Category Archives: Hormone Replacement Therapy

Puppies Puppies (Jade Kuriki Olivo), Brain on Estrogen, progesterone, spironolactone, Truvada, Advil and Marijuana, 2018, cow brain, marijuana leaf, progesterone, estrogen, spironolactone, prep and pain killers. Photo: Courtesy the artist.

Jade Kuriki Olivos retrospective at the Kunsthaus Glarus in Switzerland brings together the Brooklyn-based artists work from the past decade. On view through August 22, the show maps the evolution of her practice as she transitioned from working under the guise of Puppies Puppies to living as an openly trans woman. Here, Olivo reflects on this transformation and discusses refusing to hide, the turning point represented by this exhibition, and the weekly Stonewall Protests for Black Trans Liberation that have kept her going over the past year.

I WAS HIDING from the world for a long time. In some ways, it was because it was so terrifying to beor even think about beinga trans woman. It felt like jumping off a cliff when I decided that it was what I wanted and needed in life.

Trans women have been consistently erased from historyour voices have been erasedso it is revolutionary for me, and for every trans person, especially BIPOC, gender-nonconforming, and two-spirit people, to be in control of the way our voices go out into the world. I still dont do many interviews, but unlike beforewhen my ex-husband or someone else would speak for me and I would be in a costume or sleeping on a sleeping pillnow I speak for myself. It means something very differentto be hidden as a trans woman. At other points in history, I wouldnt have been able to exist. So when I came out, I exposed myself fully and physically in a nude performance in Paris as a way of saying, Im here and Im not going to hide anymore. I couldnt be out as a trans woman and have hiding be a part of my work. I also wanted to document the changes in my body as my hormone-replacement therapy continued.

This is part of the arc of my exhibition at the Kunsthaus Glarus. It was emotional pulling this show together because I really wanted people to understand the evolution thats happened within me. The show covers eleven years of work. I called it a retrospective because I was thinking about how the amount of time that one is given, that a person is allowed to exist, is different for different people. Trans women often dont live as long as other people. It creates a different way of relating to time. Its definitely more precious for me, also having had a brain tumor.

The show marks a new way of making work for me. Ive always worked with other artists, so collaboration is nothing new, but Im moving into a more curatorial rolebecoming a conduit or a pathwayso that I can give a platform to other artists, especially a growing family of trans/GNC/2S+ artists. Going forward, when an institution asks me to do a solo show, I will invite another artist to do their own solo show, and they can decide how or if they want that to be associated with me. This is the direction I want to go in, and Im doing sex work and figuring out a way to survive so I can keep moving toward it. This new chapter begins with Bri Williams and Elliot Reeds exhibitions opening at Glarus in September.

Next to giving other artists I believe in space to express themselves, Stonewall Protests is the part of my life I am most passionate about. Stonewall is organized by Qween Jean and Joela Rivera, who have been holding weekly demonstrations for the past year in the wake of the murder of George Floyd. They are really the civil-rights leaders of now. Ive been protesting since the age of sixteen, but when I finally found Stonewall Protests at thirty-one, I was like, Oh my God, you found your family and your home. I also found a reason to keep going at a time when my art practice was not fulfilling me. It is a healing space. Stonewall is first and foremost a leading formation within the current Black Trans Lives Matter movement. The protests relate in some ways to the ballroom scene, which was founded by Black and Latinx trans women in New York City, specifically in Harlem, and brings that culture to protesting. An amazing group of bikers called Riders4Rights block intersections so the space can become a dance floor where people are able to express themselves to their fullest and feel safe enough to do so. There are different chants and a drum line and music made by a fantastic group called Musicians United NYC. A huge part of the Stonewall protests are mutual-aid events which emphasize the need to support one another, as well as the communities some Stonewall protesters live or grew up in.

In different Indigenous histories, trans people have been identified as healers or helpers, and Im drawn to this way of existing as a kind of sacred work. This is a practice I became familiar with through my father, who was Indigenous and taught me what he knew, and from my chosen Indigenous queer family members over time. In articulating all this, and thinking about when art and life blend together, Ive been really grateful to reflect on this evolution. As Puppies Puppies, I was making meme videos, really concealed from the world in this little shell. And now this is whats happening. Its my life and Im here.

As told to Camila McHugh

Read more here:
Puppies Puppies (Jade Kuriki-Olivo) on transition, retrospection, and year of protest - Artforum

Currently recruiting healthy participants

CHICAGO, August 11, 2021--(BUSINESS WIRE)--Xeris Pharmaceuticals, Inc. (Nasdaq: XERS), a pharmaceutical company leveraging its novel formulation technology platforms to develop and commercialize ready-to-use injectable and infusible drug formulations, today announced that the Food and Drug Administration (FDA) has allowed the Investigational New Drug Application (IND) for its XeriSol levothyroxine for hypothyroidism to proceed. The active IND enables Xeris to initiate a Phase 1 clinical study for XP-8121 using its novel formulation of levothyroxine in a subcutaneous injection for the treatment of hypothyroidism. The Phase 1 study will characterize Pharmacokinetics (PK) and evaluate the safety and tolerability of XP-8121 in healthy participants.

"Levothyroxine is one of the most widely prescribed drug products in the United States. However, due to the many challenges associated with oral formulations there remains an area of significant unmet need. We believe that a potentially weekly subcutaneous injection of XeriSol levothyroxine can mitigate many of these challenges and improve compliance. The Phase 1 study is the first step toward addressing this unmet need," said Kenneth E. Johnson, PharmD, Xeris Senior Vice President of Global Development and Medical Affairs.

"The FDA acceptance of our XP-8121 further underscores the applicability of our XeriSol technology and progress of our pipeline. We will continue to invest in our pipeline in therapeutic areas where we have an established commercial footprint," said Paul R. Edick, Chairman and CEO of Xeris.

About Levothyroxine and Hypothyroidism

The thyroid gland is responsible for the synthesis, storage, and release of metabolic hormones including thyroxine (T4) and triiodothyronine (T3) [Colucci et al, 2013]. These hormones are crucial in the regulation of critical metabolic processes and are vital for normal growth and development during fetal life, infancy, and childhood.

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Therapeutically, levothyroxine is administered when the body is deficient in the endogenous hormone. The goal of therapy is restoration of the euthyroid state which can reverse the clinical manifestations of hypothyroidism and significantly improve quality of life [Winther et al, 2016]. The treatment of choice for correction of hypothyroidism is levothyroxine, which is the mainstay of thyroid hormone replacement therapy. It is one of the most widely prescribed drug products in the United States, but the complexity of maintaining biochemical and clinical euthyroidism in patients undergoing treatment with oral levothyroxine cannot be underestimated. It has been reported that nearly 40% of patients undergoing treatment with oral levothyroxine are either over- or under-treated [Laurent et al, 2018] due to factors that include, but are not limited to, drug formulation, use of the drug with food, adherence to the drug, use of concomitant medications, and pre-existing medical conditions. Many patients failing to reach target TSH levels are generally managed by simply increasing their levothyroxine daily dose [Chiovato et al, 2019]. However, levothyroxine is a drug with a narrow therapeutic index [Vita et al, 2014], meaning that relatively small deviations from the proper dose can cause a clinically meaningful shift in pharmacological effects when administered to a patient; thus, the titration of levothyroxine oral drug may be a tailored and incremental process.

About Xeris Pharmaceuticals, Inc.

Xeris (Nasdaq: XERS) is a pharmaceutical company delivering innovative solutions to simplify the experience of administering important therapies that people rely on every day around the world.

