Category Archives: Hormone Replacement Therapy

If you've experienced gender dysphoria the distressing feeling that occurs when your gender identity differs from the one you were assigned at birth you might have considered hormone-replacement therapy. Originally, HRT referred to the process of prescribing sex hormones like estrogen to people going through menopause as a way of treating symptoms such as hot flashes (a practice that has since been the subject of some controversy). But today, the term "HRT" is commonly used to describe "gender affirming hormone therapy" for "individuals who are seeking to alter their secondary sex characteristics for a more 'masculine' or more 'feminine' gender presentation," as defined by Folx, an online health and wellness provider for the LGBTQ+ community. At Folx and other gender-affirming-therapy providers, HRT involves using hormones like estrogen or testosterone to give the body a more traditionally feminine or masculine appearance to match one's gender identity.

While many trans and nonbinary people describe the medicine as life-saving, the process isn't for everyone, nor is it a requirement for trans and nonbinary people. "HRT does not make a trans person trans," stresses TikToker and professional actor Dylan Mulvaney, a trans woman who has been chronicling her self-described girlhood on the app. "If there is a trans person out there, and for whatever reason, they don't think HRT is right for them right now, or ever, we need to see them as such and respect their pronouns as such," Mulvaney adds.

The decision to start HRT is individual and can be complex. Sade Bolger, a Vermont-based activist and public-affairs organizer for Planned Parenthood, started HRT specifically testosterone therapy (or T) in May of 2017. But when he began, the decision was one of uncertainty. "When I did start T, I didn't really actually fully feel like I did know that for certain this is going to be the right thing," Bolger says. "I stepped into T in an explorative way, having seen other people who had gone through that process, and utilized it as a tool for self-discovery and self-exploration."

California-based Mulvaney echoes a similar sentiment: "The initial reason for going on HRT was just to sort of explore what that side to me was." Before beginning HRT, the actor had considered themself nonbinary for about 18 months. "But I always knew that I wanted to be more feminine," she says. "And even while I was nonbinary I knew that I loved the features on a woman, that I would love to have." Even so, she tells POPSUGAR, "I was so nervous to start [HRT] because it really is a huge decision to be potentially altering your body."

Josie Moon, another trans TikToker, also described her decision to start HRT as a tough one. Moon says she didn't know what the word "trans" meant until she was late into high school. The Nashville-based content creator got married at 24 years old, came out to her now-ex-wife as trans about two years into their marriage, and decided to get divorced just before the 2020 COVID lockdown. Through her own research, she discovered that some trans people don't take hormones. When making the choice for herself, she considered how it would affect her. "I was very concerned that even if I went on hormones at 29, it wasn't going to be enough for me to feel comfortable in my body," Moon tells POPSUGAR.

So she gathered more information, reading relevant threads on Reddit and Twitter and speaking to others in the trans community to make sure HRT was the right decision for her. "There's a subreddit called Trans timelines which shows pictures of mostly trans women but also trans men, really trans people in general before and after hormones," Moon says. "And I was like, wow, these people are the same age as me . . . and they look amazing. The results are amazing. So maybe this could work for me too." It had gotten to the point, Moon says, where she was constantly looking at these pictures and "imagining just feeling comfortable in my body and what that would look like." Now, two years on HRT, Moon is happy with her decision to start the therapy. So are Mulvaney and Bolger. "I look at myself in the mirror now and every day I get a little bit closer to finding myself to be a beautiful woman," Mulvaney says. "I think it was through the process of experiencing the changes that came alongside taking T that really kind of confirmed for me that this was what I wanted to do and who I wanted to be on the planet," says Bolger.

If you're still trying to figure out whether HRT is right for you, this explainer will help answer some of your questions, including what to ask your doctor, when to expect changes, and what side effects to be aware of.

Masculinizing or feminizing hormone therapy, also commonly referred to as hormone-replacement therapy or HRT, is a process used to "induce the physical changes in your body" caused by male or female hormones "to promote the matching of your gender identity and body (gender congruence)," per the Mayo Clinic.

Someone transitioning from male to female (MTF) would typically use feminizing hormone therapy and "be given medication to block the action of the hormone testosterone. You'll also be given the hormone estrogen to decrease testosterone production and induce feminine secondary sex characteristics," the Mayo Clinic states. In a female to male (FTM) transition with hormone therapy, "you'll be given the male hormone testosterone, which suppresses your menstrual cycles and decreases the production of estrogen from your ovaries."

The method in which those hormones are administered can vary, says Dave Usman, nurse practitioner at Radiant Health Centers, a California-based LGBTQIA+ Health and HIV care center. "It depends on the comfortability of the individual that's seeking hormone therapy," he says. For those receiving masculinizing HRT through testosterone, there are two options, Usman says. The most common route is injection. "It can be self-administered or office-administered," he says. There's also a topical gel option. For estrogen therapy, there's a pill, injectable, or patch.

Not every hospital or clinic provides gender-affirming healthcare. There are some instances in which medical providers can get exceptions, specifically hospitals and clinics with religious affiliations. It's important to do your research beforehand to ensure that you can get the care you need.

Bolger was referred to an endocrinologist after expressing to his therapist that he was considering HRT. Mulvaney recommends going to a queer health center in your area. "The great part is that they focus primarily on queer trans clients, so they are very in the know as far as treatment plans," she explains. Another good option? An informed-consent clinic, which means that a referral or therapy note is not required to receive care. (Planned Parenthood is an informed-consent clinic.) You can also receive hormone therapy online through services like Folx and Plume.

As far as cost goes, many insurance plans cover hormone therapy. For those who are uninsured or have trouble accessing hormone therapy, health centers like Radiant Health rely on contracted pharmacies that provide the medication at a low out-of-pocket cost for patients. Brands like Folx also offer an HRT care fund which distributes financial resources to an annual grant covering 12 months of hormone-replacement therapy, including prescription medication, unlimited clinical visits and messaging, and labs. Eighty percent of the Folx HRT grants are reserved for BIPOC. Eligibility starts at 18 years old, and you must live in a state where Folx is currently available.

"The first visit is mainly educating the patient, asking questions, and telling them what is expected," Usman says. "And then, once they have all the questions answered, they feel like they're ready, they're mentally and physically ready, that's when we start initiating therapy." That initiation point can be that day or weeks later. It's really about the patient's comfortability level.

Mulvaney first went to get information and ask questions about the process and then was prescribed spironolactone and estradiol. Spironolactone is a testosterone blocker and estradiol is a form of estrogen. "I went for the information, I got it, I got my mind put at ease. And then I started [the hormones] a few weeks later," Mulvaney says. She adds that she started out with a low dosage "because I was still new to it. I was nervous. I just didn't want to throw myself into it too fully quite yet."

One major conversation you should have with your provider, Mulvaney stresses, is about reproductive options, which will change during hormone therapy. Testosterone and estrogen therapy can lower your sperm count or egg production and may permanently change or stop your body's production of eggs and/or sperm altogether. So if someone is planning to undergo hormone therapy and they may want to conceive a child in the future, Usman says it's encouraged to do egg or sperm retrieval or freezing. "I actually didn't start the spironolactone until recently because I wanted to freeze my sperm first," Mulvaney says. "Being in my 20s, I just wanted to keep all my options open for the future and family planning because I don't know what that's going to look like when I'm older." But Bolger adds that not knowing what you want your reproductive options to be is OK, too. They started T when they were 19 years old. "I didn't know what I wanted to do reproduction wise I still don't. I'm 23 now, and I'm still figuring it out." But it's important that you know all of your options and make the decision that's best for you.

Everyone's timeline of changes is different, but Usman says you can start to see small physical changes as early as a month in.

