Contrary to prior understanding, many hormones related to spermatogenesis take longer to recover than previously thought, and up to 3 years in some cases after anabolic steroid misuse, according to a fertility expert speaking at the Royal Society of Medicine webinar series.

Dr Channa Jayasena, consultant in reproductive endocrinology and andrology at Imperial College and Hammersmith Hospital, London, gave a talk on male hypogonadism that he admitted might seem provocative to some people but addresses issues that extend current knowledge. The three key issues discussed were: how quickly can men recover fertility after androgen use; how to assist azoospermic men with Klinefelter syndrome (or XXY) father children; and whether testosterone therapy affects progression to diabetes in obese men.

Dr Jayasena spoke at last weeks 3-day webinar held by the Royal Society of Medicine, Endocrinology and Diabetes section, entitled, EDN50:What's new in endocrinology and diabetes 2020?

He began by asking how quicky do men who take anabolic steroids recover fertility? "This has never been studied to much extent."

Self-confessed steroid user and reality television star, Spencer Matthews, said in a tabloid newspaper article that the UK is in the grips of an epidemic of anabolic steroid use, Dr Jayasena remarked. "I see men who take anabolic steroids but then they want a baby and want to know whats next?"

The nearest data to understanding recovery from anabolic steroids comes from studies of the male pill, said the andrologist. This involves giving a high level of progesterone to suppress luteinising hormone and follicle stimulating hormone (in effect the male pill), and then giving the men testosterone replacement. A Lancet paper (Liu at al 2006) involving this regimen looked at the time from stopping the male pill to recovery of sperm. It shows that, by 12 months, all participants had recovered some sperm function, with 80% recovering to the pre-treatment semen level, explained Dr Jayasena. "This has long been presumed to be the measure of recovery. However, this does not resonate with reality and the observation that actually there are many people who dont recover within this time frame and take a lot longer, some with azoospermia[semen containing no sperm]," he pointed out.

Another cross-sectional observational study looked at 41 current users of anabolic steroids, 31 recent ( 3 months since last use), and 21 healthy eugonadal men. All were 18-55 years, exercising at least three times a week. "The critical strength of this study is that these men were all clinically indistinct," Dr Jayasena remarked. "This matching of baseline characteristics is critical for interpretation of the data. Due to recruitment issues, weve never had such a good look at recovery in this way before."

The study looked at the reproductive endocrine profiles including the levels of luteinising hormone, follicle stimulating hormone, and testosterone. In current users, the former two were suppressed and the testosterone level was high, as expected, displaying a hypogonadatropic profile. "Past users and non-users have very similar profiles, suggesting reversible luteinising hormone and follicle stimulating hormone suppression," said Dr Jayasena, adding, "this is really interesting and looking at acne, gynaecomastia, hair loss and smaller testicles all classical features of androgen abuse - appear to persist in many of the men who are past users. Its important we counsel these men that we, the clinicians, are not really clear about how long these side effects will persist."

Results also showed low HDL cholesterol and high triglycerides in users, but not in non-users or past users, and cardiac hypertrophy in users but not past users. "The latter finding is encouraging," Dr Jayasena pointed out.

Regarding fertility, the study by Shankara-Naranya found that when comparing non-users to users of anabolic steroids, it took a mean of 10.7 months for users to recover their luteinising hormone levels to the mean luteinising hormone of a non-user. "But recovery time is highly variable. Luteinising hormone (and testosterone by inference), and sperm concentration seem to recover within a year, with a mean of 10 months, but all the other hormones that are important for spermatogenesis take much longer to recover so follicle stimulating hormone was 20 months, inhibin B was 32 months, sperm motility was 38 months, up to 3 years to recover. This is critical and we didnt know this," reported Dr Jaysena.

"In answer to what is the prognosis for recovery in men after androgen misuse? The endocrine system mostly recovers in the first year but sperm take much longer to recover," he concluded.

Along with Downs syndrome, Klinefelter is the most common chromosomal disorder in men, affecting 1 in 500 men. A total of 90% of those with Klinefelter syndrome are azoospermic, and it has long been assumed to be incompatible with fatherhood.

"Things have changed, and Id like to ask what is the chance of fatherhood for a man with XXY undergoing microdissection testicular sperm extraction (mTESE)?" said Dr Jayasena. "This can be done by dissecting open a testicle and looking for an engorged seminiferous tubule that is likely to be full of sperm," he explained. "If this is confirmed, after some processing, the sperm can be used in intracytoplasmicsperm injection (ICSI)."

It has been known that it was possible for patients with Klinefelter syndrome to father children for the past 20 years, but, asked Dr Jayasena, how successful is it? "Its still an embryonic field," he noted. Referring to a meta-analysis of 37 studies, Dr Jayasena said 40% of men with Klinefelters syndrome had sperm retrieved, and of these 40%, an average of nearly 50% of men had live births after ICSI. But some studies reported 10% and others 90%.

In conclusion, the chances of fatherhood in XXY men undergoing mTESE, is around 20% but a large randomised controlled trial (RCT) is needed to confirm this, said Dr Jayasena.

Finally, the researcher moved on to the third topic of whether testosterone therapy improves the effectiveness of weight loss in men over 50 years with type 2 diabetes. Referring to outcomes of the largest, as yet unpublished, testosterone trial ever, in more than 1000 men by Dr Gary Wittert, from the University of Adelaide, Dr Jayasena described the study.

Most importantly, they did not select men with hypogonadism these results are not valid for hypogonadism because not all men had hypogonadism, explained Dr Jayasena. Two-hour plasma glucose was 7.8 to 15 mmol/l. The men were randomised to Weight Watchers weight loss programme plus placebo versus the same weight loss programme plus testosterone. They also excluded men with high cardiovascular risk, due to a Food and Drug Administration [FDA] unproven concern about cardiovascular risk. "Testosterone may be dangerous in some of these men (59-75 years and obese) in real life," he pointed out.

The paper is currently in review but some preliminary findings were presented at a conference earlier this year. Dr Jayasena says: "If testosterone improves the prevention of type 2 diabetes during weight loss in men without hypogonadism, then that would challenge our understanding of how it works. However, testosterone is still not a treatment to prevent type 2 diabetes,"

To answer the question definitively, said Dr Jayasena, confirmatory data, mechanistic data, and safety data are needed.

COI: Dr Jayasena received an honorarium for speaking during a debate organised by the Society for Endocrinology and sponsored by Besins Healthcare. He has an investigator-led grant by Logixx Pharma Ltd.

Presented at the Royal Society of Medicine, Endocrinology and Diabetes section, entitled, EDN50: What's new in endocrinology and diabetes 2020? , Day 3. September 23, 2020

Continue reading here:
Sperm Take Up to 3 Years to Recover After Anabolic Steroids - Medscape

Recommendation and review posted by Bethany Smith

Covid-19 could lower testosterone levels and libido in men - heres what the new study found(Photo: Shutterstock)

A new study has revealed that men who contracted Covid-19 have their testosterone levels lowered by 30 per cent, on average.

Even two thirds of men who showed no symptoms reported a loss of libido.

Researchers in Turkey analysed levels of sex hormone in 232 men who were hospitalised after they tested positive for Covid-19.

What is hypogonadism?

More than half (51 per cent) of the men had developed a condition called hypogonadism, meaning their bodies did not produce enough testosterone.

On average participants levels were drained by 30 per cent post-infection, to borderline unhealthy levels.

Academics from the University of Mersin who ran the study claim there is a direct correlation between severe illness and lower testosterone levels.

Lead author, Professor Selahittin ayan (a urologist at the university) said, In our study, the mean total testosterone decreased, as the severity of the Covid-19 increased.

The mean total testosterone level was significantly lower in the ICU group than in the asymptomatic group.

In addition, the mean total testosterone level was significantly lower in the ICU group than in the standard care group.

Why do men need testosterone?

Testosterone is key to the development of sex organs and muscle growth. The hormone also helps regulate the bodys immune responses, including fighting off viral infections.

Low levels have been linked to an increased risk of dying from the flu, as well as inflammation, heart disease and high blood pressure.

A healthy level of testosterone is usually considered to be above 300 nanograms per decilitre (ng/dl).

Results in the study showed that patients saw their levels drop by a third, on average, from 458 ng/dl to 315 ng/dl.

Professor ayan describes the uses of the hormone saying, Testosterone is associated with the immune system of respiratory organs, and low levels of testosterone might increase the risk of respiratory infections.

Low testosterone is also associated with infection-related hospitalisation and all-cause mortality in male in ICU patients, so testosterone treatment may also have benefits beyond improving outcomes for Covid-19.

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Covid-19 could lower testosterone levels and libido in men - heres what the new study found - Shields Gazette

Recommendation and review posted by Bethany Smith

Global Testosterone Replacement Therapy Market Research Report provides primary Data, surveys, Scope of the Product and vendor briefing. The market dynamic forces have been determined after conducting a detailed study of the Global Testosterone Replacement Therapy market. It also provides key analysis on the market status of the Testosterone Replacement Therapy manufacturers with best facts and figures, meaning, definition, SWOT analysis, expert opinions and the latest developments across the globe. The Report also calculate the market size, Testosterone Replacement Therapy Sales, Price, Revenue, Gross Margin and Market Share, cost structure and growth rate. The report considers the revenue generated from the sales of This Report and technologies by various application segments.

COVID-19 can affect the global economy in three main ways: by directly affecting production and demand, by creating supply chain and market disruption, and by its financial impact on firms and financial markets.

Final Report will add the analysis of the impact of COVID-19 on this industry.

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Short Description About Testosterone Replacement Therapy Market:

Testosterone replacement therapy (TRT) is a class of hormone replacement therapy in which androgens, often testosterone, are replaced. Testosterone replacement therapy (TRT) is an FDA-approved medical treatment for men of any age who have low testosterone, a hormone necessary for male sexual development.

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The research covers the current Testosterone Replacement Therapy market size of the market and its growth rates based on 5-year records with company outline ofKey players/manufacturers:

Scope of the Testosterone Replacement Therapy Market Report:This report focuses on the Testosterone Replacement Therapy in global market, especially in North America, Europe and Asia-Pacific, South America, Middle East and Africa. This report categorizes the market based on manufacturers, regions, type and application.Testosterone deficiency, also referred to as hypogonadism, is a common problem among men aged between 40 and 79 years, with some studies stating that nearly 30% of all men worldwide are affected by hypogonadism. As the incidence of testosterone deficiency increases, it is expected that the demand for TRT will also show a simultaneous increase.The global average price of testosterone replacement therapy is in the decreasing trend, from 45.4 USD/Unit in 2012 to 34.9 USD/Unit in 2016. With the situation of global economy, prices will be in decreasing trend in the following five years.The classification of testosterone replacement therapy includes gels, injections, patches and other types, and the proportion of gels in 2016 is about 72%.Testosterone replacement therapy is widely sold in hospitals, clinics and other field. The most proportion of testosterone replacement therapy is sold in clinics, and the consumption proportion is about 43%.North America region is the largest supplier of testosterone replacement therapy, with a production market share nearly 86% in 2016. Europe is the second largest supplier of Testosterone Replacement Therapy, enjoying production market share nearly 9.9% in 2016.North America is the largest consumption place, with a consumption market share nearly 83% in 2016. Following North America, Europe is the second largest consumption place with the consumption market share of 12%. Market competition is intense. AbbVie, Endo International, Eli Lilly, Pfizer, Actavis (Allergan)Bayer, etc. are the leaders of the industry. The top five players together held about 80% of the market in the same year and they hold key technologies and patents, with high-end customers; have been formed in the monopoly position in the industry. The worldwide market for Testosterone Replacement Therapy is expected to grow at a CAGR of roughly -4.2% over the next five years, will reach 1410 million US$ in 2023, from 1820 million US$ in 2020, According to a New Research study.

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Report further studies the market development status and future Testosterone Replacement Therapy Market trend across the world. Also, it splits Testosterone Replacement Therapy market Segmentation by Type and by Applications to fully and deeply research and reveal market profile and prospects.

Major Classifications are as follows:

Major Applications are as follows:

Geographically,this report is segmented into severalkey regions, with sales, revenue, market share and growth Rate of Testosterone Replacement Therapy in these regions, from 2014 to 2024, covering

This Testosterone Replacement Therapy Market Research/Analysis Report Contains Answers to your following Questions

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Major Points from Table of Contents:

1. Market Overview1.1 Testosterone Replacement Therapy Introduction1.2 Market Analysis by Type1.3 Market Analysis by Applications1.4 Market Dynamics1.4.1 Market Opportunities1.4.2 Market Risk1.4.3 Market Driving Force

2.Manufacturers Profiles

2.4.1 Business Overview2.4.2 Testosterone Replacement Therapy Type and Applications2.4.2.1 Product A2.4.2.2 Product B

3.Global Testosterone Replacement Therapy Sales, Revenue, Market Share and Competition By Manufacturer (2019-2020)

3.1 Global Testosterone Replacement Therapy Sales and Market Share by Manufacturer (2019-2020)3.2 Global Testosterone Replacement Therapy Revenue and Market Share by Manufacturer (2019-2020)3.3 Market Concentration Rates3.3.1 Top 3 Testosterone Replacement Therapy Manufacturer Market Share in 20203.3.2 Top 6 Testosterone Replacement Therapy Manufacturer Market Share in 20203.4 Market Competition Trend

4.Global Testosterone Replacement Therapy Market Analysis by Regions

4.1 Global Testosterone Replacement Therapy Sales, Revenue and Market Share by Regions4.1.1 Global Testosterone Replacement Therapy Sales and Market Share by Regions (2014-2019)4.1.2 Global Testosterone Replacement Therapy Revenue and Market Share by Regions (2014-2019)4.2 North America Testosterone Replacement Therapy Sales and Growth Rate (2014-2019)4.3 Europe Testosterone Replacement Therapy Sales and Growth Rate (2014-2019)4.4 Asia-Pacific Testosterone Replacement Therapy Sales and Growth Rate (2014-2019)4.6 South America Testosterone Replacement Therapy Sales and Growth Rate (2014-2019)4.6 Middle East and Africa Testosterone Replacement Therapy Sales and Growth Rate (2014-2019)

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5.Testosterone Replacement Therapy Market Forecast (2020-2024)5.1 Global Testosterone Replacement Therapy Sales, Revenue and Growth Rate (2020-2024)5.2 Testosterone Replacement Therapy Market Forecast by Regions (2020-2024)5.3 Testosterone Replacement Therapy Market Forecast by Type (2020-2024)5.3.1 Global Testosterone Replacement Therapy Sales Forecast by Type (2020-2024)5.3.2 Global Testosterone Replacement Therapy Market Share Forecast by Type (2020-2024)5.4 Testosterone Replacement Therapy Market Forecast by Application (2020-2024)5.4.1 Global Testosterone Replacement Therapy Sales Forecast by Application (2020-2024)5.4.2 Global Testosterone Replacement Therapy Market Share Forecast by Application (2020-2024)

6.Sales Channel, Distributors, Traders and Dealers6.1 Sales Channel6.1.1 Direct Marketing6.1.2 Indirect Marketing6.1.3 Marketing Channel Future Trend6.2 Distributors, Traders and Dealers

7.Research Findings and Conclusion

8.Appendix8.1 Methodology8.2 Data Source

Continued..

