Category Archives: Testosterone Replacement Therapy

What some people may imagine when they think of feminism are the womens marches that were predominantly white, and occured during Trumps inauguration. Feminism is much more complex than that. As Womens History Month draws to a close, the world around us continually reminds us how important intersectionality is, and how it affects all women.

The term intersectional feminism was first introduced in 1989 by Kimberl Crenshaw, a law professor at UCLA School of Law and Columbia Law. Intersectional feminism is defined as the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage, or, as Crenshaw describes it, how not all inequality is created equally. Womens rights and womens rights activists didnt start at intersectionality. One of the first and largest womens rights movements in America started with the womens suffrage movement. But, the suffrage movement catered to white women specifically, and many of the larger suffrage groups discriminated against women of color. In turn, when the 19th amendment was ratified in 1920, women were granted the right to vote. But, due to the movements discrimination, Black, Latina and Asain women were disenfranchised in many states. This led to many women of color not being able to cast votes until the 1960s. This is just one of many examples of how when feminism isnt intersectional, it is actively working against women that arent white, cis or straight.

Today, people who identify as feminists are much more likely to practice intersectionality, and work to uplift women who are different than themselves. But, there are still people who discriminate against women in their community. Headlines have swirled recently about Lia Thomas, who is a competitive swimmer for the University of Pennsylvania womens swim team, and who also happens to be transgender. Thomas competed at the NCAA championship, and swam a season best in the 500 free at 4:33:24. She placed first in the event, making her the first transgender woman to take home an NCAA championship title. But, this win was also followed with heavy criticism and controversy. Thomas has undergone two and a half years of hormone replacement treatment which works to block the hormone testosterone, and works to replace that with estrogen, which promotes female characteristics in the body. Even though she has been using hormone replacement therapy for two and a half years, she is still facing ridicule. One of her harshest critics being fellow competitor Reka Gyorgy, a Hungarian swimmer who competes for Virginia Tech. Gyorgy blames her failure to qualify for finals on Thomas and the NCAA for letting her compete. In her open letter to NCAA, Gyorgy states, One spot was taken away from the girl who got 9th in the 500 free and didnt make it back to the A final preventing her from being an All-American. Every event that transgender athletes competed in was one spot taken away from biological females throughout the meet. Considering that Thomas is hormonally female, Gyorgy technically has no one else to blame but herself. Scapegoating Thomas for being faster doesnt take away from the fact that Gyorgy could have swam faster. There wasnt a word from Gyorgy when she didnt make it to the semifinals at the Olympics. Blaming transgender athletes for her lack of accomplishments doesnt make Gyorgy look better or more worthy, it makes her look like shes making transphobic excuses. Thomas wasnt shattering records, as the New York Post reported. In fact, her time at the NCAA Championships is nine seconds slower than Katie Ledekys world record.

This is just a current example of how feminism can be discriminatory when it isnt intersectional, and paints a picture of just how important it is to be intersectional. While Gyorgy believed that she was fighting for her counterparts within the NCAA, she shrinks the room made for women that are transgender. It has taken decades for the NCAA to even recognize transgender athletes, and Gyorgys discriminatory letter illustrates why it was so hard in the first place.

This focus on Thomas and her accomplishments also takes away from actual issues that press collegiate athletes, such as funding discrepancies between male and female teams, and sexual harrassment. Fellow swimmer Erica Sullivan, who did make it to the final for the 500 freestyle, echoes this in her comments on the controversy. Womens sports are stronger when all women including trans women are protected from discrimination, and free to be their true selves, Sullivan said.

Intersectional feminism doesnt just stop with welcoming and accomodating trans people, but rather starts with it. Intersectional feminism is meant to welcome and fight for women of all different backgrounds, women of color, disabled women, women in the LGBTQ+ community and women who come from impoverished areas. Intersectional feminism reminds women that we are stronger together than we are apart. It reminds us that every woman deserves equal opportunity, not just a select few, and that its up to women ourselves to make that happen.

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Intersectionality and its effects on women's rights - Northern Iowan

Erectile Dysfunction (ED) Drugs Market 2022-2026: Segmentation

The erectile dysfunction (ED) drugs market share growth by the oral drugssegment will be significant during the forecast period.Oral drugs have the advantage of high patient compliance due to easy route of administration and high bioavailability.These drugs have been dominating the market for a long time due to the ease of administration or self-administration. Moreover, the OTC availability of these drugs is a major factor that contributes to their large market share.The oral drugs segment is expected to exhibit decelerating growth during the forecast period. Most of the leading drugs used for the treatment of ED belong to this segment. The patent expiration of these drugs is paving the way for genericization, which is responsible for the declining growth of this segment.

39% of the market's growth will originate from North America during the forecast period. The USand Canada are the key markets forerectile dysfunction (ED) drugsin North America. Market growth in this region will be slower than the growth of the market in the European and Asian regions.

The increasing prevalence of chronic diseaseswill facilitate theerectile dysfunction (ED) drugs market growth in North America over the forecast period.

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Increasing Prevalence of Chronic Diseases to Boost the Market Growth

Sexual dysfunction disorders are more common in women than in men and involve loss of desire, orgasm problems, and pain during sex. The onset of sexual dysfunction disorders in women is attributed to hormonal factors, menstrual irregularities, amenorrhea, lack of vaginal lubrication, and failure to conceive.Female sexual dysfunction can be caused due to various chronic diseases such as diabetes. Globally, diabetes is one of the most common chronic diseases. Patients with diabetes may have several clinical conditions, including overweight, hypertension, obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are risk factors for sexual dysfunction. The rising prevalence of these conditions across the globe is expected to increase the patient pool with a large number of men and women having sexual dysfunctions, which, in turn, will drive the growth of the global ED drugs market during the forecast period.

Patent Expiry of Blockbuster Drugs to Hamper the Market Growth

The blockbuster drugs dominating the global ED drugs market have already faced or are on the verge of facing patent expiration. The key drugs in the market include VIAGRA (Pfizer), CIALIS (Eli Lilly), and LEVITRA and STAXYN (Bayer). For instance, the patents for VIAGRA expired in December 2017 in the US. To recover the losses due to patent expiration, Pfizer has entered into a patent litigation settlement with Teva Pharmaceuticals and has launched the generic version of VIAGRA in the US in December 2017. For manufacturing the generic version of a drug, there are limited legal procedures, and the production expenses are also low. Hence, the market emergence of a wide range of generic versions, which are priced lower than the branded versions, is a major challenge faced by the market.

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Our Erectile Dysfunction (ED) Drugs Market Report Covers the Following Areas:

Erectile Dysfunction (ED) Drugs Market 2022-2026: Vendor Analysis

The erectile dysfunction (ED) drugs market report offers information on several market vendors, including Aurobindo Pharma Ltd., Bayer AG, Cadila Healthcare Ltd., Cipla Ltd., Dr. Reddys Laboratories Ltd., Eli Lilly and Co., Endo International Plc, Futura Medical plc, GlaxoSmithKline Plc, Innovcare Lifesciences Pvt. Ltd., Lupin Ltd., Pfizer Inc., SK Chemicals Co. Ltd., Teva Pharmaceutical Industries Ltd., TTK Healthcare Ltd., Viatris Inc., VIVUS Inc., and Sanzyme (P) Ltd. among others.

Moreover, the market is fragmented and the vendors are deploying growth strategies such asforming strategic alliances to increase their product offerings and geographical reachto compete in the market.