"My first sort of notice was stretch marks on my booty," says Mulvaney. It was an unexpected surprise to her less than three months on HRT, in addition to a smoothing of her face and the loss of muscle mass in the chest. "I never had hard nipples before," Mulvaney says. "And now they are starting to bud."

For Bolger, the most notable initial changes were voice deepening, peach-fuzz hairs on the lip, and clitoral enlargement, which is commonly referred to as bottom growth. In terms of mood, Bolger says, "My libido pretty greatly increased and stayed kind of intense for the first couple of months into that first year." They also dealt with recurring mood swings. But this was predominantly "just during the period of time where my hormone balance was off because I was transitioning between estrogen and testosterone. And once I kind of plateaued with the T in my body, and that became the main hormone in my body, then all that stuff kind of settled out."

What's important to note is that the mental and emotional changes are just as important to address as the physical ones, and they may hit you sooner. "The first two weeks, I'm not gonna lie, were tough. I didn't feel like myself in some ways. My mind was foggy, I felt very emotional, I had some anxiety," says Mulvaney. These changes ultimately went away, or Mulvaney became accustomed to them. "I think my body learned to accept that this was the new normal and I started to feel like myself again," she says.

Therapy also helped, she adds. "I'm in therapy once a week and I have been with the same therapist for two years, it's changed my whole life and outlook on things." With HRT, you're seeing a doctor every three months or so for check-ins. "But you also need to have a support system in place that can help you with the day-to-day, because it can get pretty overwhelming," says Mulvaney.

Moon agrees that at times, the emotional aspects of HRT can become overwhelming. "When I was younger, I used to say I had three emotions angry, happy, neutral and that was just how it was," says Moon. But in starting HRT, she unlocked a new range of emotions with various depths and layers. "Angry is actually, 'I'm a little bit hungry, but I feel hurt and misunderstood and just sad in general.' And then when I was happy, I'm not just happy or euphoric, it's like, 'I'm excited about this and there's a little bit of joy about this.'" The whole process is "also a little bit bittersweet, because in transitioning, I get to be myself, but I also lost so, so much and had to rebuild," Moon says. "I think emotionally, it took me off guard."

One change that Bolger says he was the most unprepared for is the way others perceive him. "I absolutely took on male privilege," he says. "I noticed that I was being treated differently. The men in the room would shake my hand before they left. I was listened to more. There was more of a platform in a space, people kind of waited for me to have something to say." Emotionally, Bolger says it was "so weird." Because they don't identify as a man, "it was like switching from feeling misgendered on one side to feeling misgendered on the other side." He also says the transition between living the first 18 years experiencing sexism against women only then to be welcomed and respected by sexist men was "not ever in my intentions." There's this layer of complexity for nonbinary individuals, Bolger says, because T or no T, "we live in a society where people assume that you're either a man or a woman."

Another unexpected change? Anecdotally, many people on T have said that it changes their sexual attraction, especially as it pertains to men. Bolger says that being on T hasn't necessarily changed his attraction level to men but rather his comfortability level being with a man. "I felt really uncomfortable being with men, for example, when I was younger, because I knew that that would make people see me as a girl," Bolger says. Being on T changed the way people perceived them and how Bolger perceived himself. Ultimately, "T didn't make me stop loving women. T didn't make me start loving men. T didn't change anything about who I loved or who I f*cked. It changed my comfort, being in those relationships and having those experiences because of how I was feeling and perceiving myself."

Yes. "That's why we screen people initially for their past medical history and family history, because both [hormones] have side effects and adverse effects that can affect their overall health," says Usman. Hormone therapy can aggravate pre-existing depression and anxiety. Other complications include developing diabetes, high cholesterol, high blood pressure, and blood clots. If you're a chronic smoker in particular and you're on estrogen, "there's higher risk of developing blood clots," Usman says. So be sure to be honest about all of your lifestyle habits within that first meeting so that your provider can assess your needs and design a hormone-therapy plan that works best for you.

Bolger, for example, is neurodivergent. "I have ADHD. I sometimes struggle with routine, like hygiene care, because of that," Bolger says, and talking to his provider about that openly was "really important" in figuring out which form of T was right for them. For example, the topical gel has to be applied once a day. "It has to be a part of your routine and for me with my ADHD, that wasn't something that I really thought was going to be plausible," Bolger says. So he went with the weekly injections instead. Even so, Bolger experienced health complications, including ovarian cysts, which were caused by going off schedule on T, a diversion caused by his ADHD. That's why Bolger emphasizes the importance of seeking out a provider who can assess and treat your whole self someone who will be looking our for your mental, physical, and emotional health not just you as a trans person, but you as a whole human, too.

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Hormone-Replacement Therapy Is Life-Changing: What to Consider Before Getting Started - POPSUGAR

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Hormonal therapy has emerged as one of the most advanced treatments for cancer, premature puberty, and excessive hair growth. But, doctors here on Tuesday warned people to be conscious about the therapy and undergo tumour screening as the high doses of hormonal drugs can increase the risk of Meningiomathe most common benign brain tumourparticularly in women.

Meningioma is mostly a non-cancerous brain tumour arising in the layers of tissue (meninges) that surround and protect the brain and spinal cord. Although the majority of meningiomas are benign, these tumours can grow slowly until they are very large, if left undiscovered, and, in some locations, can be severely disabling and life-threatening.

World Brain Tumour Day is observed annually on June 8 to raise awareness of the condition.

The fluctuations in meningioma growth during the menstrual cycle, pregnancy, and breastfeeding are well-documented. These tumours have hormonal receptors in certain meningiomas located at the base of the skull.

"There is also an association between the growth of meningiomas and hormonal treatments, particularly prolonged and high dose use of the drug cyproterone acetate (CPA)," said Dr Nagesh Chandra, Senior Consultant and HOD, Neurosurgery and Spine Surgery, Aakash Healthcare. "The higher the dose, and the longer the drug is taken for, the greater the risk of meningioma," he added.

Cyproterone acetate is a steroid used in combination with Ethinyl oestradiol to treat women with severe acne. But recent studies, published in peer-reviewed journals Scientific Reports and The BMJ showed high doses of the widely-used drug can raise the risk of brain tumours by seven-fold.

In men, it is used to treat inoperable prostate cancer, while in women it is used for conditions such as severe acne and excessive hair growth. Very small doses are also used in birth control pills and hormone replacement therapy.

The occurrence of meningiomas has been reported in association with the use of cyproterone acetate, primarily at doses of 25 mg/day and above.

"When hormone medicine doses are high and therapy is prolonged, the chances of meningioma formation increase. Meningioma develops in the tissues that surround and protect the brain and spinal cord (meninges). However, the risk decreases significantly after the treatment is discontinued," said Dr Arun Sharma, Consultant, Neurosurgeon, Indian Spinal Injuries Centre.

"We've had a number of cases of meningioma in our hospital in the last couple of years. All of them had long-term usage of high-dose cyproterone acetate. This drug's dosage ranges from 25mg to 100mg daily, depending on the patient's condition. It has been discovered that cyproterone acetate increases the risk of meningioma by a factor of around 10," Sharma added.

However, it has been seen that the risk of meningioma decreases noticeably after hormonal therapy is stopped. Therefore, it's essential that people who use high dose cyproterone acetate for at least three to five years should be informed about the increased risk of meningioma by their doctor.

Symptoms of meningioma include changes in vision, hearing loss or ringing in the ears, loss of smell, headaches, memory loss, seizures or weakness in arms and legs.

If a patient is diagnosed with meningioma, treatment with cyproterone medicines must be stopped permanently, according to recommendations from the European Medicines Agency as well as the UK Health Security Agency.

The agencies recommend women take only daily doses of 10 mg. In men, cyproterone medicines should only be used to reduce sex drive in sexual deviations when other options for treatment are not suitable.

