Archive for the ‘Hormone Clinic’ Category

What is human chorionic gonadotrophin?

Human chorionic gonadotrophin (hCG) is a hormone produced by the placenta during pregnancy. Its sometimes called the pregnancy hormone because of its unique role in supporting a pregnancy. HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Healthcare providers measure hCG to confirm a pregnancy and provide details on how the pregnancy is progressing.

After conception occurs, a fertilized egg travels through your fallopian tubes to your uterus. The fertilized egg (called an embryo) implants (attaches) into the wall of your uterus. This triggers the placenta to form. Your placenta begins producing and releasing hCG into your blood and urine. HCG can be found in a persons blood around 11 days after conception. It takes slightly longer for hCG to register on urine tests.

HCG increases quickly (almost doubling every three days) for the first eight to 10 weeks of pregnancy. Healthcare providers look at how quickly a persons hCG levels rise in early pregnancy to determine how the pregnancy and fetus are developing.

Once your placenta begins making hCG, it triggers your body to create more estrogen and progesterone. Together with hCG, these hormones help thicken your uterine lining and tell your body to stop menstruating (or releasing eggs). The correct balance of these three hormones sustains and supports the pregnancy.

This chart shows how your hCG levels rise quickly and steadily in the first trimester before declining:

These numbers should be used as a guide only. Your levels may rise differently. Its not the number that matters as much as how the number changes. Your healthcare provider will let you know if your hCG levels need to be checked and what your test results mean for your pregnancy. Remember that healthy pregnancies may have lower than average hCG levels.

HCG can be detected in either blood or urine. However, a blood test is more accurate because it can detect smaller amounts of hCG.

There are two different types of blood tests to detect hCG:

An at-home pregnancy test will be positive if hCG is detected in your urine. A urine hCG test is performed by either peeing on a chemical strip or placing a drop of urine on a chemical strip. At-home urine tests typically require higher hCG levels to return a positive.

Keep in mind a low hCG level doesnt diagnose anything. Its a tool to detect potential issues. If your healthcare provider is concerned about your hCG level, they will test your levels again in two or three days. Then, they will compare the results to get a better picture of whats going on with your pregnancy.

HCG levels are typically not checked more than once or twice during pregnancy. Healthcare providers check hCG levels in the first trimester but usually dont need to check again. If initial hCG levels are lower than average, your provider will test hCG levels again in a few days. Assessing hCG levels is done sequentially, testing several days apart and comparing levels. Some prenatal genetic tests use hCG levels to check for the possibility of a fetus having a congenital disorder.

All people have small amounts of hCG in their bodies (almost undetectable levels). Your hCG levels rise fast and peak around 10 weeks of pregnancy. After that, they fall gradually until childbirth. In rare cases, germ cell tumors or other cancers may cause your body to produce hCG.

A low or declining hCG level may mean several things:

If your hCG level is low for the gestational age of the pregnancy, your healthcare provider will recheck your hCG levels in two or three days or perform an ultrasound to get a better look at your uterus.

High levels of hCG could indicate:

HCG injections can increase your chances of becoming pregnant when used with IVF (in-vitro fertilization) or IUI (intrauterine insemination). It works by inducing ovulation (when ovaries release an egg).

If you have a history of infertility, monitoring hCG levels early in pregnancy can help healthcare providers determine if a successful pregnancy has occurred.

HCG helps with the production of testosterone and sperm in people assigned male at birth (AMAB). Its also been used to treat undescended testicles in male infants.

Most of the time, youre unaware of your hCG levels other than when you take an at-home pregnancy test. Your healthcare provider may tell you your hCG levels are low based on the gestational age of the pregnancy. Obstetricians typically check hCG early on in pregnancy but dont continue to check it unless there are signs of problems. If your healthcare provider is concerned about how your pregnancy is progressing, they will recheck hCG levels and perform other diagnostic tests like ultrasound.

A note from Cleveland Clinic

Human chorionic gonadotropin (hCG) is known as the pregnancy hormone. Its claim to fame is that its the hormone at-home pregnancy tests check for. Your body produces a lot of hCG during the first trimester to support your growing baby. Your hCG levels provide valuable insight into your pregnancy and may alert your obstetrician to potential issues. However, if your pregnancy is going well, chances are you wont ever know what your hCG levels are. Contact your healthcare provider if you have questions about your hCG levels or what they mean.

See the original post:
Human Chorionic Gonadotropin: Hormone, Purpose & Levels - Cleveland Clinic

Overview Polycystic ovary syndrome Open pop-up dialog box

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Polycystic ovary syndrome is a condition where you have few, unusual or very long periods. It often results in having too much of a male hormone called androgen. Many small sacs of fluid develop on the ovaries. They may fail to regularly release eggs.

Polycystic ovary syndrome (PCOS) is a problem with hormones that happens during the reproductive years. If you have PCOS, you may not have periods very often. Or you may have periods that last many days. You may also have too much of a hormone called androgen in your body.

With PCOS, many small sacs of fluid develop along the outer edge of the ovary. These are called cysts. The small fluid-filled cysts contain immature eggs. These are called follicles. The follicles fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may lower the risk of long-term complications such as type 2 diabetes and heart disease.

Symptoms of PCOS often start around the time of the first menstrual period. Sometimes symptoms develop later after you have had periods for a while.

The symptoms of PCOS vary. A diagnosis of PCOS is made when you have at least two of these:

PCOS signs and symptoms are typically more severe in people with obesity.

See your health care provider if you're worried about your periods, if you're having trouble getting pregnant, or if you have signs of excess androgen. These might include new hair growth on your face and body, acne and male-pattern baldness.

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The exact cause of PCOS isn't known. Factors that might play a role include:

Insulin resistance. Insulin is a hormone that the pancreas makes. It allows cells to use sugar, your body's primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can go up. This can cause your body to make more insulin to try to bring down the blood sugar level.

Too much insulin might cause your body to make too much of the male hormone androgen. You could have trouble with ovulation, the process where eggs are released from the ovary.

One sign of insulin resistance is dark, velvety patches of skin on the lower part of the neck, armpits, groin or under the breasts. A bigger appetite and weight gain may be other signs.

Complications of PCOS can include:

Obesity commonly occurs with PCOS and can worsen complications of the disorder.

Polycystic ovary syndrome (PCOS) care at Mayo Clinic

Sept. 08, 2022

Read more here:
Polycystic ovary syndrome (PCOS) - Symptoms and causes - Mayo Clinic

Overview

The birth of a baby can start a variety of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect depression.

Most new moms experience postpartum "baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Sometimes it's called peripartum depression because it can start during pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression is not a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

Symptoms of depression after childbirth vary, and they can range from mild to severe.

Symptoms of baby blues which last only a few days to a week or two after your baby is born may include:

Postpartum depression may be mistaken for baby blues at first but the symptoms are more intense and last longer. These may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth. But they may begin earlier during pregnancy or later up to a year after birth.

Postpartum depression symptoms may include:

Untreated, postpartum depression may last for many months or longer.

With postpartum psychosis a rare condition that usually develops within the first week after delivery the symptoms are severe. Symptoms may include:

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

Studies show that new fathers can experience postpartum depression, too. They may feel sad, tired, overwhelmed, anxious, or have changes in their usual eating and sleeping patterns. These are the same symptoms that mothers with postpartum depression experience.

Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers sometimes called paternal postpartum depression can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you're a partner of a new mother and are having symptoms of depression or anxiety during your partner's pregnancy or after your child's birth, talk to your health care provider. Similar treatments and supports provided to mothers with postpartum depression can help treat postpartum depression in the other parent.

If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your primary health care provider or your obstetrician or gynecologist and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.

It's important to call your provider as soon as possible if the symptoms of depression have any of these features:

If at any point you have thoughts of harming yourself or your baby, immediately seek help from your partner or loved ones in taking care of your baby. Call 911 or your local emergency assistance number to get help.

Also consider these options if you're having suicidal thoughts:

People with depression may not recognize or admit that they're depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don't wait and hope for improvement.

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There is no single cause of postpartum depression, but genetics, physical changes and emotional issues may play a role.

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

If you have a history of depression especially postpartum depression tell your health care provider if you're planning on becoming pregnant or as soon as you find out you're pregnant.

Nov. 24, 2022

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Postpartum depression - Symptoms and causes - Mayo Clinic

OverviewWhat is hypothyroidism?

Hypothyroidism is a condition where there isnt enough thyroid hormone in your bloodstream and your metabolism slows down.

Hypothyroidism happens when your thyroid doesnt create and release enough thyroid hormone into your body. This makes your metabolism slow down, affecting you entire body. Also known as underactive thyroid disease, hypothyroidism is fairly common.

When your thyroid levels are extremely low, this is called myxedema. A very serious condition, myxedema can cause serious symptoms, including:

This severe type of hypothyroidism is life-threatening.

In general, hypothyroidism is a very treatable condition. It can be managed with regular medications and follow-up appointments with your healthcare provider.

The thyroid gland is a small, butterfly-shaped organ located in the front of your neck just under the voice box (larynx). Picture the middle of the butterflys body centered on your neck, with the wings hugging around your windpipe (trachea). The main job of the thyroid is to control your metabolism. Metabolism is the process that your body uses to transform food to energy your body uses to function. The thyroid creates the hormones T4 and T3 to control your metabolism. These hormones work throughout the body to tell the bodys cells how much energy to use. They control your body temperature and heart rate.

When your thyroid works correctly, its constantly making hormones, releasing them and then making new hormones to replace whats been used. This keeps your metabolism functioning and all of your bodys systems in check. The amount of thyroid hormones in the bloodstream is controlled by the pituitary gland, which is located in the center of the skull below the brain. When the pituitary gland senses either a lack of thyroid hormone or too much, it adjusts its own hormone (thyroid stimulating hormone, or TSH) and sends it to the thyroid to balance out the amounts.

If the amount of thyroid hormones is too high (hyperthyroidism) or too low (hypothyroidism), the entire body is impacted.

Hypothyroidism can affect people of all ages, genders and ethnicities. Its a common condition, particularly among women over age 60. Women are generally more likely to develop hypothyroidism after menopause than earlier in life.

In hypothyroidism, the thyroid doesnt make enough thyroid hormone.

The difference between hypothyroidism and hyperthyroidism is quantity. In hypothyroidism, the thyroid makes very little thyroid hormone. On the flip side, someone with hyperthyroidism has a thyroid that makes too much thyroid hormone. Hyperthyroidism involves higher levels of thyroid hormones, which makes your metabolism speed up. If you have hypothyroidism, your metabolism slows down.

Many things are the opposite between these two conditions. If you have hypothyroidism, you may have a difficult time dealing with the cold. If you have hyperthyroidism, you may not handle the heat. They are opposite extremes of thyroid function. Ideally, you should be in the middle. Treatments for both of these conditions work to get your thyroid function as close to that middle ground as possible.

Hypothyroidism can have a primary cause or a secondary cause. A primary cause is a condition that directly impacts the thyroid and causes it to create low levels of thyroid hormones. A secondary cause is something that causes the pituitary gland to fail, which means it cant send thyroid stimulating hormone (TSH) to the thyroid to balance out the thyroid hormones.

Primary causes of hypothyroidism are much more common. The most common of these primary causes is an autoimmune condition called Hashimotos disease. Also called Hashimotos thyroiditis or chronic lymphocytic thyroiditis, this condition is hereditary (passed down through a family). In Hashimotos disease, the bodys immune system attacks and damages the thyroid. This prevents the thyroid from making and releasing enough thyroid hormone.

The other primary causes of hypothyroidism can include:

In some cases, thyroiditis can happen after a pregnancy (postpartum thyroiditis) or a viral illness.

In most cases, women with hypothyroidism during pregnancy have Hashimotos disease. This autoimmune disease causes the bodys immune system to attack and damage the thyroid. When that happens, the thyroid cant produce and release high enough levels of thyroid hormones, impacting the entire body. Pregnant people with hypothyroidism may feel very tired, have a hard time dealing with cold temperatures and experience muscles cramps.

Thyroid hormones are important to fetal development. These hormones help develop the brain and nervous system. If you have hypothyroidism, its important to manage your thyroid levels during pregnancy. If the fetus doesnt get enough thyroid hormone during development, the brain may not develop correctly and there could be issues later. Untreated or insufficiently treated hypothyroidism during pregnancy may lead to complications like miscarriage or preterm labor.

When youre on birth control pills, the estrogen and progesterone inside of the pills can affect your thyroid-binding proteins. This increases your levels. If you have hypothyroidism, the dose of your medications will need to be increased while youre using birth control pills. Once you stop using birth control pills, the dosage will need to be lowered.

In some cases, there can be a connection between untreated hypothyroidism and erectile dysfunction. When your hypothyroidism is caused by an issue with the pituitary gland, you can also have low testosterone levels. Treating hypothyroidism can often help with erectile dysfunction if it was directly caused by the hormone imbalance.

The symptoms of hypothyroidism usually develop slowly over time sometimes years. They can include:

If your hypothyroidism is not treated, you could gain weight. Once you are treating the condition, the weight should start to lower. However, you will still need to watch your calories and exercise to lose weight. Talk to your healthcare provider about weight loss and ways to develop a diet that works for you.

It can actually be difficult to diagnose hypothyroidism because the symptoms can be easily confused with other conditions. If you have any of the symptoms of hypothyroidism, talk to your healthcare provider. The main way to diagnose hypothyroidism is a blood test called the thyroid stimulating hormone (TSH) test. Your healthcare provider may also order blood tests for conditions like Hashimotos disease. If the thyroid is enlarged, your provider may be able to feel it during a physical exam during an appointment.

In most cases, hypothyroidism is treated by replacing the amount of hormone that your thyroid is no longer making. This is typically done with a medication. One medication that is commonly used is called levothyroxine. Taken orally, this medication increases the amount of thyroid hormone your body produces, evening out your levels.

Hypothyroidism is a manageable disease. However, you will need to continuously take medication to normalize the amount of hormones in your body for the rest of your life. With careful management, and follow-up appointments with your healthcare provider to make sure your treatment is working properly, you can lead a normal and healthy life.

Hypothyroidism can become a serious and life-threatening medical condition if you do not get treatment from a healthcare provider. If you are not treated, your symptoms can become more severe and can include:

You can also develop a serious medical condition called myxedema coma. This can happen when hypothyroidism isnt treated.

The dose of your medication can actually change over time. At different points in your life, you may need to have the amounts of medication changed so that it manages your symptoms. This could happen because of things like weight gain or weight loss. Your levels will need to be monitored throughout your life to make sure your medication is working correctly.

Hypothyroidism cannot be prevented. The best way to prevent developing a serious form of the condition or having the symptoms impact your life in a serious way is to watch for signs of hypothyroidism. If you experience any of the symptoms of hypothyroidism, the best thing to do is talk to your healthcare provider. Hypothyroidism is very manageable if you catch it early and begin treatment.

Most foods in western diets contain iodine, so you do not have to worry about your diet. Iodine is a mineral that helps your thyroid produce hormones. One idea is that if you have low levels of thyroid hormone, eating foods rich in iodine could help increase your hormone levels. The most reliable way to increase your hormone levels is with a prescription medication from your healthcare provider. Do not try any new diets without talking to your provider first. Its important to always have a conversation before starting a new diet, especially if you have a medical condition like hypothyroidism.

Foods that are high in iodine include:

Work with your healthcare provider or a nutritionist (a healthcare provider who specializes in food) to craft a meal plan. Your food is your fuel. Making sure you are eating foods that will help your body, along with taking your medications as instructed by your healthcare provider, can keep you healthy over time. People with thyroid condition should not consume large amounts of iodine because the effect may be paradoxical (self-contradictory).

In some mild cases, you may not have symptoms of hypothyroidism or the symptoms may fade over time. In other cases, the symptoms of hypothyroidism will go away shortly after you start treatment. For those with particularly low levels of thyroid hormones, hypothyroidism is a life-long condition that will need to be managed with medication on a regular schedule.

