 43. Karl Malone, who had become the oldest NBA MVP ever at almost 36, was reported in 2013 to still be retaining his playing weight by working out three hours a day at the age of 50.
Brady and Malone have never been officially accused of PED use -- save a few blind allegations that they could not possibly be that fit at that age -- but even so, one could say they are the exception, not the rule.
Professor Yoon Joon-shik of the rehabilitation department at Korea University explained that among the deteriorating effects that accompanies aging is sarcopenia, defined by the loss of muscle mass and strength with aging. Korean Longitudinal Study on Health and Aging found sarcopenia to be prevalent among 16.7 percent of the male population above 65 in Korea, and 5.7 percent of the same female population.
It usually manifests after 40, and becomes one of the biggest (health) issues around 50 or 60. Its not just the loss of muscles, but also the accompanying changes in hormones and give effects on related organs, Yoon explained, adding that working out is the most common advice he would give patients.
But he stressed that age alone would not be enough in determining a persons physical condition as the age when ones body breaks down differs for everyone. Sarcopenia is likely to manifest later in a body of a person who has taken great care of his or her body. It would help to test ones strength, cardiopulmonary function and to be aware of the hormonal level changes within ones body.
Hormone levels are another issue. The general clinical opinion is that testosterone, the primary sex hormone in males, usually start declining around age 30 at rate of 1 percent per year.
Juiced up athletes
But Kim has a famously high testosterone level. In the aforementioned SBS show, it was revealed that Kims total testosterone was 9.24 nanograms per milliliter, which was considered very high for a man his age -- 42 at the time -- since the average figure for a man was 2.7-10.7 ng per mL, according to Severance Hospital in Seoul.
In a video Kim uploaded to his YouTube channel Friday, a blood test at a local hospital found Kims total testosterone levels to be 8.38, a lower figure than three years ago, but still very high for his age.
While it is clear Kims body is flowing with male hormones, the dispute is over where they came from. One of the most notable smoking guns in doping tests is actually low -- not high -- testosterone levels.
In 2017, one of the top UFC fighters of his generation, Jon Jones was tested to having abnormally low total testosterone levels. The samples collected on Dec. 4 showed results of 0.59 ng per mL and 1.8 ng per mL. But a test on samples collected Dec. 18 tested at 4.9 ng per mL.
He tested positive for Turinabol, an anabolic steroid in an early drug test, although he stated that he did not knowingly take any prohibited substances. He received a 15-month suspension.
Not judging the validity of Jones case, the extended use of anabolic steroids and other PEDs can have long-term deteriorating effects on testosterone levels. In laymans terms, injecting steroids will pump up your testosterone in the short term, but your body will get lazy and stop producing them over time.
In a Q&A session with a local newspaper, endocrinologist Jung Yoon-seok of Ajou University said that consistent exposure to large quantities of steroids can suppress hormone production inside the body. He was further quoted as saying that abusing such substances can affect the bodys capacity to maintain homeostasis -- the state of the internal, physical and chemical condition -- which can be very difficult to repair.
But Kims high testosterone levels are exactly the opposite of this case, although his accusers claim this is also unnatural because of his age.
Kim looks natural, but doubters doubtDoucette has said from the beginning that Kim looks 100 percent natural, but that is unlikely because nobody can grow forever. Kim has claimed that his weight has not varied beyond 1 or 2 kilograms for the last 15 years, showing he hasnt grown forever.
Urologist and YouTuber Lee Yeong-jin, who runs a clinic in Daegu, posted on his channel a video saying that a man in his 40s with a testosterone level of 9.24 is perfectly feasible. If ones hormone (testosterone) levels were to increase because of drugs, the figure would be ridiculously high or low, not within normal range like Kim, he said in his video.
There is no substantial evidence as of now that ties Kim to ever using HRT or steroids, but it would still be a tall order convincing everyone he is natural. This is from the simple fact that it is nearly impossible to prove a lifetime of PED non-use, despite how thorough the testing is.
Upon the accusations, Kim went out and immediately tested his blood to find that he had 99.4 micrograms per deciliter of dehydroepiandrosterone sulfate, the endogenous androstane steroid. The typical male range is 80-560 micrograms per deciliter, which puts Kims figures within the normal range.
This contrasts from the aforementioned Jones, who tested at 2.1 micrograms per deciliter, significantly lower than the male average.
But even this would not be definitive proof, as it is possible to also inject DHEAS for medical purposes.
Another suggestion would be to test his epitestosterone, as the testosterone to epitestosterone ratio is used as an important barometer for screening PED use. But even this can be faked, as athletes sometimes take synthetic epitestosterone to equalize the ratio.
Kim has expressed his willingness to take every drug test available and said he is currently taking necessary steps to do so. And while a great many people believe in what they perceive to be his earnest attitude toward working out, it is highly likely there will always be doubters regardless of the medical proof. No test covers a lifetime, at least not with todays technology.
Kim himself said it best, People are going to believe what they want to believe anyway. The controversy, after all, started without any presentation of scientific proof.
By Yoon Min-sik (minsikyoon@heraldcorp.com)
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Gender-Affirming Care: What It Is and How to Find It – Livestrong
Posted: November 19, 2021 at 1:59 am
Gender-affirming services have evolved quite a bit in the last 50 years, but we still have a long way to go.
Image Credit: LIVESTRONG.com Creative
From "genderqueer" to "gender-affirming care," the newest terminology in the LGBTQ+ community does much more than slap a new label on an old idea. The words we're now using to identify patients and their health care needs show that the goals of care providers are becoming more closely aligned with the needs of transgender and gender-nonconforming people.