"Reasons for prescribing cyproterone acetate should also be clearly defined by the doctor. It should be prescribed with the lowest possible daily dose to avoid the development of tumours in the body. When prolonged use of high dose cyproterone acetate is necessary, more thorough screening should be considered, and in patients with a documented meningioma, cyproterone acetate should be discontinued," Sharma noted.

**

The above article has been published from a wire agency with minimal modifications to the headline and text.

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High Doses of Widely-Used Cancer Drug in Hormonal Therapy Can Increase Risk of Brain Tumour in Women by Seven Times | The Weather Channel - Articles...

The first product for male birth control isalmosthere.

In the first phase of clinical trials, two experimental male contraceptive pills -DMAU and 11-MNTDC - appearedto effectively lower testosterone without causing unacceptable side effects.

The study will be presented on Monday at ENDO 2022, the Endocrine Society's annual meeting in Atlanta, Ga, as per a press release.

According to the researchers, there are similar pathways for the hormonal control of reproductive function in women.

"We are building on the knowledge of many decades of contraceptive development for women as well as our success with other combination hormonal methods such as Nestorone (a progestogen) and Testosterone gel for regulating LH secretion and sperm production in men," lead researcher,Tamar Jacobsohnof the Contraceptive Development Program (CPD) at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Dr.Diana Blithe, Program Chief of CDP, toldIEin an interview.

Ever since thebirth control pill was first approved as a contraceptive in the US in 1960, the onus of birth control has largely fallen on people with female reproductive systems.

According to the Centers for Disease Control and Prevention(CDC), in 2015-2017, 64.9 percent of the 72.2 million women aged 1549 in the United States were using contraception, with the most common method being female sterilization, oral contraceptive pills, long-acting reversible contraceptives (LARCs), and the male condom (8.7%).

Data from the 20152017 National Survey of Family Growthrevealed that nearly all women use some form of contraception methodat some point in their lifetime. Currently, the US Food and Drug Administration has approved 17 birth control methods for people with female reproductive systems and only two for people with male reproductive systems - condoms and vasectomy. Some people also practice methods such as natural family planning (or "fertility awareness") or the pullout method, but both of these methods have a very high rate of failure.

In recent years, there have beenreports of trials for hormone gels and injectionsfor men, but these are not widely available. According to data from Global Market Insights, if a new male contraceptive method were to be approved in the next five years, the market is projected to be around $1 billion by 2024 and could grow at the rate of six percent over the next ten years,

As yet, however, there areno new birth control methods on the market for those who produce sperm.

There have been several challenges when it comes to developing a male hormonal contraceptive.

"The first includes developing a first-of-its-kind drug to be used by healthy men who do not face health risks from pregnancy," said Blithe and Jacobsohn.

This sets the bar for safety very high. As always, with the new medication, extensive testing is required to ensure that there are no health risks, which is different from the side effects, they stressed.

Androgens are male hormones; these are naturally produced in the body and are a requirement for the normal sexual development of both males and females. In males, the predominant androgen is testosterone. In genetic males,testosterone has a number of roles, includingregulating sex drive, bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm.

However, current formulations of oral testosterone derivatives require multiple doses per day.

There have been a number of obstacles to the development of a male oral contraceptive.One is that reliably and completely blocking the production of millions of sperm every day (in males) versus preventing the release of a single egg a month (in females) is a lot more complicated, biologically speaking. Those drugs that have been tested have often had serious side effects.

However, there has also been little interest from largepharmaceutical companies, some of whom make billions from the female contraceptive pill, and there is little funding available for clinical trials of these drugs. All of this makes the research more challenging.

However, "With more awareness of the potential market for these products, through clinical trials and acceptability trials globally, large pharmaceutical companies may become more interested in supporting the research. If that happens, through our research efforts and the efforts of male contraceptive development generally, it could help speed up the process of developing more options for men," Blithe and Jacobsohn said.

The drugs involved in the current study are Dimethandrolone (DMA) and 11-methyl-19-nortestosterone (11-MNT), which areprogestogenic-androgens,which means they are single agents with two functions.

To elaborate, "the progestogenic function serves to lower the pituitary production of gonadotropin hormones (FSH and LH). Inhibiting LH leads to lower testosterone in the testis," according to Blithe and Jacobsohn.

In theory, sperm production would be inhibited in the absence of adequate testosterone in the testis.

Why these specific compounds?

"The androgenic function of these molecules supports sexual function and other bodily functions that rely on adequate testosterone levels in the blood. These progestogenic androgens are being tested because they are orally bioavailable and thus can be used as a pill (research shows that men would like to use oral pills), and because both functions may be delivered with a single drug instead of two combined drugs," Blithe and Jacobsohn explained.

The study included 96 healthy male participants in two Phase 1 clinical trials. As aforementioned, the usage of DMAU and 11-MNTDC suppress testosterone. Lowering testosterone levels can lead to unpleasant side effects, but most men involved in the study were willing to continue using the drugs.

"Many of the men joining our clinical trials are extremely enthusiastic about the prospect of male contraception. They are dedicated to helping move the product forward through clinical trials," Blithe and Jacobsohn said.

In each trial, the men were randomly assigned to receive doses of two or four oral pills, of either the active drug or the placebo, daily for 28 days. Testosterone levels in those taking the active drug notably dropped below the normal range after seven days on the active drug. And in men taking the placebo, testosterone levels stayed within the normal range.

Among the participants, 75 percent of the men who took the active drug said that they would be willing to use it in the future, in comparison with 46.4 percent of those who took the placebo.

It was also observed that men who took the four-pill daily dose (400 milligrams) had lower levels of testosterone than those taking the two-pill, 200-milligram dose.

Despite thefact that lowering testosterone levels can lead to unpleasant and serious side effects, many researchers favor contraceptives that use hormones.

"Research on non-hormonal methods is quite active, with several different mechanisms being explored," Blithe and Jacobsohn said.

A few months ago, a team of researchers based at the University of Minnesota Twin Cities tested the compound YCT529,which focuses on receptors for a specific form of vitamin A, called retinoic acid, that's essential to the growth and development of cells and embryos. After the drug was given to mice for several weeks, the pregnancies among the mice went down.

"No [non-hormonal medication] has successfully transitioned to clinical evaluation, but progress is being made toward that goal. It cannot be assumed that non-hormonal methods will be free of side effects, so we will have to wait for those clinical trials to begin to see if anything emerges that was not evident in pre-clinical qualifying studies," Blithe and Jacobsohn said.

Jacobsohn and her team are working with contraceptive mechanisms to replace androgen function either with testosterone or other androgenic drugs to minimize or prevent side effects.

And in the current studies, no adverse effects or side effects were observed with either of the drugs. "Mild side effects included acne and changes in libido (both increased and decreased), headaches, and erectile dysfunction in a few individuals. All side effects were resolved by the end of the study," they said.

In the Phase 1b trial of testing, the researchers are looking at the pharmacodynamics, pharmacokinetics, and safety of the drug.

After Phase 1 trials, longer and larger studies are required, the researchers pointed out. "Since the treatment is used in healthy men, the studies are sequential and escalating to ensure that safety is maintained across longer treatment in a larger number of individuals," Blithe and Jacobsohn said.

Phase 2 trials would look at the longer periods of treatment to confirm safety "and determine if the drugs can inhibit sperm production."

Additionally, researchers at the CDP are also amid conducting a Phase 2b (efficacy) trial for a combination Nestorone/Testosterone gel product, "which we hope will be the first groundbreaking product for male contraception, thus paving the way for other drugs to become available within the next ten years," Blithe and Jacobsohn said.