Read this article:
Hypothyroidism: Symptoms, Causes, Treatment & Medication - Cleveland Clinic

Let's Talk Sex | Unpacking the Mystery of PCOS: Causes, Symptoms and Treatments  News18

Original post:
Let's Talk Sex | Unpacking the Mystery of PCOS: Causes, Symptoms and Treatments - News18

Overview

Masculinizing hormone therapy is used to induce the physical changes in your body caused by male hormones during puberty (secondary sex characteristics) to promote the matching of your gender identity and body (gender congruence). If masculinizing hormone therapy is started before the changes of female puberty begins, female secondary sex characteristics, such as the development of breasts, can be avoided. Masculinizing hormone therapy is also known as gender-affirming hormone therapy.

During masculinizing hormone therapy, you'll be given the male hormone testosterone, which suppresses your menstrual cycles and decreases the production of estrogen from your ovaries. Changes caused by these medications can be temporary or permanent. Masculinizing hormone therapy can be done alone or in combination with masculinizing surgery.

Masculinizing hormone therapy isn't for all transgender men, however. Masculinizing hormone therapy can affect your fertility and sexual function and cause other health problems. Your doctor can help you weigh the risks and benefits.

Masculinizing hormone therapy is used to alter your hormone levels to match your gender identity.

Typically, people who seek masculinizing hormone therapy experience discomfort or distress because their gender identity differs from their sex assigned at birth or from their sex-related physical characteristics (gender dysphoria). To avoid excess risk, the goal is to maintain hormone levels in the reference range for the target gender.

Masculinizing hormone therapy can:

Research suggests that masculinizing hormone therapy can be safe and effective.

If used in an adolescent, hormone therapy typically begins at age 16. Ideally, treatment starts before the development of secondary sex characteristics so that teens can go through puberty astheir identified gender. Gender affirming hormone therapy is not typically used in children.

Masculinizing hormone therapy isn't for everyone, however. Your doctor might discourage masculinizing hormone therapy if you:

Talk to your doctor about the changes in your body and any concerns you might have. Complications of masculinizing hormone therapy include:

Evidence suggests that transgender men have no increased risk of breast cancer or cardiovascular disease when compared to women whose gender identity and expression matches the stereotypical societal characteristics related to their sex assigned at birth (cisgender women).

Conclusions cant be drawn about whether masculinizing hormone therapy increases the risk of ovarian and uterine cancer. Further research is needed.

Because masculinizing hormone therapy might reduce your fertility, you'll need to make decisions about your fertility before starting treatment. The risk of permanent infertility increases with long-term use of hormones, especially when hormone therapy is initiated before puberty. Even after stopping hormone therapy, ovarian and uterine function might not recover well enough to ensure that you can become pregnant without reproductive technology assistance.

If you want to have biological children, talk to your doctor about egg freezing (mature oocyte cryopreservation) or embryo freezing (embryo cryopreservation). Another option involves having ovarian tissue surgically removed, frozen and later thawed and reimplanted (ovarian tissue cryopreservation). Keep in mind that egg freezing has multiple steps ovulation induction, egg retrieval and freezing. If you want to freeze embryos, you'll need to go through the additional step of having your eggs fertilized before they are frozen.

At the same time, while testosterone might limit your fertility, you're still at risk of pregnancy if you have your uterus and ovaries. If you want to avoid becoming pregnant, use an intrauterine device, a barrier form of contraception or a continuous progestin form of birth control.

Before starting masculinizing hormone therapy, your doctor will evaluate your health to rule out or address any medical conditions that might affect or contraindicate treatment. The evaluation might include:

You might also need a behavioral health evaluation by a provider with expertise in transgender health. The evaluation might assess:

Adolescents younger than age 18, accompanied by their custodial parents or guardians, also should see doctors and behavioral health providers with expertise in pediatric transgender health to discuss the risks of hormone therapy, as well as the impact and possible complications of gender transition in that age group.

You'll begin masculinizing hormone therapy by taking testosterone. Typically, your doctor will prescribe a low dose and slowly increase the dosage over a period of months. Testosterone is given either by injection or a gel applied to the skin. Other testosterone preparations can be used, such as a patch or pellets placed under the skin. In the U.S., testosterone also can be given as a long lasting injection or as twice daily pills (testosterone undecanoate). Oral methyltestosterone or synthetic male sex hormone (androgen) medication shouldn't be used because of potential harmful effects on your liver and lipids.

If you have persistent menstrual flow, your doctor might recommend taking progesterone to control it.

Masculinizing hormone therapy will begin producing changes in your body within weeks to months. Your timeline might look as follows:

While on masculinizing hormone therapy, you'll meet regularly with your doctor. He or she will:

You will also need routine preventive care if you havent had certain surgical interventions, including:

The rest is here:
Masculinizing hormone therapy - Mayo Clinic

What is human growth hormone (hGH)?

Human growth hormone, also known as hGH and somatotropin, is a natural hormone your pituitary gland makes and releases that acts on many parts of the body to promote growth in children. Once the growth plates in your bones (epiphyses) have fused, hGH no longer increases height, but your body still needs hGH. After youve finished growing, hGH helps to maintain normal body structure and metabolism, including helping to keep your blood sugar (glucose) levels within a healthy range.

Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues. These signals tell your body what to do and when to do it. Your body makes over 50 hormones, and many of them interact with each other, creating a complex web of processes.

Your pituitary gland is a small, pea-sized endocrine gland located at the base of your brain below your hypothalamus. Its made of two lobes: the anterior (front) lobe and posterior (back) lobe. Your anterior lobe makes hGH.

Your pituitary gland is connected to your hypothalamus through a stalk of blood vessels and nerves. This is called the pituitary stalk. Your hypothalamus is the part of your brain that controls functions like blood pressure, heart rate, body temperature and digestion. Through the stalk, your hypothalamus communicates with your pituitary gland and tells it to release certain hormones. In this case, your hypothalamus releases growth hormone-releasing hormone (GHRH), which stimulates your pituitary gland to release hGH, and somatostatin, which prevents (inhibits) that release.

Healthcare providers use a synthetic form of hGH (sometimes called recombinant hGH) to treat certain health conditions, including growth hormone deficiency. You should never take synthetic hGH without a prescription from your provider.

Your pituitary gland normally releases hGH in short bursts (pulses) throughout the day. The release of hGH is mainly controlled by two hormones your hypothalamus releases: growth hormone-releasing hormone (GHRH), which stimulates hGH release, and somatostatin, which prevents (inhibits) hGH release.

Several other endocrine hormones also regulate hGH, including insulin-like growth factor 1 (IGF-1). IGF-1 is a major suppressor of GH production, whereas thyroxine, glucocorticoids and ghrelin stimulate hGH release.

IGF-1 thats released by your liver is one of the best-characterized effects of hGH activity. IGF-1 plays a critical role in preventing (inhibiting) the release of the hGH through a negative feedback loop by stimulating somatostatin and inhibiting GHRH release. However, hGH and IGF-1 secretion are regulated by each other, where hGH triggers IGF-1 release and the IGF-1 inhibits hGH release in a feedback loop. In healthy people, hGH release is inhibited by hyperglycemia (high blood sugar) and stimulated by sleep, stress, exercise, hypoglycemia (low blood sugar) and amino acids.

Human growth hormone has two main functions: stimulating growth (mainly in children) and impacting metabolism (how your body turns the food you eat into energy).

Human growth hormone triggers growth in nearly every tissue and organ in your body. However, its most well-known for its growth-promoting effect on cartilage and bone, especially in the adolescent years during puberty. Cells in cartilage called chondrocytes and cells in bones called osteoblasts receive signals from hGH to increase replication and thus allow for growth in size.

Once the growth plates in a childs bones have fused, hGH no longer increases height. Instead, hGH helps to maintain normal body structure throughout the rest of your life.

Metabolism consists of the chemical reactions in your body that change the food you eat into energy. All of the cells in your body need energy to function properly. Several different complex processes are involved in metabolism.

hGH impacts metabolism primarily by increasing the production of insulin-like growth factor-1 (IGF-1) and its effect on cells in your body. IGF-1 is a hormone similar in structure to insulin that manages the effects of hGH in your body. Insulin is an essential hormone your pancreas makes that helps regulate your blood sugar (glucose) levels by decreasing them. Like insulin, IGF-1 has glucose-lowering effects.

Your body normally carefully regulates your blood glucose levels. Blood glucose, or sugar, is the main sugar found in your blood. You get glucose from carbohydrates in the food you eat. This sugar is an important source of energy and provides nutrients to your body's organs, muscles and nervous system.

Insulin is the main hormone your pancreas makes to lower blood glucose levels when they get too high, and glucagon is the main hormone your pancreas makes to raise glucose levels when they get too low. Other hormones can counteract the effects of insulin, such as epinephrine (adrenaline) and cortisol.

While hGH normally increases blood glucose levels when they get too low, if you have excess amounts of hGH in your body, it can counteract the effects of insulin, causing elevated blood glucose levels.

Human growth hormone increases vertical growth in children. However, once your growth plates have fused, hGH cannot make you taller. Instead, after youve reached your final height, hGH helps maintain your bodys structure and has other important effects on your metabolism.

Your pituitary gland releases hGH in pulses. The size and duration of the pulses vary with time of day and your age and sex. Because of this, random hGH measurements are rarely useful to healthcare providers in confirming or ruling out a diagnosis. Instead, hGH measurement tests are most useful when measured as part of a stimulation or suppression test.

In general, the normal range for hGh levels include:

Normal value ranges may vary from lab to lab. Be sure to reference your labs normal range on your lab report when analyzing your results. If you have any questions about your results, talk to your healthcare provider.

Having lower-than-normal levels of hGH is called growth hormone deficiency. Its usually due to an issue with or damage to your pituitary gland that results in hypopituitarism when one, several or all of the hormones your pituitary gland makes are deficient. Human growth hormone could be one of the affected hormones.

Growth hormone deficiency affects adults and children differently.

When adults have a lack of hGH, it causes the following issues:

In adults, hypopituitarism that results in hGH deficiency may develop due to a benign pituitary adenoma (a noncancerous tumor) or damage to your pituitary gland or hypothalamus.

A lack of hGH in children results in poor growth. The main sign of hGH deficiency in children is slow height growth each year after a child's third birthday. This means they grow less than about 1.4 inches in height a year. A child with hGH deficiency may also have:

In children, hypopituitarism that results in hGH deficiency may be present from birth where the cause can be unknown (idiopathic), genetic or due to injury to their pituitary gland (during fetal development or at birth).

Children can also develop hypopituitarism due to damage to their pituitary gland or hypothalamus later in life.

The main condition associated with higher-than-normal hGH levels is a condition called acromegaly, though it affects adults and children differently. Its a rare condition.

Adults with acromegaly usually have enlarged or swollen hands and feet and altered facial features.

Adults with acromegaly can also have thickened bones and enlarged organs and are more likely to have conditions such as high blood pressure (hypertension), Type 2 diabetes and heart disease. Over 99% of acromegaly cases are due to pituitary adenomas, noncancerous (benign) tumors on your pituitary gland. These tumors can produce excess amounts of hGH. Acromegaly is more common after middle-age when growth is complete. Because of this, adults with acromegaly dont get any taller. Instead, their bones can become thicker.

Very rarely, children can experience elevated growth hormone levels before they reach their final height, which can lead to excessive growth of long bones and very tall height. This condition is called pediatric acromegaly, but its sometimes called gigantism. If left untreated, children with acromegaly usually grow to be seven feet tall or taller. Children with acromegaly may also have general weakness, delayed puberty and headaches.

Pituitary adenomas are usually the cause of pediatric acromegaly.

Your healthcare provider can order a series of blood tests to check your hGH levels if youre experiencing symptoms related to hGH issues.

Your pituitary gland normally releases hGH into your bloodstream in pulses throughout the day and night, with peaks that occur mostly during the night. Because of this, a single blood test to measure hGH measurement is difficult to interpret and is not usually medically useful.

Providers most often use procedures called growth hormone stimulation and suppression tests to diagnose conditions caused by hGH deficiency or excess.

They may also order a blood test that measures the amount of insulin-like growth factor 1 (IGF-1) in your blood.

The U.S. Food and Drug Administration (FDA) has approved the synthetic form of hGH for treatment for certain conditions. The synthetic form of hGH is available only by prescription and is injected.

In children, healthcare providers prescribe hGH to treat:

In adults, providers prescribe hGH to treat:

Its important to only take synthetic hGH if your provider has prescribed it for you.

The use of synthetic hGH for medical treatment can cause certain side effects including:

Researchers dont have enough information about the long-term effects of hGH treatment.

If you or your child are experiencing symptoms related to hGH deficiency or excess, contact your healthcare provider.

If youre receiving treatment for abnormal hGH levels, its important to see your provider regularly to make sure your treatment is working.

A note from Cleveland Clinic

Human growth hormone (hGH) is a powerful hormone thats necessary for several important bodily processes. Sometimes, your pituitary gland can make too much or too little of it. If you or your child are experiencing symptoms related to hGH deficiency or excess, its important to talk to your healthcare provider. Theyre there to help.

More here:
Human Growth Hormone (hGH) - Cleveland Clinic

Chronic stress puts your health at risk

Chronic stress can wreak havoc on your mind and body. Take steps to control your stress.

Your body is hard-wired to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today, but that doesn't mean that life is free of stress.

On the contrary, you likely face many demands each day, such as taking on a huge workload, paying the bills and taking care of your family. Your body treats these so-called minor hassles as threats. As a result, you may feel as if you're constantly under attack. But you can fight back. You don't have to let stress control your life.

When you encounter a perceived threat such as a large dog barking at you during your morning walk your hypothalamus, a tiny region at your brain's base, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol.

Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.

Cortisol also curbs functions that would be nonessential or harmful in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with the brain regions that control mood, motivation and fear.

The body's stress response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels, and other systems resume their regular activities.

But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress response system and the overexposure to cortisol and other stress hormones that follows can disrupt almost all your body's processes. This puts you at increased risk of many health problems, including:

That's why it's so important to learn healthy ways to cope with your life stressors.

Your reaction to a potentially stressful event is different from anyone else's. How you react to your life stressors is affected by such factors as:

You may have some friends who seem relaxed about almost everything and others who react strongly to the slightest stress. Most people react to life stressors somewhere between those extremes.

Stressful events are facts of life. And you may not be able to change your current situation. But you can take steps to manage the impact these events have on you.

You can learn to identify what causes you stress and how to take care of yourself physically and emotionally in the face of stressful situations.

Stress management strategies include:

Avoid unhealthy ways of managing your stress, such as using alcohol, tobacco, drugs or excess food. If you're concerned that your use of these products has increased or changed due to stress, talk to your doctor.

The rewards for learning to manage stress can include peace of mind, less stress and anxiety, a better quality of life, improvement in conditions such as high blood pressure, better self-control and focus, and better relationships. And it might even lead to a longer, healthier life.

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Chronic stress puts your health at risk - Mayo Clinic

OverviewWhats a migraine? What does it feel like?

A migraine is more than a bad headache. Its a neurologic disease with a series of symptoms that might include debilitating pain on one side of your head that you may describe as pulsing or throbbing. Menstrual migraines, also known as hormone headaches, happen right before or during a womans period (up to two days before through three days during) and may get worse with movement, light, smells, or sound. Your symptoms may last for a few hours, but theyll likely last days.

Its estimated that 70% of people who experience migraines are women. Of these women, 60% to 70% report a connection between their menstruation (periods) and their migraine attacks. Women experience migraine attacks three times more frequently than men.

A menstrual migraine is one of several types of migraine headaches. Examples of other migraines include migraine with aura, migraine without aura and chronic migraine.

Hormones are often called your bodys chemical messengers. Theyre in your organs, tissues and bloodstream and theyre made by the endocrine glands. Examples of endocrine glands include your thyroid gland, adrenal glands and pituitary gland. If you have too little of a certain hormone, or too much, that can throw your entire system off balance.

Estrogen and progesterone are the two main sex hormones in women. Estrogen causes female physical features, sets off puberty and aids with reproduction. It also affects your cholesterol, controls your menstrual cycle, protects bone health and affects your heart, skin, bones, brain and other tissues. Its mostly produced by your ovaries.