The best part? Gender-affirming care isn't just helping a small fraction of the population; it's making health care better for everyone.
What Is Gender-Affirming Care?
Gender-affirming care describes an array of health services that alleviate the suffering associated with gender dysphoria, defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as clinically significant distress or impairment related to a strong desire to be of another gender.
But gender-affirming care is more than hormones and surgery. "At its core, it's about seeing the whole person, affirming them exactly as they are," J. Aleah Nesteby, nurse practitioner, former director of LGBTQ services for Cooley-Dickinson Hospital and a clinician and educator with Transhealth Northampton, tells LIVESTRONG.com.
Gender-affirming care isn't just a new way to say "sex change." And that's important, because how trans and gender-nonconforming people's identities and experiences are named and described reflect our broader cultural values of diversity, equity of access and consent.
While language like "sex reassignment" or "gender-confirmation surgery" used to be accepted, today it is recognized that sex assignments at birth are an unscientific guess at best, and that only the individual can confirm their own gender. We don't know everything there is to know about gender, but we know it is evident in early childhood, and no amount of therapy or conditioning can change a person's innate sense of their gender, according to a landmark article in the March 2006 issue of the OAH Magazine of History.
Gender-affirming care allows a patient to change their sex characteristics, bringing their minds and bodies into greater alignment, while continuing to receive a lifetime of competent care from providers who recognize that the challenges people who are trans and gender-nonconforming or nonbinary (TGNC) face are not just medical, but social. This type of care goes far beyond treating dysphoria to acknowledge the physical differences of postoperative bodies and the stress of living with transphobia.
More than 50 years after the first gender clinic (that is, a center that provides transition-related services) opened its doors, gender-affirming care is no longer experimental. The June 2017 issue of The Journal of Sex and Marital Therapy describes it as the best, most effective treatment for gender dysphoria.
The authors behind a March-April 2021 paper in The International Brazilian Journal of Urology agree, adding that gender-affirming care enjoys a very high rate of patient satisfaction. According to the most recent World Professional Association for Transgender Health (WPATH) Standards of Care (SoC), published in 2012, satisfaction rates range from 87 to 97 percent and regrets are rare, topping out at just 1.5 percent.
Who Needs Gender-Affirming Care?
As we mentioned, gender-affirming care directly benefits people with gender dysphoria. About 44 million people worldwide have a diagnosis of gender dysphoria, according to The International Brazilian Journal of Urology paper mentioned above. But estimates like these likely underreport the true figures, according to WPATH.
In previous editions of the DSM, the desire to be of another gender was described as a disease doctors were meant to cure; but today, we embrace a diversity of gender identities as healthy and normal. Still, gender dysphoria can cause distress or impairment, and a person with the condition may want to change their body's primary and/or secondary sex characteristics through hormones, surgery and other procedures.
In the U.S., there are about 1 million TGNC people, a number that is expected to continue rising, according to the January 2017 issue of the American Journal of Public Health. But not everyone who is TGNC wants or needs gender-affirming services.
That's because a diagnosis of gender dysphoria is completely separate from a person's gender identity or sexual orientation. Transgender people, for example, have a gender identity or expression that's different from the sex they were assigned at birth. But that doesn't automatically mean they want to change their sex characteristics, or that this difference causes them the stress or impairment marked by gender dysphoria.
Similarly, people who do not feel strictly like a man or a woman all the time might identify as nonbinary, gender-nonconforming, genderqueer or with another label to describe their gender. Nonbinary people (also called "enby" or "enbies") are a fast-growing demographic, making up about 35 percent of the trans community, according to the June 2019 issue of Translational Andrology and Urology. Like men and women, enbies can be straight, gay, bisexual, asexual or identify with another sexual orientation. And like other trans people, enbies may seek gender-affirming care, or they may not.
For people who do want gender-affirming services, though, this approach to treating gender dysphoria has been overwhelmingly successful, and has been the standard of care for more than 30 years.
Gender-Affirming Care Is Patient-Centered Care
The first U.S. gender clinics only accepted patients who would complete a social, legal and medical transition that resulted in a perfect binary: a heterosexual man or woman who "passed" as such in society, and who retained no reproductive capacities associated with the sex assigned to them at birth.
Retention of reproductive capacity is a human rights issue. In the past, certain areas of the country and some clinics and private practices had policies that required transgender people be sterilized before they were issued corrected documentation of their sex or access to gender-affirming care. These policies are now recognized as a serious breach of human rights.
But obstacles to getting corrected legal documents still exist in some states, and there are medical providers who still insist on sterilization before performing reconstructive genital surgery. Yet patients are pushing back, and finding surgeons who will work with them to achieve outcomes that treat symptoms without sacrificing fertility.
James, who first sought gender-affirming care in 2001, wanted to keep his options open. (Several of the people LIVESTRONG.com interviewed for this story asked to be identified by their first names only for privacy reasons.) Now married, he and his wife are using reciprocal in-vitro fertilization (IVF) to grow their family. In this process, an egg from James is harvested and fertilized using donor sperm; the resulting zygote is implanted in his wife's uterus. James has already gone through one successful round of egg retrieval. If all goes well, his wife will experience a normal, healthy pregnancy, and both parents will have a biological connection with their child.