With a novel technology platform that enables ready-to-use, room-temperature stable formulations of injectable, the company is advancing a portfolio of solutions in various therapeutic categories, including its first commercial product, Gvoke in the U.S. Its proprietary XeriSol and XeriJect formulation technologies have the potential to offer distinct advantages over conventional product formulations, including eliminating the need for reconstitution, enabling long-term, room-temperature stability, significantly reducing injection volume, and eliminating the requirement for intravenous (IV) infusion. With Xeris technology, new product formulations are designed to be easier to use by patients, caregivers, and health practitioners and help reduce costs for payers and the healthcare system.

Xeris is headquartered in Chicago, IL. For more information, visit http://www.xerispharma.com, or follow us on Twitter, LinkedIn or Instagram.

Forward-Looking Statements

Any statements in this press release about future expectations, plans and prospects for Xeris Pharmaceuticals, Inc., including statements regarding the market and therapeutic potential of its products and product candidates, expectations regarding clinical data or results from planned clinical trials, the timing or likelihood of regulatory approval and commercialization of its product candidates, the timing and likelihood of the consummation of the Strongbridge Biopharma acquisition, the timing or likelihood of expansion into additional markets, the timing or likelihood of identifying potential development and commercialization partnerships, the potential utility of its formulation platforms and other statements containing the words "will," "would," "continue," and similar expressions, constitute forward-looking statements within the meaning of The Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by such forward-looking statements as a result of various important factors, including, without limitation, the impact of COVID-19 on its business operations, its reliance on third-party suppliers for Gvoke and Ogluo, the regulatory approval of its product candidates, its ability to market and sell its products, if approved, and other factors discussed in the "Risk Factors" section of the most recently filed Quarterly Report on Form 10-Q filed with the United States Securities and Exchange Commission (the "SEC"), as well as discussions of potential risks, uncertainties, and other important factors in Xeris subsequent filings with the SEC. Any forward-looking statements contained in this press release speak only as of the date hereof, and Xeris expressly disclaims any obligation to update any forward-looking statements, whether as a result of new information, future events or otherwise.

The Company intends to use the investor relations portion of its website as a means of disclosing material non-public information and for complying with disclosure obligations under Regulation FD.

View source version on businesswire.com: https://www.businesswire.com/news/home/20210811005814/en/

Contacts

Investor Contact Allison WeySenior Vice President, Investor Relations and Corporate Communicationsawey@xerispharma.com 312-736-1237

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Xeris Pharmaceuticals Announces FDA Acceptance of its IND Application for XeriSol Levothyroxine (XP-8121) for the Treatment of Hypothyroidism - Yahoo...

Attitude and action to win over this past years challengesLive long and prosper. That famous line from the Vulcan Mr. Spock (played by Leonard Nimoy) should be your motto for the coming year. And heres how to do it despite the recent news about just how tough its been.

A study that looked at 29 folks, ages 90 to 100, uncovered two powerful secrets to longevity: acceptance of and recovery from things you cant change and an impulse to fight for the things you can alter. This is valuable information especially now that life expectancy in the U.S. is falling.

COVID-19 contributed to a decline in life expectancy from age 78.8 in 2019 to age 77.3 in 2020, according to the National Center for Health Statistics. In addition, more than 93,000 people died from drug overdoses a 30 percent increase over 2019. Homicides and deaths from diabetes and chronic liver disease also made major dents in longevity.

So what can you do to buck this trend?1. Get vaccinated pronto. 100 percent of the deaths from COVID-19 in June in Maryland were among nonvaccinated people.

2. Reassert control over your health. See your doctor for checkups and tests, especially if you have diabetes or other chronic conditions and nonalcoholic fatty liver disease. Reach out to support groups if you have alcohol- or substance-related disorders or suicidal thoughts and behavior.

3. Revamp your nutrition and your physical activity routine. Nutrition influences everything from longevity to mood. Theres great guidance in Dr. Mikes book What to Eat When and at DoctorOz.com, click on OZtube/Body.

If you arent getting vaccinated for yourself do it for your pet!When John Legend did the ad This Shot Is Our Shot to encourage people to get a COVID-19 vaccine and then put his inoculation up online, he was thinking about all the heartache that could be prevented by protecting folks from contracting the sometimes-fatal infection. But we bet John and his wife Chrissy Teigen who posted info on her shot on Facebook didnt know what a huge benefit their inoculations would be to their bulldogs Pablo, Penny and Pippa and their poodle named Petey.

It turns out that when a pet owner gets COVID-19, 67 percent of housecats and 43 percent of dogs also become infected. Thats the conclusion of researchers from Canadas University of Guelph, who did a study of 48 cats and 54 dogs from 77 households in which an owner had been diagnosed with COVID-19. Their paper, presented at the European Congress of Clinical Microbiology & Infectious Diseases 2021, found that while most infected pets were asymptomatic, 20 percent of the dogs experienced lack of energy and loss of appetite, a cough or diarrhea; 27 percent of cats ended up with a runny nose and difficulty breathing.

The researchers advice: If you get COVID-19, stay away from your pet, and dont allow it to sleep with you. Also smart: If you have COVID-19 in your house, keep your pet away from other people and pets. Once a cat or dog becomes infected, pet-to-pet and pet-to-human transmission cannot be ruled out say the researchers.

How to stay cool in a heat waveMartha and the Vandellas sang about the torment of a Heat Wave in their 1963 hit: Its like a heat wave/burnin in my heart/ Its like a heat wave/Its tearin me apart. They did a pretty good job of predicting the effect of the scorching temperatures the U.S. has been experiencing this summer.

At least 67 weather stations from Washington State through New Mexico have recorded their hottest temperatures ever, according to the National Weather Service. And as risky as that is for the earths and peoples future, it also poses an immediate threat to you. High temperatures can cause dehydration, heatstroke, heat exhaustion and heat cramps; strain the cardiovascular and respiratory systems; and even increase interpersonal conflict. Research also shows strong links between climate crises and development of depression, anxiety and PTSD. So how can you stay cool, calm and collected when its steamy outside?

BIG NEWS: Dont use an electric fan when the indoor air temperature is over 95 degrees. The breeze can actually cause your body to gain heat instead of losing it!

If you have air conditioning, use it or go to an air-conditioned building or cooling center. For locations, Google cooling centers (and the name of your town). And (duh!) wear lightweight, light-colored, loose-fitting clothing.

In a cool environment, drink a tall glass of plain water every couple hours. In the heat, have a water bottle with you and sip every 10-15 minutes. Nothing sugary.

Exercise (keep doing it!) indoors in a cool place.

Think, sweat, think sweat that may delay dementiaBrute strength: 6 feet 9 inch tall Game of Thrones actor Hafthor Bjornsson set a world deadlifting record by lifting 1,104 pounds. Brain power: Dr. Sho Yano has an IQ of 200, started college at age 9 and earned an M.D. and Ph.D. by the time he was 21.

Imagine if such brains and brawn were found in one person. Well, they can be in you! And you dont have to hold the worlds record in both strength and intelligence to get the benefits of that combination: a reduced risk of Alzheimers and a healthier cardio and respiratory system. So heres how to harness the benefits.

A study in the journal Neurology followed 1,978 people, average age 80, and found that doing simple cognitive exercises such as reading, writing letters, playing card games and doing puzzles may delay the onset of Alzheimers disease by up to five years. And brain workouts later in life not as a younger person are what delayed the participants cognitive decline.

While youre strengthening your brain, pay attention to your body. Another research team found that one year of moderate- to vigorous-intensity aerobic walking two to three times a week for 30 minutes gradually increasing to four to five times weekly with two sessions of high intensity improves cardiorespiratory fitness, cerebral blood flow, memory and executive function in folks with mild cognitive impairment. The researchers say that also may reduce your risk of Alzheimers. We say combine brains and brawn and youll have a win-win well into your 80s and 90s!