Your levels of estrogen change. Theyre at the highest amount in the middle of your cycle and the lowest amount when youre on your period. When youre in menopause, they drop very low.

Headaches in women, especially migraines, are related to changes in the levels of estrogen. Levels of estrogen drop immediately before the start of your menstrual flow (menses).

Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, drop to their lowest levels.

Migraine attacks usually improve during pregnancy. However, some women have reported that their migraines started during the first trimester of pregnancy, and then went away.

Menstrual migraines are triggered by a drop in estrogen. Other migraines may be triggered by stress, missing a meal, caffeine, or many other reasons.

About 12% of Americans experience migraines. The majority are women, at least 60% of those women have observed a correlation between their menstrual cycle and their migraines. In other words, theyve noticed that they get a migraine right before or during their period.

Menstrual migraines can start up to three days before your period.

While migraines can start when youre a child, menstrual migraines dont until your periods begin. Women who have periods are the ones who get menstrual migraines.

Changes in estrogen levels, which happen right before your period begins.

In addition to a drop in estrogen, birth control pills and hormone replacement therapy for menopause can change the frequency or severity of migraines. If you notice your migraine headache getting worse after starting one of these medications, it may be worthwhile to ask your healthcare provider for a medication that contains a lower dose of estrogen, or ask for a change from an interrupted dosing regimen to a continuous one.

The symptoms of a menstrual migraine are the same as the symptoms for other types of migraines:

Your healthcare provider will want to establish a history of your migraine-related symptoms, likely asking you to:

Your healthcare provider may also order blood tests and imaging tests (such as a CT scan or MRI) to make sure there are no other causes for your headache. An electroencephalogram (EEG) may be ordered to rule out seizures.

Its helpful to both you and your healthcare provider if you keep a migraine journal. Take note of what symptoms you get, how long your symptoms last, and what makes your menstrual migraine better or worse. You and your healthcare provider may be able to use that information to help you heal, and possibly prevent or anticipate your migraine.

A menstrual migraine is usually treated with nonsteroidal anti-inflammatory medications (NSAIDs). The NSAIDs most often used for menstrual migraine include:

Treatment with the NSAID should begin two to three days before your period starts, and continue through your menstrual flow. Because the medication is taken for a short time only, the risk of gastrointestinal side effects is limited.

Triptans selective serotonin receptor agonists are medicines used for acute migraines. They stop your menstrual migraine after it begins. In the United States there are seven triptan medications approved for use:

Other medications that might be prescribed include:

These drugs should also be started two to three days before your period starts. Continue taking them throughout your menstrual flow.

Because fluid retention (retaining water) often occurs at the same time as your menses, diuretics have been used to prevent menstrual migraines. Some healthcare providers may recommend that you follow a low-salt diet immediately before the start of your menses.

Leuprolide (Lupron) is a medication that affects your hormone levels. Its used only when all other treatment methods have been tried and havent worked.

Talk with your healthcare provider and pharmacist about the side effects of each medication prescribed. The most common side effects of medications prescribed to fight migraines include:

Ask your primary healthcare provider to refer you to a headache specialist.

If you need to continue estrogen supplements after menopause, you should start on the lowest dose of these agents, on an uninterrupted basis. Instead of seven days off the drug, you may be told to take it every day. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm) may be effective in stabilizing the levels of estrogen.

Because most medications taken for migraines can affect your baby, you should avoid them. However, your healthcare provider may give you permission to take a mild pain reliever like acetaminophen. Talk to your healthcare provider before you take any medicine.

Do your best to figure out what makes your hormone headaches better or worse. For example, if light causes pain and you feel overheated, stay in a cool, dark room. Additional tips include:

Your healthcare provider may prescribe preventative medications that you take daily, then increase the dose when youre near your period. Possibilities include:

No type of migraine causes brain damage.

You may have menstrual migraines until youre in menopause.

Schedule a visit with your healthcare provider if:

Call 911 or go immediately to an Emergency Room if:

A note from Cleveland Clinic

A migraine is more than a bad headache. Not only can menstrual migraines get severe, but women have reported that they can be even worse than a migraine that occurs when theyre not on their period. Talk to your healthcare provider about your symptoms. There are preventative measures and treatment options. A menstrual migraine might not be something you just have to live with every month.

Read more from the original source:
Menstrual Migraines (Hormone Headaches) - Cleveland Clinic

OverviewWhat is acromegaly?

Acromegaly (pronounced a-krow-meh-guh-lee) is a rare but serious medical condition that happens when you have high levels of growth hormone (GH) in your body. Your pituitary gland normally produces GH, but tumors on your pituitary or in other parts of your body produce excess GH in acromegaly.

Your pituitary gland is a small, pea-sized endocrine gland located at the base of your brain below your hypothalamus. Your pituitary gland releases eight important hormones, including GH.

Growth hormone, also known as human growth hormone (hGH) and somatotropin, is a natural hormone that acts on many parts of the body to promote growth in children. Once the growth plates (epiphyses) in your bones have fused, GH no longer increases height, but your body still needs GH. After youve finished growing, GH helps to maintain normal bone, cartilage and organ structure and metabolism, including helping to keep your blood glucose (sugar) levels within a healthy range.

If you have too much GH in your body as an adult, it can result in irregularly-shaped bones, increased organ size, elevated blood sugar levels (hyperglycemia) and other symptoms.

Acromegaly and gigantism are both conditions that result from excess growth hormone (GH). The difference is in who the conditions affect adults develop acromegaly, whereas children develop gigantism.

In children, gigantism occurs when they experience excess GH before the growth plates in their bones fuse (before the end of puberty). This causes them to grow very tall. Gigantism is more rare than acromegaly. Some healthcare providers refer to gigantism as pediatric acromegaly.

Once your growth plates have fused, excess GH causes acromegaly. In this case, you dont grow in height, but the excess GH affects your bones shape and your organ size as well as other health factors.

Acromegaly can develop at any age after puberty, but healthcare providers most often diagnose it during the fourth and fifth decades of life (middle age).

Acromegaly is rare. Approximately 3 to 14 of every 100,000 people have been diagnosed with acromegaly.

In adults, acromegaly (excess growth hormone) causes bones, cartilage, body organs and other tissues to increase in size. Characteristic changes in appearance include larger hands, feet, ears, lips and nose and a more prominent jaw and forehead.

Growth hormone (GH) signals your liver to produce another hormone called insulin-like growth factor 1 (IGF-1). IGF-1 is the hormone that actually causes your bones and body tissue to grow and also affects how your body processes blood glucose (sugar) and lipids (fats). High levels of GH result in high levels of IFG-1, which can lead to Type 2 diabetes, high blood pressure (hypertension) and heart disease.

The most common cause of acromegaly is a tumor in your pituitary gland called a pituitary adenoma that causes your pituitary gland to release excess growth hormone (GH).

Pituitary adenomas (tumors) are almost always benign (noncancerous). Most adenomas that cause acromegaly grow slowly, and you may not notice symptoms of excess GH for many years.

Depending on its size and location, the adenoma may press against other pituitary tissue and affect other hormones your pituitary gland makes. If the adenoma is large, it may also press against nearby parts of your brain, causing headaches and vision problems.

In adults, acromegaly affects your bodys bones and tissues and causes them to grow in irregular ways.

Adults with acromegaly may experience the following symptoms:

Other symptoms include:

Acromegaly symptoms often start slowly and may be difficult to notice at first. Some people only notice their hands have grown in size when rings they regularly wear feel tight or their shoe size changes, especially the width.

If youre experiencing these symptoms, its important to talk to your healthcare provider.

Symptoms of acromegaly often show up very slowly over many years. This makes it hard to diagnose.

Your healthcare provider may recommend you see an endocrinologist, a healthcare provider who specializes in hormone-related conditions. They'll make a diagnosis based on your medical history, a thorough clinical evaluation and specialized tests like blood tests and imaging tests.

If youve been diagnosed with acromegaly, your provider may order additional tests to see if the condition has affected other parts of your body. These tests may include:

There are several treatment options for acromegaly. Your healthcare provider will consider your symptoms and circumstances before offering treatment options that are right for you.

The most common treatments for acromegaly are surgery, medication and radiation therapy.

In many cases, surgery greatly improves acromegaly symptoms or corrects the condition entirely. Surgeons most often use a type of surgery called transsphenoidal surgery, which involves going through your nose and sphenoid sinus, a hollow space in your skull behind the nasal passages and below your brain, to perform surgery.

The specifics of the surgery will depend on the size and location of the tumor. The goal of surgery is to remove all of a tumor that is causing excess growth hormone production. If your surgeon removes enough of the tumor, you may not need further treatment. If your surgeon can remove only a part of a tumor, you may need medication or radiation therapy to manage your symptoms and reduce the production of growth hormone.

Your healthcare provider may prescribe one medication or a combination of medications. Medications work in different ways to normalize your bodys growth hormone levels and improve your symptoms. In some cases, a person may take medication until the tumor has shrunk. This can allow a surgeon to then safely remove it. Other people may need to take medication long-term to effectively manage growth hormone levels and symptoms.

Acromegaly is curable in some situations but not all. The cure rate for surgical removal of a pituitary tumor thats causing acromegaly is about 85% for small tumors and 40% to 50% percent for large tumors.

Medication cant cure acromegaly but offers long-term, safe treatment.

Unfortunately, theres nothing you can do to prevent acromegaly. Scientists arent sure what causes pituitary tumors that cause acromegaly to develop, though they think certain genetic factors may play a role.

The prognosis (outlook) for acromegaly depends on how severe it is and how effectively therapies treat the symptoms. Many people with acromegaly see a significant improvement in symptoms after treatment.

If its not treated, acromegaly can significantly change your appearance and the shape of your bones. These symptoms can greatly affect your self-image and quality of life. Support groups help some people cope with the challenges they face because of acromegaly.

Health complications of acromegaly such as heart disease or Type 2 diabetes can also decrease quality of life and even shorten your lifespan. Because of this, its important to contact your healthcare provider if youre experiencing symptoms and to adhere to your treatment plan if youve been diagnosed.

If left untreated, acromegaly can cause the following complications:

Life expectancy for someone with acromegaly depends on the severity of the condition and if they have other health conditions, usually due to untreated acromegaly.

If your growth hormone levels arent properly managed and you have other conditions like heart disease and Type 2 diabetes, your life expectancy may reduce by approximately 10 years.

If you have acromegaly thats properly treated and have normal growth hormone and insulin-like growth factor 1 (IGF-1) levels, youll likely have a normal life expectancy.

If youre experiencing symptoms of acromegaly, its important to talk to your healthcare provider.

If youve been diagnosed with acromegaly, youll need to see your provider regularly to make sure your treatment is working well.

A note from Cleveland Clinic

Acromegaly is a rare but serious condition. The good news is that its treatable with surgery, medication and/or radiation therapy. If youve noticed an increase in size in your hands, feet and/or facial features, its important to talk to your healthcare provider. They can order some simple tests to see if your growth hormone levels are the cause of your symptoms.

See original here:
Acromegaly: What It Is, Causes, Symptoms & Treatment - Cleveland Clinic

It is sometimes called frozen shoulder, even menopause shoulder.

Doctors say the condition, known as adhesive capsulitis, causes stiffness and pain in the shoulder joint. Little is definitively known about the cause.

The ailment more commonly occurs in women over the age of 40. Having diabetes, thyroid disease, heart disease, or Parkinsons disease can also put you at higher risk.

In a new study, researchers decided to hone in on the demographic most affected by adhesive capsulitis menopausal women.

The Duke University team conducted the first known study evaluating whether hormone therapy might reduce the risk of adhesive capsulitis in menopausal women.

The team evaluated medical records from a single institution for nearly 2,000 menopausal women ages 45 to 60. In the group, 152 of the women were receiving hormone replacement therapy (HRT).

While acknowledging the small sample size, the researchers concluded that those not receiving hormone replacement therapy had 99% greater odds of adhesive capsulitis compared to those receiving HRT.

The findings are being presented this week at the North American Menopause Society annual meeting in Atlanta, Georgia. The results have not been published yet in a peer-reviewed journal.

Dr. Anne Cunanan Ford, NCMP, an associate professor of obstetrics and gynecology at the Duke University Medical Center in North Carolina, is the studys lead author.

Our study draws attention to estrogens potential benefit apart from the FDA (Food and Drug Administration) approved indications vasomotor symptoms, bone protection, and vulvovaginal atrophy, she told Healthline.

We know that estrogen plays an important role in the musculoskeletal system, stimulating new bone formation, promoting muscle growth and repair, maintaining connective tissue integrity, and reducing inflammation Ford explained.

If borne out by future prospective studies, the use of systemic hormone therapy may be protective in minimizing adhesive capsulitis she added. Its a condition that causes significant pain, reduction in range of motion, and decreased quality of life in peri and post-menopausal women.

Experts who spoke to Healthline agreed that there needs to be more research.

This pilot study provides preliminary data that will guide future studies further investigating a potential link between menopause and hormone therapy use or non-use, and risk of adhesive capsulitis, said Dr. Stephanie Faubion, the director of the Mayo Clinics Center for Womens Health in Minnesota and Medical Director of the North American Menopause Society.

No conclusions can be made based on these data, she told Healthline.

Its a small study so something like this has to be looked at in bigger numbers, added Dr. G. Thomas Ruiz, the lead OB-GYN at MemorialCare Orange Coast Medical Center in California.

I think its an interesting study in that we know that estrogen receptors are found throughout a womans body, he told Healthline. So its not surprising that there would also be an interaction between joint function ligaments and tendons with estrogen.

So the menopausal state in the absence of estrogen is probably going to change he added. We know with bone, for example, in the absence of estrogen, women will start to lose calcium at a more rapid rate. That puts them at risk of osteoporosis and osteopenia, at an increased risk for hip fractures. So looking at this study I dont necessarily find it too surprising but its also too small a number to make a definitive statement.

Going forward, Ford said: Our data is preliminary and due to the small sample size, this association did not reach statistical significance. Larger prospective studies are needed to evaluate and confirm our findings.

Would hormone therapy work to treat adhesive capsulitis?

We have no idea. There is no data. Hormone therapy does appear to be associated with less joint pain. But the mechanism behind this effect is unknown Faubion said.

Hormone therapy is effective for management of hot flashes, night sweats, sleep disturbance associated with menopause, prevention of osteoporosis, fractures and the treatment of genitourinary syndrome of menopause she explained. It also appears to help with depressive symptoms in the menopause transition.

The benefits of hormone therapy typically outweigh the risks for symptomatic women who are under the age of 60 and within 10 years of the onset of menopause, she added.

Still, many women have questions about the safety of hormone treatment because of previous studies linking some forms of hormone treatment to an increased breast cancer risk.

The American Cancer Society states that estrogen-only HRT is not linked to a higher risk of breast cancer. The Womens Health Initiative studies also found no increase in breast cancer risk in women using systemic estrogen-only HRT.

But organization officials note that in women who have a uterus, using systemic estrogen-only HRT has been shown to increase the risk of endometrial cancer.

Other studies have found a link between systemic estrogen-only HRT and a higher risk of ovarian cancer.

Ruiz says theres an increase in the use of bioidentical hormones that replicate those your body produces and methods of delivering the hormones that bypass the liver.

Keep in mind the medications that were used Premarin and Provera were taken orally and metabolized through the liver, he said. Physiologically that causes a lot of activity in the breast tissue.

Bioidentical hormones are more like your ovaries made thats the definition he added. Then the estrogen can even be given in cream or patch thats absorbed directly So these medications are not metabolized in the liver to make them active.

Ruiz says hormone replacement doses are much lower now and that perhaps new studies need to be done.

Read more from the original source:
Hormone Therapy and Shoulder Pain During Menopause - Healthline

CARBONDALE (WSIL) -- A reproductive health clinic that will also provide abortion serves has opened in Carbondale.

TheCHOICES: Memphis Center for Reproductive Health announced they would open a clinic in southern Illinois after learning the Supreme Court would overrule Roe v. Wade. Tennessee has now banned abortion services.