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Testosterone Replacement Therapy Market 2020 Global Industry Sales, Industry Analysis with Top Countries Data, Share, Trends, Market Demand, Revenue,...

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This is the second part of a 2-part Infertility series. Read Part 1: The diagnosis of the infertile couple

Infertility treatment begins with shared decision-making with the couple. Besides the usual risks, benefits, and alternatives, the couples desire for a biologic child, their resources, and their insurance coverage will govern subsequent therapy.

Accurate diagnosis from a basic infertility evaluation often results in an easy therapeutic recommendation.

Based on their diagnosis, a couple may be offered a variety of treatments: often simple, sometimes very complex. Genetic testing of couples or their embryos will also provide additional opportunities in family building. Donor gametes, donor embryos, and adoption are often the most cost-effective route to having a child.

Clomiphene citrate is a synthetic estrogen receptor modulator. By blocking the estrogen receptor at the level of the hypothalamus and pituitary, the negative feedback of estrogen is eschewed and gonadotropin-releasing hormone (GNRH) pulses increase follicle-stimulating hormone (FSH) and luteinizing hormone (LH) production.1

These elevated gonadotropins stimulate early follicle development, increase estradiol production, and mature the oocyte. Clomiphene is most often administered as a daily oral dose for 5 days in the early follicular phase (eg, beginning between day 3 and day 5 of the menstrual cycle), beginning at 50 mg/day.

Clomiphene citrate causes FSH and LH to rise; after discontinuation, gonadotropins fall and allow the normal estrogen feedback of a developing follicle to return. Thus, when the oocyte is mature, an LH surge is triggered by the ovary, or an exogenous human chorionic gonadotropin hormone (HcG) trigger can be administered, and ovulation ensues.

Adverse effects (AEs) of clomiphene citrate include hot flashes, thickened cervical mucus, vaginal dryness, scotomata, pelvic heaviness, and headaches.1 Hyperstimulation of the ovaries is rare. Because clomiphene citrate may cause thickened cervical mucus, it is often used in combination with intrauterine insemination, especially in treatment of unexplained infertility.2

Aromatase inhibitors act in a similar fashion to clomiphene citrate, although by a different mechanism.

These medications block aromatase, the enzyme which converts androgens to estrogens; estrogen is decreased to menopausal levels. The low concentration of estrogen results in increased GNRH pulses and stimulates gonadotropin release from the pituitary.

Aromatase inhibitors are given orally, starting at 2.5 mg per day from day 3 to 8 of the cycle. AEs include hot flashes, vaginal dryness, nausea, muscle aches, and headaches. Data from meta-analyses, registry studies, and retrospective cohort studies do not appear to suggest increased risk of birth defects with either clomiphene citrate or letrozole.3-10

Patients treated with clomiphene citrate or aromatase inhibitors may use an ovulation predictor kit to measure the LH surge and time their intercourse accordingly. Ovulation occurs an average of 7 days after discontinuation of clomiphene citrate and approximately 34 to 40 hours after detection of the LH surge.

Thus, patients may start testing their urine with an ovulation predictor kit on day 11 of their cycle and have intercourse on the day of the surge and the day after. Both clomiphene citrate and aromatase inhibitors have a multiple pregnancy rate of less than 10%, the majority of which are twin pregnancies,11 compared with 3% of the general population.

Gonadotropins (LH and FSH) directly stimulate the ovarian follicles and have been used in the treatment of anovulation related to eugonadotropic hypogonadism (eg, polycystic ovary syndrome), when clomiphene citrate or aromatase inhibitors fail, as well as for women with hypogonadotropic hypogonadism who will typically not respond to clomiphene or letrozole.

Estrogen concentrations are stimulated to much higher than physiologic concentrations and thus inhibit the natural ovulatory LH surge; thus, the LH surge must be exogenously administered and is done so by treating with HcG, which has LH activity.

Gonadotropin administration should be performed only under the supervision of a reproductive endocrinologist. Administration must be monitored by frequent estradiol measurement and ultrasonography of the ovaries.12 Multiple pregnancy rates can be in excess of 25% per cycle with 3% to 5% higher-order multiple pregnancy rates.

Another serious consequence of gonadotropin treatment is ovarian hyperstimulation syndrome (OHSS), resulting in ascites, pleural effusion, hyponatremia, pulmonary edema,13,14 and vascular depletion, with the resultant hemoconcentration leading to decreased renal perfusion and pulmonary embolism.

In light of the high multiple pregnancy rate as well as the need for stringent monitoring and cycle cancellation,5 gonadotropin therapy for anovulation related to eugonadotropic hypogonadism is generally discouraged.

It is important to note that once a patient is ovulating, she has the same chance of conceiving that fertile patients of similar age have, unless another infertility factor is present.

Therefore, after 4 to 6 ovulatory cycles without pregnancy in an anovulatory patient, the patient should be evaluated for other causes of infertility, if a workup has not already been completed.15

Intrauterine insemination (IUI) is used in the treatment of mild male factor infertility, cervical factor infertility, and, along with ovarian stimulation, in the treatment of unexplained infertility. This requires serial dilution of the ejaculate,16 centrifugation, and reconstitution with media.

The washed, concentrated sperm is placed into the uterus with a catheter 24 to 36 hours after an endogenous LH surge or the exogenous ovulation trigger. The sperm will be waiting in the Fallopian tube to fertilize the oocyte after ovulation.

For unexplained infertility in the absence of male factor, IUI alone does not increase pregnancy rates over expectant management; therefore, IUI should be utilized in combination with OS in these instances.17

If severe male factor infertility exists (eg, less than 4 million total sperm, or the strict morphology reveals less than 4% normal forms), the pregnancy rate with in vitro fertilization (IVF) is higher than with IUI.18

Ovarian stimulation (OS) may be used to treat unexplained infertility, male factor infertility, or hypogonadotropic hypogonadism, and may be performed with clomiphene citrate, aromatase inhibitors, or gonadotropins. The premise of OS is to allow for 2 or 3 oocytes to be ovulated and increase the statistical change of conception that might occur in any 1 cycle.

Pregnancy rates with OS depend on the diagnosis, choice of therapy, sperm viability, and ovarian response. OS in combination with IUI is largely used in the treatment of unexplained infertility or male factor infertility; particularly for unexplained infertility, neither clomiphene nor letrozole is more effective than expectant management when combined with timed intercourse alone.17 Pregnancy rates with OS-IUI depend on the diagnosis, sperm viability, and ovarian response.

With respect to OS with gonadotropins, the Fast Track and Standard Treatment Trial randomized women aged less than 40 years with unexplained infertility to treatment with clomiphene-IUI followed, if unsuccessful, by (1) gonadotropins-IUI or (2) IVF; results showed that the time to pregnancy was significantly shorter in the clomiphene to IVF group.19

Therefore, in most cases, it is generally recommended that unsuccessful trials of OS with oral medications be followed by IVF rather than gonadotropins. Additionally, multiple pregnancies, as well as OHSS, represent serious consequences of OS with gonadotropins, and their use to treat unexplained infertility is not recommended.17

Infertile women may be at an increased risk of invasive ovarian, endometrial, and breast cancer, but fertility drugs do not appear to increase this risk significantly.20,21

Small cohort studies suggest that infertility medications may increase theriskof borderline ovarian cancer slightly in infertile women treated with infertility drugs, but the absolute risk is small. However, it appears that this risk does not occur unless clomiphene is given for an extended time, and it has not been shown with aromatase inhibitors.22

In vitro fertilization (IVF) initially used for the treatment of tubal factor infertility in 1978, has been extended to treat a variety of causes of infertility; IVF is also used by noninfertile individuals pursuing fertility preservation.

Indeed, IVF allows women without oocytes or a uterus and men without sperm in the ejaculate to have a biological child. IVF is indicated in cases of severe oligospermia or azoospermia, untreated tubal factor, or infertility in women 40 years and older, and it may also be utilized in women with endometriosis, anovulation, or unexplained infertility when ovulation induction and IUI have been unsuccessful. IVF is also utilized when genetic screening of embryos is planned.

IVF protocols vary depending on the indication, patient age, treatment history, and other considerations.

A typical IVF cycle involves, first, ovulation induction to stimulate multiple ovarian follicles, followed by oocyte aspiration using a transvaginal ultrasound-guided needle. Collected oocytes are fertilized in vitroby mixing them with spermatozoa (IVF) or by injecting selected spermatozoa directly into the oocyte cytoplasm (intracytoplasmic sperm injection).

Embryos are cultured under carefully controlled conditions, optimizing oxygen concentration, embryo culture media, and other modifications to promote the development of high-quality embryos.

The embryos are then transferred into the uterus through a catheter under ultrasound guidance. In the case of severe male factor infertility, sperm retrieval from the epididymis or testis may also be performed. Embryos not transferred may be cryopreserved to transfer in a later cycle (frozen embryo transfer).

Preimplantation genetic testing (PGT) is a procedure in which cultured embryos can be biopsied and tested in order to select the most appropriate embryos for transfer.

Prior to transfer, PGT can be used to screen for euploid embryos for transfer (PGT-aneuploid [PGT-A]); however, specific groups of infertility patients most likely to benefit from PGT-A have not been clearly defined. PGT may also be utilized to identify embryos with a single gene disorder (PGT-monogenic or preimplantation genetic diagnosis); this would be used, for example, if both partners are carriers for the same autosomal recessive condition, such as cystic fibrosis.

Donor gametes may be considered when either partner has severe defects in gamete quality or quantity. For males, such situations may include severe oligospermia, azoospermia, failure of fertilization in prior IVF cycles, ejaculatory dysfunction, or other severe male factor infertility (ie, after gonadotoxic chemotherapy).

Donor oocytes or embryos may be used when a womans oocyte reserve is low (ie, advanced reproductive age or diminished ovarian reserve) or oocyte quality is poor, when multiple attempts at IVF with her own oocytes have failed, or when a condition such as premature ovarian insufficiency makes the likelihood of conceiving with her own gametes extremely low.

Donor gametes may also be utilized when either partner has a significant genetic defect, or if there is a family history of a genetic condition for which carrier status cannot be determined.

Females without male partners, same-sex couples, or males without female partners may also utilize donor gametes, either anonymously from donor gamete banks or known donors.23

A gestational carrier (GC) is defined as a woman who carries a pregnancy and is not sexually intimate with the genetic parents or gamete donors.24

A GC may be used when a medical condition prevents a woman from carrying a pregnancy or when she has a congenital or surgical absence of a uterus. A GC may also be indicated if a pregnancy would pose significant risk to a womans health or life, or if there is a biological inability to carry a pregnancy, as with single males or gay male couples.

Lastly, uterine transplant is an emerging option for individuals without a uterus; it is currently available only in the setting of clinical research trials.25

Although legal adoption has allowed couples to build a family for more than a century, modern technology now allows for effective therapy for infertility in many cases, guided by accurate diagnosis and shared decision-making.

The basic evaluation of an infertile couple has been supplemented with an evaluation of related health issues, as our knowledge has advanced to include surveillance beyond the reproductive system (Table).

The primary care practitioner is vital in not only initiating the evaluation, surveying for related health problems, and referring to specialty care, but also longitudinally, following patients for possible disease processes harbingered by infertility.

__

About the Authors

DR. KALLEN is an assistant professor of Obstetrics, Gynecology, and Reproductive Sciences in the Division of Reproductive Endocrinology and Infertility within the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, Yale University.

DR. CARSON is a professor of Obstetrics, Gynecology, and Reproductive Sciences in the Division Chief, Division of Reproductive Endocrinology and Infertility within the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, Yale University.

__

See the article here:
Treatment of the infertile couple - Contemporary Obgyn

Recommendation and review posted by Bethany Smith

Netflixs Hope Frozen documentary follows a family in Thailand that turns to science in their fervent desire that their daughter may one day live again. It is a surprisingly poignant portrait of familial love and grief.

In Hope Frozen: A Quest to Live Twice, filmmaker Pailin Wedel masterfully documents the compelling story of the Naovaratpong family, comprised of the father, Sahatorn, his wife Nareerat and their teenage son Matrix, who suffer the terrible loss of their beloved two-year-old daughter Einz from ependymoblastoma, a rare and aggressive brain cancer.

During Einzs illness, her father frantically uses his science background (he is an engineer) to try and learn on the fly and discover a cure for his ailing daughter as she deteriorates.

After a dozen surgeries and 20 chemotherapy and radiation treatments, it becomes readily apparent that time is running out for little Einz. In response, Sahatorn then turns his attention to cryogenics, in the hope that he could freeze his daughter after death, in order to one day re-animate her when a cure for her disease is found.

Immediately following Einzs heart-breaking demise, doctors from the Alcor Life Extension Foundation go about cryogenically freezing her. Once that process is completed, Einzs body is sent from Thailand to storage in Arizona.

This story sounds like some bizarre science fiction, but Hope Frozen masterfully turns this strange tale into a morally and ethically complex story that is intensified by the emotional power of grief.

In addition, the film raises a plethora of profound philosophical questions, but to its credit it never presumes to know the answers.

The film ponders such matter as what is consciousness? Is consciousness attached to the body? Are memories kept intact when someone is cryogenically frozen? Is that frozen body really a person or just a collection of flesh and bones? Can death be scientifically defeated? Will cryogenics even work? Can people be re-animated in the future? Will a cure for cancer ever be found?

These questions are made even more complicated by the familys fervent faith in science coupled with their spiritual belief in Buddhism. This results in the family grappling with issues such as will freezing Einz stop her from reincarnating? And is cryogenics just imprisoning Einzs soul in a lifeless body?

The most intriguing member of the Naovaratpong family is the son Matrix, a smart and sensitive young man haunted by his sisters death.

At his fathers prodding, Matrix is a scientific genius who dedicates his life to finding a way to bring his sister back to life. Ever the big brother, he even becomes a novice Buddhist monk in an attempt to try and protect his dead sisters soul.

Like his mother and father, Matrix will never shed the painful burden that is the death of Einz. The Naovaratpongs simply cant let go of their daughter, of the dream of her future and of their grieving wound.

By cryogenically freezing Einz, the family freezes themselves into a perpetual state of hope and grief this keeps Einz fresh in their minds. Their hope and grief are all they have left so they do not want to let them go. As long as hope for her return and grief for her loss are frozen in place, Einz lives on.

As the film progresses, the story takes on multiple twists and turns that makes for interesting viewing particularly a scene where Matrix calls home after a trip to America but the most fascinating part of the film is the love for Einz that is at the core of it.

You can question the familys decision to cryogenically freeze their daughter and their quest to keep the hope of her alive in the face of death, I know I did, but what I never did was question the purity of their motives or the profundity of their love.

As a parent, it is impossible to watch Hope Frozen and not have compassion and empathy for Sahatorn, Nareerat and Matrix. Their love for Einz is exquisitely beautiful to witness even when it is wildly contorted by grief and despair.

The familys devotion to science in the form of cryogenics in the hope of overcoming death is no different than any other faith taking center stage in an existential crisis. Faith is our shield against the slings and arrows of life and the inevitability of our own annihilation.