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Erectile Dysfunction (ED) Drugs Market 2022-2026: Key Highlights

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Testosterone Replacement Therapy Market by Product and Geography - Forecast and Analysis: The testosterone replacement therapy market size has the potential to grow by USD113.54 million and the market's growth momentum will decelerateduring the forecast period. To get more exclusive research insights: Download Our FREE Sample Report

Sexual Enhancement Supplements Market by Product and Geography - Forecast and Analysis: The sexual enhancement supplements market size has the potential to grow by USD407.16 million and the market's growth momentum will accelerateduring the forecast period. To get more exclusive research insights: Download Our FREE Sample Report

Erectile Dysfunction (ED) Drugs Market Scope

Report Coverage

Details

Page number

120

Base year

2021

Forecast period

2022-2026

Growth momentum & CAGR

Accelerate at a CAGR of 6.1%

Market growth 2022-2026

$ 1.20 billion

Market structure

Fragmented

YoY growth (%)

4.76

Regional analysis

North America, Europe, Asia, and Rest of World (ROW)

Performing market contribution

North America at 39%

Key consumer countries

US, Canada, Germany, UK, and China

Competitive landscape

Leading companies, competitive strategies, consumer engagement scope

Companies profiled

Aurobindo Pharma Ltd., Bayer AG, Cadila Healthcare Ltd., Cipla Ltd., Dr. Reddys Laboratories Ltd., Eli Lilly and Co., Endo International Plc, Futura Medical plc, GlaxoSmithKline Plc, Innovcare Lifesciences Pvt. Ltd., Lupin Ltd., Pfizer Inc., SK Chemicals Co. Ltd., Teva Pharmaceutical Industries Ltd., TTK Healthcare Ltd., Viatris Inc., VIVUS Inc., and Sanzyme (P) Ltd.

Market Dynamics

Parent market analysis, Market growth inducers and obstacles, Fast-growing and slow-growing segment analysis, COVID-19 impact and future consumer dynamics, market condition analysis for the forecast period,

Customization preview

If our report has not included the data that you are looking for, you can reach out to our analysts and get segments customized.

Table of Contents:

1 Executive Summary

2 Market Landscape

3 Market Sizing

4 Five Forces Analysis

5 Market Segmentation by Product

6 Customer Landscape

7 Geographic Landscape

8 Drivers, Challenges, and Trends

9 Vendor Landscape

10 Vendor Analysis

11 Appendix

About Us

Technavio is a leading global technology research and advisory company. Their research and analysis focus on emerging market trends and provides actionable insights to help businesses identify market opportunities and develop effective strategies to optimize their market positions. With over 500 specialized analysts, Technavio's report library consists of more than 17,000 reports and counting, covering 800 technologies, spanning across 50 countries. Their client base consists of enterprises of all sizes, including more than 100 Fortune 500 companies. This growing client base relies on Technavio's comprehensive coverage, extensive research, and actionable market insights to identify opportunities in existing and potential markets and assess their competitive positions within changing market scenarios.

Contact

Technavio ResearchJesse MaidaMedia & Marketing ExecutiveUS: +1 844 364 1100UK: +44 203 893 3200Email: [emailprotected]Website: http://www.technavio.com/

SOURCE Technavio

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Erectile Dysfunction (ED) Drugs Market: 4.76% YOY Growth Rate in 2022 | By Product (oral drugs, topical drugs, and others) and Geography | Growth,...

This Trans Day of Visibility, were publishing a series of essays from trans writers who pose questions about what being visible has meant for us. Who is seeing us? How do we want to be seen? And at what cost? You can read all essays from the series here.

The moment I realized I wanted to have a baby, I was also coming to terms with the fact that I am transgender. I had just changed my name and started using gender-neutral pronouns, and the possibilities of who I could become were overwhelming. I couldnt stop thinking about starting Hormone Replacement Therapy (HRT). Everything was new to me: the language around being nonbinary, how testosterone actually changed a body, the thought of living past my twenties.

I called a local clinic and quietly asked if they had any doctors accepting new patients. When they asked me why I needed to schedule an appointment, my throat became an empty churchmy sins exposed. I thought, going into that appointment, that I was certain about starting testosterone. But, when my doctor recommended I also find a back up birth control method like an IUD, I realized how much I had been holding onto the desire to have a baby.

Existing as a person who wants to have a baby in a world where the representation of pregnancy is mostly for cis women is exhausting. My community then was rock climbers and yoga teachers. Not the most trans-inclusive (or aware) groups of people. I didnt know who to turn to for support with my unique experience of both wanting to transition and have a baby.

Artist: A. Andrews.

I decided to wait to medically transition. Sometimes I think I waited out of fear of what the people in my life would think of me. For years, I preached self-love and acceptance, exactly the way you were. I didnt realize how much I needed to physically change before I could love myself.

A year into my decision to wait, the pandemic reached the United States. Days later, I got a positive pregnancy result. I remember watching myself pee on the stick, astral projecting into the tiny studio apartment bathroom where the clawfoot tub took up most of the space. I saw the range of emotions play on my face: fear, excitement, the idea that this meant I could have a baby and then transition.

Having a baby was by far one of the most badass and amazing things Ive done in my life, but I did it all with a body that didnt feel like mine. Pregnancy was rough. My body was changing at a rate most people would be uncomfortable with. I would stand in front of the full-length mirror in my bedroom and stare from every angle. At my chest that wouldnt flatten anymore. At my stomach that I secretly hoped people saw as a beer belly. At my hips widening, possibly forever.

My mom used to complain that having four kids ruined her bodyher reason for getting a breast augmentation. My entire pregnancy I thought about the possibility that having a baby would completely deflate my chest. I hoped.

When it was time to give birth, I once again watched from the outside. I stood by the hospital bed, watching this other person push for three hours, incapable of opening their eyes. I whispered promises to this rented body: the sooner they are out, the sooner you can begin your own life.

My baby was born on January 6th, 2021. My partner and I stared at the freshness of this new living, breathing being. Hours after delivery, my doctor came in to check on us. Well, she sighed, Democracy has failed us today. We turned on our phones for the first time, abruptly losing the moment wed waited nine months for, to see the white supremacist insurrection at the Capitol. Being a parent has been an overwhelming amount of feeling guilty. My therapist asks what Im feeling guilty about and I recite: for letting my kid watch TV sometimes, for feeding them french fries, for bringing them into a world that is full of violence and climate catastrophe.

Following my doctor was the lactation consultant. She asked how I was feeling about breastfeeding, how the baby was latching. There had been no issues so far, and it was nice to feel like my chest had a job. But I knew I didnt want this to be long term. I wanted to chestfeed for three to six months, but the lactation consultant pushed for a full year, and I didnt want to deprive my baby of something that seemed so urgently necessary for their health.

As the months went on, I found myself dreading feeding sessions. I knew that weaning was a possibility, there was always formula, but everyone kept telling me how great I was doing, feeding them only my milk. I once again bought into the rhetoric of there being just one good way to have a baby. Around six months in, the depression and thoughts of self-harm were taking over my every breath. I knew my medical transition couldnt be paused for much longer.

Finally, I would begin the process of weaning my baby off so that I could begin my own growth. It happened when they were 10 months old. I began testosterone on my 27th birthday, almost a year after giving birth. I wish it had been sooner. I wish I had started transitioning before I even got pregnant, so that I could have gone through pregnancy more comfortable in my weird body. I wish it was me giving birth that day.

Having a baby was by far one of the most badass and amazing things Ive done in my life, but I did it all with a body that didnt feel like mine.

Since starting testosterone, everything has changed. The cloud of dysphoria is beginning to clear. Despite the new challenges that come with a second puberty in my late twenties, getting up in the morning is no longer an act of resilience. Ive been exploring my sexuality in a completely new waywhere I used to avoid touch, I now lean into comfortably. I am starting to understand my body. Communicating my needs and desires to my partner has been a revelation, and the possibilities we can now discover together have invigorated a relationship where Ive mostly felt absent. In the mirror, I recognize myself looking back. When I move, touch, breathe, I feel it happening in my body and my mind. Im no longer watching myself exist, but coming into an existence of my own.

I dont regret my choices around medically transitioning, but knowing now what I didnt know then, I never would have waited. Transitioning has allowed me to prioritize my own mental health, something that pregnancy and parenting often kicks to the side. Ive found empowerment through putting myself first, so that I can have the confidence to show up as a parent and a partner.

My therapist asks what Im proud of, and I say, Im proud that my kid can see someone every day who isnt afraid of being the truest version of themselves.