The alpha and omega-3 of a longer lifeAn adult male bear on Kodiak Island in Alaska eats more than 6,000 pounds of salmon a year; females gobble up about half of that. And without any bagels! Fortunately, to get the remarkable benefits of eating omega-3-rich foods, you only need to eat a 3- to 6-ounce serving of salmon regularly. Dr. Mike loves salmon burgers even for breakfast. For lunch or dinner, he adds olives and broccoli or grilled vegetables.

A new study in the American Journal of Clinical Nutrition looked at data from blood tests on more than 2,200 people over age 65 for an average of 11 years. The researchers from The Fatty Acid Research Institute in the United States and colleagues in universities in the U.S. and Canada found that folks with high levels of omega-3 fatty acids in their blood saw an increase in life expectancy of almost five years. Thats a huge increase in longevity from simply enjoying incredibly tasty foods.

The alpha and omega-3 of your choices: In every 3.5-ounce serving, wild salmon has 2,260 milligrams, herring 2,366 milligrams, sardines 1,480 milligrams and anchovies 2,113 milligrams. Flaxseed delivers 7,260 milligrams per tablespoon; and chia seeds and walnuts dish up 5,060 milligrams and 2,570 milligrams per ounce respectively. The benefit of adding these foods (in human size portions) is clear. According to the study author: It reinforces the idea that small changes in diet in the right direction can have a much more powerful effect than we think, and it is never too late or too early to make these changes.

Shades of brain healthIn 1986, when Cyndi Lauper sang True Colors I see your true colors shining through/I see your true colors and thats why I love you/So dont be afraid to let them show she had no idea just how important it was for everyone to put those true colors on display on their breakfast, lunch and dinner plates! But a new study in the journal Neurology reveals the power of colorful fruits and vegetables to protect you from cognitive decline as you get older.

The study, led by renowned Harvard nutrition researcher Walter Willet, followed almost 50,000 men and women, average age 51 at the start of the study, for 20 years. It revealed that eating flavonoid-rich, colorful foods such as apples; celery; red, blue and purple berries and grapes; hot and sweet peppers; eggplant; plums; carrots; citrus fruits; and even thyme and parsley can reduce your risk for encroaching dementia by 20 percent.

The study found that taking in 600 milligrams of flavonoids a day is what it takes to help combat cognitive decline 3.5 ounces of strawberries dishes up around 180 milligrams; a medium apple, 113 milligrams. In the U.S., adults only get about 200 to 250 milligrams a day, just a bit above the study group with the lowest intake and greatest risk of cognition problems.

If you make an effort to increase your intake, youll gain flavonoids neuroprotection. They also turn out to be anti-inflammatory and anti-diabetic. So make your life a bowl full of cherries and other colorful flavonoid-rich foods.

Foods that damage your immune strengthKryptonite immobilizes Superman. Spider-Mans archenemy, Venom, changes from predator to weakling at the sight of a flame. And you? Well, it turns out certain foods have superpowers that weaken your immune system, transforming you from super-germ fighter to a target for everything from the common cold to COVID-19. The most immune-weakening consumables are:

Excess alcohol. Whether its a daily overdose or you binge once a week, youre increasing your risk for pneumonia and acute respiratory stress syndromes. That could potentially impact the outcome of COVID-19. It also leads to slower recovery from infection and post-op complications.

Too much salt. That causes a cascade of events, starting with the kidneys excreting excess sodium and ending with a reduction in your bodys ability to fight bacterial infections. As little as 6 extra grams a day has that effect. Your daily average should be below 3 grams a day.

Added sugar. As little as 3.5 ounces (thats in a 16-ounce Coke, a Big Mac and a slice of pecan pie) can reduce the ability of immune cells to neutralize bacteria for up to five hours.

Highly processed foods. Stripped of fiber, these alter the mix of microbes in your gut biome, where 70 percent to 80 percent of immune cells hang out, making them less able to battle viruses. Getting adequate fiber (25 to 30 grams daily) has been shown to strengthen your flu-fighting powers. Whole cereals, veggies and fruit, and beans are go-to sources plus they supply vitamins A and C, folate and bioactive compounds that also boost immune health.

Playing hooky from your statin? Look for some new alternativesThere are over 1 million students in the New York City public school system, and more than 22 percent of them are chronically absent from the classroom (pre-pandemic). Thats not good for their future. But even more adults around 50 percent fail to show up for their life-saving daily dose of a statin. Now, that really threatens their future.

Fortunately, there are new cholesterol-fighting medications that even your doc might not be aware of, according to a new JAMA Insights Clinical Update. So if youre not taking your prescribed statin or your lousy LDL cholesterol level is too high, ask about trying one of the following drugs on its own or with a statin. Most are covered by insurance if youre statin resistant or have had statin myopathy from two different statins.

PSCK-9 inhibitors. A monoclonal antibody administered by injection every two to four weeks, it reduces LDL by 50 percent to 60 percent and is well-tolerated. Check to see if your insurance covers it.Ezetimibe. An inexpensive generic, this cuts intestinal absorption of cholesterol and reduces LDL levels by 10 percent to 20 percent. Good in combo with a statin.

Bempedoic acid. It lowers LDL by about 20 percent with few side effects. Its not yet known how much it reduces the risk of atherosclerotic-related cardiovascular disease; check price and insurance coverage.

Icosapent ethyl. An omega-3 fatty acid that, when added to statin therapy for patients with high triglyceride levels, can reduce atherosclerotic cardiovascular disease risk by 25 percent. Highly variable out-of-pocket cost.

As you age you may need fewer calories but more nutrientsThe worlds oldest magic trick, acetabula et calculi, reportedly dates back to early Rome. Today, its known as cups and balls and while there are endless variations, it all comes down to trying to figure out how small balls pop in and out of three upside-down cups unseen.

Making sure you get enough nutrition as you get older also requires a sleight of hand. You need extra nutrients to protect your strength, cognition, immune function and bone, eye and heart health, while you take in fewer calories daily. Here are four nutrients you should pack into every day.

Calcium: For bone health, aim for three servings a day of fat-free dairy, two servings daily of dark leafy greens like kale, spinach and collards. Also good: canned fish, like sardines.

Vitamin D: Get a good daily dose from fish such as salmon, mushrooms and fortified foods. Get your blood level checked: Most folks need a supplement too. It helps with immune function and bone strength.

Vitamin B12: Essential for nerve and blood cell health, its in fortified whole-grain cereals, lean meat and fish. A blood test will show if you need a supplement.

Protein: Whole grains and legumes, tofu, fish, nuts and lean poultry can deliver the protein you need to gain and maintain muscle mass and function. A 150- to 160-pound senior might need 65 to 70 grams daily. That could come from 6 ounces of salmon (40 grams), 3 ounces of white meat turkey (24 grams) and 1 cup of brown rice (5 grams).

The amazing power of diet to cool menopause hot flashesIn 2014, then 61-year-old Emma Thompson joked about her hot flashes as she accepted a best actress award from the National Board of Review for her role in Saving Mr. Banks: Its such a cold night. You know, its the first time Ive been actively grateful for the menopause. Sound familiar?

Around 85 percent of postmenopausal women say symptoms such as hot flashes, palpitations and insomnia define the months or years around the cessation of menstruation. Many just tough it out, because for years they were told to take hormone replacement therapy, then told, No, hormone therapy is too risky, then, that its really OK if done immediately after menopause and for no more than 10-20 years (the correct information in our opinion if you also take low-dose aspirin).

Too bad this new study, led by Physicians for Responsible Medicines founding president Neal Barnard, wasnt around sooner. Its a real game changer. During the 12-week study, the research published in the journal Menopause found that a plant-based diet, rich in soy, reduces moderate-to-severe hot flashes by 84 percent! Close to 60 percent of participants became totally free of moderate-to-severe hot flashes and women who experienced mild hot flashes saw them decrease by 79 percent.