IVF technology has been available for more than 40 years; the innovation is in putting a high priority on James' desired outcomes from gender-affirming treatment. Under the model of care most doctors used to be trained in, medical experts would assess James, diagnose him and decide how to treat him, all without asking him what he wants.
In the informed consent model, on the other hand which is the backbone of gender-affirming care communication between patient and physician is intended to allow the patient to make educated choices about their care. This approach isn't just for TGNC patients: Informed consent increases patient satisfaction across the board. "Over time, most of the prescribing world has caught up to the informed consent model, and now it's seen as the standard of care," Nesteby says.
"Fifteen years ago when I entered practice, the bar was so low for providers in terms of who was considered good and trans competent," Nesteby says. "Now, expectations have changed. Patients, especially younger people, expect providers to talk to them about their options, including what's outside the typical standards of care."
Joshua Tenpenny's experience with gender-affirming care illustrates this point. Tenpenny is a massage therapist who lives as a man and identifies as nonbinary. When he sought genital surgery years ago, he wanted a nonbinary outcome neither male nor female so he looked for a surgeon who was open to an experimental approach, he tells LIVESTRONG.com.
The initial procedure was not entirely successful, and the surgeon was reluctant to perform a revision, but Tenpenny says he may try again in the future with another provider to achieve the results he envisioned. All procedures come with risks of complications and failure, and despite the outcome, Tenpenny found that not being confined to a small menu of options for bottom surgery has been an empowering experience.
The History of Gender-Affirming Care in the U.S.
The concept of gender-affirming care first reached most Americans in 1952 when Christine Jorgensen's transition from male to female made headlines. The first gender clinic in the U.S. opened in 1966 at Johns Hopkins. Backed by the most influential professionals in transgender care, the Harry Benjamin International Gender Dysphoria Association today the World Professional Association for Transgender Health (WPATH) became the standard-bearer in the early 1980s.
But through the '80s and early '90s, seeking gender-affirming care continued to be an isolating experience, with cruel barriers like the "real-life test," in which people with gender dysphoria were only allowed to access hormones and surgery after six months, a year or longer living successfully in the target gender. For trans people who did not pass, the dangers of the real-life test ranged from harassment, unemployment and homelessness to violence and death.
Today, trans people are rewriting the standards for their own care. The WPATH Standards of Care, which have been broadly adopted worldwide, are in their seventh edition. Authors of the most recent version and the current board of WPATH include trans professionals: people who have a TGNC identity as well as cultural competency and expertise in the medical care of TGNC people. Even more significantly, stakeholders in gender-affirming care TGNC people, their families and their caregivers are changing health care for the better, making it easier to access and using informed consent to customize treatment to a patient's individual needs.
These changes are allowing people like Ian, who identifies as nonbinary, to receive the care they want. "When I first learned that the Standards of Care had been updated to include nonbinary people back in 2013, I made an appointment at Fenway Health in Boston in the hope of starting HRT [hormone replacement therapy]," Ian recalls. "I'd known that I was genderqueer and wanted to go on T since 2001, but I hadn't been willing to lie about my identity by pretending to be binary trans to obtain it."
Still, past versions of the SoC continue to influence the law, health insurance practices and guidelines developed by health care providers. Levi Diamond, a 43-year-old trans man, was recently told by surgeons that they would not perform top surgery on him (to alter the appearance of his chest) until he had lived a year in the male role. The current SoC criteria for mastectomy and creation of a male chest in transmasculine patients make no mention of a real-life test, but some providers crafted their own guidelines years ago, based on older versions of these standards, and have not updated their policies to reflect advances in care.
Similarly, Katy sought gender-affirming care after learning she was born with Klinefelter syndrome, a chromosomal difference of sexual development. Genetically XXY, people with Klinefelter syndrome are assigned male at birth. The signs of having an XXY karyotype versus the more common XY for boys can be subtle and difficult to discern, and those with Klinefelter syndrome are frequently unaware of their genetic difference from XY men and boys.
After a karyotype test confirmed her doctor's diagnosis, Katy was referred to an endocrinologist. Male hormones are often prescribed to treat symptoms of Klinefelter syndrome, but Katy asked for a prescription for estrogen. Disregarding her request and focusing on her intersex diagnosis, Katy's endocrinologist prescribed her testosterone. By doing so, he exemplified the bias many trans people encounter in seeking care, and the limits of the "pathology" model of care.
After nine months on testosterone, Katy was more certain than ever that male hormones were not for her. Years later, she found a more patient-affirming health care provider and began feminizing hormone therapy, a decision she knew was right within days of beginning treatment. Now 50, Katy has had four gender-affirming surgeries.
Innovations in Gender-Affirming Care
Both acknowledgment by the medical profession that gender-affirming care is medically necessary and laws preventing discrimination against TGNC people have led to an increase in gender-affirming services, according to a February 2018 article in The Washington Post. Coverage by health insurance has created greater access to care, which has also driven demand. The growing market has led more professionals to specialize in gender-affirming services, and more procedures have led to improvements, making treatments safer. Surgical results are also more aesthetic and more functional.
The typical order in which gender-affirming care is applied mental health services before HRT, then chest surgery, and finally, lower surgery has not changed, but protocols have evolved, and the sequence is more flexible in patient-affirming care models that use informed consent and harm reduction.
Usually, someone with gender dysphoria begins gender-affirming care with a mental health professional who diagnoses them and helps them decide on priorities and address concerns related to the next phase of treatment. Patients may be referred for hormone therapy in coordination with mental health treatment, or they may be assessed and prescribed by a physician.