If drugs successfully reach Phase 2b efficacy testing in couples, the trials will be lengthy, requiring a two-year commitment from couples to demonstrate suppression, efficacy, and recovery. Discussions with the FDA on what would be expected in Phase 3 will take place if the Phase 2 trials are successful.

The researchers are hoping to create a birth control pill that can be taken once daily, like those which are available for women.

"Given that these drugs also combat the side effects of hypogonadism with their androgenic effects, further research is necessary to look at them as a possibility for androgen replacement therapy as well. Similar to the use of hormonal birth control for women for a variety of reasons other than pregnancy prevention, the same may be possible for men," Blithe and Jacobsohn said.

Just the prospect of male contraception becoming widely available is imperative for reproductive autonomy and equality. "The development of contraceptive products for men will both increase available options for men and allow for many women to have more options for sharing the contraceptive burden," they added.

Abstract:A promising development in hormonal male contraception (HMC) is a class of bifunctional prodrugs that combine both androgenic and progestogenic activities into a single molecule. Examples of these prodrugs currently being studied are dimethandrolone undecanoate (DMAU) and 11-methyl-19-nortestosterone-17-dodecylcarbonate (11-MNTDC) (1, 2). The inactive prodrugs are cleaved to release active drug over a 24-hour timeframe, providing once-a-day dosing. As potent androgens, these steroids suppress gonadotropin secretion, leading to markedly decreased serum testosterone production and circulating levels. Low testosterone levels might lead to unpleasant symptoms of hypogonadism if DMAU and 11-MNTDC are not providing sufficient and effective androgenicity. Therefore, we examined the impact of the novel progestogenic androgens on serum testosterone levels and acceptability of varying dosages of these oral prodrugs in a secondary analysis of two Phase 1 placebo-controlled trials. Healthy male participants were randomized to take two or four oral pills of active drug or placebo per day. As DMAU and 11-MNTDC share similar mechanisms of action and tolerability, we examined the association of dosage as well as testosterone concentrations on combined drug acceptability versus placebo. Survey respondents across the two trials (39 DMAU, 30 11-MNTDC, 28 combined placebo group) shared similar baseline demographics. After seven days of usage, testosterone levels for those using either prodrug dropped to levels below 100 ng/dL while testosterone levels for those using the placebo (400-600 ng/dL) remained within the reference. Recipients of either DMAU or 11-MNTDC reported greater willingness to use the active prodrug in the future (75%), compared to placebo recipients (46.4%, p=0.007). Throughout the 28-day oral pill usage, while average testosterone levels during the period of suppression (day 7 to 28) were very low, they were significantly higher in the 200 mg group than in the 400 mg group (92.7 ng/dL vs. 49.6 ng/dL, p-value <0.001). Participants using 2 pills (200 mg, n=33) versus 4 pills (400 mg, n=35) of active drug did not report a significant difference in general satisfaction, willingness to use in the future, or recommendation of the study pill to other men (p=0.85, p=0.48, p=0.60, respectively). In placebo-controlled trials, men randomized to use active, daily oral progestogenic androgen prodrugs reported greater acceptability with their respective regimens than did men who received placebo pills despite low serum testosterone levels. Oral hormonal male contraceptive pill prototypes, DMAU and 11-MNTDC, significantly suppress serum testosterone while providing sufficient androgenicity to be acceptable to most men.

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Latest study reveals that two male contraceptive pills could expand options for birth control - Interesting Engineering

Medical transition-related treatments like HRT are associated with positive physical and mental health outcomes. amtitus/Getty Images hide caption

Medical transition-related treatments like HRT are associated with positive physical and mental health outcomes.

Medical transition-related treatments like hormone replacement therapy are associated with overwhelmingly positive outcomes in terms of both physical and mental health for transgender people. But, it can be hard to know exactly how to get started. Reporter James Factora explains where to start, common misconceptions about HRT, and the importance of finding community through the process. Read James' full reporting here:

If you're just learning about hormone replacement therapy for the first time, welcome! We're so glad you're here. You might want to read about the basics before listening to this episode. We'll be here when you get back!

This episode was produced by Brit Hanson, fact-checked by Indi Khera and edited by Viet Le. Joshua Newell and Kwesi Lee provided engineering support.

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Pride Week: Beginning Hormone Replacement Therapy : Short Wave - NPR

Sometimes there are no words to take away her sons pain.

So Marie wraps her arms around her child and cries with him.

A few times a week, the 11-year-old breaks down, overwhelmed with the adversity he faces as a transgender boy. His peers, his mother said, have called him gross, stupid and a pervert.

The Penobscot County fifth-grader also suffers from gender dysphoria, a psychological condition that causes distress for those whose gender identity does not match their birth-assigned sex.

He despises the feminine body he sees when he looks in the mirror. He has pulled his hair out, cut himself and banged his head against the wall.

Its heartbreaking, his mother said. I validate him as much as I can, so that he knows at the end of the day that its not about him. He is not whats wrong.

You just try to keep telling yourself that you know who you are, explained the Penobscot County fifth grader. Photo by Fred J. Field.

A study recently released by the Williams Institute at UCLA estimated there were 5,900 adults 18 and older in Maine and 1,200 children aged 13-17 who identified as transgender.

The states transgender adolescents, according to the 2019 Maine Integrated Youth Health Survey, were twice as likely to have been bullied at school and four times as likely to have been threatened or injured with a weapon. Half of them had considered suicide compared to 15 percent of their non-transgender peers.

It can be really scary and isolating coming out, said Aiden Campbell, a transgender male who works at OUT Maine, an LBGTQ advocacy organization.

Living as a transgender youth in a largely rural state can be especially difficult. Medical and mental health resources are hard to come by, and growing up as a trans kid in a small town or school can be lonely and heartbreaking.

They may be the only one coming out in their school or town, said Campbell, who endured bullying before he transitioned and became the sole transgender student at Cony High in Augusta.

Campbell tried to end his life in 2012, believing he would never be loved or accepted.

I know what it feels like to be in a dark place and feel really lonely, he said. But kids shouldnt think suicide is the answer they have to turn to because they dont feel accepted.

Along with the struggle to fit in at school, at home or in their community, Maine transgender youths and their families are reeling from the heavy number of political attacks nationally.

More than 100 bills targeting transgender people have been proposed in other state legislatures since 2020, according to the American Civil Liberties Union. The bills include banning transgender students from playing girls or womens sports, using bathrooms that match their gender identity and criminalizing gender-affirming treatment for children.

Maines legislature has defeated proposed anti-trans laws in recent years, but the states Republican party amended its platform during its April convention to call for a ban on discussing transgender identity in schools. Former Republican Gov. Paul LePage, who is running for re-election, has supported laws restricting transgender rights.

Though Democratic Gov. Janet Mills has a history of voting for LBGTQ rights, advocates recently criticized her for removing a teacher-made video from the Maine Department of Educations website that discussed gender identity and same-sex relationships and was intended for kindergarten students. After the video was used in a Republican attack ad, Mills and the DOE eliminated it from the state website, saying the lesson plan was not age-appropriate for kindergartners.

The push to ban discussions about LBGTQ students in the classroom and to restrict their rights and medical treatment, frightens Marie, who is being identified by her middle name to protect her sons privacy.

I have a lot of feelings and fears about these laws, she said. To not get my son treatment is criminal. There is substantially higher risk of him committing suicide if he doesnt get help. And I will do anything I can to make sure that doesnt happen.

When parents like Marie seek resources for their children, they often turn to advocacy groups like Maine Transgender Networkor OUT Maine, which offer online support groups, workshops and links to medical and mental health professionals.

Medical care is typically provided at the states two pediatric gender clinics, in Portland and Bangor. The Gender Clinic at Barbara Bush Childrens Hospital at Maine Medical Center opened in 2015 because of a growing need to treat adolescents who had to travel out of state for services. The clinic has 1,000 patients ranging in age from 3 to 25 from Maine and New Hampshire, said the clinic program manager, Brandy Brown.