The diet that produced these remarkable results was low-fat and vegan, based on fruits, vegetables, whole grains and legumes, reduced intake of added oils and fatty foods, and heres the kicker 1/2 cup of cooked non-GMO soybeans daily. In our humble opinion, this diet deserves to be adopted by any woman whos contending with menopause symptoms.

Mehmet Oz, M.D. is host of The Dr. Oz Show, and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into The Dr. Oz Show or visit http://www.sharecare.com.

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Health tips from Dr. Oz and Dr. Roizen for 8-17-21 - The Dispatch - The Commercial Dispatch

My breasts are not huge, but theyre undeniably there (Picture: Shutterstock / nito)

When I close my eyes, I imagine myself with a flat chest and the scars from top surgery still visible and I feel strength and power of being my best, truest self.

However, when I open them, I see a chest that is anything but flat. Im looking at a body with hips and curves and breasts that are partially hidden by a 34G bralette.

Although I want top surgery,as abisexualtransgender man, Im anxious that men wont find me attractive if I get a subcutaneous mastectomy the medical term for the procedure.

I have a huge amount of dysphoria, which is defined by theGender Identity Clinic(GIC) as the distress experienced by those whose gender identity feels at odds with aspects of their body and/or the social gender role assigned to them at birth.

I experience it most acutely around my breasts, struggling daily with the disconnect between how my body looks in my head and how it looks in the mirror.

Its not the clich of having been born in the wrong body so much as people assuming that everyone with a body like mine must be a woman. The discomfort is sharp and painful and reverberates through me: everything feels wrong.

Its been 18 months since I began the process of socially transitioning: coming out to the people around me as trans, asking people to respect my pronouns, and changing the way I present to the world.

Even before I had fully acknowledged my own transness and that I wasnt cisgender (meaning my gender identity is not the same as the gender I was assigned at birth when a doctor looked at my genitals) I had begun to think about the kind of medical transition I wanted.

Stepping into my gender has shown me how important pursuing hormone replacement therapy (HRT) and surgery are for me.

My breasts are not huge, but theyre undeniably there. I dont remember when they developed, because for most of my childhood and teenage years, I was scared of my body and ignored it as much as possible.

Some days it feels like my whole body is shouting its wrongness at me until I want to cry. Yet even as I came out to my GP and asked for a referral to a Gender Identity Clinic, a tiny part of my brain worried at how getting top surgery would change the way people saw me.

Strangers will be more likely to see me as a man after top surgery of course, which is what I want. It can be incredibly painful to go through life being misgendered, and sometimes the thought that people see a woman when they look at me makes me want to tear my skin off. The three to five year waiting list for surgery feels interminable.

So why does a small part of me care that I might be less attractive if I have the gender affirming surgery that it often feels like my whole body is yearning for?

I am already a man, albeit one with breasts that I often forget I have

The answer, while not pretty, is simple: its because Ive spent my whole life being tolda cisnormative (the harmful assumption that everyone is cisgender), heteropatriarchal society both indirectly and explicitly that my worth is based on my desirability to straight, cisgender men. It feels deeply unfeminist and a betrayal of my own queer identity to admit that.

As a bisexual trans guy, I have no interest in sleeping with straight, cis men yet the need to centre their desire persists.

As someone whose body is automatically sexualisedby men who feel entitled to it, with or without my consent, Ive learned to reclaim that.

I feel so powerless when I am cat-called in the street. Theres fear, yes, but theres also shame that twists red-hot inside me when a group of laughing men shout are you legal yet? after me as I walk away with my whole body shaking.

I know that men are attracted to my breasts though Ive experienced more sexual harassment while wearing shorts or crop tops so I find it empowering to pick out tight or low-cut tops to emphasise my breasts.

Even now, dressing in ways that show off my cleavage can still feel good: owning my sexuality feels powerful because it is something that society has told me to be ashamed of.

When I have top surgery, I can imagine myself standing taller. Not because Im free from the sexualisation of being a person with breasts, but because I will have made my body undeniably mine in a way that feels like a raised middle finger to that shame. Its a rejection of who I should be for who I really am.

I dont want to take testosterone or have top surgery to become a man. I am already a man, albeit one with breasts that I often forget I have. I want top surgery because I want my body to feel right in the way the rest of me does since stepping into my transness, yet I still trip up over the anxiety that men will no longer find me attractive without my breasts.

That anxiety shows that as much as Ive spent the last six years immersing myself in queer and feminist culture, I still have the flawed yet fundamental belief that my worth is based in how much straight, cis men want to have sex with me.

I hate how much I believe that lie. It horrifies me that I dont even want to have sex with straight, cis men yet I still cant seem to shake it. How many choices must women (and other people affected by misogyny) make every day because weve been conditioned that our own wants should be secondary?

We can reframe getting nails done as self-care and we can find that wearing high heels gives us confidence even though they hurt our feet, but those choices are not independent of patriarchal repercussions.

Adjusting everything from our behaviour to our breasts is the price we pay for being taken seriously in a society that revolves around the axis of straight, cis mens desire. And when were still punished for not falling in line with the male gaze, it becomes even harder to de-centre that desire and stand steady in our own self-worth.

Despite how inaccessible gender-affirming healthcare is, truly internalising the belief that I have value beyond my desirability might actually be harder. Even when not if I get top surgery, thats something that Im going to have to keep working on.

Do you have a story youd like to share? Get in touch by emailing James.Besanvalle@metro.co.uk.

Share your views in the comments below.

MORE : Transgender man faces gruelling body dysphoria and is desperate for top surgery

MORE : Coming out as transgender during lockdown feels like Im in limbo

MORE : Elliot Page says undergoing top surgery as part of transgender journey has been life changing and lifesaving

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I worry that men won't find me attractive if I get my breasts removed - Metro.co.uk

In 2019, Maras weekly performance review meetings grew intolerable; she would sit in a cramped conference room with her supervisors only to be told that she wasnt performing well enough. I felt like a child, says Mara, who is 48, lives in Hampshire and works and works as a public servant. They would tell me off. Theyd say: You wont meet this deadline, will you? You didnt put a paragraph in this document.

A year earlier, Mara had had a hysterectomy, to alleviate her endometriosis. Afterwards, in surgically induced menopause, she began to experience debilitating brain fog, anxiety and depression. I was drowning, she says. I was overwhelmed. I couldnt see or think. Doctors prescribed antidepressants and oestrogen gel, but nothing helped. Mara could barely function at work. I couldnt retain anything, she says. I had no memory. I couldnt see or think clearly enough to do my work. I had no confidence at all. I thought I was useless.

Mara told her supervisors she had depression and anxiety, and submitted a doctors note, but they put her on a first warning. At the time she didnt realise her depression was linked to the menopause - all she knew was that she needed help. (In the autumn of 2019, a specialist explained that her symptoms were caused by the menopause, and provided her with a doctors note explaining this to her employers, but they continued to monitor her performance, as theyd done previously.)

Every week, she had to attend a meeting with her supervisors, where theyd tell her that, once again, she had failed to meet the standard expected. By the summer of 2019, Mara couldnt cope any more.

That weekend, she spent a sunny afternoon with her husband and son at a local fair. The following day, she woke up and drove to a nearby motorway bridge. She sat on a patch of grass and ignored the fact her phone was vibrating with texts from her concerned husband. Instead, she spent a few hours assessing what she felt, then, were her options. It wasnt that I wanted to die, she says. I needed to die. Work wasnt ever going to stop doing what they were doing to me. And I was so ashamed to be so incompetent at my job.

She stood up and approached the bridge, feeling completely empty. She peered over the side, then realised, to her dismay, that the bridge wasnt high enough. I thought, she says, if I jump, I will survive. And there was no way I wanted to survive. And that is the only reason I am alive today. Because it wasnt high enough.