The Naovaratpongs wrap themselves in the cloak of science in order to maintain the illusion that Einz will rise from the dead, just as a Catholic like myself clings to that same delusion that death can be conquered through Gods love and power.

This need to believe in something, anything, to make the colossal pain of grief, and the terrifying prospect of the eternal abyss of death, subside, is all too human, and is strikingly highlighted in Hope Frozen.

This is a deeply moving documentary because it reminds us that life is fleeting and that love isnt everything its the only thing.

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The statements, views and opinions expressed in this column are solely those of the author and do not necessarily represent those of RT.

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Intimate & heart-wrenching: The compelling story of parents who cryogenically freeze their dead 2-year-old child - RT

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HALIFAX -- Protesters gathered outside of the Fredericton legislature on Saturday to show support for a New Brunswick clinic that was seen as a haven for the province's LGBTQ+ community.

Clinic 554, which has now officially closed its doors, was also the only facility left in the province that provided abortion services outside of a hospital.

"I'm like, extremely frustrated with how the government is treating queer people and women," said protester Live Brennan.

Despite months of advocacy and calls from politicians and medical staff to keep the clinic open, it has been forced to close its doors.

The facility is known as a safe-haven for the entire LGBTQ+ community, with its specialization in transgender health-care.

"Before I found Dr. Edgar, I was suicidal. I didn't really feel like I had much left," said Raelyn Hamill, who participated in the protest on Saturday. "Then I realized in the hospital, after I had mental health episodes, whatever you want to call it, that I was transgender and I just felt like I had something to live for, finally."

Guest speaker at the protest, Amour Love, said this is an issue that won't be swept under the rug.

"This is a human rights issue. These are health issues and values that deserve to be heard and unfortunately, they're not," said Amour Love. "And these are regulations that are moving forward, completely steamrolling over the holistic health of these individuals."

Now, many are wondering what will happen to the patients at Clinic 554.

"I'm here today because, well, I was originally supposed to be here for hormone therapy, and then it closed down and this clinic means a lot to the community," said Jayden James, an organizer of the protest. "Plus, there are over 3,000 people that have a family doctor that works at the clinic and to close that down, it's just going to cause a disaster."

Activists are calling on the government to not only keep the clinic open, but to also repeal New Brunswick's Regulation 84-20, which prevents the province from funding abortions outside of hospitals, under the Medical Services Payment Act.

"With hormones that he provided, the care that only he can provide, it just, it made me who I am," said Hamill. "And to think a politician could take that away from me."

Protesters say they plan to keep the issue in the light, whether that means more protests, or reaching out to their local politicians.

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Protests continue in support of the now-closed Clinic 554 in Fredericton - CTV News Atlantic

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Within the last few months, blood clots were added to the constantly changing list of COVID-19 symptoms. Theyve also been the source of COVID toes, breathing problems and a number of other medical conditions that have created even greater challenges for healthcare providers as they battle this devastating virus.

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The connection between COVID-19 and blood clots has created a new set of concerns for those who are pregnant, taking birth control or undergoing hormone therapy. But is there a reason to ditch the pills, patches, gels or go through pregnancy on edge? Vascular medicine specialist Meghann McCarthy, DO, explains the link between the coronavirus, blood clots and hormones, and also shares some advice for reducing the risk.

Blood clots are gel-like collections of blood that form in veins or arteries. They form when blood changes from liquid to partially solid. While clotting is a normal process, but clots can be dangerous when they do not dissolve on their own.

If you take birth control, youve heard the warnings about blood clots. But what causes them to occur and do they occur often?

Dr. McCarthy explains.

Birth control and hormone therapy (in particular those containing estrogen) may increase the risk of blood clots, although the absolute risk in the general population remains low. The thought is that these hormones may affect some clotting factors produced by the liver, which in turn, can promote the development of blood clots.

When coupled with hormone therapy, Dr. McCarthy says that additional factors may also increase the risk of blood clots. They can include underlying clotting disorders, a history of blood clots, vessel problems (like heart disease or stroke), high blood pressure, age, obesity and if you smoke.

Hormone pills, injections, implants and intrauterine devices containing only progesterone have a lower risk of associated blood clots than forms which have an estrogen or estrogen-progesterone combination. Oral forms of estrogens tend to be associated with higher rates of blood clots than other forms of estrogen (patches or creams). Higher doses of estrogen, dosage changes with hormonal medicines or starting hormone therapy can also carry a higher risk, says Dr. McCarthy.

According to Dr. McCarthy, hormonal fluctuations during pregnancy can cause clotting issues. However, the chances are pretty low for women who dont have a history of blood clots.

There are major fluctuations in the production of hormones during pregnancy. Pregnancy, like hormone medications, can also affect some of the clotting factors (proteins in the blood that help promote clotting) that are created by the liver and in turn, may increase the risk of getting blood clots. However, the risk of blood clots during pregnancy in a woman with no prior clotting history remains relatively low.

Dr. McCarthy adds that women with a history of blood clots who are planning a pregnancy should consult with a healthcare provider who is familiar with this condition beforehand. They can determine if blood-thinning medications need to be incorporated into the plan as a safety precaution.

As stated earlier, COVID-19 has been shown to cause clotting throughout the body. Dr. McCarthy says that while COVID-19 may increase the risk of blood clots, the exact reason for this is unclear. At this point, it cant be said that if you are on hormonal medication or pregnant, youre at a greater risk for getting blood clots if you contract the coronavirus. But there are still some factors that we can watch out for.

There are a number factors that may play into this risk, including injury/inflammation to the vessel wall (which leads to a buildup of cells around the injured wall and creation of a blood clot) and increased reactivity of the platelets (which are the clotting cells in the blood). The virus also affects inflammatory and coagulation (clotting) factors that circulate in the blood. This may increase the risk of blood clots.

Dr. McCarthy adds that the risk of blood clots are likely related to a combination of how the body reacts to the virus (inflammation, vascular injury, changes in clotting factors, etc.) and things like immobilization in seriously ill, hospitalized patients who have COVID-19.

Dr. McCarthy stresses that its not a good idea to stop taking hormone medications without contacting your healthcare provider first. Stopping therapy without talking to your doctor may lead to serious adverse health effects and in the case of birth control pills lead to the possibility of an unexpected pregnancy. I always recommend talking with your provider about the risks and benefits of stopping or changing therapy.

While alarming, its not exactly clear how common blood clots are with people who have mild cases of COVID-19. Researchers are still studying how the coronavirus affects the body. Theyre also currently working on anti-blood clotting treatments to combat this symptom.

It may seem like getting blood clots is beyond our control, but Dr. McCarthy says there are things we can do lessen the risk.

In general, the risk of blood clots can be reduced with regular activity or exercise, a healthy diet and watching your weight. If you plan to travel, stopping frequently to walk around during road trips, staying hydrated and wearing compression socks may help reduce the risk of clots. It is also important to keep up with age-appropriate cancer screenings like mammograms, pap smears and colonoscopies. Quitting smoking (or not even starting) can also help reduce the risk of blood clots and many other health problems. And like weve been doing since the pandemic started, its still important to follow guidelines regarding social distancing, hand hygiene and mask-wearing to reduce the risk of exposure to COVID-19.

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Hormones, Blood Clots and COVID-19: Should You Be Worried? - Health Essentials from Cleveland Clinic

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The Mayo Clinic says hormone therapy is only used for breast cancers that are found to have receptors for estrogen or progesterone. Doctors refer to these types of cancers as estrogen receptor positive (ER positive) or progesterone receptor positive (PR positive). Doctors who specialize in analyzing blood and body tissue will study a sample of cancer cells to see if they have receptors for estrogen or progesterone.

It is important not to mistake hormone therapy for breast cancer with menopausal hormone therapy, which is sometimes called hormone replacement therapy, advises the National Cancer Institute. With menopause treatments, progesterone and estrogen may be used to relieve symptoms of menopause. Cancer hormone treatment does the opposite. The therapy blocks the growth of ER or PR positive breast cancer cells. Typically, drugs are used to stop estrogen and progesterone from helping breast cancer cells grow; otherwise, drugs or surgery will be used to keep the ovaries from making these hormones. Radiation therapy aimed at the ovaries also may help stop hormone production.

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Hormone therapy is an option to treat breast cancer - Dayton Daily News

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Low glucocorticoid receptor (GR) expression led to excessive inflammation and lung damage by neutrophils through enhancing the expression of CXCL8 and other cytokines. Credit: Professor Heung Kyu Lee, KAIST. Created with Biorender.com

Airway cell analyses showing an activated immune axis could pinpoint the COVID-19 patients who will most benefit from targeted therapies.

KAIST researchers have identified key markers that could help pinpoint patients who are bound to get a severe reaction to COVID-19 infection. This would help doctors provide the right treatments at the right time, potentially saving lives. The findings were published in the journal Frontiers in Immunology.

Peoples immune systems react differently to infection with SARS-CoV-2, the virus that causes COVID-19, ranging from mild to severe, life-threatening responses.

To understand the differences in responses, Professor Heung Kyu Lee and PhD candidate Jang Hyun Park from the Graduate School of Medical Science and Engineering at KAIST analysed ribonucleic acid (RNA) sequencing data extracted from individual airway cells of healthy controls and of mildly and severely ill patients with COVID-19. The data was available in a public database previously published by a group of Chinese researchers.

Our analyses identified an association between immune cells called neutrophils and special cell receptors that bind to the steroid hormone glucocorticoid, Professor Lee explained. This finding could be used as a biomarker for predicting disease severity in patients and thus selecting a targeted therapy that can help treat them at an appropriate time, he added.

Severe illness in COVID-19 is associated with an exaggerated immune response that leads to excessive airway-damaging inflammation. This condition, known as acute respiratory distress syndrome (ARDS), accounts for 70% of deaths in fatal COVID-19 infections.

Scientists already know that this excessive inflammation involves heightened neutrophil recruitment to the airways, but the detailed mechanisms of this reaction are still unclear.

Lee and Parks analyses found that a group of immune cells called myeloid cells produced excess amounts of neutrophil-recruiting chemicals in severely ill patients, including a cytokine called tumour necrosis factor (TNF) and a chemokine called CXCL8.

Further RNA analyses of neutrophils in severely ill patients showed they were less able to recruit very important T cells needed for attacking the virus. At the same time, the neutrophils produced too many extracellular molecules that normally trap pathogens, but damage airway cells when produced in excess.

The researchers additionally found that the airway cells in severely ill patients were not expressing enough glucocorticoid receptors. This was correlated with increased CXCL8 expression and neutrophil recruitment.

Glucocorticoids, like the well-known drug dexamethasone, are anti-inflammatory agents that could play a role in treating COVID-19. However, using them in early or mild forms of the infection could suppress the necessary immune reactions to combat the virus. But if airway damage has already happened in more severe cases, glucocorticoid treatment would be ineffective.

Knowing who to give this treatment to and when is really important. COVID-19 patients showing reduced glucocorticoid receptor expression, increased CXCL8 expression, and excess neutrophil recruitment to the airways could benefit from treatment with glucocorticoids to prevent airway damage. Further research is needed, however, to confirm the relationship between glucocorticoids and neutrophil inflammation at the protein level.

Our study could serve as a springboard towards more accurate and reliable COVID-19 treatments, Professor Lee said.

Reference: Re-analysis of Single Cell Transcriptome Reveals That the NR3C1-CXCL8-Neutrophil Axis Determines the Severity of COVID-19 by Jang Hyun Park and Heung Kyu Lee, 28 August 2020, Frontiers in Immunology.DOI: 10.3389/fimmu.2020.02145

This work was supported by the National Research Foundation of Korea, and Mobile Clinic Module Project funded by KAIST.

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Researchers Identify Key Biomarker That Predicts Who Will Have Severe COVID-19 - SciTechDaily

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New results to be presented at the 12th European Breast Cancer Conference show that a test, which looks at the activity of 70 genes in breast cancer tissue, is possible to use in the clinic to identify patients with invasive lobular carcinoma (ILC) that is at high risk of recurring and progressing.

Adjuvant treatments, such as chemotherapy, radiation therapy or targeted therapies, are not usually offered to ILC patients after surgery as the disease is slow growing and often responds well to hormone treatment alone. So far, there has been little evidence that such treatments improve outcomes, but they can affect people's quality of life.

However, the 70-gene signature test (commercially known as MammaPrint) identified some ILC patients whose genetic make-up puts them at high risk of the cancer recurring if they are treated with hormone therapy alone. These patients may benefit from additional adjuvant therapy.

ILC is a type of cancer that begins in the milk glands (lobules) of the breast. It becomes invasive when the cancer cells start spreading beyond the lobules and has the potential to spread to the lymph glands and other parts of the body. It affects about 10% of people with invasive breast cancer. By comparison, invasive ductal carcinoma (IDC) accounts for about 80% of breast cancers in women. It begins in the milk ducts and grows into the surrounding breast tissue, and is often treated with radiation, chemotherapy, hormone therapy or targeted therapies such as trastuzumab and T-DM1, in addition to surgery.

Dr Otto Metzger, a medical oncologist at the Dana-Farber Cancer Institute and assistant professor at Harvard Medical School, Boston, USA, told the conference: "The decision about whether or not to treat patients diagnosed with invasive lobular carcinoma with chemotherapy is difficult. Results from earlier research, which I carried out with Professor Christos Sotiriou while I was at the Institut Jules Bordet in Belgium, indicated that 10 to 15% of ILC cases were classified as high-risk at a genomic level. These had worse survival outcomes when compared to those classified as low-risk."

In a statement before the conference, the principle investigator of the MINDACT trial, Professor Fatima Cardoso, Director of the Breast Unit of the Champalimaud Clinical Centre in Lisbon, Portugal, said: "In this sub-study of the MINDACT trial, we have investigated further the biology of ILC and have identified a subset of ILC patients who could potentially benefit from chemotherapy or other adjuvant treatments. Here we report for the first time the utility of the 70-gene signature test in a large group of patients with ILC in the MINDACT randomised phase III clinical trial. These results are important for clinicians to help them choose a precise treatment approach tailored to the individual patient. This work was possible due to generous support of the Breast Cancer Research Foundation."

A total of 6,693 women with early-stage breast cancer enrolled in the international MINDACT trial. Of these, 5,313 patients were included in the current analysis: 487 women had ILC, including 255 classic cases of the disease and 232 variants, and 4,826 had IDC. The tissue samples were reviewed by a central pathology service to ensure consistency in categorising the different types and variants of cancer. The patients were followed for an average (median) of five years after diagnosis.

The 70-gene signature test classified 16.2% of ILC as high genomic risk and 39.1% of IDC as high genomic risk. By comparing classic ILC to variants of ILC, it classified 10.2% of classic ILC and 22.8% of ILC variants as high genomic risk.

The researchers found that estimates for the proportion of patients surviving without the disease recurring (disease-free survival, DFS) or without the disease spreading to other parts of the body (distant metastases-free survival, DMFS) at five years were similar for both ILCs and IDCs that had been classified as high risk by the 70-gene signature test. DFS was 87.1% for IDC and 84.6% for ILC. DMFS was 92.3% for IDC and 89.4% for ILC.