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I Wish I Medically Transitioned Before Giving Birth - http://www.autostraddle.com

Gilbert, AZ Limitless TRT and Aesthetics is addressing one of the most common problems affecting men of all ages. The providers at the new mens health clinic are focused on working closely with men to restore their strength, function, and ability to engage in certain activities that may have been lost due to age. Through their proven and effective treatment solutions, including testosterone replacement therapy, they have been able to address common problems like erectile dysfunction, loss of strength and muscle mass, and others.

At Limitless TRT & Aesthetics, we dont give up on men as they age. In fact, its just the opposite. We think men can get even better as the years go by as long as they pay attention to their health and take action when necessary. The word limitless is in our name for a reason there is no limit to what a man can accomplish, and its our purpose to help men push their boundaries and make their vision for life a reality, said the companys spokesperson.

To help more men live a full life that they love, the mens health clinic offers a variety of services and treatments that are based on the specific complaints of each patient. Each patient will have access to personalized care and treatment that begins with an initial consultation and comprehensive assessment of their health. As great listeners, the providers will listen closely to each patients complaints, assess them comprehensively, and determine the next line of action regarding treatment.

Added to Testosterone Replacement Therapy, they also offer Focused Shockwave therapy, a non-invasive treatment procedure that addresses a variety of physical issues including erectile dysfunction, pain and discomfort, etc. As a focused mens health clinic, Limitless TRT and Aesthetics further provides aesthetic treatments and services to help men look their best, irrespective of their age. Some of the aesthetic procedures offered include CO2 Laser Resurfacing to address all kinds of skin blemishes and problems, including lost skin tone, target lines on the skin, etc.

Men can also take advantage of the non-invasive cryolypolisis service offered to address excess fat deposits in areas like the underarm, stomach, thighs, and other areas. They also offer botulinum toxin type A treatments, facial fillers, electro muscle stimulation sculpting, and concierge medicine services.

Men who wish to take control of their health, appearance, and wellness can contact Limitless TRT and Aesthetics via phone at 1-480-400-0105, or visit them at 3483 S Mercy Rd Suite 104, Gilbert, Arizona 85297, US. For more information, visit their website.

Media Contact

Company NameLimitless TRT and AestheticsContact NameJosh LeimbachPhone1-480-400-0105Address3483 S Mercy Rd Suite 104CityGilbertStateArizonaPostal Code85297CountryUnited StatesWebsitehttps://limitlesstrtandaesthetics.com/

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Limitless TRT and Aesthetics is the New Testosterone Replacement Therapy Clinic in Gilbert Arizona - Digital Journal

Testosterone replacement therapy can sound a little like the fountain of youth. Replace lost levels of the hormone, travel back in time to your younger years?

As guys age, their levels of testosterone tend to decline. And thats a big problem: Testosterone binds to proteins throughout your body and brain called androgen receptors, which help control and regulate a whole range of different bodily functions, explains Ronald Tamler, M.D., Ph.D., associate professor of medicine at the Icahn School of Medicine at Mount Sinai.

If theres not enough testosterone to go around, those androgen receptors all over your body and brain stay silent, leading to symptoms like low libido, weak erections and orgasms, inability to build muscle mass, low energy, or just feeling a little blue. A condition called hypogonadism low testosteronedevelops when your body cant produce enough of it.

Related: 8 Sneaky Signs Your Testosterone Is Too Low

Thats where testosterone replacement therapya treatment that raises your low testosterone levelscomes in. Testosterone can be supplemented in the form of an injection, a gel, a suction cup on your gums, and even a deodorant. It comes down to personal preference and what your insurance covers, says Dr. Tamler.

Now, testosterone therapy is just for guys whose levels are actually low, usually under 300 nanograms per deciliter (ng/dl) on a blood test. If youre in the normal range, T-therapy isnt on the tableand wouldnt do you good anyway, he says.

If you are prescribed testosterone therapy, youll likely start to see some changes, big and small, pleasant and not-so-pleasant. You may not see them all, and they may not all appear right away, but here are 9 benefits and drawbacks of testosterone therapy you should watch for.

When youre low on testosterone, you might notice your sex drive begin to dip. Androgen receptors are located in the parts of your brain that influence sexual desire, so if you dont have enough T to activate them, you may notice a drop in wanting to get it on, says Abraham Morgentaler, M.D., the director of Men's Health Boston and author of Why Men Fake It: The Truth About Men and Sexand Testosterone for Life.

When you replace your lost testosterone, that can activate those androgen receptors in the part of your brain that controls desire. In fact, regaining a healthy sex drive is one of the biggest benefits of testosterone replacement therapy, says Dr. Morgentaler.

In addition to upping libido, T-therapy can possibly make your erections more satisfying, too. You need to have testosterone to work on the receptors in the penis to help it trap blood to keep it [erect], says Dr. Tamler. Receptors help steer that process, and if you dont have enough T then the process is impaired.

This isnt the only piece of the puzzle, thougherections also rely on healthy nerves and blood flow. So that means that testosterone therapy by itself isnt a cure for erectile dysfunction itself.

Related: 5 Ways Happy Couples Deal When Their Sex Drives Diverge

"Muscles are extremely responsive to testosteroneone of the most reliable things we see [when someone starts testosterone replacement therapy] is an increase in muscle mass," says Dr. Morgentaler.

This is because androgen receptors are found in muscle tissue, so testosterone activates them to stimulate growth. Of course, to make the most of this benefit, youll need to be doing your part by strength training as well.

In addition to an increase in lean muscle mass, some men report fat loss as well. While testosterone doesnt directly incite fat loss itself, part of it may be thanks to the uptick in muscle massthe more muscle you have, the higher your basal metabolic rate (or BMR) will be, which means your body will burn more calories at rest. (Want to max out the process even more? Try The 21-Day Metashred from Men's Health, the at-home workout plan that will help you build lean muscle and burn fat at the same time.)

Jed Kaminetsky, M.D., a clinical assistant professor in the department of urology at NYU Langone Medical Center also notes that this may be partially because testosterone improves overall motivation to get up and sweat it out, so if you're motivated to put in the work again, you'll see results.

Related: 7 Reasons You're Not Building As Much Muscle As You Could

"It's very common for men to come in with low T and one of their primary symptoms is fatigue," says Dr. Morgentaler. "And when we treat them, a lot of men will say that their energy has improved." Many men also report an improvement in the "brain fog" that can come along with low testosterone, adds Dr. Tamler.

While researchers aren't exactly sure how exactly testosterone plays a role in energy yet, Dr. Morgentaler says one of the thoughts is that it has an effect on your mitochondria, which produce energy within cells. This case isnt closed on this yet, but the theory is that "testosterone turns them on so they're more productive in terms of creating the energy that the cells need."

Dr. Tamler also notes that it may be tied back to androgen receptors as well. "If they don't get sufficient input, that can cause fatigue," he says. So bringing testosterone levels back up can help reverse this.

Related: The 8 Best Foods to Keep You Energized All Day Long

Similar to its effects on energy, experts don't have a definitive answer to why testosterone impacts mood so deeplyafter all, "the brain is a complicated thing," says Dr. Tamlerbut they do see it as a potential life-changing benefit.

"In some ways, the impact on mood is one of the most profound benefits of T that we see," says Dr. Morgentaler. "Not everybody has that, but when we see it, it's remarkable. In my practice, patients will say, 'Oh, my mood's OK, maybe I just feel a little bit tired or blah.' And they come back and they say things like, 'I wake up in the morning and I'm optimistic about my day. I haven't felt that way in years.'"

In fact, a 2012 study published in The Aging Male found that after 12 months of testosterone therapy, the percentages of guys with moderately severe to severe depression symptoms decreased from 17 percent to 2 percent.

And more recent research also backs that up: "The largest randomized control trial for T was just completed a year ago, called the T Trials, and it showed that men who received T had a greater improvement in mood than men who received placebo," notes Dr. Morgentaler.

Related: 7 Surprising Symptoms Of Depression In Men That Prove It's Not All About Sadness

This is one of the most common side effects of testosterone replacement theory.

