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Androgenic Alopecia

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221. Evidence for two independent functional variants for androgenetic alopecia around the androgen receptor gene. (Abstract)

Evidence for two independent functional variants for androgenetic alopecia around the androgen receptor gene. The gene encoding the androgen receptor (AR) is associated with male pattern baldness (androgenetic alopecia - AGA). In case-control and family analyses, we mapped AR and the adjacent intergenic regions. We found evidence for association with two independent loci, one upstream and previously described and the other downstream and apparently novel. The haplotype comprising these SNPs

2010 Experimental Dermatology

222. Polycystic ovary syndrome

hypertension scalp hair loss oily skin or excessive sweating acanthosis nigricans family history of PCOS premature adrenarche low birth weight fetal androgen exposure obesity environmental endocrine disruptors Diagnostic investigations serum total and free testosterone serum dehydroepiandrosterone sulfate (DHEAS) serum 17-hydroxyprogesterone serum prolactin serum thyroid-stimulating hormone oral glucose tolerance test fasting lipid panel serum androstenedione pelvic ultrasound basal body temperature (...) hyper-androgenism or to induce fertility. Definition Polycystic ovary syndrome (PCOS) includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine F, et al., eds. Polycystic Ovary Syndrome. Cambridge, MA: Blackwell Scientific; 1992:377-84. The Rotterdam ESHRE/ASRM-sponsored PCOS

2019 BMJ Best Practice

223. Bariatric surgery in Belgium: organisation and payment of care before and after surgery

²) or severe category II obesity (BMI 35- 35 kg/m². Weight loss is higher for RYGB and SG compared to LAGB. Observational data shows that the b ‘Remission’ does not equal definitive cure. weight loss is, in most cases, durable. After 10 years or more there is still, in most cases, a substantial weight loss. 1 Risk on obesity-related mortality Based on observational studies it can be concluded that the relative risk of premature mortality due to obesity related conditions may decrease with 30- 45%. 1 (...) and only include LAGB (for which the effect on OSAS is assumed to be lower compared to RYGB and SG). 1 Efficacy of bariatric surgery in adolescents The effect of bariatric surgery on weight loss in adolescents seems to be comparable to that documented in studies in adults. Yet the evidence is only based on 1 RCT (LAGB versus conservative treatment, patients aged 14-18 years). Two years after surgery, the mean weight loss in the LAGB group was 34.6 kg (95% CI: 30.2-39.0), with a mean BMI change of 12.7

2020 Belgian Health Care Knowledge Centre

224. Testosterone Treatment in Adult Men with Age-Related Low Testosterone (Full text)

nonspecific signs and symptoms associated with age-related low testosterone, such as sexual dysfunction, decreases in energy and muscle mass, mood disturbances, changes in bone mineral density, cardiovascular disease, depression, decreased libido, erectile dysfunction, decreased volume of ejaculate, loss of body and facial hair, weakness, and mortality, are a consequence of age-related low testosterone or whether they are a result of other factors, such as chronic illnesses or concomitant medications (...) testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence). A gradual, age-associated decline in serum total testosterone levels begins in men in their mid-30s and continues at an average rate of 1.6% per year ( ). This condition is referred to as age-related low testosterone and is accompanied by clinical symptoms associated with androgen deficiency. No well-defined, universally accepted

2020 American College of Physicians PubMed abstract

225. Abiraterone acetate (Zytiga) - for the treatment of newly diagnosed high risk metastatic hormone sensitive prostate cancer

a full submission assessed under the orphan medicine process abiraterone acetate (Zytiga ® ) is accepted for use within NHSScotland. Indication under review: abiraterone acetate with prednisone or prednisolone for the treatment of newly diagnosed high risk metastatic hormone sensitive prostate cancer in adult men in combination with androgen deprivation therapy. Abiraterone acetate in combination with prednisone and androgen deprivation therapy demonstrated superiority over androgen deprivation (...) with prednisone or prednisolone for the treatment of newly diagnosed high risk metastatic hormone sensitive prostate cancer (mHSPC) in adult men in combination with androgen deprivation therapy (ADT). 1 Dosing Information The recommended dose is 1,000mg (two 500mg tablets) as a single daily dose that must not be taken with food. The tablets should be taken at least one hour before or at least two hours after eating. For men with high risk mHSPC, abiraterone is to be taken with 5mg prednisone or prednisolone