Maras story is an extreme example of the devastating impact the menopause can have on womens jobs and their mental and physical health. Its really difficult to collect data on how many women may be leaving the workplace due to the menopause, says Dr Vanessa Beck, an expert in work and organisation at the University of Bristol, because its not something people tend to talk about in exit interviews. Even if women were asked about the menopause when leaving companies, Beck isnt sure it would help. Im not convinced that women would disclose, she says. Theres a lot of shame.

Some data does exist, however. A 2019 survey from Bupa and the Chartered Institute of Personnel and Development (CIPD) found that 59% of working women aged 45 to 55 who were experiencing the menopause reported that it had a negative impact on them at work, with the most common issues including a reduced ability to concentrate, and feeling more stressed and less patient with clients and colleagues. The same survey estimated that 900,000 women had so far left their jobs, due to menopausal symptoms.

Meanwhile, a survey of 1,132 women from Newson Health Menopause and Wellbeing Centre, also published in 2019, found that over 90% of respondents felt that menopausal or perimenopausal symptoms were affecting their performance at work, and one-third of women had considered reducing their working hours or even leaving their job as a result. Also, earlier this month, the Guardian reported on the growing number of women taking their employers to tribunal, claiming unfair dismissal and sex discrimination due to their experience of the menopause.

In July, the House of Commons women and equalities committee launched an inquiry into menopause and the workplace. These are women in the prime of their lives, says the committees chair, Caroline Nokes MP, in their late 40s and 50s, who should be in senior positions ... These are the people who should be the trailblazers and role models for younger people in the workplace.

Almost uniformly, women experiencing menopausal symptoms at work struggle to talk openly about it. Quite simply, its embarrassing. Theres a stigma around it, says Rachel Weiss, founder of The Menopause Cafe, a safe space where men and women can gather to talk about the menopause. Being an older woman is not viewed as a positive thing in our society.

It is not hard to see why many women would not want to disclose that they are menopausal or perimenopausal at work. Menopausal women are too often represented as figures of fun, to be excoriated or mocked. I remember a senior civil servant using the term menopausal as if it was some kind of insult, says Nokes. You wouldnt be able to discriminate against black or gay people in that way and use their status and who they are as an insult. But it is seen as OK when were talking about women of a certain age.

Using the word as a slur can create a toxic working environment for women. Every little mistake I made, says Sukie Stratton, a 51-year-old insurance investigator from Gloucestershire, people would say: Oh, you must be in the menopause. That was during her short stint in 2019 as a trainee police officer (not for Gloucestershire police).

She realised early on that her age might be a problem. One of my trainers came up to me, Stratton remembers, and said: I am worried about you, because youre in your late 40s. You wont be able to do the night shift. I said: Why not? She said: Because youll be menopausal, wont you? You wont be sleeping and youll be tired all the time.

Even though Stratton did not even have menopausal symptoms, the comments were constant. When her colleagues saw her sweating in her cumbersome body armour, they would make jibes about hot flushes. If she made a minor mistake, they would assume it was memory loss. One of the final straws was when a relief sergeant referred to Stratton as a bloody knackered menopausal woman in front of an office full of her peers.

Stratton emailed HR, but she says they didnt respond to her emails. One morning, she was on patrol. It was 4am, and she was sitting in the van, talking to a trusted colleague. She confided in him. He told her, candidly: This is how it is. You will never get anywhere, she remembers. Stratton realised he was right. All the women her age had been moved to desk jobs, or sent to rural offices with little chance of promotion. She handed in her notice.

I felt massive disappointment, she says. Because Id always wanted to join the police, and Id held the police in high regard. I couldnt understand why theyd dismiss someone who was capable. They seemed to think that being menopausal meant that I wasnt up to the job.

Not all women, of course, are driven out by such rank discrimination. Others, including Mara, leave because they feel unsupported by employers. But a third cohort of women leave because the very thought of disclosing their menopausal status to their employers is too horrifying to consider.

Cara, who is 46 and lives in Wiltshire, walked away from her job in higher education in November 2020 due to the perimenopause. I wasnt actively forced out, Cara says, but I didnt feel like I had any choice, or options. Cara had low mood, brain fog, muscle and joint pain. Id find it hard to concentrate on stuff I would be sailing through normally, she says. Worst of all was the loss of sleep. There would be some nights where I would get no sleep, she says. A good night would be four hours.

Cara handed in her notice because she felt unable to perform at the level she had previously. I wasnt giving my best, she says. I felt isolated and embarrassed and I didnt want to get to a point where my job did suffer, and someone would say something. I felt I wasnt able to do the job I had done for all those years at the same level. I ask Cara why she didnt ask her employers for extra support. I felt ashamed, is the reply.

This self-enforced silence is common among the women who attend Weisss menopause cafes. What we find, she says, is that a lot of women arent talking to anyone else about their menopause symptoms. They wonder if theyre going mad, or if theres something wrong with them. Women may feel mortified by some symptoms such as menstrual flooding (very heavy bleeding), and feel that it is easier to quit than endure the mortification of explaining to their supervisors why they cant be more than a few metres from a toilet.

Physically, says Dr Helen Douglas, 49, from Glenshee in the Scottish Highlands, I didnt feel well enough to stand on my feet all day. Douglas went into surgical menopause in 2013, aged 41, after a hysterectomy for endometriosis and uterine fibroids. At the time, she managed a forensic laboratory. It was stressful, she says. The sort of job where you need attention to detail.

Afterwards, Douglass stomach was swollen, making it impossible to get into her clothes, and she had persistent bleeding. Mentally, she wasnt doing well. I wasnt sleeping, she says. I had anxiety and my hands would shake. Memory issues. I was short-tempered and irritable. I just wanted to tell everyone where to go. If someone cancelled a meeting at short notice, Douglas would internalise the anger until it led to a panic attack, she says.

She had suffered from depression in the past, and at the time, she didnt realise her symptoms were menopause-related. I thought it was just a bad episode of depression again, Douglas says. She resigned in 2014. I couldnt do it any more, she says. Id been having recurrent thoughts of ending my life.

Yet the outlook for women approaching the menopause in the workplace is not totally bleak. The stigma is abating. Over the last year or so women have been much more open about it than ever before, says Nokes. Women like Davina McCall [who recently made a documentary on the subject for Channel 4] have spoken about their own experiences honestly.

Nokes is willing to practise what she preaches. I am prepared to say I think I probably am perimenopausal, she says. I have horrific night sweats. She recently had to alter the bedding she uses. Ive got the thinnest duvet on my bed ever, Nokes says. But at least Im not waking up at 3am, dripping in sweat.

Many believe the NHS needs to improve its offering to menopausal women. We need a multidisciplinary team to look after women after the menopause, says Douglas. Rather than seeing it as a gynaecological issue, women should be referred to someone who has a handle on the mental health side of things.

Mara believes GPs could also do with better training: it was only through reading menopause support forums online that she learned about a drug called utrogestan, a form of hormone replacement therapy. I rang my doctor, she says, and she prescribed it, and literally overnight I started feeling better. My husband noticed within 48 hours. He said: Are you on new medication? Youve turned nice again.

Another obvious solution would be menopause-friendly workplaces. Douglas advocates for companies to have specific policies around it. It would be really helpful if there was a menopause-in-the-workplace champion, she says, someone women knew they could go to. Simple adjustments switching uniforms from synthetic fibres to natural fabrics. Having free and frequent access to bathrooms, in case women are flooding.

Some employers are ahead on this. The water company Severn Trent was the first UK employer to specifically introduce a menopause policy. The CIPD has subsequently published guidance for employers on addressing the menopause at work, while last year the Wales TUC published a toolkit.