Normally, when your pituitary gland senses that there's not enough testosterone in the bloodstream, it sends down a hormone called luteinizing hormone (LH) to signal your testicles to start producing more testosterone, and a hormone called follicle stimulating hormone (FSH) to signal sperm production.

Related: Why Your Balls Might Feel Like a Bag Of Worms

When you take outside testosterone, the pituitary gland gets the memo that there's enough T in your bloodstream, so it stops sending these signals. This essentially puts the testicles to sleep (read: little or no sperm and testosterone production), says Dr. Kaminetsky.

"Most of the size of the testicle is dedicated to making sperm, so when you're making less sperm, the testicles get smaller," says Dr. Morgentaler. This also means it can hamper fertility, acting like birth control, so if you're planning on having kids, testosterone replacement therapy isn't an option.

6 Things Every Man Should Know About His Penis:

And production doesn't always go back to normal afterwards, either says Dr. Kaminetsky. A 2017 study in Fertility & Sterility found that increasing age and longer length of T-therapy was linked to less chances of normal sperm recovery. (Here are 7things you do every day that might be messing with your sperm.)

Some people notice a little swelling in their feet and ankles because testosterone can encourages your body to hold onto excess fluid, says Dr. Morgentaler.

This isn't a big deal for most people, he says, and its more common to see it if you're taking a non-daily treatment like an injection, where you're getting a higher dose of T in one sitting. You may notice a pound or two of difference on the scale, but it should melt away after a few days.

Related: Tom Brady Drinks 25 Glasses Of Water a Day. Should You Drink That Much, Too?

Going on testosterone replacement therapy may change your skin typefor better or for worse, says Dr. Morgentaler.

Like other hormones, testosterone can increase oil production, which isn't necessarily a bad thing. It's important for healthy skin, so you may actually end up with a better complexion. However, too much oily buildup can lead to breakouts.

Thankfully, this isn't that common, says Dr. Morgentaler, and it's typically seen in men who have a history of acne. (If you shudder at the reminder of your teenage skin, this might be a more likely side effect.)

Similar to the fluid retention, this is mainly seen with treatments like injections, when you're getting a higher dose all at once.

Related: 5 Reasons You Still Get Acne As a Grown-Ass Man

In all menwhether youre taking T or notsome testosterone is converted into the hormone estradiol, a form of estrogen. And in men who have more breast tissue by nature, the T they're taking that's naturally converted into estradiol could stimulate this breast tissue to grow.

This is called gynecomastia, says Dr. Morgentaler, and it's relatively uncommonhe says he doesn't even see one case a year.

If this does happen, though, your doctor will likely stop treatment for a month or two to allow your breast tissue to go back to normal, and then start you back up with T along with a drug that blocks the conversion of testosterone to estradiol.

Related: How to Get Rid Of Man Boobs

Testosterone replacement therapy has traditionally come along with serious warning labels that your risk for heart attack, stroke, and prostate cancer could rise, but this is still very controversialand recent evidence has begun to debunk some of these fears.

In the case of heart attacks and strokes, the concern is that testosterone thickens blood because it binds to androgen receptors that stimulate bone marrow to produce more red blood cells. Thicker blood is linked to a greater risk of heart attack and stroke.

But there isn't strong evidence to connect these cardiac events to testosterone itself, and some more recent studies actually suggest that normal testosterone levels might actually protect against these risks, says Dr. Morgentaler.

One mechanism at play here could be that reduced body fat is linked to overall better health, and testosterone replacement therapy can encourage this, says Dr. Morgentaler. More research is needed, he says, and to be safe your doctor will monitor your red blood cell count throughout your treatment.

As far as prostate cancer goes, this is fuzzy, too. Because there are androgen receptors in the prostate, testosterone can make it grow. So if you already have an enlarged prostate that makes it difficult to urinate, testosterone could exacerbate the issue, says Dr. Tamler.

Related: Should You Get the PSA Test to Screen For Prostate Cancer?

If you have existing prostate cancer, theoretically, testosterone could make it grow in the same way, says Dr. Kaminetsky. However, there isn't evidence to suggest that T actually causes prostate cancer.

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Testosterone Therapy Effects: What to Expect After ...

IMH doctor discusses how to avoid fertility issues during testosterone replacement therapy

Marc DiJulio, MD, FACEP

You may be wondering about testosterone replacement therapy (TRT) and fertility issues. We know that TRT may reduce sperm production and impact fertility. Very simply, the pituitary gland in the brain is the director of testicular function. If it sees a high testosterone level, it stops telling the testes to produce testosterone. This also affects sperm production. This also explains why testes shrink a bit on TRT. That is why we use Human Chorionic Gonadotropin (HCG) in our TRT programs to periodically stimulate the testes. It reminds the testes that they do have a job to do other than just making testosterone.

Clomid (clomiphene citrate) uses a different approach to increase testosterone and spermatogenesis. It was originally developed and tested to increase ovulation and, thereby, improve fertility in women. The result in men is a modest improvement in testosterone levels while preserving sperm production. We can usually achieve a 100% increase in T levels with Clomid. In some cases, one may see up to a 200% increase. This increase is not as high as pellets or injections but it can make a big difference depending on how low you are. So if you had an initial level of 300, we would hope to see an increase to 600, +/-. Some clients may even see a larger increase.

DIAGNOSIS & TREATMENT OF LOW T

Clomid for men stimulates the bodys own production of testosterone. Clomid is a pill taken daily. It is generic and cheap. No shots. It does not interfere with the bodys checks and balances of testosterone. Fertility is preserved. No testicular shrinkage. It has few, if any, side effects and this is usually dose-related. Clomid, by increasing T levels, can produce the same/similar effects as traditional TRT. Each patient is different and the response will vary depending on current testosterone level. It is inexpensive and usually covered by health insurance.

In lower levels of testosterone, it takes longer to see the benefits of Clomid than with injection therapy. It may also not work, especially in patients over 60 and those with compound medical issues. Some patients may not see an increase in libido as Clomid does have some mild estrogenic properties. Of course, we follow the labs, just like in TRT, and would correct for an elevated estradiol level if needed (anastrozole). There have been rare reports of vision changes. If this happens, the patient should note very specifically what occurred, how long it lasted, etc. and then stop the Clomid until you speak with your doctor.

A typical candidate for Clomid is younger and planning on having children soon or in the future. Patients who just do not want to deal with injection or pellet therapy and are willing to accept a lower T level. Patients who have been on TRT and have decided to have children but want to maintain some increase in testosterone levels. Men who have known low sperm counts. Patients who have a varicocele (a problem with the blood vessel around the testes) that can cause infertility.

The fact that these conditions were also more prevalent in the older age group seems to indicate that the lack of clinical response may be the result of comorbid medical factors than of age alone.

The dosage range is 12.5mg 50mg per day. I prefer to start at 25mg every other day for a short trial period and then increase to daily dosing. Dosage can be adjusted based on any side effects, lab results, and an overall improvement in the T-effect. You will read any number of protocols that involve more complicated patterns of dosing. I prefer to keep it simple.

Some authors recommend taking Vitamin E to improve the success of Clomid. More than 400 iu is not recommended, a much smaller dose is fine.

It takes 90 to 108 days from the time that sperm is produced in the testicles until it is ejaculated. It takes time for a man to see fertility results from Clomid. As such, a man should not stop taking the medication unless there is no improvement by the fourth month of treatment.

Like traditional TRT, most physicians do not have a good understanding of TRT or even that Clomid is a treatment choice. Most doctors think about Clomid as a womans drug and do not want to prescribe off-label. It is generic and inexpensive so there is little or no advertising.

If you are considering Testosterone Replacement Therapy but worry about possible fertility issues, you can trust the experienced physicians at Innovative Men's Health clinic to restore your quality of life and minimize possible side effects of the therapy. Schedule a consultation with our doctor today.

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Clomid For Men On Testosterone Replacement Therapy (TRT ...