2020 Scottish Medicines Consortium

226. Infertility Workup for the Women’s Health Specialist

of the female partner should be performed with a focus on vital signs and include a thyroid, breast, and pelvic examination. Key physical factors include the following (3): c weight, body mass index, blood pressure, and pulse c thyroid enlargement and presence of any nodules or tenderness c breast secretions and their character c signs of androgen excess c tanner staging of breasts and pubic and axillary hair c vaginal or cervical abnormality, secretions, or discharge c pelvic or abdominal tenderness, organ (...) of the luteal phase (3, 21). Anovulation may be related to obesity, hypothalamic and pituitary dysfunction, PCOS, and other etiologies. Polycystic ovary syndrome is the most common cause of ovulatory infertility (22, 23). There is no universally accepteddefinitionofPCOS;however,itmaybediagnosed based on the National Institutes of Health, Rotterdam, or Androgen Excess and PCOS Society criteria (24–26). Although many women with PCOS will present with a chief report of infertility, obstetrician–gynecologists

2020 Society for Assisted Reproductive Technology

227. European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest. 1. Summary of recommendations The recommendations (R (...) ? LH in women ? oestrogens/androgens Insulin resistance 25-OH vitamin D ? Trapping in adipose tissue, ? sun exposure ? 25OH vitamin D binding protein ? liver synthesis PTH N or ? Secondary due to vitamin D deficiency Insulin ? Insulin resistance Renin ? ? Sympathetic tone Aldosterone ? ? Adipokines, renin- angiotensin, leptin GLP-1 ? ? FFA, microbiota Leptin ? Increased adipose mass, Leptin resistance Ghrelin ? Lack of ghrelin decrease after meals 11-HSD, 11ß-hydroxysteroid dehydrogenase; ACTH

2020 European Society of Endocrinology

228. Testosterone Testing - Protocol

. Men Women , Confirmed or suspected: Hypothalamic/pituitary tumour* Hyperprolactinemia* Hemochromatosis Idiopathic hypogonadotropic hypogonadism Cryptorchidism, anorchia Genetic conditions including Klinefelter syndrome, Kallmann syndrome, myotonic dystrophy Male factor infertility Confirmed or suspected: Rapid virilisation/rapid hair loss* Symptoms consistent androgen-secreting tumour of adrenal or ovarian origin* Cushing syndrome* Acromegaly* Congenital adrenal hyperplasia (CAH) Polycystic ovary (...) because the prevalence of hypogonadism among patients with erectile dysfunction is low. Table 1: Symptoms and signs of testosterone deficiency in men, in order of specificity , Specific to testosterone deficiency Supportive of testosterone deficiency Not specific to testosterone deficiency Loss of body (axillary, facial, pubic) hair Very small testes (<6 mL) Breast discomfort, gynecomastia Eunuchoidal body proportions Infertility, low sperm count Height loss, low-trauma fracture, low bone mineral

2019 Clinical Practice Guidelines and Protocols in British Columbia

230. Cyproterone acetate: new advice to minimise risk of meningioma

evidence for off-label use of high-dose cyproterone as hormone therapy in gender reassignment and in female patients for conditions related to androgen sensitivity such as acne, hirsutism, and baldness. The association of high dose (50mg per day) cyproterone acetate with meningioma was first described in 2008 and a warning on the possible risk of meningioma together with a contraindication in patients with meningioma or a history of meningioma was added to the product information for high dose (...) to the Cyproterone acetate and risk of meningioma Cyproterone acetate is a synthetic progestogen with anti-androgenic activity. High-dose products containing 50–100 milligram (mg) are used in the treatment of prostate cancer (Cyprostat) and hypersexuality disorders (Androcur). Low-dose products containing 2mg cyproterone acetate in combination with 35 microgram (µg) ethinylestradiol (Dianette and Co-cyprindiol) are approved for use in the treatment of acne and hirsutism (see for full indications). There is also