Deborah Garlick of the training provider Menopause in the Workplace began offering menopause training to employers in 2016. We organised our first menopause in the workplace conference, says Garlick, and people thought we were bonkers. But then some very large employers said, Why didnt we know this? And thats how we got started.

Part of the select committees forthcoming work will be to evaluate whether UK discrimination law is fit for purpose on the menopause. Do we need to make menopause a protected characteristic, in the same way that maternity leave currently is? asks Nokes.

Under existing law, menopausal women are protected because age, sex and disability are protected characteristics under the 2010 Equality Act. But because menopause is not specifically protected, women have to pick the characteristic they want to take a case under, Beck says.

Nokes says she is open-minded about introducing such legislation. This is impacting 50% of the population, Nokes says, and its pushing them out of the workplace. So maybe it should be a protected characteristic. Regardless of whether or not legislation is introduced, Beck urges employers to make adjustments for older women. Theres the business case, she says. Its costly to replace an experienced worker. But its about more than that its the right thing to do. If you are a good employer, you should want to support your workers.

The hope is that, with time, more enlightened employers, and government intervention if necessary, no woman should ever have to go through what Mara endured. I was a person with value, and they were happy to destroy me and get rid of me, because of the menopause, Mara says. Thankfully, with the help of medication, her symptoms have abated. My energy levels are a bit low, she says, but Im almost there.

After five years out of the workforce, living on savings and focusing on her mental health, Douglas, likewise, has found a new vocation, as a writer and menopause awareness activist. I dont regret leaving my old job, she says thoughtfully. Its taken a lot of time and work to get to a place where I am comfortable saying that. But what I do now can make a positive difference. Its more satisfying.

Some names have been changed.

In the UK and Ireland, Samaritans can be contacted on 116 123 or by emailing jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.

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My bosses were happy to destroy me the women forced out of work by menopause - The Guardian

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of themenopause. It replaces hormones that are at a lower level as you approach themenopause.

The main benefit of HRT is that it can help relieve most of the menopausal symptoms, such as:

Many of these symptoms pass after a few years, but they canbe unpleasant and taking HRT can offer relief for many women.

Itcan also help prevent weakening of the bones (osteoporosis), which is more common after the menopause.

Some types of HRT can increase your risk of breast cancer.

The benefits of HRT are generally believed to outweigh the risks. But speak to a GP if you have any concerns about taking HRT.

Read more abouttherisks of HRT.

Speak to a GP if you're interested in starting HRT.

You can usually begin HRT as soon asyou start experiencing menopausal symptoms and will not usually need to have any tests first.

A GP can explain thedifferent types of HRTavailable and help you choose one that's suitable for you.

You'll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be someside effects at first.

A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT you're taking.

Most women can have HRT if they're having symptoms associated with the menopause.

ButHRT may not be suitable if you:

Inthese circumstances,alternatives to HRTmay be recommended instead.

There are many different types of HRT and finding the right 1 for you can be difficult.

There are different:

A GP can give you advice to help you choose which type is best for you.You may need to try more than 1 type before you find 1 that works best.

Find out more about the different types ofHRT.

There's no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment.

Most womenstop takingitonce their menopausal symptoms pass, which is usually after a few years.

Women who take HRT for more than 1 year have a higher risk of breast cancer than women who never use HRT. The risk is linked to all types of HRT except vaginal oestrogen.

The increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.

When you decide to stop, you can choose to do so suddenly or gradually.

Gradually decreasing your HRT dose is usually recommended because it's less likely to cause your symptoms to come back in the short term.

Contact a GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again.

As with any medicine, HRT can cause side effects. But these will usually pass within 3 months of starting treatment.

Common side effects include:

If you're unable totake HRT or decide not to,you may want to consider alternativeways of controlling your menopausal symptoms.

Alternatives to HRT include:

Several remedies (such as bioidenticalhormones) are claimed to help withmenopausal symptoms, but these are not recommended because it's not clear how safe and effective they are.

Bioidentical hormones are not the same as body identical hormones. Body identical hormones, or micronised progesterone, can be prescribed to treat menopausal symptoms.

Read more about alternatives to HRT.

Page last reviewed: 09 September 2019Next review due: 09 September 2022

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Hormone replacement therapy (HRT) - NHS

Menopause is a natural biological process that all women experience at some point in their lives. During this time, your body goes through numerous changes as it adjusts to fluctuating hormone levels. The hormones that once existed in such vast amounts begin to dwindle as you pass childbearing years, and theyll continue to decrease throughout the rest of your life. These changes can cause symptoms, such as hot flashes, mood swings, and even depression.

Hormone replacement therapy (HRT) can make a big difference in counteracting these symptoms by replacing the diminished hormones in a natural way. However, HRT isnt without risks. In fact, it has been linked to an increased risk of breast cancer, heart disease, and stroke. You should carefully consider these risks before deciding if HRT is the best treatment option for your symptoms.

In the early years of HRT, doctors most often prescribed it in the form of synthetic prescription medications. These drugs are made from a blend of hormones isolated from a pregnant horses urine. Premarin is the synthetic form of estrogen, while Provera is the synthetic version of progesterone. Though synthetic drugs used to be the preferred HRT theyve become less popular in recent years. Some risks were identified in clinical trials that led many women to seek out an alternative form of HRT called bioidentical HRT.

In bioidentical HRT, a pharmacist mixes a special blend of hormones intended to replace the depleted hormones in your body. Bioidentical hormones are generally extracted from elements found in nature. Its believed that your body is unable to differentiate between these hormones and the natural hormones your body creates. This way of tricking your body into its former state has been shown to be successful in many women. However, medical researchers dont yet know exactly how much of each hormone is needed. As a result, bioidentical HRT may involve multiple doctor visits and frequent tests to find the level of HRT dosing thats right for you.

Since each dose varies from person-to-person, bioidentical hormones are difficult to test for safety and effectiveness on an overall basis. The lack of information on the risks of bioidentical hormones causes many women to assume that these natural hormones are better or safer than synthetic hormones.

However, the word natural is open to interpretation. Bioidentical hormones arent found in this form in nature. Rather, theyre made, or synthesized, from a plant chemical extracted from yams and soy. This same chemical is used in soy supplements, so bioidentical hormones are technically categorized as natural supplements. As a result, the U.S. Food and Drug Administration regulates them under a different set of rules than those covering prescription and over-the-counter drugs. This means that bioidentical hormones dont need to be rigorously tested in humans, making it hard to know whether theyre safe or effective. Though theres no definitive answer, most experts believe bioidentical HRT involves the same risks as synthetic HRT. Neither type of HRT is considered to be safer than the other.

In your childbearing years, your ovaries produce estrogen and progesterone. These hormones regulate your reproductive cycle and promote the bodys use of calcium. The ovaries decrease their production of these hormones as you age, which often results in:

HRT replenishes estrogen and progesterone levels in the body, helping to reduce these effects. This type of treatment comes with other benefits as well. In addition to easing the symptoms of menopause, HRT may also reduce your risk for diabetes, tooth loss, and cataracts. Many women are able to live a more productive and comfortable life after successful HRT treatments.

While some health benefits are linked to HRT, several risks are associated with it as well.

HRT has been connected to an increased risk for certain types of cancers, especially breast cancer. The studies that discovered a link between HRT and breast cancer refer to women being treated with synthetic HRT, not bioidentical HRT. However, there are no studies that show that bioidentical HRT is any safer than synthetic HRT. The risk of breast cancer increases the longer a woman engages in any type of HRT, and the risk decreases once HRT is stopped.

A higher risk for uterine cancer also exists when menopausal women with a uterus use estrogen HRT only. This is why doctors will generally prescribe progesterone along with estrogen. If youve had a hysterectomy, you can forego progesterone and simply take estrogen.