In a recent OncView discussion, Aaron Berger, MD, vice president and chief medical officer at Associated Urological Specialists in Chicago, Illinois, shared clinical experiences and perspectives regarding treatments of patients with nonmetastatic castration-resistant prostate cancer (nmCRPC).

Clinicians need to be aware of all the treatment options available in this space, as many FDA-approved indications have emerged in the past few years, Berger said.

Thereve been several new options for nonmetastatic castration-resistant prostate cancer to come to market, he noted. The first was enzalutamide [Xtandi] followed shortly thereafter by apalutamide [Erleada], and then most recently darolutamide [Nubeqa]. Weve used all of them in our advanced prostate cancer clinic, and its certainly an improvement over the previous options [such] as first-generation antiandrogen therapies.

Berger detailed his strategies for therapy selection in this patient population, including insights in baseline patient characteristics, clinical trial data, and toxicity profiles of each novel agent that guide his decisions.

Berger said his first consideration in a patient with nmCRPC is whether they need additional systemic therapy. Age, comorbidities, prostate-specific antigen (PSA) doubling time, and medication adherence are some of the factors that may incline a clinician to treat a patient with a newer antiandrogen medication.

Some of these patients have a lot of other [medical] issues, Berger said. If theyre not excited about another medication or are worried about [adverse] effects, we may just observe them, especially if their [PSA is] rising somewhat slowly.

Ultimately, the treatment goals in this setting are to prevent progression of disease from nonmetastatic to metastatic, as survival rates dramatically decrease in later stages of the disease. Typically, we will check PSA and testosterone levels every 3 months, Berger said. He noted that testosterone less than 50 ng/mL and a PSA doubling of 10 months or less was the threshold for administering medication to patients in clinical trials.

Thats not in the labeling for all these medications. You certainly can use the medication if their doubling time is 11 months or 12 months, but normally its [with a PSA doubling time of] 10 months or less were really focused on, he said.

For imaging in a patient with a significant PSA rise, Berger said he references the RADAR III guidelines, which recommend next-generation imaging techniques for detecting previously metastases (Table 1).

We would certainly consider doing conventional imaging initially, such as a CT scan or bone scan, and if its negative then we would likely continue observation, Berger said. I typically wouldnt wait until PSA is 5, 10, or 20 ng/mL and just keep doing conventional imagingwe would likely move on to doing next-generation imaging studies earlier. Some other factors that might motivate imaging sooner include pain in the back, hips, or legs; urinary symptoms; or obstructions in the kidneys.

Regarding the 3 available next-generation androgen receptor inhibitors that are available to treat patients in this setting, Berger said their mechanisms of action are similar but varying molecular sizes account for the biggest differences reflected in slightly different toxicity profiles.

Darolutamide typically has less in the way of central nervous system effectssuch as fatigue, light headedness, or dizzinessthan what we sometimes may see [with the other agents], Berger said. But mechanistically, they work very similar.

Regarding metastasis-free and overall survival (OS) rates, pivotal clinical trials that led to the approval of these agents reflect similar results. The design of the studies are very similar and the results of the studies are very similar, Berger said. Sometimes theres a reason why you may not use one versus the other, such as if a patient does have significant fatigue or has any other central nervous system issues [such as] gait abnormalities. Potentially, the darolutamide may be a better choice than enzalutamide or the apalutamide. But in my experience, theyre all tolerated pretty well.

Berger then explored data from the phase 3 PROSPER (NCT02003924), ARAMIS (NCT02200614), and SPARTAN (NCT01946204) trials that led to the approvals of enzalutamide, darolutamide, and apalutamide, respectively.

All 3 trials had very similar patient populations with a PSA doubling times of 10 months or less. All the patients had rising PSA that was confirmed on more than 1 occasion and castrate levels of testosterone less than 50 ng/mL, Berger said. They were all looking at metastasis-free survival as the primary end point.

At the initial readout of the SPARTAN trial, metastasis-free survival (MFS) was statistically significantly improved with apalutamide versus the placebo group (HR, 0.28; 95% CI, 0.23-0.36; P < .001).2 Similarly, MFS in PROSPER showed a 71% reduction in the risk of metastasis or death with enzalutamide compared with placebo (HR, 0.29; 95% CI, 0.24-0.35; P < .001).3 In ARAMIS, patients treated with darolutamide derived a significant treatment benefit versus those treated in the placebo group (HR, 0.41; 95% CI, 0.34-0.50; P < .001).4

In subsequent analyses, it is now borne out that they all do result in improvements in overall survival, Berger said. OS results with next-generation agents versus placebo were statistically significant for SPARTAN (HR, 0.78; 95% CI, 0.64-0.96; P = .016),5 PROSPER (HR, 0.73; 95% CI, 0.61-0.89; P = .001),6 and ARAMIS (HR, 0.69; 95% CI, 0.53-0.88; P = .003).7

When discussing toxicity, Berger detailed each in the context of which adverse effects were commonly associated with each agent.

We typically see with enzalutamide fatigue or asthenia. These patients are all on androgen deprivation therapy at baseline [and] they have low testosterone at baseline, which can certainly decrease their overall energy level to start with, Berger said. Adding the enzalutamide in some patients does zap their energy substantially to the point where some dont really feel like they have any motivation and dont want to get out of bed.

For these patients, Berger said a slight dose reduction can have a profound effect on their energy levels. For example, reducing the dosage by 25% or switching a patient from a 4-pill dose to a 3-pill dose may help a patients experience without significant effects on their overall disease outcomes.

With apalutamide, full body rash 2 to 3 months into treatment may occur but often can be managed with oral antihistamines or topical corticosteroids. Rarely, patients have a severe full body rash that requires discontinuation of therapy.

Theres also a slightly higher risk with apalutamide of hypothyroidism, but this is not typically something we screen for routinely, Berger said. Its mainly for those patients who have a history of hypothyroidism and are on medications already for thyroid replacement that well check a thyroid panel along with their PSA and testosterone.

Regarding darolutamide, Berger said its toxicity profile is likely the most favorable of the 3 available agents with its lower rate of fatigue, with most symptoms occurring during treatment.8 The bottom line is to know what to potentially expect and let the patients know what to be on the lookout for, he said.

Berger said comorbid conditions, such as obesity or diabetes, may inform the decision to administer an androgen inhibitor but they do not necessarily preclude a patient from treatment.

If they dont have significant cardiovascular issues and havent had a heart attacks, stroke, or congestive heart failure issues, Im not going to withhold a second-generation androgen inhibitor just because theyre a bit overweight, Berger said.

In fact, the relatively manageable safety profile of these agents means that treatment can be given without many dose adjustments even to patients with renal insufficiencies, he said.

Neurologic issues that may be present, such as unsteadiness, dizziness, or a history of falls should be taken into consideration, Berger said. Then the data would indicate that darolutamide may be a better option [because] there wasnt an increased risk from falls and fractures in the ARAMIS trial.

Regarding unmet needs in the treatment space, Berger said that guidance for prescribers on drug-drug interactions is lacking. There are a lot of medications patients are on, whether its antihypertensives, diabetes medications, or cardiovascular medications, especially the anticoagulants that may have some interactions with these medications. And the guidance, as far as what we can glean from the studies, is not always clear about whats safe and what may not be safe, he said.

Another consideration is whether nmCRPC will continue to be a disease state in the future, as next-generation imaging techniques become more prevalent in the treatment landscape and reveal metastasis in patients who would have been formerly considered nonmetastatic.

When you have a scan that can pick up an area of metastasis at [PSA of] 0.2 to 0.3 ng/mL, it may turn out that these patients are metastatic. All of these studies were done with conventional imaging, Berger said. The big question as far as this entire disease state is, will it still be a disease state 5 years from now?

Overall, Berger said clinicians shouldnt shy away from prescribing these medications to their patients, given their tolerability and ease of administration. I would not be afraid of these medications because you can easily add them into your clinical practice without a lot of trepidation, he said.