2020 MHRA Drug Safety Update

231. Anabolic steroid use disorder

of medication routines, many users have a coach who helps coordinate the drugs given and the schedule. Users take other drugs to minimise unwanted effects or mask their use. Focus of treatment is the management of complications associated with chronic use and preventing further abuse. Cardiac complications are the major cause of sudden and premature death. Definition Androgenic anabolic steroid (AAS) abuse refers to the use of testosterone derivatives to improve athletic performance and/or to increase lean (...) effects of steroids increased weight gain and muscular build increased appetite aggression and mood swings hirsutism voice pitch alterations clitoral hypertrophy disproportionate muscular development of upper torso testicular atrophy acne and/or oily skin temporal hairline recession/male pattern baldness striae or keloids menstrual irregularities changes in libido scrotal pain impotence infertility premature masculinisation/feminisation (adolescents) cognitive impairment GI upset short stature

2018 BMJ Best Practice

232. Gynaecomastia

or symptoms of liver failure (e.g., jaundice, ascites, spiders) signs or symptoms of hyperthyroidism (e.g., heat intolerance, weight loss, goitre) decreased body hair painless or enlarging testicular mass diminished strength or muscle atrophy anabolic steroid usage occupational exposure to embalming fluid or oral contraceptives contact with environmental phyto-oestrogens or phthalates prostate cancer gender identity disorder hyperthyroidism renal failure cirrhosis drugs that reduce testosterone synthesis (...) occurs in the newborn period, during puberty, and with ageing and obesity. Many drugs, environmental exposures, illnesses, and some genetic conditions increase the risk for gynaecomastia. Most cases require no specific treatment. Therapies for persistent pain or embarrassment include anti-oestrogen therapy such as tamoxifen, androgens, or surgery (liposuction or mammoplasty). Definition Gynaecomastia is the benign enlargement of the male breast with firm tissue extending concentrically beyond

2018 BMJ Best Practice

233. Sexual dysfunction in women

atrophy loss of pubic hair galactorrhoea depression antidepressant use comorbid anxiety disorder psychological aspects of cancer breast cancer gynaecological and other pelvic cancer neurological disease hyperprolactinaemia radical hysterectomy (non-nerve-sparing) cystectomy or proctectomy mood, affect, and personality relationship difficulties attitudes partner sexual dysfunction reduced androgen activity oestrogen deficiency premature ovarian failure post-partum ageing diabetes renal failure (...) whereas serum levels of sex hormones do not. Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during mid-life due to aging or menopause? Fertil Steril. 2001 Sep;76(3):456-60. http://www.ncbi.nlm.nih.gov/pubmed/11532464?tool=bestpractice.com Santoro N, Torrens J, Crawford S, et al. Correlates of circulating androgens in midlife women: the study of women's health across the nation. J Clin Endocrinol Metab. 2005 Aug;90(8):4836-45. http://jcem.endojournals.org/cgi/content/full/90/8

2018 BMJ Best Practice

234. Polycystic ovary syndrome

hypertension scalp hair loss oily skin or excessive sweating acanthosis nigricans family history of PCOS premature adrenarche low birth weight fetal androgen exposure obesity environmental endocrine disruptors Diagnostic investigations serum total and free testosterone serum dehydroepiandrosterone sulfate (DHEAS) serum 17-hydroxyprogesterone serum prolactin serum thyroid-stimulating hormone oral glucose tolerance test fasting lipid panel serum androstenedione pelvic ultrasound basal body temperature (...) hyper-androgenism or to induce fertility. Definition Polycystic ovary syndrome (PCOS) includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine F, et al., eds. Polycystic Ovary Syndrome. Cambridge, MA: Blackwell Scientific; 1992:377-84. The Rotterdam ESHRE/ASRM-sponsored PCOS

2018 BMJ Best Practice

235. Assessment of hirsutism

Around 70% to 80% of women with androgen excess manifest hirsutism. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995-1007. http://www.ncbi.nlm.nih.gov/pubmed/12738163?tool=bestpractice.com Excessive sexual hair may be accompanied by signs of virilisation: male-pattern alopecia, deepening of the voice, clitoromegaly, increased muscle bulk. When present, virilisation indicates an underlying condition associated with moderately to severely elevated androgen (...) Assessment of hirsutism Assessment of hirsutism - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of hirsutism Last reviewed: February 2019 Last updated: November 2018 Summary Hirsutism is a condition seen in women that is associated with development of androgen-dependent terminal hair (coarse, pigmented) following a male-pattern distribution (face, chest, abdomen, back). Pathophysiology Hair in different