Other risks for women undergoing HRT include osteoporosis and stroke. Osteoporosis is particularly prevalent among postmenopausal women, which is why synthetic HRT is now mostly used for short-term relief of menopause symptoms. However, its important to note that the risks of osteoporosis exist in menopause without HRT.

Though there are risks involved with HRT, its still the best way to treat severe menopause symptoms and improve quality of life. You and your doctor can discuss the risks and benefits for you specifically and evaluate other treatment options. Its critical to work closely with your doctor so you can decide whats right for you.

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Estrogen and Hormone Replacement Therapy: Is it Right for You?

Transgender hormone therapy, also sometimes called cross-sex hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is feminization or masculinization:

Some intersex people may also undergo hormone therapy, either starting in childhood to confirm the sex they were assigned at birth, or later in order to align their sex with their gender identity. Non-binary people may also undergo hormone therapy in order to achieve a desired balance of sex hormones or to pass as a desired gender. [1]

The formal requirements for hormone therapy vary widely.

Historically, many health centers required a psychiatric evaluation and/or a letter from a therapist before beginning therapy. Many centers now use an informed consent model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment.[2] Some LGBT health organizations (notably Chicago's Howard Brown Health Center[3] and Planned Parenthood[4]) advocate for this type of informed consent model.

The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC) require that the patient be referred by a mental health professional who has diagnosed the patient with persistent gender dysphoria. The Standards also require that the patient give informed consent, in other words, that they consent to the treatment after being fully informed of the risks involved.[5]

The World Professional Association for Transgender Health (WPATH) Standards of Care, 7th edition, note that both of these approaches to care are appropriate.[6]

The World Professional Association for Transgender Health (WPATH) and the Endocrine Society formulated guidelines that created a foundation for health care providers to care for transgender patients.[7] UCSF guidelines are also used.[8][citation needed] There is no generally agreed-upon set of guidelines, however.[citation needed]

Feminizing hormone therapy usually includes medication to suppress testosterone production and induce feminization. Types of medications include estrogens, antiandrogens (testosterone blockers), and progestogens.[9] Most commonly, an estrogen is combined with an antiandrogen to suppress and block testosterone. This allows for demasculinization and promotion of feminization and breast development.

Masculinizing hormone therapy usually includes testosterone to produce masculinization and suppress the production of estrogen.[10] Treatment options include oral, parenteral, subcutaneous implant, and transdermal (patches, gels). Dosing is patient-specific and is discussed with the physician.[11] The most commonly prescribed methods are intramuscular and subcutaneous injections. This dosing can be weekly or biweekly depending on the individual patient.[citation needed]

Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional.[12] There are potential risks with hormone treatment that will be monitored through screenings and lab tests such as blood count (hemoglobin), kidney and liver function, blood sugar, potassium, and cholesterol.[11][9] Taking more medication than directed may lead to health problems such as increased risk of cancer, heart attack from thickening of the blood, blood clots, and elevated cholesterol.[11][13]

Transgender hormone therapy may limit fertility potential.[14] Should a transgender individual choose to undergo sex reassignment surgery, their fertility potential is lost completely.[15] Before starting any treatment, individuals may consider fertility issues and fertility preservation. Options include semen cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation.[14][15]

A study due to be presented at ENDO 2019 (the Endocrine Society's conference) reportedly shows that even after one year of treatment with testosterone, a transgender man can preserve his fertility potential.[16]

Many providers use informed consent, whereby someone seeking hormone therapy can sign a statement of informed consent and begin treatment without much gatekeeping. For other providers, eligibility is determined using major diagnostic tools such as ICD-10 or the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric conditions can commonly accompany or present similar to gender incongruence and gender dysphoria. For this reason, patients are assessed using DSM-5 criteria or ICD-10 criteria in addition to screening for psychiatric disorders. The Endocrine Society requires physicians that diagnose gender dysphoria and gender incongruence to be trained in psychiatric disorders with competency in ICD-10 and DSM-5. The healthcare provider should also obtain a thorough assessment of the patient's mental health and identify potential psychosocial factors that can affect therapy.[17]

The ICD-10 system requires that patients have a diagnosis of either transsexualism or gender identity disorder of childhood. The criteria for transsexualism include:[18]

Individuals cannot be diagnosed with transsexualism if their symptoms are believed to be a result of another mental disorder, or of a genetic or chromosomal abnormality.[citation needed]

For a child to be diagnosed with gender identity disorder of childhood under ICD-10 criteria, they must be pre-pubescent and have intense and persistent distress about being the opposite sex. The distress must be present for at least six months. The child must either:

The DSM-5 states that at least two of the following criteria must be experienced for at least six months' duration for a diagnosis of gender dysphoria:[19]

In addition, the condition must be associated with clinically significant distress or impairment.[19]

Some organizations but fewer than in the past require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience (RLE). The Endocrine Society stated in 2009 that individuals should either have a documented three months of RLE or undergo psychotherapy for a period of time specified by their mental health provider, usually a minimum of three months.[20]

Transgender and gender non-conforming activists, such as Kate Bornstein, have asserted that RLE is psychologically harmful and is a form of "gatekeeping", effectively barring individuals from transitioning for as long as possible, if not permanently.[21]

Gender-affirming care is health care that affirms people to live authentically in their genders, no matter the gender they were assigned at birth or the path their gender affirmation (or transition) takes. It allows each person to seek only the changes or medical interventions they desire to affirm their own gender identity, and hormone therapy (HRT or gender-affirming hormone therapy) may be a part of that. [22]

Some transgender people choose to self-administer hormone replacement medications, often because doctors have too little experience in this area, or because no doctor is available. Others self-administer because their doctor will not prescribe hormones without a letter from a psychotherapist stating that the patient meets the diagnostic criteria and is making an informed decision to transition. Many therapists require at least three months of continuous psychotherapy and/or real-life experience before they will write such a letter. Because many individuals must pay for evaluation and care out-of-pocket, costs can be prohibitive.

Access to medication can be poor even where health care is provided free. In a patient survey conducted by the United Kingdom's National Health Service in 2008, 5% of respondents acknowledged resorting to self-medication, and 46% were dissatisfied with the amount of time it took to receive hormone therapy. The report concluded in part: "The NHS must provide a service that is easy to access so that vulnerable patients do not feel forced to turn to DIY remedies such as buying drugs online with all the risks that entails. Patients must be able to access professional help and advice so that they can make informed decisions about their care, whether they wish to take the NHS or private route without putting their health and indeed their lives in danger."[23] Self-administration of hormone replacement medications may have untoward health effects and risks.[24]

A number of private companies have attempted to increase accessibility for hormone replacement medications and help transgender people navigate the complexities of access to treatment. Plume is building a healthcare service specifically for the transgender community.[25] In September of 2020, Plume partnered[26] with Solace to expand accessibility and awareness of Gender-Affirming Hormone Therapy (GAHT). Solace is a mobile application focused on providing access to credible, relevant transition information and allowing users to create a custom transition roadmaps and goals.[27]

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Transgender hormone therapy - Wikipedia

ExploreMenopause affects both gray and white brain matter, study finds

By 2025, more than 1 billion women around the globe will be postmenopausal, according to the North American Menopause Society, and yet, while most women generally know what menopause is, the modern characterization of this transition as negative or mysterious has left them without a deeper understanding.

In some ways, that seems to be changing as conversation about menopause becomes more normalized. New products, books and communities are cropping up daily providing women with information and support through menopause. Dr. Jen Gunter, author of The Menopause Manifesto (Kensington, $18.95), said in an essay for The New York Times the time has come for a feminist menopause that rejects the patriarchal notion that a womans worth is tied to her ovarian function and that the end of her reproductive life represents the end of her productive life.