It's a common misconception that gender-affirming care must be handled by a specialist. "A lot of people think you need to see an endocrinologist to be on hormones," Nesteby says. "It's not necessary for every person. A lot of cases can be managed in primary care." She compares HRT to diabetes care, which is typically handled by primary care providers.
About 80 percent of TGNC people will seek HRT, according to Jerrica Kirkley, MD, co-founder and chief medical officer of Plume, which provides gender-affirming care using telemedicine in 33 U.S. states. HRT in TGNC patients usually involves administering estrogen, testosterone and/or hormone blockers to achieve blood levels typical among cisgender people.
In the late 1960s, transgender patients were warned their surgical outcomes from what's collectively called "lower surgery" or "bottom surgery" would not resemble the genitals of cisgender women and men. For trans women, a vagina that could be penetrated by a penis was considered the only functional goal of surgery. By contrast, in the November 2013 issue of Sexual and Relationship Therapy, researchers note that patient satisfaction is now a well-accepted tool for measuring whether a health care service has been successful.
By the late 1980s, surgeons offered vulvoplasty creation of the labia and clitoris and were able to preserve sensation in the new structures. In recent years, the surgical results of transfeminine vaginoplasty closely resemble the cultural ideal, and 80 percent of trans women surveyed were orgasmic following lower surgery, The Journal of Sexual Medicine reported in February 2017. In Plastic and Reconstructive Surgery in June 2018, it was reported that 94 percent of one surgeon's patients, treated over a 15-year period, were pleased with the results overall and would repeat the procedure.
Bottom surgery for trans men has also come a long way. There are two general categories: metoidioplasty and phalloplasty. The former takes advantage of the physical changes caused by testosterone therapy, which include the growth of the clitoris (the analogous organ to the penis). This larger clitoris becomes a penis that retains sexual function and sensitivity but may be too short for penetration. The latter creates a penis using a graft taken from the forearm, thigh or abdomen, which looks and functions like that of a cisgender man but doesn't always retain sensation.
In an article in the May 2021 issue of The Journal of Sexual Medicine on patient satisfaction with transmasculine lower surgery, two-thirds were satisfied with the appearance of their genitals after surgery, but only one-third were satisfied with sexual function. However, 82 percent were happy with the effects of the operation on their masculinity.
Chest or "top surgery," sought by up to a quarter of people with gender dysphoria, has been about twice as common as lower surgery among patients seeking gender-affirming care, according to the Translational Andrology and Urology article. Today, there are methods available to retain greater sensation and result in less scarring for chests of all sizes.
Besides "top" and "bottom" surgeries, other procedures for masculinizing or feminizing the appearance to reduce gender dysphoria include facial feminization surgery (FFS), which is a category of aesthetic procedures including hairline correction, rhinoplasty and jaw reduction. Hair removal, nipple tattoos, vocal training, facial masculinization surgery, liposuction and other cosmetic procedures may also help treat gender dysphoria.
Hair removal has emerged as a critical gap in access to care for people using health insurance to pay for lower surgery. It is medically necessary preoperative treatment, delivered by a licensed professional. In a catch-22, though, hair removal has traditionally been offered in clinics that do not accept health insurance, because their services have not been covered in the past. "No one was credentialed to get covered by insurance," Nesteby explains. "Now you have this necessary service, but people are still having to pay out of pocket. That's been an access issue we only realized after insurance started covering surgery."
How to Access Gender-Affirming Care
The people who responded to interview requests for this article reported starting their search for gender-affirming care with a primary care physician, or through a clinic for underserved sexual minorities. Callen Lorde in New York City, Lyon Martin in San Francisco and Tapestry in Greenfield, Massachusetts, all came up in interviews. "I had an excellent experience with the Equality Health Center in Concord, New Hampshire," Ian says. "EHC offers informed consent as an access protocol for HRT. This fit well with my personal goals and preferences."
A major hurdle in accessing gender-affirming care is that, often, finding one educated and trans-competent provider isn't enough, because TGNC people need a lifetime of treatment.
For example, if a patient has surgery at a center hundreds of miles away, then experiences a complication after returning home, local emergency medical service providers must understand the treatment the patient has received and how his body differs from their expectations in order to properly care for him.
Similarly, trans women who have had vaginoplasty need urological and gynecological services that are different from the care appropriate for a cisgender man or woman. Yet both patients and physicians have reported a lack of provider competence, per an August 2021 paper in the Journal of Gynecologic Surgery.
Using a clinic whose mission is to serve the transgender community does not guarantee competent care either. In fact, one interview subject treated by a big-city provider focusing on the TGNC community routinely felt they mismanaged a common side effect of HRT, causing him distress when his dysphoric symptoms returned. Rather, gender-affirming care can come from small towns, family doctors and providers who don't specialize in TGNC care.
But it takes more than good intentions to provide appropriate care: It requires ongoing medical and cultural competency training. Many patients rely on word of mouth, transgender community message boards and online directories to find competent providers. A directory of transgender-aware care providers is available through the WPATH Global Education Institute, which offers a 50-hour training program to its members. (Patients can search for WPATH members who are care professionals here.)
"Gender-affirming services have evolved quite a bit in the last 50 years, but there's still a great lack of access," Dr. Kirkley says. "Primary care is improving, but there is no standardized curriculum of gender-affirming care in medical schools, nursing schools and public health programs. We still have a long way to go."
More recently, in the age of COVID-19, telemedicine is helping to close another gap in access: geography.