While most of the patients are between ages 14 and 19, there are some who are pre-kindergarten or in grade school.

With most of our young patients, the parents have a lot of questions, Brown said. Theyre here for support and guidance.

Younger pre-teen patients, Brown said, are generally exploring their gender with social transitions such as wearing clothes that may not align with their birth-assigned sex. Sometimes they also choose to rename themselves.

In the third grade, Maries son began altering his appearance to diminish his female characteristics.

He had these long waist-length curls and he shaved one side, Marie said. And then he slowly worked up (his head) until all of the sides were shaved and he just had a bit of hair on top.

At age 9, he told his mother, I think Im a boy.

The dark-haired, sensitive child did not waver in his chosen identity, Marie said. He changed his name and appearance in the spring of 2020 when his school went to remote learning during the pandemic. When he began attending a new school in the fourth grade in the fall, he dressed in baggy pants and shirts. His classmates, his mother said, accepted him as a boy.

Most of the kids in the class were new to him, said Marie. At that time the transition was pretty easy.

But a few students who knew him before began teasing him, Marie said. Others in the class also taunted him after her son explained, I was born a girl but now Im a boy.

It was a constant barrage, Marie said. Hes got a shaky self-esteem so if he is having a bad day, hes taking it out on himself.

His emotions, Marie said, pour out in a stream of self-hate.

Im ugly, he tells his mother. Im fat. Im stupid. Im not good enough. Nobody loves me. I wish I was dead.

He also continued to hurt himself, Marie said, cutting and scratching his arms until he left scars.

Sometimes there are no words to take away her sons pain. So Marie wraps her arms around her child and cries with him. Photo by Fred J. Field.

Marie sought help for her son at Northern Light Eastern Maine Medical Center Gender Clinic in Bangor, which opened in 2017 and currently has 200 patients. The clinics psychologist and endocrinologist a doctor who specializes in the bodys glands and the hormones they make evaluated Maries 11-year-old child and determined he had gender dysphoria.

While not all clinic patients receive medical treatment, doctors prescribed puberty blockers for Maries son, she said, to ease his distress. The medication suppresses hormones that would cause changes like breast development and menstruation.

He is very conscious of how his body looks and cries at the sight of it, Marie said. He wears these oversized T-shirts and loose baggy clothing to try and hide it. We were fortunate that he could start treatment before his puberty progressed.

Puberty blockers, explained Dr. Mahmuda Ahmed, the Bangor clinics lead pediatric endocrinologist, delay puberty and give children time to see if their gender identity is long lasting. The medication, Ahmed added, is also given to non-transgender youth experiencing early or precocious puberty.

The World Professional Association for Transgender Health supports the use of puberty blockers, and the countrys top medical associations, including the American Academy of Pediatrics, the American Medical Association and the American Psychiatric Association, also endorse some forms of treatment for transgender youth.

When it comes to puberty blockers, though, critics argue more research is needed to understand the medications effect on a patients fertility and bone density.

Once the blockers are stopped, an adolescents body begins to produce hormones again. Pausing the production of estrogen and testosterone hormones provides relief to children whose biological bodies do not align with their gender identity, said Dr. Anna Mayo, a psychologist who evaluates patients at the Bangor clinic.

All of a sudden your body is changing in ways that dont match your identity and that can be a really distressing time in a childs life, said Mayo.

When a transgender child does not receive treatment and undergoes puberty that conflicts with their identity, the results can be dire, said Susan Maasch, director of Trans Youth Equality Foundation, a Portland-based nonprofit that provides education and support for transgender youth and their families.

Kids begin to give up hope, Maasch said. They become destructive, do badly in school. Inevitably they fall into a deep dark place and need mental health services, or worse and they take their own life.

Gender-affirming care for adolescents is controversial in many states, and conservative groups like the Christian Civic League of Maine assert that such medical treatment harms youth. But Ahmed points to several studies, including a recent report published in the Journal of Adolescent Health,which found treatment of patients with forms of gender dysphoria lowered moderate or severe depression and decreased suicidal thoughts and attempts.

Often, doctors say, families have questions about medical research on transgender youth and are hesitant to seek treatment that will change their childs appearance. Sometimes children alternate between divorced parents who disagree on care or social transitioning a child with clothing and name changes.

The kids are stuck in the middle suffering, said Maasch. I have one child now where the mother accepts her (as a transgender girl) and the dad doesnt. Besides suffering depression, a kid who shows up to school one day dressed as a boy and then later dressed as a girl is more vulnerable and more likely to be harassed.

Using correct pronouns with transgender youth is important to affirm their gender. Photo by Fred J. Field.

Maine and most states do not have laws governing transgender pediatric care. Maines gender clinics follow the World Professional Association for Transgender Health guidelines. Depending on what provider they see, a youth can receive puberty blockers with only one parents consent. But surgery to alter a childs body or hormone replacement therapy which can feminize or masculinize an adolescents secondary sexual characteristics like facial hair and breast formation requires both parents permission.

In recent years, gender-affirming care for adolescents has become a controversial issue. As of March, according to the Williams Institute, 15 states have restricted access to treatment or are proposing laws to do so. Some of the bills criminalize medical care, and impose penalties on healthcare providers and families if they access puberty blockers, hormone therapy or surgery for a transgender child.

Concerned about the political battle over medical treatment for transgender minors, the AMA has urged governors to veto legislation that would prohibit care, saying it is a dangerous intrusion into the practice of medicine.

Forgoing gender-affirming care, the AMA wrote in a 2021 letter to the National Governors Association, can have tragic health consequences, both mental and physical.

Laws to criminalize care for transgender minors disturbs Marie, but it is not a topic she discusses with her son, knowing it will upset him.

We dont talk about whats going on in Texas (and other states) right now because I have a lot of feelings about it and a lot of fear, Marie said.

Though Marie has primary custody of her son, her ex-husband, she said, does not support gender-affirming care and continues to call their child by his feminine birth name. The slight, referred to as dead-naming among transgender people, is painful, explained Marie son, who has chosen the new middle name Lion to represent his courage.

You just try to keep telling yourself that you know who you are, said Lion. I try to talk to my dad about it, but it just escalates and gets into a fight.

When his father calls him by his birth name or refers to Lion as she or her, the fifth-grader tries to not let the pain affect him.

I try to stick up for myself, he said. I try to be like Batman or the Green Lantern, tough like them.

Last Christmas, Lions father wrote both his feminine birth name and his new masculine chosen name on gift tags for his presents. The gesture gave Lion hope.

Maybe things will get better, he said.

A child caught in the middle of a familys polarizing views frequently experiences trauma, said Carmen Leighton, a mental health counselor who specializes in treating LBGTQ youth.

Often we see a divide in the family, which can be very destructive, said Leighton, a therapist at Higher Ground Services in Brewer. And every time it falls on a trans kid who feels like, I know that this is my truth, my identity, but its causing all of this conflict, so its my fault.

Parents often wrestle with fear and grief, Leighton said, when they try to understand why their childs birth sex does not align with their chosen identity.

Its the fear of the unknown and its the grief of I birthed this person and gave them this name, Leighton said. And then this grief that Im losing my daughter or Im losing my son and theyre becoming someone that I may not recognize anymore.

Parents often wrestle with fear and grief when they try to understand why their childs birth sex does not align with their chosen identity, said Carmen Leighton, a mental health counselor who specializes in treating LGBTQ youth. Photo by Fred J. Field.