The femtech industry which refers to software and technology designed to address the health care needs of women is expected to reach almost $50 billion by 2025 and menopause management has high market potential as indicated by the explosion in startup companies focusing on the area.

Its hard to miss all the advertisements for products that claim to alleviate symptoms of menopause from the inside out. Supplements claiming to relieve hot flashes, sleep disturbances and mood swings are widely available but have little supporting evidence on their efficacy. Other products take a more general focus, such as skin creams or shampoos, specifically advertised to address the skin and hair concerns of women in perimenopause.

In the 1960s, estrogen replacement became the dominant regimen for treating menopause, but estrogen is not the wonder drug everyone thought it was, writes Susan Mattern, distinguished research professor of history at the University of Georgia and author of The Slow Moon Climbs (Princeton, $19.95), and while hormone replacement therapy may help with hot flashes, studies have revealed that it also comes with elevated risk of stroke, breast cancer, heart disease and more.

Most doctors advise short-term hormone replacement and only for severe symptoms, Mattern said, but when women are hyper-focused on physical symptoms that we attribute to menopause, they could be missing the bigger point.

Usually it is hard for me to listen to conversations about menopause because most of what people say about it is wrong, she said. We think of it as a medical condition and something you need to go to the doctor for. There has been an enormous amount of profit made off of menopause, selling drugs to women who think they are sick.

Because menopause can impact so many different systems in the body, addressing any concerns requires a multidisciplinary approach, one that doesnt place outsized importance on menopause as a physical transformation. I wish doctors would become more educated about what other disciplines are saying about menopause, said Mattern.

Menopause only became a subject of medical interest in Europe in the 18th century, said Mattern in her book, and our understanding of it rests on that most recent and somewhat faulty foundation. For most of human history, menopause has been seen as a developmental transition to an important stage of life something we should consider a solution rather than a problem, Mattern writes.

Why would animals outlive a time when they can reproduce copies of themselves? (Menopause) is something that has been important to the success of our species, said Mattern. Because women have a long post-reproductive life stage, humans across time have been able to rapidly populate while also controlling population size and managing resources.

So why do so many women seem to be in the dark about the changes to their bodies?

We dont talk about it because it is a mortifying subject, Mattern said. There is no reason to fear menopause and there is no reason to be embarrassed about it.

Part of changing the narrative means creating a space for women to talk about menopause in a more revolutionary manner than what has existed in the past.

About five years ago, Licia Freeman, a marriage and family therapist in Atlanta, created a 12-week menopause therapy group when she began attracting clients that mirrored what was happening in her own life.

It was not a group to just complain, Freeman said. It was about menopause but it merged into more existential topics what is going on in their lives outside of their bodies.

The women discuss careers and retirement, relationships, travel and how to manage it all during a perimenopausal and postmenopausal period that they are learning to reframe as a time and space for living life more passionately and freely. Freeman helps the women find skills to manage depression, anxiety and irrational thinking that may be exacerbated by the traditional messaging surrounding menopause.

There are so many necessary losses in life. We are constantly grieving something, said Freeman. The aim is to reach acceptance. (Menopause) is a stage of life with no limitation really.

Read more on the Real Life blog (www.ajc.com/opinion/real-life-blog/) and find Nedra on Facebook (www.facebook.com/AJCRealLifeColumn) and Twitter (@nrhoneajc) or email her at nedra.rhone@ajc.com

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OPINION: Changing the myths, mystery and mortification around menopause - Atlanta Journal Constitution

The Department of Health and Human Services (DHHS) is the U.S. federal government agency responsible for protecting the health of the American public.

The DHHS HIV guidelines help inform healthcare professionals of the best ways to treat HIV based on the latest clinical evidence and expert opinions.

In this article, we break down some of the key points of the DHHS guidelines and what to know about the most recent changes.

The main goal of the DHHS guidelines is to offer recommendations to healthcare professionals on the best treatment options for people with HIV. The guidelines are written and updated based on the most recent scientific evidence.

Doctors can consult these guidelines to determine the right treatment at various stages of HIV. For example, the guidelines provide recommendations on when to start antiretroviral therapy (ART), which drugs should be used, and what to do if initial treatment isnt working.

The full guidelines provide a long list of recommendations you can read here. Weve summarized some key points below so you can get an idea of the type of information these guidelines include.

Initial HIV treatment generally consists of two medications called nucleoside reverse transcriptase inhibitors in combination with a third active antiretroviral (ARV) drug from one of three drug classes:

The following drug regimens are classified as recommended initial regimens for most people with HIV. A slash (/) between medications means theyre available as a combination drug within the same pill:

When ART isnt working, several factors should be considered, including:

At the time this article was written, the DHHS guidelines were most recently updated on June 3, 2021.

Researchers are continuing to improve their understanding of how to best treat and manage HIV. The guidelines are updated periodically to include the latest research and expert opinions.

Heres an overview of the most recent changes included in the 2021 update.

New evidence from the Botswana Tsepamo Study, an ongoing observational study that started in 2014, suggests that the rate of neural tube defects (a type of structural change in a developing fetus) is lower than expected in women taking dolutegravir at the time of conception.

Dolutegravir is now recommended as an initial treatment option for people who may get pregnant.

The medication raltegravir was moved from recommended initial regimens for most people with HIV to recommended initial regimen in certain clinical situations.

The change was partially made due to the results of the Botswana Tsepamo Study. Since dolutegravir is now a viable treatment for people who can get pregnant, its no longer necessary to choose raltegravir over dolutegravir.

It was initially recommended that if ART treatment doesnt work, it should be followed by two and preferably three fully active ARV drugs.

Its now recommended that the new treatment can include two fully active drugs if at least one has a high resistance barrier. Examples of such drugs include boosted darunavir or dolutegravir. The change was made based on the results of ongoing clinical trials.

Updates include the mechanism behind declining CD4 counts despite suppressive ART.

CD4 cells are a type of white blood that fights infections. Knowing a persons CD4 count helps determine their risk of developing opportunistic infections.

The new guidelines also include updated strategies to reduce persistent inflammation.

Updates include the role of long-acting injectable regimens cabotegravir plus rilpivirine. Long-acting injectables are a new form of ART that involve infrequent injections instead of daily oral medication.

The Food and Drug Administration (FDA) approved the first long-acting injectable for treating HIV in January 2021.

The adolescent and young adults section has been updated to include current data on the rate of HIV among youth in the United States.

The guidelines now also have more details on the unique challenges that youth with HIV face compared to adults.

This section now includes data from a 2020 review of eight studies that found that women are more likely to gain weight than men after starting ART.

Theres also now more information regarding the effects of menopause and hormone replacement therapy while on HIV treatment.

This section now includes information about when to consider the long-acting injectable cabotegravir plus rilpivirine in people with a substance use disorder.

Current research is limited to people with good medication adherence.

Newly discovered drug interactions have been included in the guidelines, including interactions between the drugs cabotegravir plus rilpivirine and fostemsavir.

A section was added discussing the cost effectiveness of new drugs, such as ibalizumab, in HIV thats resistant to multiple ARV drugs.

Monthly prices of commonly prescribed ARV drugs have been updated with 2021 prices.

Updates describe current recommendations for ARV drugs that can be used if 3 months of isoniazid and rifapentine are prescribed for tuberculosis.

There are many free or low-cost programs available to help people with HIV. Here are some resources that may be helpful:

The DDHS HIV guidelines were developed to help healthcare professionals stay up to date with the latest HIV research so they can provide the best possible treatment. The guidelines are updated regularly as new research or evidence becomes available.

The guidelines are available online for free to anybody who wants to read them.

Original post:
Overview of the Latest DHHS HIV Treatment Guidelines - Healthline