"Virtual care has changed the dynamics of all health care dramatically," Dr. Kirkley says. Insurance began to routinely cover telemedicine during the novel coronavirus pandemic, making trans-aware providers available to patients who would not have otherwise been able to access their services. "Before COVID there was a lot of doubt [that telemedicine is effective], but [the shutdown] has really validated the model. As an innovation in health care delivery, it has enabled Plume and other providers to provide gender-affirming care."
Still, the changes that have come with gender-affirming care benefit more than the TGNC community. People in all walks of life can appreciate the greater access telemedicine brings and the revolution in patient-centered care.
"I think that one of the benefits that cisgender, heterosexual people don't see about gender-affirming care or trans visibility is that it helps everybody," Nesteby says. "It's not only trans people who suffer from rigid boxes we put people in. When we don't force people into binaries, everybody wins."
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I’m trans and take testosterone. Reddit helps more than my doctor. – Insider
Posted: November 6, 2021 at 1:51 am
Editor's note: This article is not medical advice. Consult a healthcare professional regarding questions about diagnoses and treatment.
I started hormone replacement therapy in April, the same day Arkansas passed the first trans medical ban in the United States, barring trans youth from accessing gender-affirming care.
With the heaviness of the wave of anti-trans legislation on my mind, I felt fortunate to have access to an endocrinologist after nearly a year of back-and-forth with insurance and several attempts with less trans-competent doctors.
I wanted to start testosterone-based HRT to treat my lifelong gender dysphoria, or extreme distress related to my body and gender, that has affected me as a transmasculine nonbinary person. I started testosterone therapy to deepen my voice, make myself a little more muscular, and overall become more comfortable in my body.
As someone who has insurance that covers gender-affirming care and lives in a major city, I am incredibly privileged.
I microdose HRT, meaning I take a smaller amount of testosterone for more gradual changes over a longer period of time. When I told my endocrinologist in New York City that I wanted to stay on a microdose long-term, he said he could write me the prescription but had to be transparent about the lack of research available on it. When I asked him what changes I could expect for my body, he told me he didn't know, even after I pressed for more information.
The only place I've been able to turn to for concrete answers on how to achieve the results I wanted like a deeper voice and larger muscles was online platforms like Reddit.
Hormone replacement therapy as a form of treatment for the gender dysphoria that trans people experience has been around since the 1920s. But treatment protocols have been slow to shift.
Because of a lack of research on the effects of different HRT options, even trans-competent medical providers are left with few concrete studies to cite when patients ask questions, and physicians receive few hours of LGBTQ+-specific training.
One of the first questions I asked my doctor was which kind of injection I should opt for to get the most dramatic effects, which for me included a deeper voice, more muscle definition, and fat redistribution.
While small studies have suggested that subcutaneous injections (injection into the fat) could help retain testosterone in the body for longer between shots, my doctor told me there wasn't enough conclusive data to confirm this. I ended up opting for intramuscular injections and was dissatisfied with how long it took to see physical changes.
In the first month of taking HRT, the skin around my jaw thickened. When I went back to the doctor and asked how long it would take for my jawline to reemerge, he told me there wasn't enough research out there for him to give me a timeline.
Puffy-faced and feeling lost, I turned to the internet for understanding.
My friends who had started HRT before me recommended going on Reddit to find specific answers about where I should inject my T for the most effective results.
There I found several subreddits, like r/FTM and r/genderqueer, where people shared similar concerns and got their questions answered by a community of trans people who had taken testosterone. That's how I found out about the small study suggesting subcutaneous injections could keep testosterone in your system longer than intramuscular injections. So I switched, and I am much happier with the results.
My only sense of understanding about my body during this process came from other trans people willing to share their experiences with HRT.
Even close friends who have been on testosterone have been more helpful in some ways to my transition than my doctor.
One of my friends has a more radical endocrinologist willing to talk about experimental treatments that have anecdotally worked on patients, so I often chat with them about what they've learned so I can take questions back to my own doctor. My other friend lives on the internet and can name trans subreddits at the drop of a hat, so they offer their knowledge.
My friends and I doctor one another in many ways, trading information like playing cards.
Trans Reddit forums became a haven of support for me when so many of my medical concerns went unanswered through official channels. While I can only take the experiences of others with a grain of salt, they have been a huge comfort during a nerve-wracking process.
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You don’t have to constantly take hormones to be trans – Insider
Posted: November 6, 2021 at 1:50 am
Before starting hormone-replacement therapy, Simon Moore, 27, thought hard about what effects they wanted to get from testosterone.
While they had always wanted a deeper voice, they didn't want all the added muscle and hair growth that sometimes comes with a full, longer-term dose of testosterone-based HRT. Like a growing number of nonbinary people, they decided a microdose would offer a slower transition.
"There is less emotional roller coaster. The vocal cords thicken slower and more gradually," Moore said.
Moore, who is nonbinary and trans, grew up in Moscow and moved to the US with their partner in 2019. They were able to access HRT for the first time in January through Plume, an online transgender-health service, they said.
It's been seven months since Moore started testosterone (commonly referred to as "T"), and they have decided to wean off it.
"I'm not really a 'trans man.' I never really wanted to be full-on masc, like go to the gym, get ripped, and get the whole beard," Moore told Insider. "I wanted something in between. I wanted to be comfortable."
Transition is often portrayed as a linear journey that has a clear beginning and end.