Estimates for IDCs and ILCs that the 70-gene signature test classified as low risk were also similar. DFS was 92.5% for IDC and 92% for ILC. DMFS was 96.5% for IDC and 96.6% for ILC.

Dr Metzger said: "We found that DMFS and DFS estimates were similar for ILC and IDC classified as either low or high-risk by the 70-gene signature test. This suggests that the test has prognostic value for ILC. The incorporation of biological features defined by the 70-gene signature test in the treatment decisions for patients diagnosed with ILC should facilitate a complex decision-making process, that includes the extent of disease, other health conditions and patients' preferences."

Chair of EBCC12, Professor Nadia Harbeck, of the University of Munich (LMU), Germany, who was not involved with the study, commented: "The results of this study show that the 70-gene signature test may play a useful role in the clinic when doctors are considering whether their patients with invasive lobular carcinoma might benefit from treatments such as chemotherapy in addition to surgery.

"As only about 10% of patients with invasive breast cancer have ILC and, in this study, the 70-gene signature test classified only 16.2% as high-risk ILC, a retrospective series of patients could have failed to identify a potential benefit for adjuvant therapies from such a small sub-group of patients. This analysis of over 5,000 women with early breast cancer in the MINDACT trial is an important contribution to our knowledge of the best way of treating these women."

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Genetic test identifies invasive lobular carcinomas that are at high risk of recurring - Science Codex

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Dr Derek Glidden and the team at Nottinghams transgender clinic have had a tough few months navigating the coronavirus pandemic while managing one of the longest waiting lists in the NHS.

Clinical lead Dr Glidden, who works at the Hockley-based centre, explained how the clinic has managed to keep operating its much-needed service in a world where everything has changed.

The Nottingham Centre for Transgender Health takes referrals from all over the country for people over the age of 17 but a long waiting list means people are currently waiting around three years for an initial appointment.

Keen not to add to the growing list, Dr Glidden and the team were faced with a huge challenge in March to keep the service going without seeing patients in person.

The clinic, which is the second largest in the UK, receives around 1,000 referrals a year from healthcare professionals.

There is a year-on-year increase in referrals and the centres main priority is to improve access.

Dr Glidden said: Weve been one of few services able to continue to start people on gender-affirming treatments.

Our patients can face inequalities when it comes to transgender healthcare and the waiting lists are not echoed in any other place in the NHS.

For the vast majority of our patients, the treatment is not a want, its a need. Its life-changing treatment for the patients we see.

It was an extremely challenging time but we maintained our much-needed service.

Reflecting on the past few months he said: It was a challenging time but extremely rewarding to work with our amazing staff.

Prior to the pandemic the vast majority of our work was face to face, which then presented huge difficulties with Covid-19.

We are a national clinic so we have patients travelling many hours to see us, often via public transport. Very swiftly we had to find a new way to deliver our service.

Dr Glidden, who has been Clinical Lead since January and has worked at the centre since 2014, said the majority of people were moved on to video consultations.

The centres support service was increased to five days a week.

Currently, 1,400 people are receiving care at the centre and 2,500 people are waiting to be seen.

There is a waiting list which is common to all seven transgender health centres in England, said Dr Glidden.

We tend to be talking about three years, it is our biggest area of concern and one of our clear priorities, he said.

Although gender-affirming surgery was postponed during the pandemic, Dr Glidden said activity levels at the centre were the exact same as pre-Covid times.

He said he is extremely hopeful that surgery can be restarted as soon as possible.

Each persons treatment programme is individualistic but can include cross sex hormone treatment, androgen blockade, voice therapy, facial hair removal, gender-affirming surgery and support.

Dr Glidden said some patients say visibility and acceptance has improved, but others say there are ongoing challenges in healthcare, life and society.

Nat Thorne, a PHD student who works at the Notts Trans Hub, praised the clinic for its work during the pandemic.

But they said long waiting lists have a huge impact on trans people.

Nat, who is currently looking into the mental health of non-binary people with the University of Nottingham and uses data from the transgender clinic, said: It is amazing that they managed to keep appointments going via Zoom as it was a massive worry in the community about the ever-growing waiting list.

It might be at four or five years by now. But everyone at the clinic is great, they are happy, positive people. We want to sing their praises because they are awesome.

Nat, 42, who has published three papers with the university, said there is a lot of nervousness when people first visit the clinic.

But they said: The way trans people have been treated generally isnt brilliant. But people come away from the clinic with a positive attitude, people feel listened to.

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Meet the man behind Nottinghams 'amazing' transgender clinic with a three-year waiting list - Nottinghamshire Live

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The North American Menopause Society (NAMS) 2020 Conference starts September 30, and four different panels will emphasize the latest research on therapy for hot flashes and night sweats.

As many as 75 percent of North American women experience the disruption and discomfort of menopause-related hot flashes, or vasomotor symptoms (VMS). These usually persist for six months to two years. Some women, however, report experiencing hot flash symptoms for 10 years. For a small minority, they never go away.

RELATED: Coping With Hot Flashes and Other Menopausal Symptoms: What 9 Celebrities Said

It is important to develop new therapies for hot flashes, because we know that one size does not fit all for any type of therapy.We have used the same hormonal therapies for the last several decades and are developing an understanding that not all estrogens are alike, and different formulations and routes of administration are associated with different risk/benefit profiles. Developing new treatments will expand the choices available to women for management of what can be long-lasting and very bothersome symptoms for some women, says Stephanie S. Faubion, MD, MBA, the medical director of NAMS and the Penny and Bill George director at the Center for Women's Health at the Mayo Clinic in Rochester, Minnesota, and Jacksonville, Florida.

Here are the top hot-flash treatment takeaways from this years conference.

Nonhormonal options, such as SSRIs, SNRIs, gabapentin, oxybutynin, and clonidinealready exist;Susan D. Reed, MD, MPH, of the department of obstetrics and gynecology at the University of Washington School of Medicine in Seattle, told Everyday Health that she will discuss the efficacy of other drugs that target the KNDy neuron complex (estrogen-sensitive neurons in the hypothalamus) at this year's meeting. During menopause, estrogen levels decrease dramatically, which causes the KNDy neurons to be hyperstimulated, spilling over and having an adverse effect on the adjacent thermoregulatory center.

The result? Hot flashes and night sweats. Currently, the FDA hasnt approved any therapies that target KNDy neurons for use for hot flashes. But there are drugs that target KNDy that are now under development for VMS treatment. So far, results have been very promising.

RELATED: Treatments for Menopausal and Perimenopausal Symptoms

Estrogen therapy has always been complicated its benefits also come with risks. Experts have been searching, without much success, for selective estrogen receptor modulators (SERMs) that provide the benefit with minimal risk of breast cancer, stroke, blood clots, or heart attack.

Hugh S. Taylor, MD, at the department of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine in New Haven, Connecticut, will present data about a new approach that is developing two fetal estrogens with SERM-like properties, called estriol and estetrol, which are different from the commonly used estradiol. Estetrol has been shown to decrease VMS intensity and frequency while providing benefits to the cardiovascular system. Estriol can also lessen some of the bad effects of estradiol. Researchers are still exploring this possible breakthrough in hormonal therapy.

RELATED: 10 Ways to Beat Menopausal Belly Fat

In 2015, NAMS provided a position statement on nonhormonal management of hot flashes. Janet S. Carpenter, PhD, RN, the Audrey Geisel Endowed Chair in Innovation and an associate dean of research at the Indiana School of Nursing in Indianapolis reviewed research done since then and will confirm the recommendations as still relevant:

RELATED: Menopause Experts Issue New Guidelines for Treating Vaginal and Urinary Symptoms

For a panel on nonhormonal management of menopause, Catherine Hansen, MD, of the Empowered Womens Circle in Houston, will report that while standard treatment is menopausal hormone therapy (HT or HRT), many women cannot tolerate HT or wish to avoid using it, yet arent fully informed about nonhormonal treatment options. This may lead them to use unproven, ineffective, or dangerous therapies. Dr. Hansen urges healthcare practitioners to educate themselves and their patients on appropriate nonhormonal care. Women should consult with their physicians before trying any new therapies, and it is best to follow plans that are appropriate for their individual and unique needs. What works for one woman may not work for another, and in fact, may be detrimental.

RELATED: 7 Fun Ways to Move More at Midlife

Dr. Faubion concludes that the important takeaways from these panels are: There are options out there for treatment of hot flashes. The only nonmedication therapies that have good evidence to support them for hot flash management are cognitive behavioral therapy and hypnosis. No over-the-counter herbs or supplements have been proved effective for hot flash treatment. At this time, hormone therapy is still the most effective option, and the benefits typically outweigh the risks for most symptomatic women under the age of 60 and within 10 years of menopause onset.

RELATED:Menopause and Sleep News: NAMS 2020 Addresses 5 Key Issues; Sex and Sex Drive in Midlife: News From NAMS 2020

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Menopausal Hot Flash Treatment Options Expand - Everyday Health

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Amy Coney Barrett, the Trump administrations supreme court nominee, publicly supported an organization in 2006 that has said life begins at fertilization. It has also said that the discarding of unused or frozen embryos created in the in vitro fertilization (IVF) process ought to be criminalized, a view that is considered to be extreme even within the anti-abortion movement.

The revelation is likely to lead to new questions about how Barretts personal views on abortion may not only shape reproductive rights in the US for decades to come if she is confirmed by the Senate, but how her appointment could affect legal rights for women undergoing fertility treatment, as well as their doctors.

In 2006, while Barrett worked as a law professor at Notre Dame, she was one of hundreds of people who signed a full-page newspaper advertisement sponsored by St Joseph County Right to Life, an extreme anti-choice group located in the city of South Bend, which is in the region know as Michiana.

The advertisement, which appeared in the South Bend Tribune, stated: We, the following citizens of Michiana, oppose abortion on demand and defend the right to life from fertilization to natural death. Please continue to pray to end abortion.

The statement was signed by Barrett and her husband, Jesse.

In an interview with the Guardian, Jackie Appleman, the executive director of St Joseph County Right to Life, said that the organizations view on life beginning at fertilization as opposed to the implantation of an embryo or a fetus being viable did have implications for in vitro fertilization, which usually involves the creation of multiple embryos.

Whether embryos are implanted in the woman and then selectively reduced or its done in a petri dish and then discarded, youre still ending a new human life at that point and we do oppose that, Appleman said, adding that the discarding of embryos during the IVF process was equal to the act of having an abortion.

Asked whether doctors who perform abortion ought to be criminalized, she said: We support the criminalization of the doctors who perform abortions. At this point we are not supportive of criminalizing the women. We would be supportive of criminalizing the discarding of frozen embryos or selective reduction through the IVF process.

Appleman said the organizations views reflected a mission to create a culture of life and love in which every child is protected by law.

The White House deputy press secretary, Judd Deere, said in a statement to the Guardian: As Judge Barrett said on the day she was nominated, A judge must apply the law as written. Judges are not policymakers, and they must be resolute in setting aside any policy views they might hold.

The White House also pointed out that in her role as an appellate court judge in the seventh circuit Barrett had declined in July to stay the execution of Daniel Lewis Lee, a white supremacist convicted killer. Barretts decision in that case apparently showed a willingness to contradict her personal stated support for all life from fertilization to natural death.

Barretts public embrace of a strict anti-choice position will nevertheless fuel concerns of progressives and pro-choice Americans about what the 48-year-old judges confirmation to the supreme court will mean for abortion rights once conservatives gain a 6-3 majority on the court.

For years, mainstream anti-abortion activists have avoided including discarded embryos created in the in vitro fertilization process in their crusade to protect every embryo, in part because seeking to curtail IVF treatment would be very unpopular. In Alabama, which has passed a near-total ban on abortion, embryos created through IVF are excepted from the law.

But the issue has gained resonance with some fringe groups who have sought to give fertilized eggs a constitutionally protected right to life.

Dov Fox, author of Birth Rights and Wrongs: How Medicine and Technology are Remaking Reproduction and the Law, said that if such a movement ever succeeded it could have the potential to prop up restrictions on fertility treatment.

For example, by banning IVF procedures that would involve freezing, destroying or donating for research any embryo a woman doesnt implant all at once, despite the health risks associated with high-order pregnancies and the hormone drugs required to extract eggs multiple times, he said.

Pro-choice advocates in South Bend described St Joseph County Right to Life as extreme, with a history of supporting super intimidating protests at the one facility in South Bend that provides abortion services.

The group was established in 1972 and has said its mission is to save children, women and men from the devastating effects of abortion and euthanasia. While it publishes a full-page advertisement every year, to mark the passage of Roe v Wade, Barretts name did not appear in any other ads that the Guardian found after 2006.

On its website, Right to Life said it focuses on outreach, advocacy, education and prayer and said it experienced a great victory in 2015 when it shut down South Bends only abortion clinic at the time, making our community free from an abortion clinic for the first time in decades. Three years later, a new clinic that provides abortions via pill up to 10 weeks was opened following a difficult campaign by pro-choice advocates.

Right to Life has said the opening of the new abortion business, a clinic called the Whole Womans Health Alliance, had led it to a doubling up on our efforts. We are closely monitoring these threats and executing fierce strategic plan to protect innocent human life at all ends of the spectrum.

Amy Hagstrom Miller, the president and CEO of Whole Womans Health Alliance, said the clinic in South Bend had direct experience with the Right to Life group, which among other anti-choice groups has used the clinics name and likeness in Facebook campaigns to arrange protests.

Clinics like Whole Womans Health Alliance face a number of barriers to treating patients in Indiana, Hagstrom Miller said, including rules that force patients who receive a non-surgical abortion to make two visits to a clinic: including for a mandatory ultrasound and counseling. The clinic sees patients only twice a week, and on those days the clinic is inundated with upwards of 70 protesters a day, she said.

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Revealed: Amy Coney Barrett supported group that said life begins at fertilization - The Guardian

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Whether you want children in the future, are undecided, or want to preserve your options due to medical reasons, the decision to freeze your eggs has become far more accessible over the last decade or so. Numerous fertility clinics have opened up across the globe, not to mention the technological innovation behind fertility treatments, which has served to promote the process further.

However, theres still a lot of confusion as to what it actually entails, and a lot of debate over the success rates. Here, we speak to some of the experts in the field to clear up everything you need to know about freezing your eggs.

There are many reasons why someone might decide to freeze their eggs, and each decision is extremely personal and unique. One of the most common reasons is that a woman isnt ready to have children or hasn't met the right person, but knows she wants children one day. Another common reason is if a woman is scheduled to receive medical treatments that affect fertility like chemotherapy, and freezing eggs helps to preserve the chance of having children down the line. Others may be inclined to freeze their eggs because they havent decided on whether or not they want children, but want to remove any feeling of time pressure from their decision making process.

The egg freezing process is similar to a cycle of IVF, except the fertilisation and embryo transfer happens at a later date explains Dr Ippokratis Sarris, Director at King's Fertility. Initially a course of daily injections (usually 2 different medications, or sometimes 3) are self-administered by the woman. These aim to stimulate the ovaries to produce a number of growing follicles (fluid-filled sacs within which the eggs reside) and also to control the ovulation so that these eggs can be collected.