As transgender children become teenagers, they tend to arrive at the Portland clinic with more complex problems and needs, said Erin Belfort, a child and adolescent psychiatrist. Roughly 65 percent of the youth referred to Belfort have a mental health diagnosis such as depression, anxiety or thoughts of suicide. Some have been hospitalized after suicide attempts.

Trying to navigate adolescence is hard enough, Belfort said. But trying to do so in a world that doesnt see you as you see yourself, especially if you dont have support at home, is incredibly stressful and traumatizing for kids.

Belfort sees youths from every Maine county, including the states rural pockets, where kids may struggle to find acceptance.

Though Maines non-discrimination laws protect all students to ensure they learn in a safe environment, transgender youths experiences vary depending on which schools they attend, Belfort said.

Kids who go to arts academies feel like they have great community and people really celebrate their identities, Belfort said. Then I have kids too who dont feel safe going to school with other students who are wearing (Make America Great Again) hats and driving their pickup trucks with a shotgun in the back.

While schools try to prevent bullying and harassment, it still happens, Belfort said.

The lack of mental health services throughout Maine and especially in rural areas makes it difficult for families to get their children help if they are feeling isolated or rejected.

After an initial evaluation, Belfort and doctors at the Bangor clinic refer patients to mental health providers in the community. But wait lists are long, especially in counties like Washington, Franklin and Piscataquis.

One of our primary challenges is finding mental health clinics, said Dr. Mayo, of the Bangor clinic. We have patients waiting more than six months to find providers.

Marie feels fortunate she was able to get her son treatment for his gender dysphoria. She is also grateful that Lions counselor is trained in the specific needs and trauma of transgender youth.

Its so hard to find trans competent care and people that really understand these kids, Marie said.

Lion, like many others, hopes for a day when transgender individuals would be viewed as an equal. I want acceptance for me and for everybody, he said. Photo by Fred J. Field.

Lion will likely continue taking puberty blockers until he turns 15, Marie said. Then it is unclear whether he will be able to receive hormone therapy to further transition his body.

If his father does not consent, Lion must wait until turning 18.

For now, hes grateful that the medication is giving him the chance to be a regular boy who loves baseball and likes to draw.

Asked to describe himself, he quickly answers, Im smart, brave and competitive, yeah, and kind.

The 11-year-old wishes people would just stop being mean to him and others who are different.

I want acceptance for me and for everybody, he said. Like racism, too. I wish it would all stop.

This series was financially supported by The Bingham Program and the Margaret E. Burnham Charitable Trust. We encourage you to share your thoughts on this series by visiting this page. Barbara A. Walsh can be reached at barbara@themainemonitor.org.

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The heartbreak, hope and courage of a Maine transgender child - The Maine Monitor

By contrast, genuine therapeutic interventions involve the safe exploration of an individuals needs and uncertainties, and value self-awareness and self-acceptance, campaigners explained. This doesnt mean that you dont challenge or question [the client], or help them explore who they are. But the starting point is one of respect and dignity for the individual, said Jayne Ozanne, a gay evangelical Christian and director of the Ozanne Foundation, which works with religious organisations to eliminate discrimination based on gender and sexuality.

[Therapeutic] conversations are intended to be exploratory, said Cara English from Gendered Intelligence. Theyre about meeting people where they are and not giving them a fixed destination.

Theres this wilful misinterpretation that people will be telling young people that theyre trans and working backwards from there. Its just so bizarre to see it be voiced like that. But it will inevitably be voiced like that by parliamentarians on Monday.

Affirmative care is about getting rid of the psychotherapists agenda and focusing on the patient, Moore agreed. Reflective work is absolutely possible in an ethical, affirmative way.

This distinction is upheld in the Memorandum of Understanding on conversion practices a joint statement signed by 25 health, counselling and psychotherapy bodies including the British Association for Counselling and Psychotherapy, the Royal College of Psychiatrists and NHS England which defines conversion practices as therapy or persuasive techniques designed to prejudice peoples choices about gender change or sexual orientation.

Moore also highlighted a tendency for opponents to deliberately conflate medical affirmation treatments like hormone replacement therapy and affirming surgeries with the affirmative therapy model.

Its a different thing altogether, she said. When were talking about therapy, were referring to talk therapy Unless they also happen to be endocrinologists or surgeons, psychotherapists are not prescribing hormones or other medical interventions.

Opponents of a trans-inclusive ban may also claim that trans conversion practices arent happening, or that there is insufficient evidence to show that these practices cause harm, say campaigners.

The governments own 2018 survey found that trans people are more likely to undergo conversion practices than lesbian, gay and bisexual people. Some 13% of trans respondents said they had been offered some form of conversion therapy.

And while there is no evidence that these practices can succeed in changing sexual orientation or gender identity, there is significant research and first-hand testimonies underscoring their severe, long-term and sometimes deadly psychological consequences.

Research carried out last year by a coalition of UK LGBT charities, together with independent research monitor Richard Matousek, found that gender-diverse participants who had experienced conversion practices were nearly twice as likely to have attempted suicide.

These findings are consistent with a 2018 study published in the American Journal of Public Health, which found that LGBT young people who had experienced conversion practices were more than twice as likely to report attempting suicide following the experience. The American Psychological Association has also linked conversion practices to depression and suicidality in survivors.

To deny that these practices are happening invalidates the experiences of countless survivors who have come forward and testified to the harm caused, Appan said. Its a kick in the face, and it denies my current life. The trauma I faced has led to lifelong health conditions, including fibromyalgia and complex post traumatic stress.

Its cruelty, said Ozanne, who is herself a survivor of conversion practices. What angers me most is the indifference of those who practice conversion therapy and have no remorse for the harm they have caused.

All recent legislative bans, including those implemented in Canada, France, New Zealand and Greece, include both sexual orientation and gender identity. Excluding trans people from the ban on conversion practices would be outdated, harmful and an international embarrassment, said Lui Asquith, from Mermaids.

I hope more than anything that the reality of the lived experiences of trans people will come through in the debate on Monday Its incredibly important that we debunk the false myths that are being spread and that we understand the harm that trans people are facing, Ozanne said.

It will be a dereliction of our duty as a society that is meant to protect the vulnerable if we do not include them in the ban.

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Trans conversion therapy: What to expect when MPs debate ban - Open Democracy

Theres a menopause revolution afoot and the three letters on everyones lips from Davina McCall to Sajid Javid are H, R, T. But one group missing from many of these discussions is cancer patients and, for many of them, hormone replacement therapy isnt a straightforward option. If this powerful patient movement is to be truly revolutionary, it must also find a way to include those going through the menopause alongside cancer.

Amy Meadows, a 48-year-old campaigns manager, tells me she feels completely excluded by the focus on HRT within the mainstream menopause discussion. A year ago, she was diagnosed with breast cancer after finding a lump. After undergoing surgery, chemotherapy and radiotherapy, Amy is now having hormone therapy a treatment that induces a chemical menopause, suppressing the bodys natural hormones to prevent oestrogen sensitive cancers like hers from spreading or recurring.

As Amys oncologist warned her, this type of medical menopause can be a more brutal experience than going through perimenopause naturally, because of the sudden drop in oestrogen levels. The nature of Amys cancer also means that HRT isnt an option to ease her menopausal symptoms of hot flushes, night sweats and insomnia. I do really welcome the extra profile being given to menopause, but I feel excluded from the fast-growing club of vocal HRT advocates, she says.

Almost all my friends are on some form of HRT and reporting the positive impacts, both in terms of short-term symptom relief but also the longer-term protective impact against dementia, diabetes, osteoporosis and cardiovascular disease. Some of these potential risks are the same very ones that I am now at greater risk of because of my cancer treatment, so I also worry that Im missing out on those benefits, Amy adds.