But many trans people go on and off hormones for a number of reasons, such as access to care, a desire to get pregnant, medical complications, or contentment with the results of HRT they already received.
Insider spoke with three trans people who have gone on and off HRT at various points for medical or personal reasons.
A popular misconception perpetuated by TV shows, films, and general misinformation is that being trans means someone needs to "medically transition," or get gender-affirming medical procedures, to be seen as valid.
The idea that gender-affirming care is one size fits all and people stop HRT only because they regret their decision is often used as a political argument to justify anti-trans medical bills that suppress access to medical care for trans people.
There is a small and vocal group of peoplewho have "detransitioned" and actively say they are no longer trans. But research suggests a majority of people who stop HRT do so for other reasons. Some trans people never take hormones at all.
"Nobody needs to be on hormone therapy. Nobody needs to undergo any medical, surgical, or other procedure, or even therapy despite what people have told us for many years to be trans," Dr. Jerrica Kirkley, the medical director for Plume, told Insider.
Stopping treatment doesn't make a person not trans, Kirkley said.
Like many young trans people who grew up with little trans visibility, Moore as a teen relied on YouTube videos on female-to-male transition to get information about gender-affirming care.
But Moore decided they wanted their care to look a little different.
On their YouTube channel, Moore blogged their personal HRT journey.
Rather than taking the standard 0.5 milligrams of testosterone every week indefinitely, Moore decided to microdose 0.3 mG of testosterone a week for just seven months.
Moore then stopped microdosing once they got a deeper voice. (Certain effects of testosterone, like facial hair and a deeper voice, are permanent, while others, like building more muscle, are not and require consistent doses of T over time.)
Moore is happy with their results. They told Insider that while they were stopping, they were open to the idea that what their future desires could differ.
"I think a lot of people kind of want you to pick a label, stick to it, pick a journey, stick to it," Moore said. "I don't need to."
Tuck Woodstock, a 29-year-old journalist, host of the "Gender Reveal" podcast, and cofounder of Sylveon Consulting, started testosterone in July 2020, four years after he came out as nonbinary to close friends and family.
As a gender educator, Woodstock knew testosterone was a resource for years before they made the decision to go on it.
"The reason that it took four years for me to start testosterone is because it took four years for me to want to start testosterone," Woodstock said. "It was very much, for me, an incremental journey where the way that I thought about my own gender inched very slowly away from womanhood."
Woodstock added: "Because that process was gradual, it took several years before I was interested in physical or medical transition, which I recognize is very different than most people I know who came out as trans nonbinary, trans men, and immediately started testosterone. That was not my experience at all."
In the past year and a half, Woodstock has stopped and restarted testosterone three times. This is partially because of being a podcaster and musician who relies on their voice heavily.
"When I hit a certain level of testosterone in me personally, it changes my voice so rapidly that it becomes harder to sing at all," Woodstock said.
In addition to giving their voice a break, Woodstock also wants to take time to relish the changes his body is going through while on testosterone and likes to take breaks.
"I think it's nice to take a moment and regroup because these changes often are at least semipermanent," Woodstock said. "And I like to make sure that I have a moment to spend in this version of my body before I progress on to a later version. It's not so much that I don't want them to actualize but that I want to enjoy every single moment of this journey individually."
Kayden Coleman, a 35-year-old trans medical advocate and educator, started taking testosterone in 2009.
While he was really excited about the changes that happened in his first year on T, he said the weekly shot became more of a hassle, especially once certain changes, like hair growth and voice deepening, plateaued.
A post shared by Kayden X Coleman (He/Him) (@kaydenxofficial)
Coleman stopped taking testosterone twice. The first time was after a surgeon told him to before he underwent top surgery in 2013, though he has since learned that may not have been medically necessary. The second time was in 2019, when he moved states, briefly lost medical coverage, and became pregnant.
"With testosterone, that first year is like, you cannot wait to take your shot because all these changes. Then, you kind of get to where you are, and you're like, 'OK, I'll take it next week,'" Coleman said. "Or like me, you'll get needle anxiety and really put it off."
When he stopped taking testosterone, he said he didn't experience many negative effects. Because Coleman already had a full beard and low voice, which are permanent effects of testosterone, he said going off it didn't change many things physically.
But he said he felt a lot more emotional going off T.
"When I'm not on testosterone, I'm like all over the place," Coleman said. "Testosterone kind of keeps me at a more level headspace."
The way gender-affirming care is framed as a journey with a clear beginning and end point, Coleman said, harms trans people because it makes it seem like care needs to look the same for everyone.
"Trans people should feel free enough to start and stop hormones as a form of self-care," Coleman said.
"If I want to try for a baby, I should be able to," he added. "If I just don't feel like sticking myself in the thigh or butt cheek or arm or stomach with a needle for the next few weeks, I should just be able to not."
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Male Menopause: Know what it is and how it affects male fertility – DNA India
Posted: November 6, 2021 at 1:50 am
Source: |Updated: Nov 05, 2021, 08:40 PM IST
It is a misconception that menopause affects only women. Globally, men are also victims of this hormonal disorder. After a man reaches the age of 30 years, his testosterone levels gradually decrease, falling an average of one per cent each year. But in India, unlike women, men suffering from menopause take it as stigma and shame on their manhood and do not seek medical help to overcome it.
While in advancing age, women fear menopause and consider it as a normal hormonal change that takes away their womanhood. In western countries, some women opt for Hormone Replacement Therapy (HRT). Hence, HRT is seen as one treatment option for men menopause too. However, experts recommend raising awareness on lifestyle modification to overcome men menopause and suggest avoiding rushing to HRT.