The daily injections continue for a couple of weeks, known as the stimulation phase. During this phase, ultrasound scans are performed every few days looking at the ovaries in order to monitor the progress of the growing follicles and occasionally a blood test to check hormone levels, says Dr Sarris. Once the follicles have grown sufficiently, and to a size where it is expected that a mature egg will be retrieved, a final maturation injection is given, followed by the egg collecting procedure two days later.

The collection procedure itself is carried out under anaesthetic (usually sedation, but sometimes local or general anaesthetic is used). Using ultrasound guidance, a needle is passed through the vagina wall, then into the ovaries, and into each of the follicles, explains Dr Sarris. The fluid from within the follicles is drawn out and taken to the laboratory. An embryologist will look at this under a microscope in order to retrieve the eggs. The eggs are then checked for maturity and frozen within a few hours after the procedure.

Theyre frozen using fast-freezing process called vitrification, and stored in specialised cryotanks. The tanks are constantly monitored electronically and maintained, and the eggs can remain there for as long as the patient requires them.

According to the experts, the number of eggs collected can vary from woman to woman. On average, around 10 eggs are collected with any treatment cycle, although this very much depends on a woman's age and her egg reserve, says Dr James Nicopoullos, Medical Director at the Lister Fertility Clinic. Some may be able to produce significantly more on an even cycle and unfortunately some less, with the key being the investigations we do prior to this to help us council the patients as to what to expect and whether it is the right thing for them.

The procedure usually lasts 20-30 minutes, and after 1-2 hours of recovery, the woman can go home, says Dr Sarris. There might be a small amount of spotting from the vagina, and occasionally discomfort over the lower abdomen. However, simple pain relief medication (such as paracetamol or ibuprofen) is usually adequate in controlling it. The woman should be able to return to normal activities by the next day, and the period should arrive within the next 2 weeks. After that, the body should be back to normal and all the effects of the hormones should have passed.

Its possible to have the egg fertilised with sperm before freezing, making it a frozen embryo - however, there are many things to think about before doing so. My recommendation to any single woman would always be to freeze eggs initially for fertility preservation, says Dr Nicopoullos. The key with egg freezing is to give women reproductive choices and should she want to have a family with a future partner, having these eggs frozen will allow them to be thawed and fertilised with his sperm. If however she freezes embryos, i.e. fertilises her eggs with donor sperm before freezing, she won't have this option available to her.

Dr Sarris raises another key consideration; The downside is that the embryo legally belongs to two people (whoever provided the egg and sperm gametes), whereas, the egg just belongs to the woman and she can decide how it is used entirely independently.

The current legal time limit that an egg can be frozen for is 10 years unless theres medical reasoning to extend it, for example, if the woman was undergoing cancer treatment at a young age. There are current calls for the government to extend this limit.

According to Dr Sarris, when a patient wants to use their eggs, they effectively need to resume the process of the original cycle of IVF which stopped at the egg collection stage. The egg is thawed and fertilised by the sperm, he says. If the egg is successfully fertilised, it then becomes an embryo which is grown in the lab over the next few days and either be put back into the womans womb or it can be frozen again (this time as an embryo).

In order for a woman to have the embryo transferred into her womb, it has to be done in an embryo transfer cycle. This can be done in two ways, either the clinic will monitor the womans natural cycle and transfer the embryo at an appropriate time after ovulation, or the clinic can recreate a natural cycle by prescribing certain medicines that prepare the lining of the womb for the embryo to implant.

According to Dr Nicopoullos, the implantation process is very quick and no more invasive than a cervical smear test.

Success rates vary dramatically based on multiple factors, including the womans age at the time of egg collection (the younger the eggs, the higher the success rate), and her general health. Success rate of frozen eggs remains under some debate, says Dr Nicopoullos, but theres increasing research suggesting that success rates of using a frozen embryo are as similar to using a fresh embryo.

Dr Sarris explains that if the eggs are frozen at a clinically optimum age then the chances of success will be higher. However, it should be noted that obstetric (pregnancy) complications increase with a womans age. In addition, success is also dependent on how technically proficient the clinic is that freezes and thaws the eggs. Overall, he says the absolute chance of an egg giving a baby can vary from as low as 1% per egg to 5-6% per egg.

Lord Robert Winston, professor of fertility studies at Imperial College London and expert on egg freezing and IVF has publicly warned that success rates can be misleading. Speaking on BBC Radio 4 Todays programme, Lord Winston described the process as a very unsuccessful technology with a success rate of around 1%. However, he later clarified that he was referring to the number of live births, rather than the number of pregnancies. Sometimes, when a clinic gives a success rate, they are actually referring to the number of successful implantations into the womb (and subsequent pregnancies) rather than the live birth rate. The distinction between the two definitions of success can result in vastly different figures.

According to The Human Fertilisation and Embryology Authority, in 2015, 2% of all thawed eggs ended up as pregnancies and 0.7% resulted in live births.

The average cost for one round of treatment is between 3500 to 4500, and there's usually an annual fee for storing the eggs of around 200 to 400 depending on the clinic. If you are receiving medical treatment that affects your fertility, you may be able to get egg freezing on the NHS.

Its up to the woman what happens to her eggs if she no longer wants to continue freezing them. They can either be discarded or donated to medical research.

Original post:
Your Ultimate Guide To Egg Freezing From The Experts - GLAMOUR UK

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The group action involves a public awareness campaign, petitions and calls to MPs. They also plan to write an international open letter to the worlds governments.

Dr Gareth Davies, PhD (Medical Physics), Imperial College, London, says the UK governments recommendation of 400 IU daily of vitamin D is 10 times smaller than the group believes is necessary during this global pandemic. Those in the alliance believe that 4,000 IUs daily should be sufficient to ensure a healthy immune response in most people, with some in the group advocating a short course of up to 10,000 IU in cases of severe deficiency.

BetweenMarch to July 2020, Dr Davies has been working full time as a coronavirus research scientist, and has continued part-time thereafter. Much of his research has been around this vitamin. He says much of the confusion around vitamin D stems from the fact it is so poorly understood, firstly due to the fact it isnt actually a vitamin but asteroid pre-hormoneproduced in the skin in strong sunlight which is then converted into an active hormone by the liver and kidneys.

For most people, the idea that a simple over-the-counter vitamin can actually help fight a pandemic is so preposterous and I think this is largely due to the fact it is referred to as a vitamin when its not; it is an essential hormone which the immune system requires in order to function adequately.

Dr Davies explains that whilst research around this hormone first centred around the avoidance of rickets, our knowledge of the health benefits of this hormone are now far more far ranging and we now understand that it is a key component to the function of our immune system.

Dr Davies argues that much of the confusion and scepticism around the research into vitamin D, immunity and COVID-19 is due to the fact that research will often show a correlation and this is not seen to be causation. But Dr Davies disagrees with this conclusion.

Correlation isnt always causation but that word always is critical because sometimes and often correlation is causation. Most doctors wrongly think clinical trials are the only way to infer cause, but we can actually do this more effectively by analysing large data sets using modern techniques.

He and two collaborating doctors, published a preprint of their research in May, drawing on methods from Physics, Data Science and Artificial Intelligence in which they conclude that vitamin D deficiency causes severe COVID19 disease in response to the Sars-Cov-2 virus. Their two part analysis looked at 1.6 million data points of deaths and recoveries from 240 global reporting locations.

In June, the UK government ordered an evidence review into vitamin D and COVID-19but Dr Davies says the scientific community was up in arms following the NICE report.

Our paperwas one of just 13 preprints acknowledged by the NICE evidence review - but was listed in an appendix of preprints excluded due not yet being peer-reviewed. Peer-review takes up to a year in normal conditions and though hundreds of studies had been published, very few had been peer-reviewed.

NICE reviewed only five papers, four for the hypothesis and one against, ignoring the hundreds of other pre-print studies on SARS-CoV-2 and vitamin D, and thousands of studies published on prior coronaviruses and vitamin D.

In a fast moving global pandemic such as this when so much new research is being carried out, surely they should look at the newest research?

Speaking about concerns around overdosing, Dr Davies says he cant understand why that concern would outweigh the urgent concern of the pandemic.

People make this hormone when their skin is exposed to the sun. If there is danger of people overdosing on this hormone then where are those people and why arent we overdosing when we spend too much time in the sun? Coronavirus has killed one million people and governments are concerned about vitamin D overdosing!"

If vitamin D levels are high, the innate immune system is strong, explains Dr Davies. This is the first line of defence the body employs when a pathogen first invades. In many cases, the innate immune response can entirely deal with an invasion before it takes hold.

Its also involved a health adaptive immune response. This is a slower response where the body begins to make antibodies that specifically target the invading pathogen if it fails to control it via innate immune response.

Dr Davies points out theres a very specific reason this hormone is important with the COVID-19 virus, due to the mechanism by which it enters our cells.

It targets a protein spike on cell surfaces called ACE2 which is part of something called the renin-angiotensin system or RAS. Among other things, the RAS regulates blood pressure and inflammatory response. To use a metaphor, its like an engine with an accelerator and a brake. To tackle an infection the accelerator is pressed to ramp up inflammatory response to deal with the invading pathogen, but the brake also is depressed to keep things under control.

When the invasion is dealt with, the accelerator comes off and the brake brings everything down to an idling state again. The ACE2 protein is the brake, but ACE2 is depleted as the virus replicates which effectively breaks the brake. With only an accelerator, the RAS quickly runs out of control leading to cytokine storm, out-of-control inflammation and the lungs fill up causing pneumonia. This is what kills people. Vitamin D helps here by keeping the accelerator under control by suppressing a mechanism further upstream that activates it.

We also know that the ACE2 receptors are normally invisible when the RAS is in its idle state, as they ACE2 receptors form a bound complex with another cell receptor. This complex comes apart during the inflammatory response when ACE2 is needed, but this also makes it visible to the virus. Vitamin D helps to keep the RAS calm so that ACE2 remains hidden.

The government says it has issued new vitamin D recommendations "to ensure that the majority of the UK population has satisfactory vitamin D blood levels throughout the year, in order to protect musculoskeletal health".

On it's NHS website, it states: "Recommendations refer to average intake over a period of time, such as one week, and take account of day-to-day variations in vitamin D intake.

"SACN also looked at possible links between vitamin D and non-musculoskeletal conditions, including cancer, multiple sclerosis and cardiovascular disease. Theydidn't find enough evidence to draw any firm conclusions.

"In spring and summer, most of us get enough vitamin D from sunlight on our skin and a healthy, balanced diet.

"However, SACN couldn'tmake any recommendations abouthow much sunlight people would need to get enough vitamin D because there are a number of factors that can affect how much vitamin D is produced in the skin. So the recommendations assume "minimal sunshine exposure".

"During autumn and winter (from October until the end of March) the sun isn't strong enoughin the UK to produce vitamin D. That meanswe have to rely on gettingit just from the food we eat.

"Becauseit's difficult to get enough vitamin D from food alone,many of us risk not getting enough. Taking a supplement helps to keep levels of the vitamin topped up during the colder months."

The NHS also advises people do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it says this could be harmful.

Martin Hewison, PhD,Professor of Molecular Endocrinology andDirector of Education at theInstitute of Metabolism and Systems Research,The University of Birmingham, is an expert on the subject of vitamin D whoisn't part of the alliance.

He agrees the current UK recommendations for vitamin D intake are "extremely conservative" and provides further explanation around the confusion.

"400 IU/day (10 micrograms/day) is not meant to optimise vitamin D but it is simply a level that SACN estimated that most UK people can reach to avoid severe vitamin D-deficiency (serum 25-hydroxyvitamin D < 10ng/ml).

"However, we do not know what the optimal level of vitamin D is for good immune function because these studies have simply not been carried out."

He is currently working with UK researchers to explore a different, UK-focused, approach based on supplementation with 1,000 IU/day vitamin D. He admits this will be seen as a compromise by North Americans but suggests it is a realistic step forward for the UK.

That being said, he says he does understand the position of those recommending 4,000 IU daily.

There are two important questions yet to be answered, he says. "Is vitamin D protecting against actual COVID-19 infection in the general population?Does vitamin D improve prognosis once you are infected?

"The answer may be both but I am guessing that the requirements for vitamin D are different for these two facets of COVID-19. Possibly you need higher levels to protect once you are infected."

Four of the doctors and scientists involved in this campaign have created a webinar on the subject of vitamin D and immunity which they have shared with the public, press and government advisors.

This open letter's current signatory list includes:

Dr Gareth Davies PhD (Medical Physics), Imperial College, London, UK; Codex World Top 50 Innovator 2019.

Professor Barbara Boucher Medical Doctor (retired), Honorary Professor, Centre for Diabetes, Bart's & The London School of Medicine and Dentistry, Queen Mary University of London, UK.

Dr David Grimes Medical Doctor (retired), University of Manchester, UK.

Dr Helga Rhein Medical Doctor (retired), Sighthill Health Centre, Edinburgh, UK.

Professor Peter Cobbold Emeritus Professor, Cell Biology, University of Liverpool, UK.

Dr Joanna Byers Medical Doctor (MBChB, Birmingham), Dip Global and Remote Healthcare (Plymouth), MSc Occupational Therapy (Essex), UK.

Dr Linda Benskin PhD, RN, SRN; Independent Researcher/Educator for VHWs and Clinical Research, Education, & Charity Liaison for Ferris Mfg. Corp, Austin/Ft. Worth TX, USA.

Dr William B Grant PhD (Physics) University of California, Berkeley; Sunlight, Director at Nutrition, and Health Research Center, San Francisco, CA, USA.

Dr Ute-Christiane Meier Dr. Med. Habil., PhD (Oxon), Kings College, Institute of Psychiatry, London, UK.

Dr Ased Ali B.Sc.(Hons), MBChB, PhD, FRCS (Urol); Consultant Urological Surgeon and Honorary Clinical Lecturer, Mid Yorkshire Hospitals NHS Trust.

Dr Jaimin Bhatt MBChB, MMed(Surg), FRCSEd(Urol), FEBU; Consultant Urological Surgeon, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde.

Dr David Carman BSc (Microbiology & Biochemistry) MBChB, University of Cape Town, South Africa.

Dr Karl Pfleger PhD (AI/Machine Learning) Stanford; Biotechnology investor, San Francisco, CA, USA.

Professor Michael F. Holick PhD, MD; Professor of Medicine, Physiology and Biophysics; Director of the General Clinical Research Unit; and Director of the Bone Health Care Clinic and the Director of the Heliotherapy, Light, and Skin Research Center at Boston University Medical Center.

Professor Bruce W. Hollis PhD, Professor of Pediatrics, Biochemistry and Molecular Biology, Director of Pediatric Nutritional Sciences, Medical University of South Carolina, USA.

Professor Richard B Mazess Emeritus Professor, Medical Physics, University of Wisconsin, Madison, USA; Founder of Bone Care Intl who developed a vitamin D analog for the treatment of end-stage renal patients.

Dr Henriette Coetzer MBChB, Medical doctor, healthcare risk consultant and NHS Trust CSO, Somerset., MBChB, Medical doctor, healthcare risk consultant and NHS Trust CSO, Somerset.

Carole Baggerly Founder Director of GrassrootsHealth, a nonprofit vitamin D research organization with 48 senior international vitamin D researchers contributing to its operations.