Menopause after cancer treatment doesnt just affect those with breast and gynaecological cancers. It can be brought on by the disease itself, or as a result of surgical removal of the ovaries, hormone therapy, chemo or radiotherapy. For example, radiotherapy to treat cancers in the pelvic area like bowel cancer can cause either temporary or permanent damage to the ovaries, inducing a medical menopause. HRT usually isnt recommended for anyone with a hormone-related cancer, most notably oestrogen receptor (ER) positive breast cancers, although topical oestrogen can be used to treat symptoms like vaginal dryness.

Even for those cancer patients who can take HRT, theres a much bigger conversation that needs to take place. Charity Trekstock, which supports young adults with cancer across the UK, runs a six-week Navigating Menopause programme and have found that 44 per cent of participants hadnt been told about early menopause by their oncology teams. 42 per cent of those who took part in the programme said they didnt get support when they sought help with their symptoms, and 88 per cent found their last doctors appointment on the subject unhelpful.

For young cancer patients, who may be going through menopause a decade or two earlier than they would have done naturally, its also a seriously isolating experience. Eighty per cent of people told us theyd never met another young person whod been through cancer and the menopause, so our programme isnt just about giving people the information and leaving them to it, its about sharing stories, empowering one another, and creating communities so people feel less alone, says Trekstocks Health Programmes and Engagement Lead Jemima Reynolds, who used her background in healthcare to co-create the programme alongside 43-year-old yoga teacher, menopause guide and patient advocate Dani Binnington.

A quality standard published by the National Institute of Health and Care Excellence (NICE) states that patients who are likely to go through menopause as a result of medical or surgical treatment should be made aware of this long-term after effect and its symptoms. In reality though, Jemima adds: Were finding time and time again that people arent told and, [even if they are told at their initial diagnosis] it isnt revisited.

Dani went through a temporary menopause during treatment for breast cancer in her 30s but at the time had no idea thats what it was. My periods stopped for a while when I was going through chemo, but I just thought all my symptoms were cancer or treatment related. I was poorly educated in terms of my biology and it wasnt until three years ago that I realised Id been in the menopause, she explains.

When Dani later found out she was a carrier of the BRCA gene mutation which increases the risk of both breast and ovarian cancers she made the decision to have a double mastectomy and an oophorectomy (surgery to remove her ovaries), with the latter putting her into an immediate surgical menopause.

This time, though, she was more clued up. I actually cancelled my oophorectomy twice because my appointment with the menopause specialist hadnt come through yet, and I knew I needed to speak to them before anyone touched my ovaries. This was six years after my cancer diagnosis and Id learned so much that I was a really good advocate for myself; I knew about my choices and what my options were, she explains.

Dani did opt for HRT, based on the fact she was more than five years on from her diagnosis, had already had a double mastectomy and had a type of breast cancer that wasnt hormonally driven. But she and Jemima are clear that cancer patients, regardless of their individual risks and treatment choices, need a far more nuanced conversation about the impact of cancer and the menopause on their lives. Theyre coping with the emotional trauma of going through cancer, with cancer-related fatigue, with body image changes, with all these costs to their mental and physical health, which are compounded by menopause. The onus shouldnt be on them to do the research and find out whats going on like Dani did. We need to equip them with the tools to not just survive cancer but thrive, Jemima says.

For this group that conversation must move beyond HRT and focus on overall health and wellbeing. We need some recognition that HRT is not the silver bullet everyone thinks it is. There are medical and non-medical alternatives to tackle menopausal symptoms, and these all need to be coupled with lifestyle factors like nutrition and exercise, Jemima says.

Weight-bearing exercise, she adds, is hugely important for post-menopausal bone health, as well as improving mood and cancer-related fatigue, both of which are often made worse by the menopause. Similarly, antidepressants which arent generally considered a first-line treatment for menopausal symptoms can be a great alternative to HRT when it comes to tackling not only mood changes but also physical symptoms like hot flushes.

Essentially, Dani adds, we need an acknowledgement that mainstream menopause advice doesnt necessarily apply to everyone. Much of this change will come from greater training and awareness for healthcare professionals within oncology and, in this sense, she says, its not too dissimilar to the mainstream menopause conversation. Theres a campaign for more GPs to go on specialist menopause courses; we also need more training for cancer nurses and oncologists. Its just an extension of the wider conversation thats going on anyway.

For patients too, there needs to be a much broader, more nuanced conversation about how menopause affects different people young and old, with and without cancer, on and off HRT. Menopause can be an isolating enough journey without being made to feel like an outsider, and this revolution must leave no one behind.

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If the menopause movement is to be truly revolutionary, it needs to include women with cancer - iNews

Dr Yasmin Tan is a Sydney gynaecologist, laparoscopic surgeon and womens ultrasound specialist. She works at the Womens Health and Research Institute of Australia (WHRIA) and at the Royal Hospital for Women. She is a Clinical Lecturer with The Universityof Sydney Northern Clinical School, Discipline of Obstetrics, Gynaecology & Neonatology.

In this session, we learn what exactly HRT is, whether it is safe and if it could help you.

Here's what we learned from Dr Yasmin Tan's session:

Hormone Replacement Therapy (HRT) is steeped in misinformation.

And that's a problem, because it's also one of the most effective methods for coping with many of the debilitating symptoms of perimenopause.

"HRT is any medication with female hormone in it, so it contains estrogen. That's the main hormone which we are trying to give back to the body because it's decided to make less of it, and as time goes by no estrogen," Dr Yasmin says.

"The second hormone we give usually with HRT is progesterone. And we need that for women who still have a uterus. The uterus is really an important organ that we have to protect with HRT because the lining of the uterus can thicken up if you just giveit estrogen alone."

HRT is used to relieve uncomfortable symptoms of perimenopause like hot flushes, mood swings, concentration issues, sleep problems and vaginal dryness.

There is a misconception that HRT is linked to breast cancer due to a study conducted over 20 years ago as Dr Yasmin explains.

"I think what this really stems from a big study that happened over 20 years ago called the Women's Health Initiative study.

"There are a lot of flaws with this study and we recognise this now. They were using very out of date, synthetic hormones, which we don't use anymore.

"The estrogen they were using was made from pregnant bears urine. So we don't use that anymore.

"And they also tried it in women of all age groups so the women were average ages around 65. That's not really our target age range for treatment.

"So they found that there was an increased risk of breast cancer and they touted this to the media and it was sold in a very catastrophic way.

Read this article:
The Very Peri Summit Resource Centre: Hormone Replacement Therapy with Dr Yasmin Tan. - Mamamia

This article was originally published on PracticalCardiology.com.

Although it has long been known that thyroid hormone levels are linked to cardiovascular (CV) regulation and that hyper- and hypo-thyroid states are detrimental to CV health, less is known about how the intensity of thyroid hormone therapy affects CV risk and mortality.

In a recent study, investigators sought to evaluate the association between thyroid replacement intensity and cardiovascular mortality by examining a large pool of data from the Veterans Health Administration database.

Josh Evron, MD, and colleagues looked at 705,307 adults who received thyroid replacement therapy.3 They found that 10.8% of those patients died of cardiovascular causes.3 Thyrotropin and Free T4 levels were gathered for all patients in the study to determine if therapy led to exogenous hypo-, euthyroid, or hyperthyroid conditions. The authors used regression modeling to produce survival analyses with cardiovascular mortality from myocardial infarction, heart failure, or stroke representing the primary outcomes studied.

The results clearly showed that patients with exogenous hyperthyroidism (thyrotropin levels <0.1 mIU/L) and those with exogenous hypothyroidism (thyrotropin levels >-20mIU/L) had increased risk of cardiovascular mortality when compared to patients who remained euthyroid.3 The association between exogenous hypo- and hyper-thyroid states and mortality increase with higher or lower thyrotropin levels in the hypo- and hyper-thyroid ranges.3

This study provides a unique perspective looking at cardiovascular risk based on a very common treatment, thyroid replacement therapy. When prescribing a replacement therapy, the goal of treatment is to achieve a normal level in vivo of whatever hormone you are replacing. This is not as easy as it seems.