1. Crawford ED, Koo PJ, Shore N, et al. A clinicians guide to next generation imaging in patients with advanced prostate cancer (RADAR III). J Urol. 2019;201(4):682-692. doi:10.1016/j.juro.2018.05.164

2. Smith MR, Saad F, Chowdhury S, et al. Apalutamide treatment and metastasis-free survival in prostate cancer. N Engl J Med. 2018;378(15):1408-1418. doi:10.1056/NEJMoa1715546

3. Hussain M, Fizazi K, Saad F, et al. Enzalutamide in men with nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2018;378(26):2465-2474. doi:10.1056/NEJMoa1800536

4. Fizazi K, Shore N, Tammela TL, et al. Darolutamide in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2019;380(13):1235-1246. doi:10.1056/NEJMoa1815671

5. Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. Eur Urol. 2021;79(1):150-158. doi:10.1016/j.eururo.2020.08.011

6. Sternberg CN, Fizazi K, Saad F, et al. Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2020;382(23):2197-2206. doi:10.1056/NEJMoa2003892

7. Fizazi K, Shore N, Tammela TL, et al. Nonmetastatic, castration-resistant prostate cancer and survival with darolutamide. N Engl J Med. 2020;383(11):1040-1049. doi:10.1056/NEJMoa2001342

8. Gratzke CJ, Fizazi K, Shore ND, et al. Time course profile of adverse events of interest and serious adverse events with darolutamide in the ARAMIS trial. Ann Oncol. 2021;32(suppl 5):S626-S677. doi:10.1016/annonc/annonc702.

Original post:
Recap: Recent Updates in the Treatment of Nonmetastatic Castration-Resistant Prostate Cancer - Cancer Network

This article was originally published here

Int J Impot Res. 2021 Nov 19. doi: 10.1038/s41443-021-00498-5. Online ahead of print.

ABSTRACT

The events of the 2019 SARS-CoV2 virus pandemic have all but ensured that telemedicine will remain an important aspect of patient care delivery. As health technologies evolve, so must physician practices. Currently, there is limited data on the management of testosterone replacement therapy (TRT) in the era of telemedicine. This review aims to explore the potential benefits and pitfalls of TRT management via telemedicine. We also propose a theoretical framework for TRT management via telemedicine. Telemedicine provides patients and physicians with a new mechanism for American Urological Association guideline-concordant TRT management that can increase patient access to care and provide a safe space for men who may otherwise not have been comfortable with in-person evaluation. However, there are significant limitations to the use of telemedicine for the management of TRT, including the inability to perform a physical exam, inability to administer specific medications, technological barriers, data security, and medical-legal considerations, and both patients and providers should engage in shared decision making before pursuing this approach. Understanding and acknowledging the potential pitfalls of telemedicine for TRT management will enable both patients and providers to achieve optimal outcomes and satisfaction.

PMID:34799712 | DOI:10.1038/s41443-021-00498-5

See the article here:
Testosterone replacement therapy in the era of telemedicine - DocWire News

Gender-affirming services have evolved quite a bit in the last 50 years, but we still have a long way to go.

Image Credit: LIVESTRONG.com Creative

From "genderqueer" to "gender-affirming care," the newest terminology in the LGBTQ+ community does much more than slap a new label on an old idea. The words we're now using to identify patients and their health care needs show that the goals of care providers are becoming more closely aligned with the needs of transgender and gender-nonconforming people.

The best part? Gender-affirming care isn't just helping a small fraction of the population; it's making health care better for everyone.

What Is Gender-Affirming Care?

Gender-affirming care describes an array of health services that alleviate the suffering associated with gender dysphoria, defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as clinically significant distress or impairment related to a strong desire to be of another gender.

But gender-affirming care is more than hormones and surgery. "At its core, it's about seeing the whole person, affirming them exactly as they are," J. Aleah Nesteby, nurse practitioner, former director of LGBTQ services for Cooley-Dickinson Hospital and a clinician and educator with Transhealth Northampton, tells LIVESTRONG.com.

Gender-affirming care isn't just a new way to say "sex change." And that's important, because how trans and gender-nonconforming people's identities and experiences are named and described reflect our broader cultural values of diversity, equity of access and consent.

While language like "sex reassignment" or "gender-confirmation surgery" used to be accepted, today it is recognized that sex assignments at birth are an unscientific guess at best, and that only the individual can confirm their own gender. We don't know everything there is to know about gender, but we know it is evident in early childhood, and no amount of therapy or conditioning can change a person's innate sense of their gender, according to a landmark article in the March 2006 issue of the OAH Magazine of History.

Gender-affirming care allows a patient to change their sex characteristics, bringing their minds and bodies into greater alignment, while continuing to receive a lifetime of competent care from providers who recognize that the challenges people who are trans and gender-nonconforming or nonbinary (TGNC) face are not just medical, but social. This type of care goes far beyond treating dysphoria to acknowledge the physical differences of postoperative bodies and the stress of living with transphobia.

More than 50 years after the first gender clinic (that is, a center that provides transition-related services) opened its doors, gender-affirming care is no longer experimental. The June 2017 issue of The Journal of Sex and Marital Therapy describes it as the best, most effective treatment for gender dysphoria.

The authors behind a March-April 2021 paper in The International Brazilian Journal of Urology agree, adding that gender-affirming care enjoys a very high rate of patient satisfaction. According to the most recent World Professional Association for Transgender Health (WPATH) Standards of Care (SoC), published in 2012, satisfaction rates range from 87 to 97 percent and regrets are rare, topping out at just 1.5 percent.

Who Needs Gender-Affirming Care?

As we mentioned, gender-affirming care directly benefits people with gender dysphoria. About 44 million people worldwide have a diagnosis of gender dysphoria, according to The International Brazilian Journal of Urology paper mentioned above. But estimates like these likely underreport the true figures, according to WPATH.

In previous editions of the DSM, the desire to be of another gender was described as a disease doctors were meant to cure; but today, we embrace a diversity of gender identities as healthy and normal. Still, gender dysphoria can cause distress or impairment, and a person with the condition may want to change their body's primary and/or secondary sex characteristics through hormones, surgery and other procedures.

In the U.S., there are about 1 million TGNC people, a number that is expected to continue rising, according to the January 2017 issue of the American Journal of Public Health. But not everyone who is TGNC wants or needs gender-affirming services.

That's because a diagnosis of gender dysphoria is completely separate from a person's gender identity or sexual orientation. Transgender people, for example, have a gender identity or expression that's different from the sex they were assigned at birth. But that doesn't automatically mean they want to change their sex characteristics, or that this difference causes them the stress or impairment marked by gender dysphoria.

Similarly, people who do not feel strictly like a man or a woman all the time might identify as nonbinary, gender-nonconforming, genderqueer or with another label to describe their gender. Nonbinary people (also called "enby" or "enbies") are a fast-growing demographic, making up about 35 percent of the trans community, according to the June 2019 issue of Translational Andrology and Urology. Like men and women, enbies can be straight, gay, bisexual, asexual or identify with another sexual orientation. And like other trans people, enbies may seek gender-affirming care, or they may not.

For people who do want gender-affirming services, though, this approach to treating gender dysphoria has been overwhelmingly successful, and has been the standard of care for more than 30 years.

Gender-Affirming Care Is Patient-Centered Care

The first U.S. gender clinics only accepted patients who would complete a social, legal and medical transition that resulted in a perfect binary: a heterosexual man or woman who "passed" as such in society, and who retained no reproductive capacities associated with the sex assigned to them at birth.

Retention of reproductive capacity is a human rights issue. In the past, certain areas of the country and some clinics and private practices had policies that required transgender people be sterilized before they were issued corrected documentation of their sex or access to gender-affirming care. These policies are now recognized as a serious breach of human rights.

But obstacles to getting corrected legal documents still exist in some states, and there are medical providers who still insist on sterilization before performing reconstructive genital surgery. Yet patients are pushing back, and finding surgeons who will work with them to achieve outcomes that treat symptoms without sacrificing fertility.