Read the original:
COVID-19: Scientists raise the vitamin D alarm - NutraIngredients.com

Recommendation and review posted by Bethany Smith

Youve started your day with a cup of coffee for as long as you can remember. But maybe the caffeine doesnt work its magic like it once didor maybe its actually too powerful these days. Its no surprise your coworkers green tea is looking more appetizing every week. But is there that big a difference health-wise between the two drinks? We called on Dr. Felicia Stoler, DCN, a registered dietitian, nutritionist and exercise physiologist, to settle the green tea vs. coffee debate once and for all.

RELATED: Why You Shouldnt Drink Coffee on an Empty Stomach, According to a Nutritionist

Theyre both very different in terms of structure, flavonoids and antioxidants, says Stoler. The main caveat for both drinks is really their caffeine contentand how your body personally reacts to it. For instance, if you have no side effects from consuming caffeine but have acid reflux, green tea might be the better choice for you. If you literally hate the taste of green tea but coffee makes you jittery, its safe to stick to the java and cut back or use a mix of decaf and regular grounds. The TLDR: Theyre both fine to drink on the regularits just a matter of choosing whats best for your body and needs. Both [drinks] naturally contain caffeine, but there are decaffeinated versions available. I actually think if people consumed both, that would be great," says Stoler. "[It will] add some variety to the types of antioxidants and phytonutrients that you receive."

Lets face it: Most of us dont drink coffee every day for our health. Its typically for the caffeine boost, which we count on to drag us out of dream mode (and um, bed) and into real life every morning. Wed guess most green tea drinkers are in it for the energy boost too, though it has less caffeine. And the fact is, its tough for scientists to conclusively narrow down the perks or pitfalls of either drink. The challenge with the research in humans is that its impossible to do longitudinal studies on [coffee or green tea] to isolate the benefits or harm without other confounding factors, says Stoler. So, what do we know for sure?

Coffee, once colloquially thought to wreak havoc on the heart, is actually healthier than you may realize (before you add your caramel syrup and creamer, that is). Coffee is rich in antioxidants, which can help protect against type 2 diabetes, Parkinsons and certain types of cancer. Some people also swear that coffee helps keep their bowel movements regular. Coffees caffeine content is great for times when you need a short burst of energy and focus, say before you hit the gym or give a big presentation at work.

Green tea is better for mellow relaxation and a subtler energy boost (it kills the 3-oclock slump like a charm). Packed with cancer-fighting polyphenols, it can help burn fat, lower cholesterol and boost your metabolism. It can help fight against potential diseases like dementia, Alzheimers and Parkinsons, as well as reduce your risk for heart attack or stroke. Green tea is loaded with antioxidants that help your body detox, slow aging and combat inflammation. Most notably, green tea has a ton of L-theanine, an amino acid that boosts dopamine and reduces anxiety. It may help you relax so well during the day that your quality of sleep might actually improve.

Stoler also notes that both beverages are solid ways to stay hydrated. For people who don't like plain water, drinking coffee or green tea are a great way to increase fluid consumption.However, if youre drinking either with lots of added ingredients (milk, cream, sweeteners, syrups, etc.), then its an easy way to add unnecessary calories.

Both the main pro and con to each of these beverages is caffeinethe side youre on just depends on your bodys reactions to it. Nobody wants a rapid heart rate or to be kept up all night, says Stoler. Caffeines consequent effects are actually why some experts dont recommend having a cup of joe first thing in the morningespecially women. Coffee increases cortisol, aka the stress hormone that helps regulate your energy and alertness throughout the day. Cortisol is naturally high in the morning, so giving yourself an extra dose when you wake up can blunt its production and get your natural cycle out of whack. In fact, some studies show that it can cause you to naturally produce more cortisol than you need. That can negatively impact your ovulation, weight and hormones over time.

If youre drinking coffee first thing in the morning and on an empty stomach, heres why you shouldnt: Coffee stimulates acid production in the stomach (if youre prone to GI issues or have GERD, odds are you already learned that the hard way). Neutralizing your stomach acid (and that of the coffee) with a calcium-rich breakfast, like yogurt and almonds, can save you a lot of discomfort down the line. Other potential downsides to drinking coffee may include reduced bone density, an increase in cholesterol and higher risk for heart diseasebut the studies are sparse and the results are all in all pretty inconclusive.

Green tea, on the other hand, is easier on the gut than coffee and pretty low-risk all around, unless you have a history of kidney stones. Green and black tea have high levels of oxalates, which can lead to the formation of more stones (though its pretty rare). Other downsides include stained teeth after long-term consumption, which coffee can also cause, and weakened iron absorption. Tanins, an antioxidant in tea, can interfere with and reduce how much iron your body actually absorbs in a meal.

It all comes down to the caffeine. If youre switching from green tea to coffee, you might notice youre a little more jittery than usual. But switching from coffee to tea might give you symptoms of caffeine withdrawal. According to the Cleveland Clinic, cutting yourself off cold turkey can bring on headache, fatigue, concentration issues, muscle pain and even flu-like nausea. Withdrawal can last up to nine days; the more caffeine youre used to consuming, the more severe the withdrawal can be. Since were talking about switching from coffee to green tea, you wont be totally cut off from caffeine. Just try gradually reducing your intake (or substituting coffee with tea or decaf coffee) for a few days until you feel no symptoms.

If caffeine is still an issue even when youve switched to drinking mostly tea, think about switching to decaffeinated tea or coffee. Removing the caffeine and its effects from the equation actually sort of levels the playing field for both beverages. But you should know: Decaffeinated tea and coffee may not be as beneficial, because the decaffeinating process strips the drinks of some of their antioxidants. So, just decide whats best for you based on the reason why you drink coffee or green tea in the first place: the energy boost, the health benefits or the routine itself.

If youre hopping on the green tea train, drink it in the morning to wake up your brain, or during an afternoon slumpthe exact time doesnt matter much, because green tea actually *reduces* stress hormones like cortisol. And just for the record, you shouldnt drink either beverage right before bed. Green tea has a third of the amount of caffeine that coffee does (about 30 milligrams versus 96), but its still to be avoided in the evening, namely in the couple of hours before you hit the hay. Its still significant enough to trigger your hormones and adrenals, which translates to less sleep and late-night alertness.

Bottom line: Pay attention to how your body feels as you tweak your daily routine. Are you sleeping better? Feeling less anxious? Take note of what makes you feel your best and run with it. Hot or cold, both drinks are great to consume and have health benefits, says Stoler. So, instead of thinking of it as either/or, consider how to make both work in the day.

RELATED: Should You Drink Green Tea Before Bed? We Weight the Pros and Cons

Here is the original post:
Green Tea vs. Coffee: Which Is Better for You? We Asked a Nutritionist - PureWow

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You wouldn't eat a food that shrinks your brain. You wouldn't drive a car that makes you sweat. You wouldn't buy a purse that worsens PMS. So why are we all so cool with stress being just "a part of life"? It doesn't have to be. And if you reduce stress, you will be better for it. Because the impact stress has on your body is remarkableand hazardous. Read on to discover 30 more things stress is doing to your bodyand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.

1

Your head is more likely to throb when you're stressed, according to the Mayo Clinic, with a tension-type headache or even a migraine. And feeling under pressure is also likely to make your headaches worse.

2

Stress kicks your body into its fight or flight mode, ramping up the release of certain hormones and preparing you to deal with danger. The result can sometimes be hands that shake like maracas.

3

We're not kidding. When we're stressed, our body releases the hormone cortisol, and in limited doses, it can actually be beneficial. But studiesincluding one at the University of California at Berkeleyhave shown that chronic stress actually decreases the weight and volume of the brain.

4

Stress can increase the production of stomach acid, leading to that annoying reflux, as acid irritates the esophagus. And if you already suffer from chronic heartburn, stress can make it worse. A study of nearly 13,000 sufferers published in Internal Medicine discovered that nearly half reported stress as the biggest factor that worsened symptoms.

5

Stress gets us all riled up and causes hyper-arousal, making it difficult to fall asleep, stay asleep and making the quality of our sleep worse.

Recommendation: The National Sleep Foundation suggests a cooling off period before bed time, which allows the brain to wind down. Two hours should do it. Put your work away, turn off the TV and grab a book or listen to music.

Story continues

RELATED: Doing This Just Minutes a Day Helps You Sleep Better

6

When you're stressed, the muscles responsible for breathing tense up, making it more difficult to catch your breath.

Recommendation: If you begin to feel panicky and short of breath, start by exhaling deeply, emptying your lungs. You can also try breathing through your nose, which automatically slows your breathing.

7

If it seems like you're more likely to be sick when you're stressed, you may not be imagining it. Studies have shed light on the link between stress and sickness, finding that those living with chronic stress (such as unemployment or caregiving to a dementia patient) had a suppressed immune system that left them more vulnerable to the flu and a host of other illnesses.

RELATED: 20 Reasons Why You Keep Getting Sick

8

When we're under stress, our hearts beat faster to help blood reach our vital organs. Often it's harmless, but it may not be for those suffering chronic stress. One study from the European Society of Cardiology found that people with stressful jobsnurses or bus drivers, for examplehad a 48% higher risk of atrial fibrillation, a condition marked by an irregular, often rapid heart beat.

9

Stress has been shown to cause reproductive problems in both men and women. In one study published in Fertility and Sterility, researchers tested 274 women who were trying to get pregnant and found that those with higher levels of a particular enzyme in their saliva correlated to stress had a 12% more difficult time getting knocked up.

10

Erectile dysfunction is complicated and can have physical as well as psychological causes. Science, however, has shown over and over that stress tends to make the condition worse by releasing more adrenaline and causing exaggerated contractions of the muscles in the penis, keeping it from filling with blood.

11

Research has shown that various kinds of stress can wreak havoc on a woman's period, making it irregular or disappear altogether. And to make matters worse, the Eunice Kennedy Shriver National Institute of Child Health and Human Development studied 259 women and found that stress can also make PMS pain worse.

12

And it's true in both men and women. The causes, a study shows, can be both physical and psychological. Stress causes hormonal changes in the body, which aren't particularly conducive for getting it on. It also makes someone distracted, and when their mind is on something else, sex can take a back seat.

Recommendation: One way to break the no-sex cycle is to get more physical with your partner, according to the Gottman Institute. "It simply forces the body to go from stress to relaxation, if you allow this. Kiss your stressed out partner a little bit more and hug them for 20 seconds longer."

13

Stress gets your heart pumping faster and spikes your blood pressure. Not good. Usually, the response in temporary, a reaction to a particular stressful event. But chronic stress over long periods of time can cause inflammation in the arteries, which could lead to a heart attack down the road.

Recommendation: Try some good ol' fashioned exercise. Working out three to five times a week can reduce your stress and will make a difference long-term in lowering your blood pressure, according to the Mayo Clinic.

14

When you're stressed, your body behaves as if it's under attack, and your liver reacts by releasing more glucose into your bloodstream. Ongoing stress can lead to long-term sugar spikes, putting you at risk of type 2 diabetes, say experts.

15

Your gut has the most nerves in your body, this side of your brain, and stress can adversely affect your entire digestive system. The hormones released when you're stressed can interfere with digestion and harm the microorganisms living in your digestive tract. Cue indigestion, cramps, nausea and a whole host of other GI issues.

16

That tightening can cause back aches and other ailments.

Recommendation: Next time you're feeling stressed, reach for the walnuts. Researchers have shown that foods containing polyunsaturated fats, like the nuts, may help us deal better with stress.

RELATED: This Can Be the First Sign of COVID, Study Finds

17

Stress can lead to a dry mouth in several ways, say experts. Anxious people tend to breathe through their mouths, drying out the inside. The acid reflux associated with stress can also have an affect on the salivary glands and keep them from producing as much.

18

Chronic stress can leave your feeling zapped of energy. It could be the accompanying insomnia, or some theorize that it might have something to do with exhausting your adrenal glandthough a 2016 review of the research debunked that diagnosis.

19

We sweat more when we're stressed and we sweat differently, studies show. Anxiety causes sweat to be produced from the apocrine glands, which secrete a thicker, milkier sweat than our eccrine glands. The downside: sweat from the apocrine glands tends to stink more.

20

Getting headaches is one thing, but actually altering your genetic code? Yep. Researchers at the University of Copenhagen have found that stress can switch on genes that weren't supposed to be switched on. "The consequence is that genes that should be turned off are now active and this may disturb cellular development, identity and growth," the researcher said.

RELATED: The Scariest New Symptoms of COVID-19

21

A study at Johns Hopkins concluded that long-term stress may affect the way that the genes controlling mood and behavior are expressed, leading a stressed-out person to be at a higher risk of depression. Tests on mice found that stress led to an increase in a protein produced by a gene called Fkbp5, which in humans has been linked to depression and bipolar disease.

22

"Are the strains and demands of modern society commonly exceeding human ability?" That's the question asked by the authors of this study of more than 17,000 working adults in Stockholm, Sweden. The scientists found that even mild stress can lead to long-term disability or an inability to work. Those who experienced mild stress were 70% more likely to collect disability benefits.

23

Watch out. Men who are moderately or highly stressed for a number of years were found to have a 50 percent higher mortality rate, according to the Journal of Aging Research. The good news is that two very stressful situations a year might actually be beneficial, teaching us to cope with adversity. Anything beyond that, however, and it might be an early grave.

24

There may be something to that cliche about stress eating. Researchers at University College London found that feeling stressed changes what we eat. Those under pressure didn't necessarily eat more, but they did reach for more sweet, fatty foods than usual.

Recommendation: If you're feeling stressed, be more aware of what you're eating and try to curb your consumption of junk foodno matter how much your brain is screaming that you need it. For food solutions, visit eatthis.com.

25

One of those areas of the brain that gets shrunken by stress is the hippocampus, which plays a big part in learning and memory. A 2018 study found that those with higher levels of the stress hormone cortisol did worse on memory tests, especially women.

26

Research has shown that periods of mild to moderate stress may actually help the brain to better encode memories and improve learning. For example, a college student freaked out about an upcoming midterm may actually retain the material better and ace the test.

RELATED: 38 Ways You're Treating Your Heart Wrong

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In addition to generally suppressing the immune system, stress can lead to the growth of malignant cells, making a cancerous tumor bigger, says one study.

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Children of parents with drinking problems face a greater risk of turning to booze after experiencing stressful situations, a University of Gothenburg study found.

Recommendation: "If alcohol relaxes you when you're stressed, then you should try to find other ways of calming yourself downrelaxation exercises, for example," the researcher suggests.

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Tinnitus, that same kind of annoying ringing you get after, say, sitting through a Metallica concert, might just be induced by stress. One study by the Egypt's Minia University found that those suffering from chronic ringing tended to be more stressed. In short, "There is a direct correlation between duration of tinnitus and severity of stress."

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It doesn't get more serious than that. Severe mental stress can bring on "sudden cardiac death," as medical professionals colorfully call it. In particular, suffering through a traumatic event, such as an earthquake or a war strike, can be so stressful that people literally keel over.

Recommendation: Don't worry. No one's ever died of a panic attack. If you're experiencing anxiety, don't miss these tips.