Arriving at the appropriate dose takes time and requires frequent measurements of thyrotropin and free thyroxine levels. Even during stable therapy patient factors may change the response, absorption, and metabolism of thyroid hormone. Thus, the intensity of treatment the authors are talking about is a constantly moving target.

The results of this study highlight the importance of regular testing and a willingness among clinicians to put in the work. The authors found that allowing thyroid replacement therapy to fall short or overshoot has real consequences in the form of increased cardiovascular mortality.3

This means lives are at stake. This is the essence of a modifiable risk factor. Only, in this case, the modification is not a behavior the patient exhibits but one the clinician is responsible for. The authors state that variability in free T4 levels and thyroid hormone dosage adjustment are inevitable and thus agree with my assertion that regular monitoring and small targeted adjustments are essential parts of not only good thyroid care but also cardiovascular risk mitigation.3

These results and conclusions are underscored by the fact that cardiovascular disease is the leading cause of death in the United States. Even though this was an observational study, the results are robust.

An important feature of these results was the linear relationship up and down between the extent of hypo- or hyperthyroid intensity and CV risk. This gives clinicians some room to work while at the same time placing guard rails and warning signs on the limits of acceptability where over and undertreating are concerned.

More work is needed. While the authors have identified an area where we as clinicians can improve, they have also brought up a few new questions. It needs to be determined if there are sex differences in this effect. Further, the degree to which comorbidities were managed was not examined in this study. It is clear however, that tighter observation, monitoring, and intervention are in order with regards to thyroid replacement therapy.

References:

Here is the original post:
Finding the "Sweet Spot": Thyroid Hormone Treatment and Cardiovascular Disease - Endocrinology Network

The term postmenopausal implies that the rest of life after what our grandmothers called the change is nothing but an afterthought. Clinical psychologist Louann Brizendine, MD, founder of UCSFs Womens Mood and Hormone Clinic and author of the bestsellers The Female Brain and The Male Brain begs to differ.

To hear her tell it, that stagewhich can be a full half of a womans lifeis more like aprs-ski: the luxurious reward after all the drama of hurtling down hormonal peaks and valleys. In her new book, The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond, she renames and reclaims the M word, which she calls the Transition and recasts the years after as the Upgrade that gives the book its title.

Rest assured that the good doctor is not just advising women to look on the bright side and think positively about acquiring the wisdom and experience that come with age. (Although shes all for that.) She also explains the science behind the Upgrade, how after the Transition, were equipped with our Brain 2.0, which is less foggy, calmer, steadier, and primed to be more focused, creative, and happy than ever before. Then she tells readers how to make the most of that new functionality. We interrupted her Upgrade to ask her a few questions.

Why dont you use the terms menopause and postmenopause?

Perimenopause, menopause, postmenopause are a medical diagnosis, pharmaceutical words. Its a very narrow shaping of whats happening to us in our lives. I call it a below-the-waist-view of the uterus, the bleeding, but its not about whats going on in the brain. The idea that its a transition and an upgrade is multifaceted, more of what I call the whole-woman approach to the stage of life that were in. And the fact that you have a whole new breath of life for this second half of life, thats the concept I want to get across.

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You write that, post-Transition, our brains are primed for an Upgrade. Why is that, neurologically speaking?

When youre menstruating, estrogen going up in those first two weeks of your cycle starts to make all of these connections in the area of the brain called the hippocampus. And then when the progesterone starts to come in after ovulation, weeks three and four, it tears down all of those connections. That cycle goes on month after month after month, and it has all kinds of pushes and pulls for our behavior. We know from behavioral studies that three or four days before ovulation, we become more talkative, and toward the end of the cycle, we become more emotionalI call it the crying-over-dog-food-commercials stage. Whats going on in our brain is the building up of the circuitry and tearing it down and building it up and tearing it down. That stops after the Transition. Thats why I call it the Upgrade, because it gives you this incredible stability.

What if you take hormone replacement therapy?

If you do, youre getting a steady amount of hormones; theyre not coming in waves. As the waves of the hormones stop and get calmer, whether you take HRT or you dont, your hormones are going to be steady. That remakes the circuitry in your brain in a more stable, calm fashion.

You also talk in the book about how neurohormones, pre-Transition and during the Transition, can push us to be self-critical, and to feel the need to please people or win their approval.

The whole fertility phase of our lives as women is a very deep, deep hormonal push to cause behavior to make us try to be more attractive, so were able to procreate better. Its not something thats right in the front of your mind; its a kind of subconscious drive to procreate in the back of our brains.

Thats not happening so much after the Transition. So were not pushing ourselves to be complete people pleasers. We still dont want to be kicked out of our family or excluded from our community by becoming a total be-atch. Thats not what I recommend. But, subconsciously, because of the neuro changes in our brain, were able to speak our minds more without the fear that we once had, now that the subconscious pressure to procreate isnt going on.

In the book, you explain how if we know whats going on in our brain, we can use that knowledge to our advantage.

We just keep learning more about the brain. For example, we always called the cerebellum, the two little bumps in the back of your brain, the sports brain because it helps with your balance. But in 2018, studies showed that it also sends all of this feedback to the rest of the brain, and it helps to assess emotions and thinking. We do that in the front part of our brain, but if we get a little bit off, our cerebellum helps us with our emotional balance. It helps us with our thinking balance. Itll help slightly correct if you get too far off center. And if you choose an activity, like yoga or barre class, that helps with your balance, it will stimulate that area of the brain.

You offer a lot of actionable tips in the book for making the most of the Upgrade by using science-backed practices. What are some of your favorites?

When I wake up in the morning, I wiggle my toes and I smile. Wiggling your toes activates the sciatic, the longest nerve in your body, and stimulates all the way up into your brain, your cerebellum, your whole motor strip. And studies show that when you smile, the smiling muscles actually feed back into your brain to tell you that youre happy, so you could increase your feeling of happiness just by smiling at yourself.

I also do butt squeezes throughout the day, because in a study where they tested cognition in 80-year-old women, those women with the best cognition also had the strongest leg strength. When your muscles are strong or when youre moving your muscles, its feeding back into your brain all the way from your cerebellum to the rest of your motor area, telling you that youre alive and that youre okay. And one of the biggest muscles in our body is the glutes, our butt muscles. So if you want to improve some of your cognition, just keep doing butt squeezes during the day when you sit down or as you brush your teeth.

In another cool study, done 2010 at Harvard, they would text people and say, What are you doing now? And then theyd have to do a happiness scale. Those people that were just daydreaming, who had a wandering mind, reported that they were not happy, but the same person, when they were engaged in what they were doing when they got the text, said they were happy. If you let your mind wander, it can run into the hamster wheel of worry or other bad places. So you want to take the steering wheel of your mind and steer it toward engagement.

So, when the chatter of all the hormonal waves dies down in your brain, you get to choose what to fill it with, and you want to choose wisely?

Yes. Thats why I wrote this book, for women to just grab the steering wheel of their life, to move forward in a way that makes them happier, with more joy and serenity. As women go through this stage, its important to know that this is coming, so then you can seize that stability in the brain, and feel empowered by this idea that you have an upgrade, a chance to do something new. You have to feel delighted about your life in this next stage, because its really great. Theres a technical term, the positivity effect, thats been studied for the last 40 years at Stanford and other places that shows that with each decade of your life, you get happier. That goes along with the Upgradepeople just get happier each decade of their life. I think thats a really important message.

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