The CHOICES clinic is located on Giant City Road and is now accepting appointments for medication abortions. They started seeing their first patients Tuesday.

The clinic will be the southernmost abortion clinic for most people across the southeast, according to a release.

Eventually, the clinic will also offer gender-affirming hormone therapy, procedural abortions, birth control, sexual wellness and more.

The Memphis location is still open, they just will no longer provide abortion services. They will still provide reproductive and sexual health care.

More coverage:

Read the original:
CHOICES Reproductive Health clinic now open in Carbondale - WSIL TV

October is recognized as Breast Cancer Awareness Month. During this time, health care systems and organizations aim to provide education, resources, support and prevention information regarding the disease.

The American Cancer Society (ACS), offers these statistics about breast cancer:

Early detection is important because there are more treatment options available and a better chance of survival when breast cancer is caught early, said Charissa Williams, APN, a ThedaCare Hematology & Oncology Specialist. Studies show theres a more than 90% survival rate, if the tumor is caught early.

Regular self-breast exams are one way to detect a cancerous tumor. A breast cancer screening is another way. Mammograms can spot tiny tumors, making it more likely to catch the disease at an earlier stage.

For most women, screening mammography is a safe and effective way to detect breast cancer early, Williams added.

Medical organizations vary on the best age to start screening mammograms (some say as early as age 40) and how often to repeat them. The Centers for Disease Control and Prevention (CDC) has a comparative chart, Breast Cancer Screening Guidelines for Women, to better sort out the timing and frequency of mammogram screening based on your particular situation.

It is important to discuss your individual screening guidelines with your primary care provider, said Williams. For example, those who have a strong family history or certain genetic mutations (BRCA1 or BRCA2) often have earlier screening guidelines than the general population.

Women might also help minimize their chances of developing the disease by modifying their lifestyle. However, Williams notes there are some risks factors that cannot be changed: your age, family history, genetics, race, and being a woman.

There are several modifiable factors that can increase your breast cancer risk, including obesity, poor diet, lack of physical activity, alcohol and tobacco use, and certain types of hormone replacement therapy, she said.

To reduce your risk of breast cancer, Williams suggests you form these habits:

There are more than 3.8 million breast cancer survivors in the United States.

For more information on breast cancer prevention tips, screenings and treatments, visit thedacare.org/breast-cancer.

About ThedaCare

For more than 110 years, ThedaCare has been committed to improving the health and well-being of the communities it serves in Northeast and Central Wisconsin. The organization delivers care to more than 600,000 residents in 17 counties and employs approximately 7,000 health care professionals. ThedaCare has 180 points of care, including eight hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their unique, best lives. ThedaCare also partners with communities to understand needs, finding solutions together, and encouraging health awareness and action. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving specialists the ability to consult with Mayo Clinic experts on a patients care. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care.

For more information, visit thedacare.org or follow ThedaCare on social media. Members of the media should call Cassandra Wallace, Public and Media Relations Consultant at 920.442.0328 or the ThedaCare Regional Medical Center-Neenah switchboard at 920.729.3100and ask for the marketing person on call.

Related

Read the original here:
Helping Reduce Your Risk of Breast Cancer ThedaCare - ThedaCare

Its not all bad news for the province, however, as it received the fewest reports of stock-outs by public healthcare users. Photo: Reuters

NEWS

Every three months, Vuyo* has to travel for about four hours from Matatiele in the Eastern Cape to Durban in KwaZulu-Natal to get her antiretroviral (ARV) treatment.

She has been featured in the second edition of the Eastern Cape State of Health report by Ritshidze, a community-led monitoring system developed by organisations representing people living with HIV.

The organisations include the Treatment Action Campaign, the National Association of People Living with HIV, the Positive Action Campaign, the Positive Womens Network, and the SA Network of Religious Leaders Living with and affected by HIV/Aids.

The Ritshidze data, which was launched on Thursday, reveal improvements at Eastern Cape clinics, but patients still complained about poor treatment at healthcare facilities, which saw them missing their appointments and even stopping their clinic visits.

READ: Intimate partner violence impedes ARV treatment adherence among adolescents - study

Vuyo tested positive for HIV two years ago and was getting her treatment from Matatiele Community Clinic.

On this day, I was in pain and decided to go to the clinic. I told the nurse my problem and she started shouting that I was being careless with my life for not using a condom. She called other nurses and they started talking about me as if I was not there. That day was so embarrassing, and I was hating myself so much. I even thought of dying, and thats when I decided to quit the clinic, she said.

For some time after that incident, Vuyo defaulted on her medication because, when she went to other clinics, she was referred back to Matatiele.

She said:

I then decided to go and get my medication in Durban, as my sister works there. It is working better for me like that, and they give me medication for three months. I dont have problems with the medication and I dont default.

No privacy

Ritshidze data show that 55% of the people interviewed thought that clinic staff were always friendly and professional in the Eastern Cape. This is down from 63% last year.

This poor treatment is off-putting enough for people to miss appointments or even stop going to the clinic altogether. Some report being terrified at what awaits them, read the report.

Some people complained that clinic staff members disclose the status of patients living with HIV in waiting areas.

There were also reports of two or more patients consulted with or counselled in the same room, and people living with HIV separated from other chronic patients.

According to the report for key populations, clinic visits can be traumatic, and staff can be unfriendly and even openly hostile.

Many people we spoke to had given up on healthcare altogether, including 47% of gay and bisexual people, and men who have sex with men; 41% of people who use drugs; 39% of sex workers; and 47% of transgender people.

Despite commitments by Pepfar [The US Presidents Emergency Plan for Aids Relief] and the national health department to roll out a robust key population sensitisation toolkit as part of standard in-service training for all facility staff, disrespect, ill-treatment and dehumanisation of key populations remain a widespread challenge that should be urgently fixed, with consequences for clinic staff who commit privacy violations.

READ: Study finds SA street sex workers have a high chance of being infected with HIV

The report states that, for those key populations still getting healthcare, most go to public healthcare facilities, yet specific services remain extremely limited.

Lubricants were only available in 41% of sites during this reporting period. While, notably, PrEP [pre-exposure prophylaxis] was reported as available at all 45 facilities monitored, the number of facilities that reported offering PrEP to key populations was far lower. Drug dependence and overdose treatments are not available at our clinics, neither is hormone therapy, yet 36% of people who use drugs wanted access to methadone and 35% wanted access to naloxone, and 29% of transgender people wanted access to hormone treatments at their facilities, reads the report.

Slight improvement

Its not all bad news for the province, however, as it received the fewest reports of stock-outs by public healthcare users in the current reporting period, with only 7% of patients who had left, or knew someone who had left, a facility without the medication they needed.

The report said:

Of the sites that reported a stock-out, 15% were forced to send people away empty-handed. The issues outlined in the second edition of the state of health report identify reasons people do not want to go to the clinic to access HIV and tuberculosis prevention and treatment services, and why some people interrupt treatment or disengage from care altogether.

According to the report, understaffed clinics meant that healthcare workers were overburdened, which led to longer waiting times, limited time to attend to public healthcare users and bad attitudes.

These factors directly and negatively impact people living with HIV from starting and staying on treatment. By June next year, the Eastern Cape health department should fill 70% of vacancies in the province, including the 322 vacancies reported at Ritshidze sites, and fill the remaining 30% by the end of the 2023/24 financial year.

The provincial health department should produce annual reports on the number of healthcare workers employed in each district and the number of people and size of areas covered by these healthcare workers. These reports should also include year-on-year comparisons (from at least 2020) of the number of filled posts in all districts and the cost of these posts to the government, the report recommends.

*Not her real name

Read more here:
HIV patients abused and humiliated - News24

Diabetes is characterized by insufficient production of insulin due to the loss or dysfunction of pancreatic beta cells.

A new study published in Cell Metabolism shows that a protein called beta cell expansion factor A (BefA) secreted by gut bacteria could induce the replication of insulin-producing beta cells in neonatal mice.

Understanding the mechanisms underlying the actions of BefA protein could help develop therapies to stimulate beta cell proliferation in individuals with diabetes.

The study also provides a potential explanation of how the gut microbiome could play a role in the development of diabetes.

Study author Dr. Karen Guillemin, a professor at the University of Oregon in Eugene, told Medical News Today:

[Our findings imply] that the activities of gut bacteria in young animals including possibly humans can shape the development of the pancreas in early life. This is important because early life corresponding to about the first 2 years of life in a human is when insulin-producing beta cells are most proliferative, after which they become more quiescent. If this population of beta cells does not proliferate enough during early life, it means that the individual with a small beta cell pool is more vulnerable to developing type 1 diabetes if beta cells are depleted by autoimmune attack.

Dr. Martin Blaser, a professor in the Departments of Medicine and Pathology and Laboratory Medicine at Rutgers University, NJ, commented that this study is exciting because it represents a novel way that we might be able to regrow beta cells in situations with injury like type 1 diabetes.

This is a great example of how basic research on the microbiome of zebrafish can lead to new approaches to treating important human diseases, he added.

Individuals with type 1 diabetes are unable to regulate blood sugar levels due to the loss of insulin-producing beta cells in the pancreas. The loss of beta cells in type 1 diabetes is caused by an autoimmune response against these cells.

In contrast, in type 2 diabetes the body is initially able to produce insulin but the cells in the body do not respond to insulin. In response to the consequent increase in blood glucose levels, beta cells produce more insulin to compensate for the resistance of cells to the hormone. This leads to the exhaustion of beta cells and their dysfunction, resulting in lower insulin levels.

The replication rate of beta cells is high immediately after birth but rapidly declines thereafter. Thus, therapies that stimulate the replication or regeneration of beta cells in adults could help treat diabetes.

The studys authors had previously identified such a protein, called BefA, secreted by gut microbes that could stimulate the proliferation of beta cells in zebrafish.

Moreover, the authors had also identified a version of the BefA protein synthesized by gut bacteria in humans that could stimulate the proliferation of beta cells in zebrafish. In other words, the BefA proteins secreted by gut microbes in humans and zebrafish share a similar structure and function.

In the present study, the researchers further examined the mechanism through which BefA could facilitate the proliferation of pancreatic beta cells in young mice and zebrafish.

Previous studies have shown that the gut microbiome could potentially play a role in the development of diabetes. In their previous work, the study authors had shown that germ-free zebrafish larvae, which show a complete absence of gut microbes, show lower levels of pancreatic beta cell proliferation during development.

In addition, exposure to BefA prevented this decline in beta cell proliferation in germ-free zebrafish larvae.

In the current study, the researchers examined whether the BefA protein performed a similar function in mice. Specifically, they examined the impact of BefA in germ-free and specific pathogen-free (SPF) mice.

SPF mice are reared so that they are not exposed to disease-causing microorganisms that may interfere with the goals of the study.

Similar to germ-free zebrafish larvae, germ-free neonatal mice and SPF mice treated with antibodies at birth showed lower levels of beta cells than untreated SPF.

Notably, the BefA protein was able to rescue beta cell development in germ-free and antibody-treated SPF neonatal mice. Moreover, mice treated with BefA also showed lower blood glucose levels than untreated animals.

The researchers then examined whether the BefA protein could directly interact with beta cells to stimulate their expansion instead of exerting these effects by interacting with other tissues. They cultured pancreatic tissue dissected from germ-free zebrafish larvae and mice pups in the laboratory and exposed the cells to the BefA protein.

The researchers found that the BefA protein was able to directly interact with and stimulate the proliferation of pancreatic beta cells.

In subsequent studies using zebrafish larvae, the researchers examined how BefA protein synthesized by gut microbes could reach the beta cells in the pancreas. The BefA protein could be transmitted to the pancreas via the bloodstream or the hepatopancreatic duct, which connects the pancreas to the gut.

Using zebrafish models with a compromised hepatopancreatic duct or lacking blood vessels, the researchers found that pancreatic beta cell proliferation was reduced in both models.

These results show that BefA protein produced by intestinal microbiota could indeed travel from the intestine via the hepatopancreatic duct or blood vessels to reach the pancreas.

To better understand the function of the BefA protein, the researchers examined the structure of the protein. They found that BefA proteins derived from the bacterial species Klebsiella aerogenes in the human gut, and Aeromonas veronii in zebrafish showed considerable structural differences but shared an identical domain or region of the protein called SYLF.

The researchers found that the SYLF domain could rescue the loss of pancreatic beta cells in germ-free zebrafish larvae. These results suggest that this region could underlie the ability of the BefA protein to induce the proliferation of pancreatic cells.

Evidence from previous studies examining other proteins containing the SYLF domain from a wide range of organisms suggested that the ability of the BefA protein to stimulate beta cell proliferation may be mediated by its interaction with lipid membranes that surround cells.

Consistent with this, the researchers found that the BefA protein was able to permeabilize or disrupt synthetic membranes as well as membranes surrounding the cells of bacteria.

The secretion of BefA protein by certain gut bacteria could damage the cell membrane of other gut bacteria and confer a competitive advantage over these microbes. Moreover, this ability to disrupt cell membranes could also potentially explain the BefA proteins ability to enhance beta cell proliferation.

To test this hypothesis, the researchers exposed cultured pancreatic beta cells to a mutated form of BefA protein with a reduced ability to permeabilize membranes. The mutated BefA protein had a reduced ability to induce the proliferation of cultured pancreatic beta cells from neonatal mice.

These results suggest that the membrane permeabilizing activity of BefA was responsible for mediating its effects on beta cell proliferation. Proteins such as BefA may be secreted by gut microbes to gain a competitive advantage over other bacteria, but could also confer incidental benefits to the human host by facilitating normal pancreatic development.

However, Dr. Guillemin noted: We dont know yet whether BefA can stimulate proliferation of beta cells in older animals, in animals that have experienced beta cell autoimmune attack, or in people, but these are questions we are currently pursuing. We also dont know yet how membrane permeabilization stimulates beta cells to proliferate, but we are also pursuing this question.

In addition to the BefA protein synthesized by a subset of gut microbes, other proteins produced by human cells also possess membrane permeabilizing properties. This includes antimicrobial proteins that form pores in the membrane of bacterial cells and protect the body from harmful bacteria.

The researchers found that the Reg3 protein, a member of the antimicrobial protein family, was also able to increase the proliferation of mice and zebrafish pancreatic cells.

Proteins such as BefA that are produced during microbial competition are known to activate antimicrobial proteins. The study authors think that proteins secreted by gut microbes such as BefA and the antimicrobial proteins that are produced in response to these proteins could play an important role in the development of pancreatic beta cells.

These findings could facilitate the development of strategies for the prevention or treatment of diabetes. The diversification of the microbial communities in the gut occurs at the same time as the proliferation of beta cells after birth.

A lack of microbial diversity during early childhood, especially lower levels of microbes that secrete proteins such as BefA, could thus increase the risk of type 1 diabetes.

Dr. Guillemin explained:

There are several potential future therapeutic applications of our findings. One area is in prevention. It may be possible to perform microbiome profiling combined with other genetic and environmental data analysis to predict whether infants are at high risk for developing type 1 diabetes and if they may benefit from prophylactic administration of BefA-producing gut bacteria or BefA protein formulations to stimulate the development of their beta cell population in the first 2 years of life, which is when beta cells are most proliferative and when the lifelong pool of beta cells is established.

The second area is in the treatment of [type 1 diabetes], she added. It is possible that BefA will prove useful for stimulating the proliferation of beta cells in older individuals and in pancreases following the autoimmune destruction of beta cells, which is the process that causes [type 1 diabetes].

Even if BefA itself is not able to stimulate beta cell proliferation in these circumstances, our studies of the BefA mechanism may uncover new strategies to stimulate beta cell proliferation through membrane manipulations, said Dr. Guillemin.

Read the rest here:
Diabetes and the gut: How a bacterial protein may impact insulin - Medical News Today

During a Targeted Oncology case-based roundtable event, Jennifer M. Matro, MD, discussed the data supporting systemic therapies for treatment of early-stage HER2-positive breast cancer including trastuzumab and pertuzumab.