As for yourself: To get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.

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30 Things Stress Is Doing to Your Body - Yahoo Lifestyle

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A study by a top American Hospital, Cleveland Clinic, shows that 5 to 10 percent of surgically induced weight loss is associated with improved life expectancy and cardiovascular health. In comparison, about 20 percent weight loss is necessary to observe similar benefits with a non-surgical treatment. The findings also show that metabolic surgery may contribute health benefits that are independent of weight loss. Thestudyis published in the October issue of Annals of Surgery.

This large observational study looked at 7,201 Cleveland Clinic patients in the U.S.: 1,223 patients with obesity and type 2 diabetes who underwent metabolic surgery (bariatric or weight loss surgery) were matched to 5,978 patients who received usual medical care. About 80 percent of the patients had hypertension, 74 percent had dyslipidemia (elevated triglycerides and cholesterol), and 31 percent were taking insulin to treat their diabetes.

Using different statistical models, the effects of weight loss were studied to identify the minimum weight loss needed to decrease the risk of death and of experiencing major adverse cardiovascular events, such as coronary artery events, cerebrovascular events, heart failure, kidney disease, and atrial fibrillation.

Following metabolic surgery, the risk of death and major heart complications appears to decrease after about 5 percent and 10 percent weight loss, respectively. Whereas, in the nonsurgical group, both the risk of death and major cardiovascular complications decreased after losing approximately 20 percent of body weight, saidAli Aminian, M.D., director of Cleveland Clinics Bariatric & Metabolic Institute, and lead author of the study.

Thisstudy suggests greater heart disease benefits are achieved with less weight loss following metabolic surgery than medical weight loss using lifestyle interventions. The study findings suggest that there are important benefits of metabolic surgery independent of the weight loss achieved, saidSteven Nissen, M.D., Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, and the studys senior author.

The groundbreakingSTAMPEDEstudy showed metabolic surgerys beneficial effects on blood glucose control. Since then, additional studies have observed health benefits other than weight loss following metabolic surgery. In fact, this research is a secondary analysis of a large study that showed weight-loss surgery is associated with a 40 percent reduction in risk of death and heart complications in patients with type 2 diabetes and obesity.

Researchers continue to study the physiological changes in the surgically modified gastrointestinal tract, the impact on hormone secretion and the microbiome. Those beneficial changes may contribute to the cardiovascular and survival benefits of metabolic surgery, independent of weight loss. More research is needed to better understand the underlying mechanisms for the health benefits of metabolic surgery in patients who have obesity and type 2 diabetes.

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Cleveland Clinic Study Identifies Weight-Loss Threshold for Cardiovascular and Survival Benefits in Patients With Obesity and Diabetes - Al-Bawaba

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In the last few years there has been more research around sexual function during the menopause transition in areas such as low libido or pain during intercourse, but very little specifically focused on how important sex is to women during this time, says Holly N. Thomas, MD, assistant professor of medicine at the University of Pittsburgh in Pennsylvania. Dr. Thomas is the lead author of research presented on the topic of the importance of sex in women as they age at the 2020 Virtual Annual Meeting of The North American Menopause Society (NAMS), which opened on September 28, 2020.

We were interested in looking at how womens ratings of how important sex was to them changes or stays the same as they move through the menopausal transition, says Thomas.

To find out the answer, investigators studied a total of 3,257 women from The Study of Womens Health Across the Nation (SWAN), all of whom completed 14 evaluations over 15 years. Visits included interviews, questionnaires, blood draws, and biometric measures such as body mass index (BMI), blood pressure levels, hormone levels, and depression symptoms.

RELATED: 10 Symptoms of Menopause and Perimenopause

Women were asked to rate how important sex was to them with the choices of not at all, not very, moderately, quite, or extremely.

Rather than look at averages of the women over time, investigators looked at trajectories within the cohort. This analysis technique allowed us to see if there are unique pathways that women can follow, explains Thomas.

If you just looked at averages of the group as a whole, it would look like how important sex is to women would go down for everyone, but what we actually found three distinct pathways women commonly follow when it comes to how much they value sex as they get older, she says.

RELATED: Masturbation 101: A Guide to Solo Sex for Women

For the largest group, about 45 percent of the women, sex did become less important to them as they went through their forties and fifties and early sixties, says Thomas. For 27 percent of the women, sex remained highly important to them throughout midlife, and for 28 percent of the women sex was not very important to them throughout the whole duration of midlife, from forties to sixties.

Its important to recognize not all women are going to follow the same pathway when it comes to sex at midlife, each woman has her own unique experience, says Thomas.

There were a few trends that Thomas and her team noticed.

These results show that its not necessarily true that sex becomes less important to all women at midlife and that its just an inevitable fact of aging, says Thomas.

RELATED: Menopause and Depression Is Strongly Linked

My takeaway was that we need to be more routinely asking women in midlife about their sexual function and whether there are barriers such as having pain during intercourse or if theyre having problems with low sexual desire thats bothering them, says Stephanie Faubion, MD, director of the Mayo Clinic Center for Womens Health in Rochester, Minnesota, and medical director of NAMS.

Sexual function is usually under addressed in women in general but certainly in women beyond menopause, adds Dr. Faubion.

RELATED:Sex Drug for Women Stirs Up Controversy in Medical Community

In general, women who have a good sex life before menopause have a good sex life after menopause, she says. This research indicates that if sex is important to a woman before menopause, its important after.

RELATED: Sexual Dysfunction in Some Women Can Occur Years Before Menopause, Study Says

Keep in mind that sex doesnt look the same with aging, says Faubion. We have to modify our expectations about sexual functioning as we get older. Sex may not be always be penis and vagina sex; I have that conversation often with my patients, she says.

As peoples bodies and health changes, including medical illnesses that can be experienced by both men and women, we may need to modify what we are doing, but nonetheless, sexual intimacy remains important to all people for as long as they live, says Faubion.

RELATED: What Is the Role of Intimacy and Sex in Overall Health?

About 30 percent or so of women in the United States report low libido or sex drive, and about 10 percent report being bothered or distressed by it, Brooke Faught, doctor of nursing practice and board-certified women's healthcare nurse practitioner, who is clinical director of the Womens Institute for Sexual Health in Nashville, Tennessee. Dr. Faught presented on sexual health, libido, and testosterone at the NAMS 2020 conference.

Having a low sex drive isnt automatically a reason for treatment; hypoactive sexual desire disorder (HSDD) is when women have a low libido and are bothered or distressed by it. If the patient isnt directly impacted or bothered by it and its not impacting their daily function, its not a true diagnosable condition, says Faught.

RELATED: The Facts About Sexual Desire Disorder (Low Libido) In Women and Men

Even when they are bothered by a lack of desire, many women put up with it rather than seek treatment; they think its a normal part of aging or something they should just deal with, she says.

One barrier that stands in the way of treating HSDD is the lack of an U.S. Food and Drug Administration (FDA)approved testosterone for women with HSDD, even though there is quite a bit of published research on how and when to use it, says Faught.

Faubion agrees, saying Testosterone is fairly well studied for sexual health in women and is effective in almost all areas of sexual function.

RELATED: Women Need Testosterone Formulation for Low Libido

The barrier that exists isnt lack of science or lack of interest, its the FDA, says Faught. The FDA has asked for more long-term data for using testosterone in hypoactive sexual desire disorder (HSDD) in women, potentially up to five years [worth], she says.

A study that would fulfill the FDAs request seems to be cost prohibitive for pharmaceutical companies, says Faught. I dont know of any specific product that is on the cusp of getting approval or seeking approval, which is unfortunate and frustrating, she adds.

There are options and guidance for how to use testosterone products for HSDD, says Faught. In 2018, the International Society for the Study of Womens Sexual Health (ISSWSH) published a process of care (POC) for the diagnosis and management of hypoactive sexual desire disorder (HSDD) in pre- and postmenopausal women, including guidelines for prescribing testosterone in postmenopausal women with HSDD.

A global consensus statement that was endorsed by several international medical societies including The International Menopause Society, The Endocrine Society, and the NAMS was published in The Journal of Clinical Endocrinology & Metabolism in October 2019. The statements purpose is to provide clear guidance on which women may benefit from testosterone therapy, as well as any potential risks.

The issue is that treating off-label can carry additional risk and expense for patients, says Faught. If I prescribe a testosterone product thats intended for men, I can prescribe it at a lower dose as is necessary, but because it isnt FDA approved for this use, usually insurance wont cover it. That could mean a cost of anywhere from $300 to $500, she says.

Compounding testosterone, a process where a pharmacist specifically makes the product from scratch may be cheaper, but then there is increased potential for human error as well as a lack of regulations, says Faught.

Probably the main reason there is no FDA-approved testosterone product for HSDD is that theres a lack of long-term safety data, says Faubion. For example, we dont know breast cancer risk, we dont know cardiovascular risk, she says.

The cardiovascular risk appears to be less of concern for women than it is for men taking testosterone, but the bigger question is breast cancer risk over time, says Faubion. This is because testosterone converts to estrogen inside the body, and so there is a question on whether that increases breast cancer risk, she says.

Ive used it in my practice and its effective for women, says Faubion. Yes, we still have questions about long-term safety and long-term efficacy, but for short-term efficacy and short-term safety, we have pretty convincing data; I think ultimately it probably will be approved for use in women.

RELATED:Menopause and Sleep News: NAMS 2020 Addresses 5 Key Issues;

Hot Flash Treatment News: 4 Takeaways From NAMS 2020

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Sex Life, Sex Drive, and Menopause: News from NAMS 2020 - Everyday Health

Recommendation and review posted by Bethany Smith

According to a recent market study published by Growth Market Reports (GMR), titled, Global Acromegaly Treatment Market by Product, End-user, and Region: Size, Share, Trends and Opportunity Analysis, 2017-2027, the market was valued at USD 1,304.4 Million in 2019 and is expected to grow at a healthy growth rate of 7.6% by the year 2027. The global acromegaly treatment market is anticipated to grow owing to rising prevalence of acromegaly especially in developed countries. Further, increasing awareness among the people for acromegaly, and rising number of clinical trials for acromegaly drugs are the factors which is expected to drive the growth of the global acromegaly treatment market.

The global acromegaly treatment market is fragmented based on product, end-user, and region. In terms of product, the market is segmented into somatostatin analogs, growth hormone receptor antagonist (GHRA), and dopamine agonist. On the basis of end-user, the market is divided into hospitals & clinics, and others. Based on region, the global acromegaly treatment market is segmented into North America, Europe, Asia Pacific, Latin America and Middle East & Africa (MEA). North America region is further bifurcated into countries such as U.S., and Canada. Latin America region is further segmented into Brazil, Mexico, and Rest of Latin America, Asia Pacific is further segmented into, China, Japan, South Korea, Australia, Southeast Asia, and Rest of Asia Pacific. The Europe region is further categorized into Germany, France, Italy, U.K., Spain, Russia, and Rest of Europe, and the MEA region is further divided into Saudi Arabia, South Africa, UAE, and Rest of MEA.

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Acromegaly is one the rare disorders which is usually caused by excess development of growth hormone by the pituitary gland. This excessive growth hormone affects a patients internal organs and physical appearance. Acromegaly is mainly caused by benign pituitary tumor (adenoma); however, in rare cases acromegaly is caused by ineffective control of GH-secreting cells by hypothalamus. If acromegaly is untreated or not treated properly, it can lead to serious and life threating complication such as ventricular arrythmia and cardiomyopathy. To detect acromegaly doctors use diagnostic approaches such as blood test to measure the level of insulin-like growth factor or growth hormones and imaging of tumor through computed tomography (CT) scan and magnetic resonance image (MRI) scan. In acromegaly treatment some of the medications which are used are 90% effective in shrinking the tumor. However, the success rate for acromegaly treatment varies health, age, and medical history of the patient.

As per GMR industry analyst Vidya Jadhav, The Global Acromegaly Treatment Market is anticipated to witness significant growth during forecast period 2021-2027 driven by increasing prevalence and incidence of acromegaly across globe, rising awareness across developing economies, increasing initiatives taken by government to promote the awareness about this rear disease. Moreover, the increasing R&D, investments, and boom in clinical trials to develop new medication for acromegaly is expected to create lucrative opportunity during forecast period.

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Global Acromegaly Treatment Market Expected to Reach USD 2299.4 Million by 2027 - The Daily Chronicle

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Amanda French, co-founder & CEO at Emme

Amanda French, cofounder and CEO at Emme, is applying her medical device development background to solve the oral contraceptives' missed pill problem. After three years of building and testing its Bluetooth-enabled "smart case," which works with more than 100 birth control brands, it has launched.

When you miss taking a pill, the app automatically sends user-customized reminders. It notifies at-risk users when back-up contraception is needed. The app also allows users to track symptoms in the categories of "mood, body, sex, and flow" related to their menstrual cycles or hormones. When you track symptoms, you can see patterns as they pertain to pill habits. The data can be used to understand the effects specific birth control pills have on hormonal issues and help women and their doctors find the right pill in the right dose. But, like many female founders tackling women's health care, funding has been a challenge.

Emerging technologies have the possibility of improving health outcomes and reducing medical costs. Yet, a massive market is ignoredwomenwho make up more than 50% of the population. Stanford Biodesign's mission is to advance health technology innovation to improve lives everywhere. In 2016-2017, as a fellow at Stanford Biodesign, French and others focused on looking for and understanding unmet needs in the healthcare space.

"I was floored and disappointed at the lack of innovation that I was seeing in women's health, especially with their experience with the [birth control] pill," she exclaimed. According to Grandview Research, the U.S. contraceptive market size is expected to reach $7.2 billion in 2020.

French noticed a gap in the "pill experience." Oral contraceptives are nearly 100% effective in preventing pregnancies. However, "adherence is such a challenge," sighed French. More than half52% of women reported missing taking the pill. She had experienced this problem herself. Unfortunately, missing taking the pill leads to 1 million unplanned pregnancies in the U.S. each year. It also disrupts hormone balance, causing side effects such as bleeding, nausea, mood changes, and headaches.

Women are blamed for the problem"user error." "Education will fix the problem" is the most common refrain. Other health sectors are taking a more proactive approach. These sectors don't expect the patient to do better. They use technology to help. "I found it shocking that there is such a common pain point that was not being addressed by any innovative technology," said French.

In 2017, she and her co-founder Janene Fuerch, MD, launched Emme. The first couple of years were spent building the first version of the system and proving its efficacy using a rigorous national data sample. "We saw an 80% reduction in missed pills and 85% improved confidence and peace of mind," said French.

Finding funding was challenging. Women's healthcare is underfunded. "Male investors didn't see how they made money solving women's health problems," said Amy Millman, president of Springboard Enterprises, in a recent article I wrote. Recently, she launched the Women's Health Innovation Coalition to focus attention on gender-specific health. "There's been a lack of acknowledgment that women's health is a massive business opportunity that's worth investing in," said French. "Many investors told me women's health is a niche industry and the missed pill problem isn't one that could lead to a pain point worth solving and worth investing in.