James, who first sought gender-affirming care in 2001, wanted to keep his options open. (Several of the people LIVESTRONG.com interviewed for this story asked to be identified by their first names only for privacy reasons.) Now married, he and his wife are using reciprocal in-vitro fertilization (IVF) to grow their family. In this process, an egg from James is harvested and fertilized using donor sperm; the resulting zygote is implanted in his wife's uterus. James has already gone through one successful round of egg retrieval. If all goes well, his wife will experience a normal, healthy pregnancy, and both parents will have a biological connection with their child.

IVF technology has been available for more than 40 years; the innovation is in putting a high priority on James' desired outcomes from gender-affirming treatment. Under the model of care most doctors used to be trained in, medical experts would assess James, diagnose him and decide how to treat him, all without asking him what he wants.

In the informed consent model, on the other hand which is the backbone of gender-affirming care communication between patient and physician is intended to allow the patient to make educated choices about their care. This approach isn't just for TGNC patients: Informed consent increases patient satisfaction across the board. "Over time, most of the prescribing world has caught up to the informed consent model, and now it's seen as the standard of care," Nesteby says.

"Fifteen years ago when I entered practice, the bar was so low for providers in terms of who was considered good and trans competent," Nesteby says. "Now, expectations have changed. Patients, especially younger people, expect providers to talk to them about their options, including what's outside the typical standards of care."

Joshua Tenpenny's experience with gender-affirming care illustrates this point. Tenpenny is a massage therapist who lives as a man and identifies as nonbinary. When he sought genital surgery years ago, he wanted a nonbinary outcome neither male nor female so he looked for a surgeon who was open to an experimental approach, he tells LIVESTRONG.com.

The initial procedure was not entirely successful, and the surgeon was reluctant to perform a revision, but Tenpenny says he may try again in the future with another provider to achieve the results he envisioned. All procedures come with risks of complications and failure, and despite the outcome, Tenpenny found that not being confined to a small menu of options for bottom surgery has been an empowering experience.

The History of Gender-Affirming Care in the U.S.

The concept of gender-affirming care first reached most Americans in 1952 when Christine Jorgensen's transition from male to female made headlines. The first gender clinic in the U.S. opened in 1966 at Johns Hopkins. Backed by the most influential professionals in transgender care, the Harry Benjamin International Gender Dysphoria Association today the World Professional Association for Transgender Health (WPATH) became the standard-bearer in the early 1980s.

But through the '80s and early '90s, seeking gender-affirming care continued to be an isolating experience, with cruel barriers like the "real-life test," in which people with gender dysphoria were only allowed to access hormones and surgery after six months, a year or longer living successfully in the target gender. For trans people who did not pass, the dangers of the real-life test ranged from harassment, unemployment and homelessness to violence and death.

Today, trans people are rewriting the standards for their own care. The WPATH Standards of Care, which have been broadly adopted worldwide, are in their seventh edition. Authors of the most recent version and the current board of WPATH include trans professionals: people who have a TGNC identity as well as cultural competency and expertise in the medical care of TGNC people. Even more significantly, stakeholders in gender-affirming care TGNC people, their families and their caregivers are changing health care for the better, making it easier to access and using informed consent to customize treatment to a patient's individual needs.

These changes are allowing people like Ian, who identifies as nonbinary, to receive the care they want. "When I first learned that the Standards of Care had been updated to include nonbinary people back in 2013, I made an appointment at Fenway Health in Boston in the hope of starting HRT [hormone replacement therapy]," Ian recalls. "I'd known that I was genderqueer and wanted to go on T since 2001, but I hadn't been willing to lie about my identity by pretending to be binary trans to obtain it."

Still, past versions of the SoC continue to influence the law, health insurance practices and guidelines developed by health care providers. Levi Diamond, a 43-year-old trans man, was recently told by surgeons that they would not perform top surgery on him (to alter the appearance of his chest) until he had lived a year in the male role. The current SoC criteria for mastectomy and creation of a male chest in transmasculine patients make no mention of a real-life test, but some providers crafted their own guidelines years ago, based on older versions of these standards, and have not updated their policies to reflect advances in care.

Similarly, Katy sought gender-affirming care after learning she was born with Klinefelter syndrome, a chromosomal difference of sexual development. Genetically XXY, people with Klinefelter syndrome are assigned male at birth. The signs of having an XXY karyotype versus the more common XY for boys can be subtle and difficult to discern, and those with Klinefelter syndrome are frequently unaware of their genetic difference from XY men and boys.

After a karyotype test confirmed her doctor's diagnosis, Katy was referred to an endocrinologist. Male hormones are often prescribed to treat symptoms of Klinefelter syndrome, but Katy asked for a prescription for estrogen. Disregarding her request and focusing on her intersex diagnosis, Katy's endocrinologist prescribed her testosterone. By doing so, he exemplified the bias many trans people encounter in seeking care, and the limits of the "pathology" model of care.

After nine months on testosterone, Katy was more certain than ever that male hormones were not for her. Years later, she found a more patient-affirming health care provider and began feminizing hormone therapy, a decision she knew was right within days of beginning treatment. Now 50, Katy has had four gender-affirming surgeries.

Innovations in Gender-Affirming Care

Both acknowledgment by the medical profession that gender-affirming care is medically necessary and laws preventing discrimination against TGNC people have led to an increase in gender-affirming services, according to a February 2018 article in The Washington Post. Coverage by health insurance has created greater access to care, which has also driven demand. The growing market has led more professionals to specialize in gender-affirming services, and more procedures have led to improvements, making treatments safer. Surgical results are also more aesthetic and more functional.

The typical order in which gender-affirming care is applied mental health services before HRT, then chest surgery, and finally, lower surgery has not changed, but protocols have evolved, and the sequence is more flexible in patient-affirming care models that use informed consent and harm reduction.

Usually, someone with gender dysphoria begins gender-affirming care with a mental health professional who diagnoses them and helps them decide on priorities and address concerns related to the next phase of treatment. Patients may be referred for hormone therapy in coordination with mental health treatment, or they may be assessed and prescribed by a physician.

It's a common misconception that gender-affirming care must be handled by a specialist. "A lot of people think you need to see an endocrinologist to be on hormones," Nesteby says. "It's not necessary for every person. A lot of cases can be managed in primary care." She compares HRT to diabetes care, which is typically handled by primary care providers.

About 80 percent of TGNC people will seek HRT, according to Jerrica Kirkley, MD, co-founder and chief medical officer of Plume, which provides gender-affirming care using telemedicine in 33 U.S. states. HRT in TGNC patients usually involves administering estrogen, testosterone and/or hormone blockers to achieve blood levels typical among cisgender people.

In the late 1960s, transgender patients were warned their surgical outcomes from what's collectively called "lower surgery" or "bottom surgery" would not resemble the genitals of cisgender women and men. For trans women, a vagina that could be penetrated by a penis was considered the only functional goal of surgery. By contrast, in the November 2013 issue of Sexual and Relationship Therapy, researchers note that patient satisfaction is now a well-accepted tool for measuring whether a health care service has been successful.

By the late 1980s, surgeons offered vulvoplasty creation of the labia and clitoris and were able to preserve sensation in the new structures. In recent years, the surgical results of transfeminine vaginoplasty closely resemble the cultural ideal, and 80 percent of trans women surveyed were orgasmic following lower surgery, The Journal of Sexual Medicine reported in February 2017. In Plastic and Reconstructive Surgery in June 2018, it was reported that 94 percent of one surgeon's patients, treated over a 15-year period, were pleased with the results overall and would repeat the procedure.

Bottom surgery for trans men has also come a long way. There are two general categories: metoidioplasty and phalloplasty. The former takes advantage of the physical changes caused by testosterone therapy, which include the growth of the clitoris (the analogous organ to the penis). This larger clitoris becomes a penis that retains sexual function and sensitivity but may be too short for penetration. The latter creates a penis using a graft taken from the forearm, thigh or abdomen, which looks and functions like that of a cisgender man but doesn't always retain sensation.