Dr Kishore Pandit, IVF & Fertility Specialist says, Like women, men also undergo menopause, called-Andropause. Medically, we describe it as ageing-related hormone changes in men. When a mans testosterone levels decline on average about 1% a year after age 40, it leads to menopause among men. It is considered a stigma and shameful so men avoid treatment. Hence, we have to increase awareness about the same.
Experts do consider HRT as an option for treatment for menopause both in women and men. The fertility of men is affected by menopause. However, the experts do not believe that the natural, age-related drop in testosterone levels is to blame for male menopause symptoms. There isn't enough data to classify male menopause as a diagnosable medical illness. Hot flushes, impatience, fat build-up around the abdomen and chest, loss of muscle mass, dry, thin skin, and excessive sweating are all possible symptoms. The most prevalent symptoms of male menopause, according to a study published in the New England Journal of Medicine (NEJM), are decreased libido, a lower frequency of morning erections, and erectile dysfunction. As a result of the decrease in male hormone levels, depression and weariness may develop.
According to Dr Archana Dhawan Bajaj, Gynaecologist, Obstetrician and IVF Expert, menopause is a progressive event. It may be visible at the age of 50 and affects people individually depending upon their health conditions. Menopause in men does not manifest in the same way that it does in women. On the other hand, it can have an impact on fertility. Hormone replacement therapy can be explored as a treatment option if testosterone levels are dangerously low, adds Dr Bajaj.
Experts say that fertility in men is influenced by several other factors such as low self-esteem, lack of sexual drive, a sense of incompetence or being old. Hence, it is very important to make men aware of it.
Dr Kishore recommends taking good, regular, long walks, training gently but regularly with weights, eating a low-carb, high protein diet, getting a good eight hours of sleep every night, avoiding stress and overcoming addictions- like alcohol and smoking.
Overall, lifestyle modification and dietary changes can make this transition easygoing. The role of Hormone Replacement Therapy in this is still uncertain, he emphasizes.
The experts also emphasize that one should always consult a well experienced and qualified expert before opting for any treatment options including HRT. According to them, menopause poses a health threat to men and it should be taken seriously so that men get the support they need.
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Male Menopause: Know what it is and how it affects male fertility - DNA India
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HRT made me depressed here’s what you need to know before you start taking it – Telegraph.co.uk
Posted: November 6, 2021 at 1:50 am
Weve never been more open about menopause. High profile women from Davina McCall to Mariella Frostrup are making books, films and podcasts, and campaigning to improve life for women at this stage of life.
Last week saw a bill before Parliament seeking to make hormone replacement therapy (HRT) more affordable. The move has been welcomed by women and doctors up and down the country, many of whom say HRT, for so long a dirty word, is a life-changing treatment that should be more widely available. But should everyone take HRT and what do you need to know if youre considering it?
The menopause defined as happening one year after your last period occurs on average at the age of 51 in the UK. But the peri or pre-menopause, when youre still having periods but are no longer likely to get pregnant, can also bring weird symptoms that accompany major hormonal shifts.
Im 49, and for the past couple of years, my usual mildly annoying PMS has ramped up from a couple of grumpy days a month to at least a week of sobbing, yelling and generally feeling that life is a wasteland of despair.
Last winter, I finally called my GP to ask whether I could be prescribed HRT. The first doctor I spoke to (male) suggested a coil, which I didnt want (I assure you, its the sensible option, he said, testily.) Then I spoke to a nurse who was a somewhat better listener, and suggested a combination of oestrogen gel and 2 weeks a month of progesterone pills.
But after several months of this combination, I found myself feeling much more stressed and depressed than usual. It seemed to me to coincide with the weeks when I took progesterone, and online research suggested a possible link.
Studies show progesterone can trigger the amygdala the threat system in the brain, which releases stress hormones. Experts say HRT, and especially progesterone, can sometimes have an effect on mood though the causes can be complicated.
There is certainly a significant minority of women who find their mood is negatively impacted by progesterone, says Dr Hannah Short, a GP and specialist in menopause and premenstrual disorders. Either their own, released during the post-ovulation phase of the menstrual cycle, or by the progestogenic component of HRT.
If a woman is sensitive to the synthetic progestogens in some hormonal medication then these symptoms can be experienced whenever she is taking them, with low mood, depression, anxiety, rage, tearfulness and in severe cases suicidal thoughts, she explains.
Experts say that side-effects such as mood changes are more likely when a woman is given a synthetic version of progesterone, rather than a body identical or natural type, which is chemically identical to the hormone your body produces naturally. Both types can be prescribed on the NHS.
When women are on conventional HRT, which contains a synthetic progestogen, it can cause mood changes, high cholesterol and depression, says Dr Jan Toledano of The London Hormone Clinic.
The real hormone is recommended by the British Menopause Society, and has exactly the opposite effect to synthetic progesterone, she says. Its actually the bodys happy hormone. Its anti-anxiety, helps you sleep, and protects breast tissue from abnormal changes.
Tania Adib, consultant gynaecologist and head of The Menopause Clinic at The Lister Hospital, agrees that side-effects of HRT are usually caused by synthetic progestens. The structure of the hormone is not exactly the same as the kind the body produces, so its associated with a greater number of side-effects, she explains.
Some women react with bloating, weight gain, headaches and depression, she adds. Using a combination of bioidentical oestrogen, progesterone, testosterone and DHEA, I can usually find a combination which suits the patient.