Targeted OncologyTM: What are the recommended approaches to treating early-stage HER2-positive breast cancer?

MATRO: [What I will discuss] is by no means meant to be a dogmatic approach, but more an adaptive algorithm for early-stage HER2-positive breast cancer. There are patients for whom neoadjuvant treatment is appropriate and patients for whom adjuvant treatment would be appropriate. Starting in the neoadjuvant population, which is now most of our patients: Generally, these are patients who have either positive lymph nodes or T2 tumors, and IV chemotherapy along with dual HER2-targeted therapies [is] appropriate.

After their up-front chemotherapy, they go to surgery. If they have a pCR, like our patient did here, then they proceed to HER2-directed therapy to complete 1 year. [When looking at] trastuzumab plus or minus pertuzumab there is some thought, extrapolating from the APHINITY trial [NCT01358877], that for patients who presented initially with a node-negative diseasemaybe they were T2N0and had a pCR, that you do not necessarily need the pertuzumab; but for patients who are node positive at presentation, include the pertuzumab.1,2

For patients who did not have a pCR, based on the KATHERINE trial [NCT01772472], we have the adjuvant T-DM1 [trastuzumab emtansine (Kadcyla)] for 14 cycles.3 Patients who do not have preoperative therapy and have surgery first are going to be patients who are mostly earlier stage with imaging, T1N0, or if there is a question of the extent of disease.

[In the patient in this case] there are 6 cm of nonmass enhancement and biopsy of the nonmass enhancement shows DCIS. It is unclear what the extent of disease is, and you go ahead with surgery first. If the patient comes out of surgery with negative lymph nodes and smaller tumors, then paclitaxel/trastuzumab for 12 weeks is recommended, as it has been shown in the APT trial [NCT00542451] and a subsequent larger study that the outcomes for those patients are excellent.4

For patients who have larger node-negative cancers, maybe 2 or 3 cm, or are younger and you are worried more about their risk, TCH [docetaxel, carboplatin, and trastuzumab] would also be appropriate. For node-positive patients, we are going to include the dual HER2 therapy. Neratinib [Nerlynx] in the ExteNET trial [NCT00878709] was shown to provide some benefit, particularly for patients with hormone receptorpositive disease and multiple positive lymph nodes.5 That is also part of the consideration in the algorithm for higher-risk patients.

I want to highlight that the trastuzumab biosimilars can be used interchangeably with the brand-name Herceptin, and the subcutaneous formulations of trastuzumab and trastuzumab/pertuzumab can also be used in place of the IV formulations.

Can you discuss APHINITY?

APHINITY is the study that led to the use of dual HER2 therapy in the adjuvant setting.1 The patients, who already had surgery, were randomized to chemotherapy with trastuzumab plus pertuzumab or placebo. The primary end point was invasive-diseasefree survival. They did not restrict the type of chemotherapy; it could be anthracycline or nonanthracycline based. Patients who had hormone-positive disease also got endocrine therapy.

[In the] updated analyses, with invasive-diseasefree survival by subgroup, in the intention-to-treat population, there was just under 3% improvement with the use of pertuzumab. It did not seem to matter whether they were hormone positive or hormone negative, but where the difference was really seen was in the patients who were node positive. The patients who were node positive were driving the benefit seen, and patients who were node negative did not see [much] difference with the addition of pertuzumab. So far, we do not have any overall survival benefit, but it is early and we are waiting for those results.

What is the role of the subcutaneous formulation of trastuzumab and pertuzumab?

The combination of trastuzumab, pertuzumab, and hyaluronidase [Phesgo] for subcutaneous injection has an FDA-approved indication for both early-stage and metastatic disease.6 It can be used in the neoadjuvant or adjuvant setting in combination with chemotherapy, and in the metastatic setting in combination with taxane therapy, predominantly in the first line. I believe it is preconcentrated. I know with the loading dose it is a slightly higher volumeI think it is 15 mL as opposed to 10 mLbut it is [like] a fixed dose.

The FeDeriCa study [NCT03493854] showed that the pharmacokinetics are essentially the same between the subcutaneous formulation and the IV formulation.7 In other studies that have used combination trastuzumab and pertuzumab in those settings, the thought is that the fixed-dose combination can be used for those indications as well.

FeDeriCa was a phase 3 study that was looking primarily at the pharmacokinetics. Patients who were getting preoperative chemotherapy, which was predominantly anthracycline based, were randomly assigned to IV formulation or subcutaneous formulation, and then they had surgery, and then afterward they were continued either on the IV formulation or the subcutaneous formulation. The primary end point was noninferiority of the cycle 7 trough concentration of the pertuzumab, with the fixed dose compared with the IV formulation.

One of the advantages of doing neoadjuvant studies is that we have an immediate end point of response rate. The rate of pCR was the same for both [Figure7]. It was well tolerated; no major differences in risks associated with the IV vs the subcutaneous formulation. A few more patients had a little bit of irritation at the injection site vs infusion reactions.

If you want to discontinue pertuzumab in a low-risk patient as adjuvant therapy, do you have to change back to IV?

There is a trastuzumab-[plus hyaluronidase] subcutaneous injection. The brand name is Hylecta. So, it is the same idea: If you can get access to Phesgo or the dual HER2 injection, you should be able to get access to the trastuzumab-based injection. The trastuzumab-based injection also has extensive pharmacokinetics studies showing that it is similar in efficacy to IV trastuzumab.8,9

Can you discuss the difference in timing between IV and subcutaneous administration?

With standard IV, in the first loading dose, the pertuzumab is supposed to be given over [30 to 60] minutes, and the trastuzumab is given over 30 to 90 minutes, and you have this observation period in between [of 30 to 60 minutes]. It can take hours.

Once you are on and tolerating the trastuzumab and pertuzumab IV, they can be given over 30 minutes each. There is a much shorter observation window, but nonetheless it is going to be at least 1 hour, potentially up to 2 hours. Whereas with the fixed-dose subcutaneous administration, the injection itself takes a couple of minutes. You watch them for another 15 to 30 minutes, so the total time is generally 20 to 40 minutes, so it takes at least half the time. This opens chair time for other patients who need IV infusions, and saves patients from having an IV placed, and it allows them to potentially get their port removed earlier. Generally, it can provide benefits to patients and providers. One thing that remains to be seen is whether this is something that eventually could be given at home.

I was working in Philadelphia at the beginning of the [COVID-19] pandemic, and the University of Pennsylvania at that time took most of the patients who were on leuprolide [Lupron] for ovarian suppression and transitioned them to home nursing. All of those patients were getting injections at home with their leuprolide. They did not have to come in. If you have skilled nursing in the community, is this something that patients may even be able to get at their home or their office? I think that is something that has potential for opening that up as an option, which would be even better for patients.

What is known about which option patients prefer?

We see, based on the PHranceSCa study [NCT03674112], that patients do prefer the subcutaneous formulation.10 PHranceSCa looked at patient preference. Patients who had completed their chemotherapy and surgery and were going to be completing a year of HER2-directed therapy were randomized. Half of the patients got the IV formulation, half got subcutaneous administration for the first 3 cycles, and then they crossed over and switched to whichever one they had not received before, and then they were allowed to choose which one they wanted to finish the rest of the year of HER2 therapy with. The primary objective was patient preference.

What we saw was that 85% of patients preferred the subcutaneous formulation over the IV and 87% chose to use that subcutaneous formulation to finish their treatment after experiencing it. The main reasons were less time in clinic and administration being more comfortable.

REFERENCES

1. Piccart M, Procter M, Fumagalli D, et al; APHINITY Steering Committee and Investigators. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer in the APHINITY trial: 6 years follow-up. J Clin Oncol. 2021;39(13):1448-1457. doi:10.1200/JCO.20.01204

2. von Minckwitz G, Procter M, de Azambuja E, et al; APHINITY Steering Committee and Investigators. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. N Engl J Med. 2017;377(2):122-131. Published correction in N Engl J Med. 2017;377(7):702

3. von Minckwitz G, Huang CS, Mano MS, et al; KATHERINE Investigators. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380(7):617-628. doi:10.1056/NEJMoa1814017

4. Tolaney SM, Barry WT, Dang CT, et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. N Engl J Med. 2015;372(2):134-141. doi:10.1056/NEJMoa1406281

5. Chan A, Delaloge S, Holmes FA, et al; ExteNET Study Group. Neratinib after trastuzumab-based adjuvant therapy in patients with HER2-positive breast cancer (ExteNET): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2016;17(3):367-377. doi:10.1016/S1470-2045(15)00551-3

6. Phesgo. Prescribing information. Genentech; 2020. Accessed May 5, 2022. https:// bit.ly/3RFnCsv

7. Tan AR, Im SA, Mattar A, et al; FeDeriCa study group. Fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection plus chemotherapy in HER2-positive early breast cancer (FeDeriCa): a randomised, open-label, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2021;22(1):85-97. Published correction in Lancet Oncol. 2021;22(2):e42

8. Pivot X, Verma S, Fallowfield L, et al. Efficacy and safety of subcutaneous trastuzumab and intravenous trastuzumab as part of adjuvant therapy for HER2-positive early breast cancer: Final analysis of the randomised, two-cohort PrefHer study. Eur J Cancer. 2017;86:82-90. doi:10.1016/j.ejca.2017.08.019

9. Jackisch C, Stroyakovskiy D, Pivot X, et al. Subcutaneous vs intravenous trastuzumab for patients with ERBB2-positive early breast cancer: final analysis of the HannaH phase 3 randomized clinical trial. JAMA Oncol. 2019;5(5):e190339. doi:10.1001/ jamaoncol.2019.0339

10. OShaughnessy J, Sousa S, Cruz J, et al; PHranceSCa study group. Preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer (PHranceSCa): a randomised, open-label phase II study. Eur J Cancer. 2021;152:223-232. doi:10.1016/j.ejca.2021.03.047

Originally posted here:
Recommended Approaches to Treatment for Early-Stage HER2+ Breast Cancer - Targeted Oncology

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In your head, you always imagine the revolution when it starts. It'll start with tanks and gunfire with chaos and soldiers in the street. You'll know when it comes, but it never does. Instead, the really big changes to American life, the profound ones that affect all of us forever, those changes almost always begin quietly with gentle pleas for tolerance. We'd like to do things a little differently, they tell you. We'd like to make a change to some custom or belief that people have been attached to for the last few thousand years, but don't be alarmed. It's not a big deal. You don't even need to participate. All we ask is that you let us live the way we want to live.

That's always the pitch and of course, you always agree to it. Why wouldn't you? Who could say no to that? Some guy down the street wants to wear a dress? OK, fine, have a party. It doesn't affect you. You don't have to wear a dress, so go ahead. Live and let live, but it turns out that's never actually the deal. The guy down the street wears his dress, but after a while, that's not enough for him. He's still angry and for some reason, he's angry with you. And that doesn't make sense because you're the person who had no problem with him wearing a dress in the first place. What did you do wrong?

Well, the problem is you're not wearing a dress and neither are your kids. Your normal-person clothes, the ones you've always worn, are suddenly immoral. You've got to change immediately.

Now, wait a second, you say, that's not what we agreed to. You do your thing and I'll do mine. Remember? They don't remember. They don't care. That's not how it works. You don't get to do your thing anymore. The dress guy's in charge now. Everybody's got to do his thing, the dress thing or face punishment. That's how it goes. "Be tolerant" becomes "show some respect" which evolves very quickly into "bow down before us and lick our feet or else will hurt you." That's the final stage. That's where we are now.

For example, a Democratic lawmaker in Virginia called Elizabeth Guzman is introducing a bill that will charge parents with a felony, strip them of their employment and imprison them if they don't wholeheartedly endorse their minor children's sex changes. So, your 12-year-old daughter says she wants a mastectomy. If you object to that in any way, if you raise questions, Elizabeth Guzman will send you to jail for real. Here's a local news report.:

GOP DEMANDS INVESTIGATION INTO SCHOOLS THAT PARTICIPATED IN GOOGLE'S 'DISCRIMINATORY' FELLOWSHIP PROGRAM

REPORTER: Her bill would expand the state's definition of child abuse and neglect to include parents who do not affirm their child's gender identity or sexual orientation.

ELIZABETH GUZMAN: There is an investigation also in place that is not only, you know, from a social worker, but there's also a police investigation before we make that decision that there is going to be a CPS charge.

REPORTER: What could the penalties be if the investigation concludes and it's concluded that a parent is not affirming of their LGBTQ child? What could the consequences be?

ELIZABETH GUZMAN: Well, we first have to have an investigation. You know, it could be a felony. It could be a misdemeanor, but we know a CPS charge could harm, you know, your employment, could harm your education.

DEMS UNDER FIRE AFTER TIES TO LAWMAKER WHO WANTS TO CRIMINALIZE PARENTS WHO DONT AFFIRM LGBT KIDS EXPOSED

Who is this Elizabeth Guzman? Well, Elizabeth Guzman came to this country not so long ago from Peru as a single mother. Now, rather than wait a while, maybe spend a few generations here before telling you how to raise your children in America, she's decided to get right to it and completely change child-rearing in this country in a way that would never be tolerated for a second in the country from which she comes. Try that in the Andes, honey, and see how that works. Yeah.

But in this country, according to Elizabeth Guzman, you have to affirm your child's sex change or else you're going to prison and the state will raise your kids.

Now you got to think maybe they've wanted this for a while. What would this mean? Well, it would mean fewer intact families. It would mean people like Elizabeth Guzman make the decisions, the meaningful decisions within your house. It means less resistance from you. It means more powerful them. What it doesn't mean is that Elizabeth Guzman will be protecting your kids. She doesn't even claim this law will protect your kids. Instead, she acknowledges the whole point is to "educate parents." Right.

Like the COVID vaccine, this is a pretty easy way to figure out who's on which side. Are you for this? OK, you're on our team. You're willing to surrender control of your own children to Elizabeth Guzman, who, again, just got here. But if you're not for it, then we know you're not on our team. We know who you are. We can silence you. We can punish you because you refuse to be educated.

So, it's a signaling mechanism and you know that because the ideology that underlies it, gender ideology, is completely incoherent. It doesn't make any sense at all. It is not rooted in science. It's a form of religion that's so crazy it dares you to say something about it. What? You can't even say that. If you do, they know you're on the other side.

And it's not just lunatics and ideologues like Elizabeth Guzman from Peru. It's doctors, it's medical professionals.

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Here's a video from Boston Children's Hospital, one of the most famous hospitals in the world, which like many hospitals in the United States at this point under the Joe Biden administration cut the breasts off of minor girls for no medically justifiable reason. Watch a practicing psychologist, now attending psychologist, at Boston Children's Hospital explain how early children can become trans.

DR KERRY MCGREGOR, BOSTON CHILDRENS HOSPITAL: So, most of the patients that we have in the clinic actually know their gender, usually around the age of puberty, but a good portion of children do know as early as seemingly from the womb, and they will usually express their gender identity as very young children, some as soon as they can talk. They might say phrases such as "I'm a girl" or "I'm a boy" or "I'm going to be a woman" or I'm going to be a mom." Kids know very, very early. So, in the Gems Clinic, we see a variety of young children all the way down to ages two and three and usually up to the ages of 9.

That's Kerry McGregor. She's a psychologist. She works at Harvard. I wonder how many children Kerry McGregor has. Has she raised a lot of kids? Has she watched kids carefully? Does she know anything about kids? Because she's telling you if you're a little kid says, "Oh I may be on the other sex," that means your kid is the other sex. Well, that's insane, because almost 100% of kids at one point or another, at a certain point in development, say things like, "I think I'm a boy. I think I'm a girl" and you smile indulgently, "Get back to me in 15 years."

But no, says Kerry McGregor, in the womb you can know.

WORLD MENTAL HEALTH DAY: 'IT'S OK TO ASK FOR SUPPORT OR HELP'

Think about what they're telling you. They're telling you that developing child in the womb is just a part of the mother. Therefore, you can abort that child at any time. It's like an appendectomy, but at the same time, that same cluster of cells, that fetus, can also be woke and ascribe to left liberal gender ideology and you need to honor that.