"As someone who came out of the cardiovascular and hearing aid health spaces, I saw there was almost no technology being developed for women's health that could be used in the hospital, clinic, and home settings," said French. An initial grant of $100,000 came from Stanford Biodesign, Atlantic Pediatric Device Consortium, and VentureWell. The funding was used to provide scientific evidence of the effectiveness of Emme's system.

Being part of organizations that support budding entrepreneurs, and being comfortable introducing herself to industry movers and shakers and leveraging those contacts has opened doors for French. A case in point was meeting Deb Kilpatrick, Evidation Health CEO, MedTechWomen cofounder, long-time mentor at Stanford Biodesign, and advisory board member of the Ferolyn Fellowship. After hearing Kilpatrick speak at a MedTechWomen in 2016, French approached her. "Let's have coffee," she said.

The relationship built over time. "There's a misconception that the mentor is always helping the mentee," said French. It wasn't just her taking from Kilpatrick. French provided insights into the sectors she knew best and referred engineers when Kilpatrick was looking for talent. Kilpatrick became an advisor to Emme. She introduced Christine Aylward of Magnetic Ventures, which led the seed round of $2.5 million, which recently closed. Kilpatrick is now on the company's board as its first independent board member. Bolt led the pre-seed round. To date, Emme has raised $3.5 million.

Money wasn't the only challenge French faced. For the company, the coronavirus pandemic didn't just mean working from home. The team had to rethink how it would do extensive testing in-house and contract firms for design verification of the hardware. One of Emme's mechanical engineers built out a full design verification test setup in his kitchen.

Emme's components are sourced from around the world. The company had to rethink its material planning strategy, too. It ordered more components to ensure it had the parts in stock.

While Emme is focused on birth control pills to start, French recognizes the system's potential for ensuring that medication and even vitamins are taken. "That is certainly on our horizon," said French.

How will you build your network so you have access to the resources you need?

Read more:
Women Use Tech To Solve Womens Health Problems, A Market Men Ignore - Forbes

Recommendation and review posted by Bethany Smith

Following a balanced diet that incorporates healthy fats and high-fiber foods can help you manage your weight when you have PCOS.

Image Credit: mapodile/E+/GettyImages

There's a close but complicated relationship between weight and PCOS, or polycystic ovary syndrome. More than half of people who have PCOS are overweight, according to the Cleveland Clinic. The condition is a common cause of infertility and can also up a person's risk for heart disease and type 2 diabetes.

People with PCOS are also more likely to gain weight and often find it harder to shed extra pounds. But why is weight gain so common for PCOS and are there tactics to help maintain a healthy weight?

Does PCOS Actually Cause Weight Gain?

This is still a chicken-and-egg question: It's not clear if extra weight causes PCOS, if PCOS is the reason for the added pounds or if the relationship works both ways, per Johns Hopkins Medicine.

Here are some possible factors behind the connection between PCOS and weight gain.

If you have PCOS, it's likely that you'll have higher levels of androgens, the so-called "male" hormones such as testosterone. While everyone has androgens in their bodies, levels are generally elevated for people with PCOS compared to people with ovaries who don't have the condition.

This uptick in androgens not only contributes to weight gain but is also implicated in common PCOS symptoms such as irregular periods and unwanted facial hair (called hirsutism), per Penn Medicine.

Insulin resistance is a key part of the weight and PCOS relationship. This occurs when your body doesn't use insulin, a hormone made by your pancreas, the way it should. Normally, insulin takes sugar from foods you eat out of your bloodstream and deposits them into cells to be used as energy, according to the Mayo Clinic.

But with insulin resistance, sugar stays in your bloodstream and doesn't get stored in cells. Instead, "it's shipped off into fat," explains Libby Mills, RD, a national spokesperson for the Academy of Nutrition and Dietetics.

This is a risk factor for type 2 diabetes. Indeed, more than half of the people diagnosed with PCOS go on to develop type 2 diabetes before the age of 40, according to the Centers for Disease Control and Prevention (CDC). Insulin may also contribute to high androgen levels, per Penn Medicine.

Why Is It Hard to Lose Weight if You Have PCOS?

Many with PCOS do find it difficult to shed those extra pounds, says Jennifer Wu, MD, an ob-gyn with Lenox Hill Hospital in New York City. That may be due to insulin resistance as blood sugar is diverted into fat instead of being stored for energy.

Extra weight can also have psychological effects that double down on this difficulty. One is self-esteem. Symptoms like hirsutism and extra weight "can fold into emotional eating, which can compound the problem," Mills says.

Here's something we do know: Losing weight, if you need to, can help ease symptoms of PCOS such as irregular periods and infertility, per the Office on Women's Health. It can also reduce the risk of future complications like heart disease and type 2 diabetes.

"Typically the severity of PCOS symptoms increases as a person gets heavier," Mills says.

Again, science points to the role of insulin resistance. For people with PCOS, losing weight improved insulin resistance while also lowering blood sugar levels, body mass index, weight and belly fat, per a July 2020 meta-analysis in the Journal of Clinical Endocrinology and Metabolism. More fat around the middle has been linked with a higher risk of hypertension, heart disease and type 2 diabetes, according to the National Institutes of Health.

How Can You Manage PCOS and Your Weight?

There's no cure for PCOS so doctors rely on medications to relieve specific symptoms and, not surprisingly, lifestyle changes. High on the list of lifestyle changes: losing weight or maintaining a healthy weight.

"That's one of the first things we tell patients: Let's try to have you achieve an ideal body weight," Dr. Wu says.

Here are the strategies commonly used to help manage this condition:

There's no official (or unofficial) PCOS diet. Instead, patients are advised to follow the same type of balanced diet that all of us should be adhering too, with a couple of emphases added.

Exercise is important, too, with studies showing that it can affect waist circumference and body fat. "Physical activity has to be part of the weight-loss equation," Mills says.

Getting enough shut-eye is also a priority for weight loss. "When we don't sleep, it's a stressor to the body and can make it really difficult to lose weight," Mills notes.

Metformin is a diabetes drug doctors sometimes prescribe as PCOS treatment to help regulate blood sugar and insulin. Some people also lose weight with the drug, Dr. Wu says. One early (but usually temporary) side effect can be nausea, Mills says.

Talk to your doctor about whether any weight-loss medications would be beneficial. "It's certainly a topic of discussion if the person is really struggling," Mills says.

Gastric bypass surgery is a last resort for people with PCOS, Dr. Wu says. Evidence is emerging that these procedures can resolve problems like insulin resistance, according to a July 2020 study in Therapeutic Advances in Endocrinology and Metabolism.

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What You Should Know About How PCOS and Weight Are Connected - LIVESTRONG.COM

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Next, to accommodate the donors immune cells, they had to wipe out Mr. Browns own immune system by bombarding him with chemotherapy and radiation. Next came the transplant procedure itself. On that same February day, Mr. Brown stopped taking his antiretroviral medication. Three months later, after a grueling recovery in which he almost died, he was H.I.V.-free.

For Mr. Brown, the epiphany came one day in the gym, when he found that he was developing muscles again after years of wasting away. That was kind of my proof that it was gone, he said.

Many hurdles remained. A recurrence of leukemia required a second transplant a year later. A brain biopsy left Mr. Brown temporarily paralyzed and nearly blind. He had to be taught how to walk and talk again. His recovery, complicated by injuries from a 2009 mugging in Berlin, left him with a stiff shoulder, limited vision and neurological damage, which prevented him from resuming his work as a translator.

My life is far from perfect, he said in 2015, but it is still my life.

He was living in Nevada in 2013 when he met Mr. Hoeffgen on the Scruff dating app. They moved to Southern California in 2015. In April, Mr. Brown was admitted to a cancer hospital; his leukemia, unrelated to H.I.V., had returned. Covid-19 restrictions kept the couple together on the medical campus for weeks.

This month, Mr. Hoeffgen told Mark S. King, a blogger and AIDS activist, that Mr. Brown had terminal cancer and had been receiving home hospice care. Mr. Brown was aware that he was dying.

I have asked him what he wants me to tell people when we make his situation public, Mr. Hoeffgen said. He said: Tell people to keep fighting. Fight for a cure for H.I.V. that works for everyone. I never wanted to be the only one.

In addition to Mr. Hoeffgen, Mr. Brown is survived by his mother.

One researcher asked whether the couple would consider donating Mr. Browns body to science.

I said, Thank you, but no, Mr. Hoeffgen said. I think hes done enough.

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Timothy Ray Brown, First Patient Cured of H.I.V., Dies at 54 - The New York Times

Recommendation and review posted by Bethany Smith

Smiths 2005 stem cell law to be reauthorized by House

Rep. Chris Smith (R-NJ)statement submitted during debate in the House of Representatives

on the Stem Cell Therapeutic and Research ActSeptember 29, 2020

Margaret Hahnmy mother-in-lawpassed away on Friday and a Mass of Christian burial will be held today at St. Mary Church in South Amboy, New Jersey. She was 96 and was deeply loved and will be deeply missed.

MargaretPegwas a great womanwife, mother, grandmother, and great-grandmother. She selflessly devoted her life to public service including her amazing work as Sayreville Borough Clerk for twenty years. She had an incredible reputation for getting things done for the people. No matter who served as mayor or on Council, everyone knew she was the power.

My wife Marie and I will join family and friends today at her funeral and internment making it impossible for me to speak today during the debate on the reauthorization of a law I originally authored fifteen years agothe Stem Cell Therapeutic and Research Act of 2005and the Stem Cell Therapeutic and Research Act of 2015.

So, I submit these comments for the Congressional Record.

Madam Speaker, today the House of Representatives will vote to reauthorize the Stem Cell Therapeutic and Research Act.

This was an original idea of mine 20 years ago. Joined by 70 cosponsors, I introduced it in 2001 and again in 2003.

After five long years of hard work and numerous setbacks, my bill was finally enacted into law in 2005.

Beginning in 2001, Dr. Joanne Kurtzberg, who is President of the Cord Blood Association, helped draft my original law.Dr. Kurtzberg has said, Cord blood transplantation is now an established field with enormous potential. In the future, it may emerge as a source of cells for cellular therapies focused on tissue repair and regeneration.

The new law created a nationwide umbilical cord blood stem cell program, designed to collect, derive, type, and freeze cord blood units for transplantation into patients to mitigate and to even cure serious disease. Pursuant to the law, it also provided stem cells for research. The new cord blood program was combined in our 2005 law with an expanded bone marrow initiative, which was crafted over several years by our distinguished colleague, CongressmanBill Young.

I was the prime sponsor again when it was reauthorized in 2015.

Umbilical cord blood stem cells, obtained after the birth of a child, have proved highly efficacious in treating 70 diseases, including sickle-cell disease, lymphoma, and leukemia. And scientists are continuing to study and better understand the regenerative effects of cord blood cell therapies for other diseases and conditions. Bone marrow donations provide lifesaving transplants to treat diseases like blood cancer, sickle cell anemia, or inherited metabolic or immune system disorders.

The National Cord Blood Inventory (NCBI) provides funding to public cord blood banks participating in the program to allow them to expand the national inventory of cord blood units available for transplant. These units are then listed on the registry by the Be the Match Program. The funds appropriated thus far have led to an important increase in the overall number of high-quality cord blood units available through the national registry, including 150,000 NCBI units. Within the Be the Match registry, there are more than 783,000 NCBI units worldwide.

The Program registry allows patients and physicians to locate matching cord blood units, as well as adult donors for marrow and peripheral blood stem cells, when a family donor is not available. The Program is the worlds largest, most diverse donor registry, with more than 22 million volunteers and more than 300,000 public cord blood units. To date, the National Marrow Donor Program/Be The Match (NMDP), through its operation of the Program, has facilitated more than 100,000 transplants. More than 45,000 patients have receivedcord bloodtransplants, according Dr. Joanne Kurtzberg.

The reauthorization before us authorizes $23 million to be appropriated for fiscal year 2021 through fiscal year 2025. It also authorizes $30 million to be appropriated for fiscal years 2021 through 2025 for the bone marrow transplant program. This continues funding at the same levels authorized in the 2015 authorization bill.

Madam Speaker, each year nearly 4 million babies are born in America. In the past, virtually every placenta and umbilical cord was tossed as medical waste. Today, doctors have turned this medical waste into medical miracles.

Not only has God in His wisdom and goodness created a placenta and umbilical cord to nurture and protect the precious life of an unborn child, but now we know that another gift awaits us immediately after birth. Something very special is left behindcord blood that is teeming with lifesaving stem cells. Indeed, it remains one of the best kept secrets in America that umbilical cord blood stem cells and adult stem cells in general are curing people of a myriad of terrible conditions and diseasesover 70 diseases in adults as well as in children.

The legislation that is before us will enable even more patients to receive the treatments that they so desperately need.

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Smith's 2005 stem cell law to be reauthorized by House - InsiderNJ

Recommendation and review posted by Bethany Smith

When 5-year-old Sawyer was diagnosed with sickle cell at a young age, his fraternal twin, Saxton, turned out to be a perfect match.

ATLANTA This is not just a birthday party, its a celebration of second chances.

We are so blessed, said OShea Guillory. We want to share this.

It is also a commitment to help others, too.

Mikari Tarpley is 16. She is at the small birthday celebration and sang her heart out for 5-year-old Sawyer and his brother Saxton. She sings from a place of understanding.

She and Sawyer, her neighbor, have both been through a lot this year.

We found out about Sawyers sickle cell disease at a very early age, Guillory said. He was about three weeks old.

Sawyers mom said she was absolutely devastated. She refused to accept there was nothing she could do to help her son.

I did a ton of research," she said. I found an organization called Be The Match.

She discovered information about transplants that could be a potential cure. Doctors take stem cells from the bone marrow of a donor and transplant it into the recipient.

They just needed a donor.

It turns out Sawyer was born with his cure, Guillory said. His twin, Saxton, was a perfect sibling match.

Across the cul-de-sac, Mikari Tarpley, an actress, was fighting Hodgkins Lymphoma and finishing chemotherapy.

She knew Sawyer has been battling sickle cell. Theyd both lost their hair from treatment. She decided she wanted to use her Sweet 16th birthday to raise money for children like Sawyer.

We couldnt do much for my sixteenth because of COVID, so we thought it would be a great idea to do a fundraiser to help others, Mikari said.

She reached her goal of $16,000 to help children being treated for sickle cell disease at the Aflac Cancer and Blood Disorders Center.

Five-year-old Sawyer received a bone marrow transplant from his fraternal twin, Saxton. It was a success. Before long, Sawyer was riding a tricycle around Childrens Healthcare of Atlanta, racing his nurses and giggling along the way.

I truly have little warriors, Guillory said. My son, who helped save his brothers life - and my son - who was able to go through all of that and come out even stronger.

Now Sawyer, Saxton and their parents are spending their 5th birthday following Mikaris lead by paying it forward.

Sawyers mom OShea is starting a nonprofit, Sawyers Sickle Circle, to spread awareness and knowledge about sickle cell, Beads of Courage and Be the Match program. They launched a fundraiser on Sawyer and Saxtons birthday.

The Guillory family said the best present they could wish for is for other kids to have the chance to celebrate many more birthdays to come.

Link:
A perfect match: Bone marrow transplant saves twin brother's life. Now their family pays it forward - 11Alive.com WXIA

Recommendation and review posted by Bethany Smith