I was not taking synthetic progesterone, however so what was making me feel depressed? According to Toledano, in my case it may have been the oestrogen. She says if youre still having regular periods, youre still producing enough oestrogen and probably dont need it though many perimenopausal women are wrongly offered it.
Unless youre actually menopausal, you may only need natural progesterone, she says.
I am indeed feeling better since stopping taking the oestrogen, though for some women, the hormonal havoc proves too much and quitting seems easier than experimenting further.
I was prescribed norethisterone (a synthetic progestogen) several times between 2018 and 2019 to stem my constant periods, one of which was so bad I took myself to A&E, says Lucy Sweet, 48, a writer from Glasgow. It made me feel terrible tearful, depressed, highly anxious and at one point, during a holiday in Spain last summer, I started having thoughts that everybody would be better off without me.
Not surprisingly, Sweet stopped taking it and has since discovered her heavy periods were due to a polyp. But she would not be tempted to try HRT again, she adds. There are still very few treatments for women in menopause that are suitable for everyone, and synthetic hormones are the absolute worst.
Short recommends speaking to your GP before stopping HRT or changing the dose. It can also be worth discussing your earlier hormone history, she adds. Any experience you had with the pill can be relevant, or whether you have had premenstrual syndrome or the more serious premenstrual dysphoric disorder. If you had symptoms of post-natal depression, that can mean HRT may have more negative symptoms.
But, she points out, that doesnt mean you cant be helped. I have found that there is a very tiny handful of women who cant get on with any type of HRT; about five per cent or so.
Amid the current debate about improving treatments for the menopause, some women who missed out on early HRT may be wondering if they are too old to try it now.
There are more benefits to starting younger and slightly increased risks if you start later in life, says Short. But there is no hard and fast rule. All HRT should be on a case-by-case basis; I have patients who started in their 70s; one doctor told a menopause conference that they have a woman of 104 still taking HRT.
That also clears up confusion about how long you can take HRT for. There used to be a guideline of no longer than five years, but now its down to individuals; as long as benefits outweigh risks, there is no reason to stop ever.
The menopause revolution and the liberation of HRT is something to be celebrated, but its important to remember that were all very different and with HRT, one size does not fit all.
Says Adib: Every woman is unique, with a different experience of the menopause, and requires an individual approach.
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HRT made me depressed here's what you need to know before you start taking it - Telegraph.co.uk
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Testosterone Treatments: Why, When, and How? – American …
Posted: October 24, 2021 at 1:58 am
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Whats Causing My Low Testosterone?
Posted: October 24, 2021 at 1:58 am
Low testosterone prevalence
Low testosterone (low T) affects 4 to 5 million men in the US.
Testosterone is an important hormone in the human body. But it starts to decrease each year after age 30. In some men this can be substantial. Between 19 and 39 percent of older men may have low levels of testosterone.
Older men with low T have increasingly sought testosterone replacement therapy (TRT) in recent years. TRT addresses symptoms such as low libido, poor muscle mass, and low energy.
Its not just older men that are affected by low T. Young men, even babies and children, can also have this problem.
Low levels of testosterone that are atypical of normal aging are due to other primary or secondary causes of hypogonadism. Hypogonadism in males happens when the testicles dont produce enough testosterone. Hypogonadism can start during fetal development, during puberty, or during adulthood.
If hypogonadism begins during fetal development, the primary result is impaired growth of external sex organs. Depending on when hypogonadism starts and the level of testosterone present during fetal development, a male child can develop:
Normal growth can be jeopardized if hypogonadism occurs during puberty. Problems occur with:
Later in life, insufficient testosterone can lead to other problems. Symptoms include:
Fatigue and mental fogginess are some commonly reported mental and emotional symptoms in men with low T.
9 Warning signs of low testosterone
The two basic types of hypogonadism are primary and secondary hypogonadism.
Underactive testes cause primary hypogonadism. Thats because they dont manufacture sufficient levels of testosterone for optimal growth and health. This underactivity can be caused by an inherited trait. It can also be acquired by accident or illness.
Inherited conditions include:
Types of testicle damage that can lead to primary hypogonadism include:
Secondary hypogonadism is caused by damage to the pituitary gland or hypothalamus. These parts of the brain control hormone production by the testes.
Inherited or disease conditions in this category include:
Acquired circumstances that can lead to secondary hypogonadism include:
You may be affected by primary, secondary, or a mixed hypogonadism. Mixed hypogonadism is more common with increased age. People undergoing glucocorticoid therapy can develop the condition. It also can affect people with sickle-cell disease, thalassemia, or alcoholism.
Learn more: 5 Natural testosterone boosters
If youre experiencing symptoms of low T, lifestyle changes may help to ease your symptoms.
A good first step is increasing activity levels and maintaining a healthy diet in order to reduce body fat. It can also be helpful to avoid glucocorticoid medications such as prednisone as well as opioid pain medications.
Diet right: 8 Testosterone boosting foods
If lifestyle changes dont work for you, you may need to begin testosterone replacement therapy (TRT) for treatment of low T. TRT can be very important for helping teenage males with hypogonadism experience normal masculine development. Sufficient testosterone levels help maintain health and well-being in adult males.
TRT has side effects, however, including:
A carefully formulated TRT treatment plan should avoid many of these undesirable side effects. Talk with your doctor to evaluate your options.
Options for increasing your testosterone
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Whats Causing My Low Testosterone?
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