No sane person could believe any of this voluntarily. It doesn't even make sense on its face. Again, it's a religion and if you resist it, they resort immediately to force. No questions allowed. Again, this is science and the essence of science is relentless questioning about what you think you know is true. That is the scientific method. That's science itself, but it's no longer allowed.

The American Medical Association, which hasutterly beclowned itself, along with the American Academy of Pediatrics and the Children's Hospital Association, just sent a letter to the attorney general of the United States demanding that the Biden administration, and we're quoting, "take swift action to investigate and prosecute high profile users on social media" who have engaged in "disinformation."

You hate to always invoke the German government of 80 years ago, but what else is that? That's totalitarian. They're saying if you disagree with what we're doing, people with guns should come and take you away. Now you'd think someone in the media would point out, "Wow, you know, we can't have that in the United States where people are free to believe what they want and to talk about it in public and to ask questions." In fact, they should be encouraged to, but the media don't say anything like that. They're joining with the Children's Hospital Association, the AMA, to call for more censorship at gun point. Watch.

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MEDHI HASAN:Obviously the question becomes then when misinformation, disinformation is being spread, when hate and threats are being spread, where are the social media companies? What's YouTube doing? What's Twitter doing? And of course, then you have the reaction to that "Oh, this is big tech silencing people." It always becomes a debate about free speech, doesn't it?

BRANDY ZADROZNY: Yeah, it does. You know, last week, Twitter suspended Libs of TikTok specifically for the policy against the promotion of threats, violence and harassment. So, great job, right? But it's been seven days and Libs of TikTok is back now and they're tweeting right this very minute. This is violence, this is harassment. It's clear what these accounts are doing.

It's so funny. Back to the point at the open, when the revolution comes, there won't be tanks and soldiers won't be stormtroopers in all uniforms and symbols. It'll be some unmarried 30-year-old woman talking in a singsong voice inflection at the end. Right. Right. Special glasses or complex glasses that don't actually improve her vision. She'll have all kinds of pointless humanities degrees and she'll be on cable news and say its violence. What she's really saying is "shut up and obey or will hurt you." She's delivering the same message any stormtrooper delivers, but she's doing it in a singsong way. This is disinformation.

Call us literal, but this is the opposite of disinformation, isn't disinformation. This is literally what they're seeing. Boston Children's Hospitals, which we showed you on tape, is telling you what they're doing. They perform double mastectomies on miners for no medical reason whatsoever. That's insane. It ought to be a crime. In a civilized country it would be and they know that because when they were caught, they tried to erase the evidence and they're not alone.

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UCSF, U.W. Health in Wisconsin, Golisano Children's Hospital in New York, Vanderbilt Health, Children's Minnesota, all of these hospitals have deleted the evidence of their gender-affirming procedures, their grotesque mutilation of children after they were publicized. Their own words were publicized online. No one's twisting it. People are just putting up their words and not all the videos have been deleted.

Planned Parenthood is big into this now because it's lucrative. Here's Planned Parenthood in 2021 telling children that so-called puberty blockers are harmless. Oh, right. That's a lie and by the way, there's no such thing as a puberty blocker. These drugs are hormone agonists and they're FDA approved for things like cancer treatment. You get prostate cancer and they lower your testosterone, for example, to prevent the cancer from growing quickly. They are not approved for so-called "puberty blocking." They're unapproved and the long-term effects are not known, but it's pretty obvious they're grim, but Planned Parenthood won't tell you that. Here's their video.

PLANNED PARENTHOOD VIDEO: You're transgender or non-binary. You may find that your puberty experiences don't line up with your gender identity or how you see yourself. That feeling can be uncomfortable, scary and stressful. If that sounds like you, know that you're not alone. There are medicines you can take to delay puberty for a while. They're called puberty blockers, and they work like a stop sign by halting the hormones, testosterone and estrogen that cause puberty changes like facial hair growth and periods. Puberty blockers are safe and can give you more time to figure out what feels right for you, your body and your gender identity.

Everything about that is dark and horrifying and there should be an uprising against that. That's aimed at your childrennot at adults who can make rational decisionsbut children who are people too young to drive or drink alcohol or smoke cigarettes or serve in the military or vote, people who are not (we have agreed as a group) capable of making rational adult decisions and that's aimed at them. It's propaganda aimed at them and it's a lie. Puberty blockers are safe. They are absolutely not safe. You can't delay puberty without damaging severely the bodies of young children. The FDA just identified several "clinically serious cases" of side effects after these drugs were recklessly administered to children by lunatic ideologues.

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FILE- In this June 4, 2019, file photo, a Planned Parenthood clinic is photographed in St. Louis. (AP Photo/Jeff Roberson, File) (AP Photo/Jeff Roberson, File)

The FDA found a "plausible association" between the use of puberty blockers and something called intracranial hypertension. Do you want that for your 13-year-old?

According to the Mayo Clinic, that condition can cause brain swelling, double vision, severe headaches, permanent vision loss. In other words, brain damage. Brain damage! Oh, great. OK.

On top of that, the European Journal of Endocrinology, among many other publications, has found that so-called puberty blockers often cause, "decreased bone density, which is associated with a high risk of osteoporosis" and there are other permanent side effects as well. We don't even know the scope of them because this has never been tested longitudinally ever, but the effects are very obvious and if you poke around on the internet for about 4 minutes, you will see them. One teenage girl just uploaded a video showing the effects of five years of puberty blockers on her. Watch this.

VIDEO: When I talk about being too far gone, I don't really know what else to call it, this is what I mean. This is how deep my voice is. It's gotten deeper over time and it's settled. This is what I mean by hair loss and it just keeps getting worse. It keeps thinning. It keeps receding backwards. You know and I'm not exactly sure that's coming back. Those are the main things when I talk about being androgenized to a point of no return. This is what happens when you give a women testosterone for five years. This is what happens.

Yeah. That's what happens. That and a lot of other things. That's what they're telling you is "gender-affirming." No, it's mutilation. It's grotesque. It's destroying people's lives, children's lives. We made a documentary on this for "Tucker Carlson Originals." We spoke to a lot of people who had endured similar torture.

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HELENA: The testosterone kind of had this effect on me, where with every step that I took, it would feel good for a short amount of time, but then eventually it's like those same feelings come back up.

WALT: There's the initial euphoria that you go through. I changed my gender and everything's going to be wonderful.

KATHY: It was euphoric. I was like, the feeling I had when I started living as a man was I was free. I was finally who I should have been all along.

TUCKER NARRATION: But that euphoria was short-lived.

KATHY: My mental health just got worse. My ability to socialize just got worse. I felt so disconnected from myself. I started using, like drugs and alcohol as a crutch, and I was just a total disaster and the effects of the testosterone on my mental health specifically just made everything 10 million times worse.

WALT: I had bought into the lie and almost took my life.

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It's just awful and every person who is participating in this in their moments of clarity knows that ten years from now, there will be thousands of vocal victims of this moment of true craziness and hysteria that has gripped our country. People's lives are being destroyed right before us. Most adults are too cowardly to say a word about it and the Democratic Party is actively doing all it can to promote this to protect hospitals that are mutilating and destroying the lives of children.

in the state of California Always a bellwether a legislator called ScottWienerhas just sponsored legislation to make California a so-called sanctuary state for kids who want to mutilate their own bodies to castrate themselves. Scott Wiener, really? Is he a good father? Would you trust this guy within 500 yards of a child? Probably not.

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Democrat Gov. Gavin Newsom of California (Tom Williams/CQ-Roll Call, Inc via Getty Images)

Gavin Newsom just signed the bill, of course. So, what's the point here? It's not to protect children. It's not protecting them. Any parent will tell you if you want to protect children, you tell them, take a deep breath and reach adulthood and then make rational decisions about how to live their lives.

You would definitely not let them make a decision, an irreversible decision like this, for themselves. You're their parent. That's the whole point. But the Democratic Party doesn't like parents. The Democratic Party is replacing parents with itself. We're in charge now. It's the most recognizable possible move for any totalitarian movement. Break up the family. Replace parents with politicians. The state is in charge. The party is in charge, obviously, and it's happening all over the country.

Tucker Carlson currently serves as the host of FOX News Channels (FNC) Tucker Carlson Tonight (weekdays 8PM/ET). He joined the network in 2009 as a contributor.

Excerpt from:
TUCKER CARLSON: The Democratic Party is replacing parents with itself - Fox News

Disclaimer: This story contains details of miscarriage which may be upsetting for some.

March 21st, 2022 was the best day of our lives. We adopted our middle daughter and our family was complete. But what got us there? Its easy to see all the highs of adoption, but few know all that goes into getting to that point.

Our story starts back in 2012, when Jared and I (Taylor) met at a softball game. Jared and I went to the same small high school in rural Indiana but did not know each other well as Jared was a few years older than me. After high school, I went to a softball game with a friend to watch her boyfriend play. I was then introduced to Jared and we became friends.

We started dating in the beginning of 2013, and we were engaged just before Christmas that year. We bought a house in May, adopted a couple dogs, and married July 26, 2014.

It was a quick engagement but we were both so confident in our decision and commitment to one another. Early on in our relationship we knew we wanted to have kids. We always envisioned having three or four kids and had always tossed around the idea of foster care and adoption, but were really enjoying just being married.

Two years after getting married, I found out I was pregnant! We were so excited and couldnt wait to begin our lives as parents. I had a relatively easy pregnancy and our daughter, Claire Kristine, was born December 6th, 2016. She was a perfect 9-pound baby, and we ooohed and ahhed over her for days. We quickly settled into our roles as parents and tried our best every day to raise Claire with love and kindness.

The sleepless nights were rough and the exhaustion was catching up with us, but nothing could wipe that new parent glow off our faces. Around Claires first birthday, we bought some land in our hometown and decided to build a home so we could raise Claire (and our future children we were dreaming of having) in the same small-town we grew up in.

We dreamt of farm animals, land to run on, unobstructed sunsets, and perfectly clear starry nights. We lived with my parents during the (longer than expected) building process and were beyond grateful for that opportunity, but were anxious to get back into our own house. We closed on our newly built home on Valentines Day 2019!

At this point in time, Claire was two years old and we had started getting the dreaded questions: Are you going to have more kids? Claire needs a brother or sister! Is she going to be an only child forever? We knew we wanted more kids and now that we were finally in our new house, we felt comfortable adding to our family.

After months of negative pregnancy tests, we were referred to a fertility clinic just to check on everything. The questions from well-meaning people started to hurt and I started to feel like there was something wrong with me. Maybe we would just have one child.

Lots of tests and blood work was done and I had a procedure scheduled. A week before the procedure I found out I was pregnant! I told Jared right away and we were beyond thrilled. I giddily called the fertility clinic and they asked me to come in so they could draw labs and check hormone levels. A couple days later I confidently walked into the clinic to have my blood drawn and was told my due date, June 14th 2020.

Not long after that, the bleeding started and my hormone levels dropped. I was having a very early miscarriage. My world shattered. What? A miscarriage? How is this fair? Didnt that baby know how loved they already were? Did God know how much we wanted this? We were doing everything right; this shouldnt be happening. But it was. Our very wanted child was gone and I was broken.

Thankfully, we were still working with the fertility clinic, had wonderfully supportive family and friends, and clung to our faith. All together they were helping us navigate how to move forward. I remember listening to the song Even If by MercyMe on repeat day after day, just trying to remind myself it would all be okay.

Several doctors appointments and trips to Chicago later, I was told my fallopian tubes were blocked and it was very unlikely I would have more children naturally. The doctor recommended IVF. The state of Indiana does not require health insurance companies to cover fertility treatment, so very few do. The cost, as so many families know, is extreme and it wasnt something we were ready to look into yet. After much prayer and discussion, we decided foster care was the right path for us.

Foster care wasnt a new subject for us. I grew up with an aunt and uncle who fostered children and ended up adopting 2 boys. I have cousins adopted from other countries. We had friends who fostered and we had talked about becoming foster parents in the past. Both of our families are extremely supportive and we knew we would have endless help on this journey.

Shortly after our miscarriage, we contacted our local DCS agency and started the literal mountain of paperwork. The paperwork is long and intense. The questions get personal and it took months to finish.

After we submitted our paperwork, a caseworker came over and studied our home. You talk about fire plans, how to properly store cleaning supplies, and they look into every part of your home and life. We took classes, were re-certified in CPR, had forms filled out and physicals done by our doctors, and asked for references to fill out forms for DCS. Once all of that was said and done, we each sat down separately with our caseworker and had a five-hour interview. Yes, you read that correctly, five hours.

In this interview they dove into our childhood, our past, our traumas, and the highs and lows of our life. They asked hypothetical questions, and attempted to learn every part of our life. Though it seemed daunting and excessive, I understand it now. If my child had to be placed in a strangers home (even if the reason for removal was my own doing) I would want to know they were staying with a family who could appropriately love and care for them.

I remember during one point of my interview, the very nice lady who was interviewing me asked why we wanted to foster and what we were hoping to gain from becoming foster parents. I explained our past fertility issues, the miscarriage, our desire to grow our family, and wanting to share the love we had to give with other children, even if it would only be for a short period of time.

The woman looked at me, gently placed her hand on mine, and said, I need you to know, you will get your heart broken. Not might, will. In this journey, your heart will shatter into a million pieces, things wont always go how you think they will, and your heart will break. Please reach out for help and get support to help you through those inevitable times. She wasnt saying that to scare me but rather to prepare me, and I often thought back to her words during our foster care time.

We became officially licensed foster parents in March of 2020, right at the beginning of the Covid-19 pandemic. Life went on and we didnt receive any phone calls for placements. We had specified we wanted to only foster children younger than our daughter for the time being; we felt that would be best for our family. DCS was more than happy to accommodate our wishes, but did let us know we might not get a call right away.

One month after becoming licensed, I found out I was pregnant again! Joy and fear filled our souls as we anxiously fumbled through the first trimester. Our fear began to subside as bloodwork showed rising hormone levels and we got to see our sweet babe on the ultrasound.

June 14th, 2021 came and it was a hard day. It was our miscarried babys due date and although I was pregnant again, I longed to have that baby in my arms. It was a Sunday and after church Claire and I went to watch Jareds weekly softball game. The game had barely started and my phone rang it was DCS.

I answered and they explained to me they were looking for a placement for a three-day old baby girl. Without even talking to Jared, I said yes. DCS told me to head to the hospital with a car seat for the baby and to have Jared go to the house to meet the social worker and go over everything for the placement. I pulled Jared out of the game and excitedly told him what was happening. He was completely on board and we all headed home to prepare.

As soon as I got home, I grabbed the infant car seat, gave Claire and Jared a hug and a kiss, then headed for the hospital while they stayed behind to wait for the social worker and prepare things for the baby. Upon arrival at the hospital, I was put in a room and told to wait.

A few minutes went by and the nurse wheeled in this tiny, precious 6-pound baby girl. I held her, rocked her, and told her how much I loved her while the nurse went over all the basic discharge information. During this process it hit me: I am in the hospital, holding a newborn baby, on my miscarried babys due date.

God knew what I needed and He provided, like He always does. After lots of paperwork, I carefully drove home and introduced Jared to our foster daughter and Claire to her foster sister, Addisyn.

Addie was such an easy baby and the love we felt for her was no different than the love we felt for our biological child. Our family fell in love with her just as quickly and they were all so helpful as we adjusted to life with a newborn again. Addie had visits with her biological mother on a regular basis as well as several court hearings. It was hard to get used to the ever-changing schedule of visits, court, and caseworkers stopping by but we managed.

Time was flying by and Addie was growing so quickly. Before we knew it, summer turned to fall and Thanksgiving was approaching. During various court hearings and conversations with our caseworker, talks of adoption began to happen. We tried not to get our hopes up, but we couldnt help it. The thought of adopting Addie made our hearts soar. We carried on and were so excited for the holiday season with Addie and the upcoming due date of our baby.

The day before Thanksgiving 2020, Claire and I were in the kitchen baking pies while Addie napped when my phone rang. It was our case worker telling me they needed a home for Addies older brother immediately. We were the only option and he would be at our house in a few hours.