In an article in the May 2021 issue of The Journal of Sexual Medicine on patient satisfaction with transmasculine lower surgery, two-thirds were satisfied with the appearance of their genitals after surgery, but only one-third were satisfied with sexual function. However, 82 percent were happy with the effects of the operation on their masculinity.

Chest or "top surgery," sought by up to a quarter of people with gender dysphoria, has been about twice as common as lower surgery among patients seeking gender-affirming care, according to the Translational Andrology and Urology article. Today, there are methods available to retain greater sensation and result in less scarring for chests of all sizes.

Besides "top" and "bottom" surgeries, other procedures for masculinizing or feminizing the appearance to reduce gender dysphoria include facial feminization surgery (FFS), which is a category of aesthetic procedures including hairline correction, rhinoplasty and jaw reduction. Hair removal, nipple tattoos, vocal training, facial masculinization surgery, liposuction and other cosmetic procedures may also help treat gender dysphoria.

Hair removal has emerged as a critical gap in access to care for people using health insurance to pay for lower surgery. It is medically necessary preoperative treatment, delivered by a licensed professional. In a catch-22, though, hair removal has traditionally been offered in clinics that do not accept health insurance, because their services have not been covered in the past. "No one was credentialed to get covered by insurance," Nesteby explains. "Now you have this necessary service, but people are still having to pay out of pocket. That's been an access issue we only realized after insurance started covering surgery."

How to Access Gender-Affirming Care

The people who responded to interview requests for this article reported starting their search for gender-affirming care with a primary care physician, or through a clinic for underserved sexual minorities. Callen Lorde in New York City, Lyon Martin in San Francisco and Tapestry in Greenfield, Massachusetts, all came up in interviews. "I had an excellent experience with the Equality Health Center in Concord, New Hampshire," Ian says. "EHC offers informed consent as an access protocol for HRT. This fit well with my personal goals and preferences."

A major hurdle in accessing gender-affirming care is that, often, finding one educated and trans-competent provider isn't enough, because TGNC people need a lifetime of treatment.

For example, if a patient has surgery at a center hundreds of miles away, then experiences a complication after returning home, local emergency medical service providers must understand the treatment the patient has received and how his body differs from their expectations in order to properly care for him.

Similarly, trans women who have had vaginoplasty need urological and gynecological services that are different from the care appropriate for a cisgender man or woman. Yet both patients and physicians have reported a lack of provider competence, per an August 2021 paper in the Journal of Gynecologic Surgery.

Using a clinic whose mission is to serve the transgender community does not guarantee competent care either. In fact, one interview subject treated by a big-city provider focusing on the TGNC community routinely felt they mismanaged a common side effect of HRT, causing him distress when his dysphoric symptoms returned. Rather, gender-affirming care can come from small towns, family doctors and providers who don't specialize in TGNC care.

But it takes more than good intentions to provide appropriate care: It requires ongoing medical and cultural competency training. Many patients rely on word of mouth, transgender community message boards and online directories to find competent providers. A directory of transgender-aware care providers is available through the WPATH Global Education Institute, which offers a 50-hour training program to its members. (Patients can search for WPATH members who are care professionals here.)

"Gender-affirming services have evolved quite a bit in the last 50 years, but there's still a great lack of access," Dr. Kirkley says. "Primary care is improving, but there is no standardized curriculum of gender-affirming care in medical schools, nursing schools and public health programs. We still have a long way to go."

More recently, in the age of COVID-19, telemedicine is helping to close another gap in access: geography.

"Virtual care has changed the dynamics of all health care dramatically," Dr. Kirkley says. Insurance began to routinely cover telemedicine during the novel coronavirus pandemic, making trans-aware providers available to patients who would not have otherwise been able to access their services. "Before COVID there was a lot of doubt [that telemedicine is effective], but [the shutdown] has really validated the model. As an innovation in health care delivery, it has enabled Plume and other providers to provide gender-affirming care."

Still, the changes that have come with gender-affirming care benefit more than the TGNC community. People in all walks of life can appreciate the greater access telemedicine brings and the revolution in patient-centered care.

"I think that one of the benefits that cisgender, heterosexual people don't see about gender-affirming care or trans visibility is that it helps everybody," Nesteby says. "It's not only trans people who suffer from rigid boxes we put people in. When we don't force people into binaries, everybody wins."

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Gender-Affirming Care: What It Is and How to Find It - Livestrong

Cne Lpez is a trans health reporter for Insider. Canela Lpez/Insider

I started hormone replacement therapy to treat my gender dysphoria in April.

I've found the online trans community more helpful at times than my actual endocrinologist.

Partly because of a lack of research on transition-related care, finding information can be hard.

Editor's note: This article is not medical advice. Consult a healthcare professional regarding questions about diagnoses and treatment.

I started hormone replacement therapy in April, the same day Arkansas passed the first trans medical ban in the United States, barring trans youth from accessing gender-affirming care.

With the heaviness of the wave of anti-trans legislation on my mind, I felt fortunate to have access to an endocrinologist after nearly a year of back-and-forth with insurance and several attempts with less trans-competent doctors.

I wanted to start testosterone-based HRT to treat my lifelong gender dysphoria, or extreme distress related to my body and gender, that has affected me as a transmasculine nonbinary person. I started testosterone therapy to deepen my voice, make myself a little more muscular, and overall become more comfortable in my body.

As someone who has insurance that covers gender-affirming care and lives in a major city, I am incredibly privileged.

I microdose HRT, meaning I take a smaller amount of testosterone for more gradual changes over a longer period of time. When I told my endocrinologist in New York City that I wanted to stay on a microdose long-term, he said he could write me the prescription but had to be transparent about the lack of research available on it. When I asked him what changes I could expect for my body, he told me he didn't know, even after I pressed for more information.

The only place I've been able to turn to for concrete answers on how to achieve the results I wanted - like a deeper voice and larger muscles - was online platforms like Reddit.

Story continues

Hormone replacement therapy as a form of treatment for the gender dysphoria that trans people experience has been around since the 1920s. But treatment protocols have been slow to shift.

Because of a lack of research on the effects of different HRT options, even trans-competent medical providers are left with few concrete studies to cite when patients ask questions, and physicians receive few hours of LGBTQ+-specific training.

One of the first questions I asked my doctor was which kind of injection I should opt for to get the most dramatic effects, which for me included a deeper voice, more muscle definition, and fat redistribution.

While small studies have suggested that subcutaneous injections (injection into the fat) could help retain testosterone in the body for longer between shots, my doctor told me there wasn't enough conclusive data to confirm this. I ended up opting for intramuscular injections and was dissatisfied with how long it took to see physical changes.

In the first month of taking HRT, the skin around my jaw thickened. When I went back to the doctor and asked how long it would take for my jawline to reemerge, he told me there wasn't enough research out there for him to give me a timeline.

Puffy-faced and feeling lost, I turned to the internet for understanding.

My friends who had started HRT before me recommended going on Reddit to find specific answers about where I should inject my T for the most effective results.

There I found several subreddits, like r/FTM and r/genderqueer, where people shared similar concerns and got their questions answered by a community of trans people who had taken testosterone. That's how I found out about the small study suggesting subcutaneous injections could keep testosterone in your system longer than intramuscular injections. So I switched, and I am much happier with the results.

My only sense of understanding about my body during this process came from other trans people willing to share their experiences with HRT.

Even close friends who have been on testosterone have been more helpful in some ways to my transition than my doctor.

One of my friends has a more radical endocrinologist willing to talk about experimental treatments that have anecdotally worked on patients, so I often chat with them about what they've learned so I can take questions back to my own doctor. My other friend lives on the internet and can name trans subreddits at the drop of a hat, so they offer their knowledge.

My friends and I doctor one another in many ways, trading information like playing cards.

Trans Reddit forums became a haven of support for me when so many of my medical concerns went unanswered through official channels. While I can only take the experiences of others with a grain of salt, they have been a huge comfort during a nerve-wracking process.

Read the original article on Insider

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I'm a trans person who recently started testosterone, and Reddit was more helpful than my doctor - Yahoo News