2018 BMJ Best Practice

236. Assessment of hirsutism

Around 70% to 80% of women with androgen excess manifest hirsutism. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995-1007. http://www.ncbi.nlm.nih.gov/pubmed/12738163?tool=bestpractice.com Excessive sexual hair may be accompanied by signs of virilisation: male-pattern alopecia, deepening of the voice, clitoromegaly, increased muscle bulk. When present, virilisation indicates an underlying condition associated with moderately to severely elevated androgen (...) Assessment of hirsutism Assessment of hirsutism - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of hirsutism Last reviewed: February 2019 Last updated: November 2018 Summary Hirsutism is a condition seen in women that is associated with development of androgen-dependent terminal hair (coarse, pigmented) following a male-pattern distribution (face, chest, abdomen, back). Pathophysiology Hair in different

2018 BMJ Best Practice

237. Finasteride

in reporting of sexual dysfunction with the use of finasteride was observed whether finasteride was indicated for hair loss (ROR = 138.17, 95% CI: 133.13, 143.4), prostatic hyperplasia (ROR= 93.88, 95% CI 2017 6. Finasteride adverse effects in subjects with androgenic alopecia: A possible therapeutic approach according to the lateralization process of the brain. Nowadays, finasteride is a relatively frequently prescribed drug in the therapeutic management of male androgenic alopecia. The reported adverse (...) the efficacy and safety of dutasteride (type 1 and 2 5-alpha reductase inhibitor) with finasteride (type 2 5-alpha reductase inhibitor) and placebo in men with androgenetic alopecia. Men aged 20 to 50 years 2014 4. "Post- finasteride syndrome": what to tell our female patients? Postmarketing surveillance from men using finasteride , a 5-alpha reductase inhibitor (5ARI), for male pattern hair loss (MPHL) includes reports of various forms of sexual dysfunction, such as decreased libido, erectile

2018 Trip Latest and Greatest

238. International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS)

Council (NHMRC) through the funded Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS) (APP1078444) and the members of this Centre who led and co-ordinated this international guideline effort 2 Our partner organisations which co-funded the guideline: ? American Society for Reproductive Medicine (ASRM) ? European Society of Human Reproduction and Embryology (ESHRE) 3 Our collaborating and engaged societies and consumer groups: ? Androgen Excess and Polycystic Ovary Syndrome Society (...) Exercise interventions 79 3.5 Obesity and weight assessment 82 CONTENTS International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 3 Chapter Four Pharmacological treatment for non-fertility indications 84 4.1 Pharmacological treatment principles in PCOS 85 4.2 Combined Oral Contraceptive Pills and & combined oral contraceptive pills in 4.3 combination with other agents 86 4.4 Metformin 91 4.5 Anti-obesity pharmacological agents 95 4.6 Anti-androgen

2018 European Society of Human Reproduction and Embryology

239. Menopause

broken or bruised. The loss of thickness and elasticity is largely due to a decline in collagen levels. Other symptoms of connective tissue atrophy are brittle nails, hair loss, muscular aches and bone and joint pain. 3. Menopause symptomsROYAL COLLEGE OF NURSING 9 Long-term effects of oestrogen deficiency Cardiovascular disease Cardiovascular disease (CVD) is the collective term for angina, myocardial infarction, stroke, and peripheral vascular disease. Despite an overall reduction in CVD in recent (...) that practices may vary in each country and outside the UK. The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly

2018 Royal College of Nursing

240. Management of Alcohol-Related Liver Disease

contamination of food, mouth wash, alcohol free beer, etc. with alcohol - UTI Incresed results: - Urine dilution deliberately or by diuretics - UTI 154,163 EtG Hair =6mo >20–40g/d for >3months 85–92% 87–97% Increases results: - Seriously impaired renal function - EtG containing hair treatment Decreases results: - Hair treatment: dying, perming, bleaching 168,172–175 Clinical Practice Guidelines 162 Journal of Hepatology 2018 vol. 69 j 154–181products of the non-oxidative metabolism of ethanol. Further- more (...) should include determi- nationofLFTsandameasureofliver?brosis.(GradeA1) Abstinence can be accurately monitored by measure- ment of EtG in urine or hair (Grade A2) Management of alcoholic hepatitis De?nition and diagnosis Alcoholic hepatitis is a distinct clinical syndrome characterised by the recent onset of jaundice with or without other signs of liver decompensation (i.e. ascites and/or encephalopathy) in patients with ongoing alcohol abuse. 176 It is not uncommon for patients to have ceased

2018 European Association for the Study of the Liver

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