We couldnt turn down a child in need of a home but we were in no way prepared for a 2-year-old boy! I frantically called my husband, my parents, family members, and a few friends, and cried to them as I tried to figure out what to do. (Eight-month pregnant Taylor was very overwhelmed at this point).

Jared came home from work, rearranged Addies room, and put together the extra bed we had in our basement. My dad went to the store to purchase a mattress and bedding. My mom and sister helped me pick up the house and get everything ready. My aunt and grandparents dropped off diapers, clothes, sippy cups, and toys (because this girl mom didnt have anything for a little boy!).

My boss and her husband dropped off more diapers, clothes, and shoes in a variety of sizes. My two best friends came over and made dinner, folded laundry, and reassured me everything would be okay. Our friends and family rallied together and made so much happen in such a short period of time. Ill never be able to appropriately express my gratitude toward them.

The sweetest little boy came to our home that night, scared and confused, but thanks to our amazing people, we had everything we needed to help make him feel comfortable and loved. The next few weeks were an absolute whirlwind. We often werent sure what was happening from one day to the next; we were just trying our best to make the world a little calmer for our kids.

We moved on with the busy holiday season, making it special for everyone in our home. We went Christmas shopping, cut down our Christmas tree, sent out Christmas cards, looked at the lights, and tried to soak up the magic of the holiday season.

A couple weeks into December, shortly after Claires 4th birthday, our caseworker called to tell us Addie and her brothers grandparents were going to be taking both kids. Our hearts sank, we couldnt speak. We knew these children might not be permanent members of our home, but that didnt ease the heartache.

We packed up all of the childrens belongings the best we could and spent every last second showering them with love. Addies brother left first as he already had a relationship with his grandparents. Addies grandparents graciously let us have a few extra days with her.

Over those days we finished packing up Addies whole life into Rubbermaid totes, taking her to see family and friends so they could say goodbye, and soaking up every last second with this perfect 6-month-old baby girl. We were fortunate enough to be able to meet Addies grandparents and actually drop her off at their house. While it didnt make saying goodbye any easier, it was nice to get to know the people who would be caring for her. They even agreed to exchange phone numbers so they could text us pictures and updates.

Claire, Jared, and I all gave Addie one last hug and kiss, as we sobbed getting back into the minivan we had purchased that summer to fit all of the kids. The heartbreak DCS warned us about was happening and it was awful.

Jared and I tried to get back to normal as quickly as possible in order to make things easier for Claire. She had been through a lot over the last six months and we didnt want her to be any more sad or confused than she already was.

The three of us enjoyed a nice Christmas, prepared for the arrival of our second biological baby, and thought about Addie every single day. We were able to stay in touch with her grandparents on a semi-regular basis but we missed her like no other.

We decided to be listed as on hold with DCS as we grieved our last placement, and to give us time to adjust when our baby arrived. January 15, 2022, I gave birth to another beautiful baby girl, Piper Kate. She was the sweetest baby and she healed our hearts.

Claire was loving being a big sister again, but often asked if we would always get to keep this baby. Jared and I reassured her Piper was here to stay, forever. We carried on as a family of four, getting into a routine, and enjoying every moment (except maybe not the ones when Piper was screaming nonstop).

In April, when Piper was four months old, Addies grandparents reached out to us. They asked if we would be willing to take Addie back into our home and family. Due to some unforeseen circumstances, they felt it was best if we raised her, but they would still like to be a part of her life. We said we would absolutely love to foster her again and they would 100% be involved as grandparents.

We talked to and arranged everything with DCS, and a few weeks later Addie moved back in. Our home was so full of joy! Life was hard but so incredibly full. It took time and a lot of support from our family and friends. We slowly settled into our roles as parents of three girls.

In the following months we had lots of court dates, caseworker visits, and Addie had visits with her biological family just like before but things were a bit different this time. Addies permanency plan was changed to adoption. We were cautiously hopeful.

That winter our caseworker advised us to hire an attorney and start getting paperwork ready to adopt Addisyn. We found an amazing attorney to represent us and she began drawing up everything we would need for adoption.

During this time we began to develop a relationship with Addies birth mom. I sent her pictures and updates periodically and she mailed us letters to give to Addie when she is older. She expressed her gratitude to us for caring for sweet Addie and we did our best to express our gratitude to her for blessing us with such an amazing little girl, though theres no way to every thank her for that beautiful gift.

March 21st, 2022, we gathered in a courtroom to officially make Addisyn our daughter. The room was filled with people we love: parents, grandparents, siblings, friends, caseworkers, and even Addies biological grandparents. We hired a photographer to capture every moment of this special day so we would never forget.

We promised to love, care for, and provide for Addisyn, just as we would Claire and Piper, for her entire life. There were tears, smiles, fist bumps, and cheers because Addisyn was officially an Emmons! Addisyn Kay Jean Emmons, forever.

Our days are chaotic but full of love. Claire is 5, Addie is 2, and Piper is 1.5. They wear Jared and I out every single day, but we wouldnt have it any other way. Never in our wildest dreams did we think we would have daughters just seven months apart in age, but God had other plans for our family!

Our foster care license is temporarily suspended so we can focus on our three young children and not losing our sanity. Im not sure what the future looks like for us as foster parents, but we love to help any way we can. There is a great need for loving people in the foster care system and even if you cant foster, you can still help. Adopt, foster, donate, or volunteer. Everybody can do something to make the world a little brighter for our future.

This article was submitted to Love What Matters by Taylor Emmons of Rolling Prairie, IN. You can follow her on Instagram. Join the Love What Matters family and subscribe to our newsletter.

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'You will get your heart broken. Not might, will.': Foster mom shares heartwarming adoption after infertility, heartbreak - Love What Matters

Premarin (or PMU) is a very common HRT drug that is derived from pregnant mares' urine. In fact, its very name stands for PREgnant MAres uRINe (via ScienceDirect).

This method of HRT production began in the 1940s, when it was discovered that estrogen taken from the urine of pregnant mares could relieve menopausal symptoms in women. The resulting industry spread rapidly throughout the northern United States and Canada, says Horsetalk in New Zealand. Today, more than 9,000,000 women take the drug to relieve menopausal symptoms that include vaginal dryness, hot flashes, and night sweats. Premarin may also prevent osteoporosis.

According to Forum Health, Premarin contains many types of equine estrogens, and only two are bio-identical to human estrogens. The others are much stronger and last longer than human estrogens, and they are suspected of having more side effects in humans.

Not surprisingly, the practice of keeping pregnant mares in small stalls for most of their one-after-another pregnancies, attached to urine bladder bags to collect all their urine, has raised the ire of animal welfare agencies. As a result, most PMU farms are now located in Canada, says Horsetalk, and overseas (via Gentle Giants Draft Horse Rescue).

Link:
Everything You Need To Know About Hormone Replacement Therapy - Health Digest

Hormones control nearly all of our bodily functions, from growth and development to emotions, sexual function and even sleep. But hormones, which occur naturally in our bodies, can also fuel the growth of certain breast cancers. We talked with breast medical oncologist Rachel Layman, M.D., to learn about hormone therapy for breast cancer, which can stop or slow the cancer-fueling action of hormones.

What is hormone therapy for breast cancer?

Hormone therapy is a form of treatment that deprives breast cancer of estrogen and progesterone, the two main female hormones that it needs to survive and grow.

Estrogen and progesterone are carried along in the bloodstream. When they encounter a breast cancer cell, they stick to proteins called hormone receptors on the cells surface. This connection acts as an on switch and triggers the cancer cell to grow. The goal of hormone therapy is to prevent hormones from attaching to cancer cells, which deprives the cancer cells of the fuel they need to grow.

Are all breast cancers fueled by hormones?

No, but most are. About 70% of all breast cancers depend on estrogen or progesterone for growth.

These hormone-dependent breast cancers are called hormone-sensitive. This means theyre either estrogen receptor positive or progesterone receptor positive, depending on which hormone they connect with. Some cancer cells have receptors for estrogen, some have receptors for progesterone, and some have receptors for both. 30% of breast cancers have no hormone receptors and dont benefit from hormone therapy.

How do hormone therapies for breast cancer work?

Hormone therapies reduce or eliminate contact between hormones and breast cancer cells in several different ways:

How and when are hormone therapy medications delivered?

Most hormone therapy drugs are taken as a daily oral pill, though a few are given as injections in the clinic.

Women usually begin hormone therapy after undergoing surgery for the removal of a breast tumor. They typically take hormone therapy drugs for at least five years and sometimes as long as 10 years after surgery, depending on how likely the cancer is to return. In some instances, hormone therapy is given before breast cancer surgery to shrink the tumor, which makes it easier to remove.

Women who arent healthy enough to withstand an operation may take hormone therapy drugs until theyre well enough to undergo surgery. The treatment wont get rid of cancer, but it can stop it from growing or shrink it until surgery can be performed.

Can hormone therapy prevent breast cancer, in addition to treating it?

Yes, women who have completed breast cancer treatment often use hormone therapy to help prevent the disease from coming back. Hormone therapy also helps lower the odds of getting cancer in the other breast.

Doctors may also recommend hormone therapy for healthy women who have a family history of breast cancer, or genetic mutations that raise their risk for the disease.

How effective is hormone therapy for breast cancer?

Clinical trials of breast cancer patients show that overall, hormone therapy cuts the risk of cancer developing or coming back in half.

What are the side effects of hormone therapy?

The potential side effects of hormone therapy depend largely on the specific drug or type of treatment. Common side effects of all hormone therapies include:

Less common, more serious side effects of some hormone therapy drugs may include:

Is hormone therapy the same as hormone replacement therapy?

No, the two are opposites. Hormone therapy blocks or removes hormones to treat breast cancer, while hormone replacement therapy adds hormones to the body to counter the effects of menopause. Hormone therapy for breast cancer is actually anti-hormone therapy or hormone-blocking therapy.

Whats your advice for people considering hormone therapy for breast cancer treatment?

Deciding on hormone therapy for breast cancer can be a complex decision. The type of therapy you receive may depend on the stage of your disease, whether youve gone through menopause, and whether you want to have children. Talk with your doctor about your options to help make the best decision for you.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Link:
What is hormone therapy for breast cancer? - MD Anderson

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As transgender healthcare guidelines have been called into question by Gov. Ron DeSantis administration and multiple Florida healthcare agencies, a Brevard clinic serving the LGBTQ community is grappling to figure out a response.

Spektrum, an LGBTQ-focused clinic with an office in Orlando and in Melbourne,serves about 3,500 patients. They provide gender-affirming healthcare for all ages, which includes hormone replacement therapy, blockers, support letters for gender-affirming surgeries and mental health services.

With the Florida Department of Health, the Agency for Health Care Administration and DeSantis administration looking to potentially restrict transgender peoples access to healthcare specifically those on Medicaid and those under 18 years oldthe clinic is facing manyunknowns.

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"We have to wait until we see what sticks to the wall before we can fully plan our response, but of course we're kind of preparing for everything, said Joey Knoll, founder and CEO of Spektrum.

With so much uncertainty, the clinic is struggling to keep up with the number of patients it needsto see. Typically, they could see about 40 to 50 patients a day. But with so many people coming in with fears about whats going to happen, that number has dropped to 30.

Our patients and their families' appointments are taking longer because they're all panicking, he said. What used to just be a quick appointment we're checking your labs, things are looking good, how are you feeling, what results are you noticing? Now it's, do I need to move and what's going to happen? Am I going to get my medicine?

Transgender healthcare has been a topic of discussion for several months with a focus on gender dysphoria, which is defined by the federal government as "significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity." It was previously called gender identity disorder.

Transgender healthcare was first brought into question in April, when the Florida Department of Health released a guidance seeking to "clarify evidence" regarding the treatment of gender dysphoria in anyone under the age of 18. It advised not only that medical transition should not be allowed under the age of 18, but also social transition, which can involve allowing a transgender child to go by a preferred name, pronouns and different clothing options.

Since then, the Agency for Health Care Administration released a 46-page report on June 2 titled "Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria." The six medical professionals who compiled the report said treatment for gender dysphoria which can include gender reassignment surgery, hormone replacement therapy and puberty blockers had the potential for harmful long-term effects, saying the treatments were "experimental and investigational."

At the time of the release of the report, AHCA requested Florida's Medicaid program review whether treatments for gender dysphoria met generally accepted professional medical standards, additionally arguing that treatments didn't meet the definition of "medically necessity." If this were found to be the case, low-income and adolescent transgender individuals would no longer have their treatments covered by Medicaid.

Separately, DeSantis' administration has asked the Florida Board of Medicine to review their findings and create a standard of care for "those complex and irreversible procedures" for gender dysphoria.

Since the initial release of its guidance in April, the Florida Department of Healthfiled a petition on July 28 to initiate rulemaking related to trans healthcare, saying that "children do not possess the cognitive or emotional maturity to comprehend the consequences of ... invasive and irreversible procedures."

In itsproposed standard of care, itsuggestedprocedures and treatments such as sex reassignment surgeries or anything altering primary or secondary sexual characteristics, puberty blockers, hormone replacement therapy and hormone antagonists be banned for transgender patients under the age of 18.

Friday the Florida Board of Medicine advanced aplan to ban healthcare providers from offering gender affirming treatments such as puberty blockers and hormone therapy to people under age 18.

Department of Health Secretary Joseph Ladapo arguedthe current standards of care were a departure from "the level of evidence and data surrounding this issue."

"Maybe it is effective, but the scientific studies that have been published today do not support that," he said at the Friday meeting in Fort Lauderdale. "Could that change in the future? Its possible. I think its very unlikely considering what Ive reviewed, but its possible."

Knoll, who has helped more than 10,000 people transition over the course of his career, said he believes the studies cited in the proposed guidelines have been misrepresented or twisted.

"It's outdated research that began in 1975 that talks about persisters and desisters when it comes to gender identity, failing to include the fact that in 1975, how was someone going to access gender affirming care?" he said.

Persistersreferto people who continued to identify as transgender into adulthood; desisters are those whoeventually reverted back to identifying with their gender assigned at birth.

"Maybe they are classified as a desister because they are living in their birth-assigned gender, but it could have been because they didn't have access to affirming care or a support system it doesn't mean that their gender identity wasn't real, so that's very terrible information for them to take,"Knoll said.

Sebastian Cook, a 17-year-old transgender boy from Melbourne, said the proposed changes are dehumanizing.

"It's honestly really scary, because it makes us look like we're just political objects and not real people, he said. We have feelings, we're human, and we just want to have our bodies feel and look the way that (they're) supposed to."

Cook will turn 18 in a few weeks, which should keep proposed guidelines surrounding healthcare for trans minors from applying to him. However, hes still facing uncertainty regarding covering the cost of hormone replacement therapy and is worried about how the guidelines will affect younger people.

"Gender-affirming healthcare it definitely does save lives, he said. We know what we want and we know how to achieve what we want, and that's something that will actually save our lives ...When it's restricted, it's going to cause so many more issues down the road, leading to depression and suicide and stuff like that."

Though its not clear how Spektrum will be required to proceed, Knoll, who has helped more than 10,000 people transition over the course of his career, has ideas for counteracting what he believes to be misinformation cited in the proposed guidelines.

"One of the things that we're trying to do to combat this is put together some research or get something published, but I'm not a publisher, I don't know how to do that stuff, I'm not a statistician," he said.

His goal is to gather statistics from the practice regarding transgender patients and their experiences. But without experience in publishing and a lack of resources in this area, he needsa volunteer to help.

The truth is, organizations like mine, other organizations around the state, we just don't have the bandwidth to gather this information, he said. "We just need help that's the hold up."

Finch Walker is a Breaking News Reporter at FLORIDA TODAY.Contact Walker at 321-290-4744orfwalker@floridatoday.com. Twitter:@_finchwalker

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Brevard LGBTQ clinic responds to proposed restrictions on trans healthcare - Florida Today

A drug that has been used to slow progression of kidney and cardiovascular disease in people with type 2 diabetes may also help people with chronic kidney disease who do not have diabetes, according to findings published Monday in the European Heart Journal. Aldosterone, a hormone produced by the triangular adrenal glands, might be the key target.

In the observational study, researchers analyzed health data from 3,680 people with chronic kidney disease for nearly 10 years. Those with elevated levels of aldosterone, a crucial, salt-conserving hormone made by the adrenal glands, which sit atop the kidneys, had a higher risk of serious kidney disease progression during the study period: they are more likely to lose half their kidney function, start dialysis, or develop end-stage kidney disease.

That finding troubled Ashish Verma, a kidney specialist and assistant professor of medicine at Boston University School of Medicine, and lead author of the study. Elevated aldosterone levels are common in the general population but often fly under the radar, even in people at high risk of developing chronic kidney disease, Verma told STAT.

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Finerenoneis a nonsteroidal drug approved by the FDA for people with type 2 diabetes and chronic kidney disease. It could also help prevent kidney disease or its progression in people without diabetes, with a lower risk of causing dangerously high potassium levels than traditional therapies like spironolactone or eplerenone, Verma said.

STAT spoke to Verma via Zoom ahead of the papers publication. The interview has been edited for clarity and brevity.

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What is the relationship between aldosterone and kidney function?

Aldosterone is a hormone made by the adrenal glands that helps the body conserve water and salt. Take, for example, somebody who is dehydrated or has very low blood pressure. This hormone actually helps conserve water and salt. But if this hormone is, all the time, at a higher concentration in the body, it leads to hypertension (high blood pressure). And that can lead to damage in the kidney and in the heart.

Why did you decide to study aldosterones role in chronic kidney disease?

There were very recent, very big randomized controlled trials, published in the New England Journal of Medicine FIDELIO and FIGARO. And they used finerenone. Aldosterone acts on mineralocorticoid receptors, which finerenone blocks. They found drastic results in patients with diabetic kidney disease who have protein in the urine, which is abnormal, and who have low kidney function.

So those patients actually benefited from finerenone their kidney disease progression halted. But those patients had diabetes. I wanted to link the mechanism: Why this drug is helpful. And the other question I had was, Wait a second. Is high aldosterone only bad in people with diabetes? Or is it also bad in people do not have diabetes?

What did you find?

We found that higher aldosterone levels were associated with the progression of kidney disease, and even with going on dialysis (a sign of severe kidney disease). There was a risk for kidney disease progression with high aldosterone levels, irrespective of if you have diabetes or not.

What is known about how finerenone or similar drugs might work in people without diabetes who have chronic kidney disease?

Interestingly, there is a trial going on, the FIND-CKD trial, which is testing finerenone to halt kidney disease progression in people who do not have diabetes. So were going to know soon, maybe next year, if these drugs are associated with decreased kidney disease progression.

Older drugs, like spironolactone or eplerenone, can cause very high potassium levels in people with low kidney function (which can lead to life-threatening heart problems). So people feared always using it. And even in my clinic, if I use these drugs on patients, I test their potassium and make sure their potassium stays okay. That was one of the hindrances for using these drugs.

But now, with more evidence in front of us that high aldosterone concentration is bad, doctors should also be checking aldosterone levels in people with diabetes, people with resistant hypertension (high blood pressure that doesnt respond to three or more antihypertensive drugs, including a diuretic) or people with central obesity. Dr. [Anand] Vaidya, co-author of this study, showed in his previous publication that excess aldosterone is very common in normal populations, but we dont check for it, so its a very unrecognized disease in the general population.

Why dont doctors regularly check aldosterone levels? Is it difficult to do?

No, its not difficult. Its a very easy task that can be done in any clinic, anywhere in this country. The problem is that there are set guidelines for checking aldosterone. We check for it in people who have resistant hypertension, people who are young and have high blood pressure. But as new reports show that high aldosterone is common, I think physicians should be more motivated to check these levels in patients.

What surprised you throughout the research process?

What we found at baseline was that the lower a persons kidney function, the higher their aldosterone is. We dont know the mechanism of it. Maybe future studies will find out why that happens. Second, when somebodys kidney function is low, they tend to excrete less potassium in the urine, so potassium in the blood gets high. But we found the opposite: people who had lower kidney function and high aldosterone actually have lower potassium [in the blood], which fits the mechanism because if you have higher aldosterone, you can excrete more potassium in the urine. So it fit the mechanism that, yes, this aldosterone was pathogenic in these patients; it was not doing the work it does in healthy people.

What do you think is the biggest contribution of this research to the scientific literature and to the understanding of kidney disease?

This is the first study to show that high aldosterone is associated with kidney disease progression. No study before has shown it. There was a study using the same cohort but less follow-up time. And they used different methods. We used different methods because we removed people who were on aldosterone antagonists like spironolactone and eplerenone. We had nine years, almost 10 years, of follow-up, with 1,412 kidney events.

The second thing: the mechanism, that its not high potassium that leads to aldosterone secretion in chronic kidney disease. Its maybe the low GFR [glomerular filtration rate, a measure of kidney function] that is causing high aldosterone secretion. And the third, most important finding is that, irrespective of diabetes status, high aldosterone causes damage.

What new questions do these findings prompt for you?

The most important thing is why low GFR leads to high aldosterone. Why do people with chronic kidney disease have higher aldosterone? Why this happens, we dont know, which is very important to find out. And another thing, which is fascinating to me, and Im going to work on it in the future, is that in humans, we always postulate through animal models that high aldosterone actually leads to fibrosis in the heart and in the kidney. But nobody actually measured these markers in humans to see how it actually happens.

Are you applying any of these findings to your clinical practice?

Im actually checking aldosterone in a lot of patients I see that have high risk, like obese patients, and patients with resistant hypertension. And Im trying to put them on spironolactone to see. In Boston Medical Center, we dont have finerenone yet because its a costly drug. I think when finerenone comes to the market, Im going to start putting people on finerenone and see if it reduces their aldosterone levels.

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Aldosterone, a hormone that prevents dehydration, is linked to worsening kidney disease, study suggests - STAT

In 2004, Jobs reportedly underwent a reconstructive surgery known as the Whipple operation (via Britannica). According to Mayo Clinic, the Whipple procedure also referred to as a pancreaticoduodenectomy is a risky and technically demanding surgery that is used to remove pancreatic tumors. Per WebMD, the Whipple procedure is the primary operation for an islet cell tumor that's positioned on the top of the "head of the pancreas."

The procedure involves the removal of many internal structures, including the head of the pancreas, and parts of the bile duct, gallbladder, and the beginning of the small intestine (via WebMD). Then, the remainder of the organs is reattached to the small intestine. This enables the patient to digest food post-surgery, says Mayo Clinic.

WebMD says that this surgery is particularly risky because of the risk of infection, internal bleeding, and abnormal connections between body parts. Unfortunately, Jobs was not out in the clear for long, and found himself back on the operating table a few years later.

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What We Learned About Steve Jobs' Health After His Death - Health Digest

By Kristen Rogers, CNN

(CNN) -- You sleep for seven to eight hours almost every night, only to feel unrested through the morning or even most of the day. How could you be following a golden rule of sleep so right, yet feel so wrong?

This discrepancy is often due to a heightened state of sleep inertia, a circadian process that modulates memory, mood, reaction time and alertness upon waking, according to a 2015 study. Some people experience impaired performance and grogginess in this period after first turning off the alarm. The effects of sleep inertia usually go away after 15 to 60 minutes but can last for up to a few hours.

Sleep inertia impairs more sophisticated cognitive skills such as evaluative thinking, decision-making, creativity and rule usage, and gets worse the more sleep deprived a person is.

But even if your job isn't saving lives or driving a truck overnight, experiencing sleep inertia for hours can still affect your quality of life.

The way to address this begins with evaluating your sleep using the "two Qs," said pulmonary and sleep specialist Dr. Raj Dasgupta, a clinical associate professor of medicine at the University of Southern California's Keck School of Medicine. "If you're getting the good quantity sleep, the next question is, 'Am I getting good quality sleep?'"

Dasgupta suggested seeing a sleep specialist, who can check for an underlying or primary sleep disorder. But there are other more easily modifiable factors that could be interfering with the restoration and recovery processes -- such as memory consolidation, hormone regulation and emotional regulation or processing -- that need to happen during sleep.

"There are a lot of conditions that cause fatigue, but they don't necessarily make people feel like they're ready to fall asleep," said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and president of the American Academy of Sleep Medicine.

These can include chronic pain conditions, metabolic or thyroid conditions, anemia, and chronic obstructive pulmonary disease.

If you're feeling inexplicable fatigue, "an important first step might just be a routine physical with your family doctor," Martin said.

Additionally, the National Sleep Foundation has said healthy adults need seven to nine hours of sleep nightly, so you might need more than eight hours of sleep to feel energized. You could try going to sleep an hour earlier or waking an hour later than usual and see if that makes a difference, said Christopher Barnes, a professor of management at the University of Washington who studies the relationship between sleep and work.

If you're sedentary, your body can get used to only having to expend low levels of energy -- so you might feel more tired than you should when trying to do basic daily activities, Martin said.

The World Health Organization has recommended that adults get at least 150 minutes (2 1/2 hours) of moderate-to-vigorous physical activity weekly, while pregnant people should do at least 150 minutes of moderate aerobic and strengthening exercises per week.

Having anxiety or depression can be energetically taxing, Dasgupta said. These conditions can also negatively influence the time needed to fall asleep, as well as whether (and how many times) you wake up throughout the night, he added.

And sometimes the medications used to treat depression or anxiety can have side effects such as insomnia or blocking deeper stages of sleep, Dasgupta said.

Sometimes our schedules differ on weekdays versus weekends, Barnes said. Schedules can also fluctuate for people with shift-based jobs.

"A very common practice would be to say, 'OK, well, it's Friday night. I don't have to work tomorrow morning, so I can stay up a bit later,'" Barnes said. Maybe you stay up even later Saturday night since you don't have to work Sunday either, then go to bed earlier on Sunday ahead of the work week.

But by this point, you've already adjusted your sleep schedule back by a couple of hours in a short period of time. "This is very much analogous to jet lag," Barnes said. "That rapid reset doesn't work very well."

More than 50% of your body is made of water, which is needed for multiple functions including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic. Being dehydrated has been linked to decreased alertness and increased sleepiness and fatigue.

The Institute of Medicine recommends women consume 2.7 liters (91 ounces) of fluids daily, and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12 cups for men.

Having good sleep hygiene includes keeping your bedroom dark, quiet and cold at night -- and only using it for sleep and sex.

Avoid consuming caffeinated drinks less than six hours before bedtime; and limit the consumption of alcohol and heavy or spicy foods at least two hours before bed. Alcohol can prevent deeper stages of sleep, and such foods can cause digestive issues that interfere with restorative sleep.

"The person (or pet) with whom you share a bed has a big impact on your sleep," Martin said.

Maybe your bed partner has a sleep disorder and snores or tosses and turns. Or maybe they have a different schedule that's disruptive to your sleep. Pets can also disrupt your sleep schedule since they don't have the same sleep patterns as humans, she added.

"The most important thing -- if your bed partner snores -- is to get them to see a sleep specialist and have them evaluated for sleep apnea," Martin said. Sleep apnea -- a condition wherein breathing stops and restarts while someone's sleeping -- is common in people who snore, she added.

On that note, sleep disorders are another factor that can dramatically diminish sleep quality, Barnes said.

Someone with sleep apnea might wake up 50 times, 100 times or even more throughout the night, he added.

"Once you're awake, you're no longer in the deep sleep and you don't get to usually drop immediately into the deepest sleep," Barnes said. "Bringing people out of that deep sleep by waking them up is going to generally result in less time spent in the deepest stage of sleep."

Other sleep disorders that can affect daily energy levels include narcolepsy and restless legs syndrome, according to the US Centers for Disease Control and Prevention.

The ideal way to track sleep quality and quantity -- especially if you think you could be diagnosed with a sleep disorder -- is undergoing polysomnography at a sleep clinic, Barnes said.

Apps and electronic wearables -- such as watches or rings -- that measure sleep aren't as accurate as clinic tests, but still provide sufficient information for healthy adults, Barnes said. "I'd want to know that it was developed and then validated against another, more accurate device."

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8 reasons why you wake up tired, and how to fix it - WDJT

Think angry, red breakouts are only for pubescent teens? Think again. Acne doesn't discriminate by ageeven adults, especially women (lucky us!), are prone to breakouts well into their 30s, 40s, and even 50s before the onset of menopause, according to the American Academy of Dermatology Association (AAD).

Even adults who never had pimples during their teen years can experience acne on any area of their face (jawline, around the mouth, or the forehead, for example) or on the body (the back or chest, for example). When this happens, dermatologists call the condition "adult-onset acne."

If you're an adult experiencing this annoyingand sometimes even painfulskin condition, experts say it's usually due to one of the following: stress, family history, hair and skincare products, medicinal side effects, an undiagnosed medical condition, or hormones.

The latter is one of the more common culprits, and the condition is typically referred to as hormonal acne.

Meet Our Experts: Michele Green, MD, a board-certified dermatologist in New York CitySanusi Umar, MD, FAAD, a board-certified dermatologist and CEO and founder of the Dr. U Hair and Skin Clinic in Los Angeles

"Hormonal acne, as the name implies, is acne that is caused by an imbalance of hormones in the body," says Dr. Michele Green, a board-certified cosmetic dermatologist in New York City.

As you might suspect: clogged pores, says Dr. Sanusi Umar, a board-certified dermatologist and CEO and founder of the Dr. U Hair and Skin Clinic in Los Angeles. Fluctuating hormones can cause excess or overproduction of sebum (the oily substance in skin glands), a buildup of dead skin cells, or an accumulation of bacteria, he explains.

"There are various conditions that may influence the presence of hormonal acne including puberty, polycystic ovarian syndrome, menopause, menstrual cycle, and increased androgen levels," says Green. "Stress and diet can also impact hormonal acne breakouts," she adds. Even pregnancy or beginning or discontinuing the use of birth control pills can cause pimples.

But how do you know if your red spots are caused by hormones or something else altogether? And why is that important? Pegging down the root cause of your acne can help inform an effective treatment plan. For example, if a product is causing breakouts, the answer could be as simple as discontinuing usage. On the other hand, if you're experiencing hormonal acne, treatment may be a little bit more complex.

Green says hormonal acne typically presents as cysts along the jawline and on the chin in adults and in the T-zone during puberty, but it can also present as whiteheads, blackheads, papules, and pustules, says Umarand that's exactly why it's important to consult a board-certified dermatologist who can help you correctly identify your condition.

In the meantime, you can also look for patterns. "It is common for hormonal acne to reappear in the same areas in a cyclic fashion," she explains. "Many adult patients struggling with hormonal acne indicate that their breakouts are more pronounced for a certain period each month or when they have endured significantly more stress."

Typically, treatment for hormonal acne is multi-pronged and includes the following, says Green:

This serum contains a hefty dose of salicylic acid to reduce excess sebum production, clear clogged pores, and decrease rednessall while fighting signs of aging at the same time.

Tea tree is the first ingredient in this lightweight, non-comedogenic moisturizer.

A combination of clarifying ingredients like tea tree and salicylic acid and soothing ingredients like chamomile oil make this face oil an effective acne-fighter.

This product contains 10 percent benzoyl peroxideas strong as you can get without a prescription.

"Hormonal acne may resolve on its own once hormone levels in the body become balanced, though it is common to experience hormonal acne breakouts in cyclic episodes as hormones fluctuate overtime," says Green.

So while your pimples may disappear in as little as one week, Green says they're likely to return and can even cause permanent scarring if left untreated. "For patients who forgo evaluation and treatment with a dermatologist, their hormonal acne can last for years," she says.

Brigitt is a freelance writer, editor and craft stylist with nearly 15 years of experience at premier lifestyle publications. She specializes in creating SEO and affiliate content in a wide range of coverage areas, including home, health, parenting, beauty and style, food and entertaining, travel, and weddings. She also has significant experience creating native and branded content.

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Hormonal Acne: Causes, Treatment, And How To Prevent It - Women's Health