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Androgenic Alopecia

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221. Hirsutism: How should I assess for an underlying cause of hirsutism?

, infertility, acne, central obesity, and acanthosis nigricans. For information on the diagnosis of PCOS, see the section on in the CKS topic on . An androgen-secreting tumour, including sudden onset or rapid progression of hair growth, progression despite treatment, signs of virilization (hair loss from the scalp, voice deepening, increased muscle bulk, clitoromegaly), and a pelvic or abdominal mass. Endocrine conditions (uncommonly cause hirsutism), including: Cushing's syndrome — facial weight gain (moon (...) progressing hirsutism, irregular menses, infertility, galactorrhoea, features of hypothyroidism or Cushing's syndrome, acromegaly, central obesity), test for elevated androgen levels (serum total testosterone level) using a reliable specialty assay. If serum total testosterone levels are normal and sexual hair growth is moderate/severe, or sexual hair growth is mild with clinical signs of a hyperandrogenic endocrine disorder (for example menstrual disturbance), measure an early morning serum total

2020 NICE Clinical Knowledge Summaries

222. Hirsutism: Scenario: Management of hirsutism

with a Ferriman–Gallwey score of eight or more considered themselves to be hirsute. How should I manage hirsutism in premenopausal women? If is not indicated: Encourage weight loss in women who are overweight or obese. See the CKS topic on for more information. Discuss of hair reduction and removal (such as shaving and waxing), as these will remain an important part of management. If hirsutism is mild and does not significantly impact on the woman's quality of life, reassure and advise that no additional (...) be painful and time-consuming. It is most effective in women with lighter skin and darker hair. Basis for recommendation Weight loss The recommendation to encourage lifestyle modifications including weight loss for women who are overweight or obese, especially those with polycystic ovary syndrome (PCOS), is supported by an Endocrine Society guideline [ ], and a number of experts [ ; ; ]. Methods of hair removal This recommendation reflects advice and information in North American and Canadian guidelines

2020 NICE Clinical Knowledge Summaries

223. 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

224. 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

225. Disorders of Ejaculation: An AUA/SMSNA Guideline

. Radiation therapy for prostate cancer is also commonly associated with loss of antegrade ejaculation. 14 Disruption of ejaculation is associated with changes in subjective experience of orgasm for some men. The act of ejaculation has important connotations for many men, aside from its association with orgasmic pleasure and necessity for procreation. Loss or anomaly of ejaculation may lead to a diminished sense of masculinity and disruption of pleasure from orgasm for many men. 15 A significant (...) acid (GABA)-ergic activation opposes ejaculation and orgasm. Agonists of opioid receptors, principally mu subtypes, are also associated with impairment of ejaculatory and orgasmic response. Specific receptors may have actions that differ (e.g., stimulation of certain serotonergic receptors in the spinal cord may promote ejaculation and orgasm). 5 Orgasm is also a neuroendocrine process. Experimental and observational data in animals and humans indicate that androgens are necessary for at least

2020 American Urological Association

227. Testosterone Treatment in Adult Men with Age-Related Low Testosterone Full Text available with Trip Pro

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

228. 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

229. 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

230. 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

231. 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

232. 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

233. 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

234. 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

235. Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealan

to grieve for the loss of a son/ daughter, fear for the future and acceptance of their child. 29 While the young person is likely to have spent considerable time developing an understanding of who they are, families may perceive the change as being sudden and require time to adjust. 30 Whanau report that they need information and time to understand their loved one’s journey. It is an important part of the role of health services to support this process. Some families find joining parent support groups

2018 New Zealand Sexual Health Society

236. 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

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. Adolescent Female with Suspected PCOS

/weight loss and medication therapy. ? Combination hormonal oral contraceptives are recommended as first-line treatment in adolescents with suspected PCOS with a therapeutic goal to treat acne, hirsutism, or anovulatory symptoms, and/or to prevent pregnancy. Some estrogen/progestin combinations are less androgenic than others and generally believed to be better for PCOS than others. ? Healthy lifestyle therapy to achieve weight loss should also be first-line treatment in the presence of overweight (...) Adolescent Female with Suspected PCOS Suggestive history and physical findings Initial laboratory and/or radiologic work-up can include: When to refer Items useful for consultation Additional information Symptoms/Signs: Signs of Hyperandrogenism: Irregular menstrual periods, hirsutism, acne, frontal and temporal balding, hoarseness of voice, clitoromegaly in severe cases Excessive weight gain common Family history: History of PCOS, infertility, irregular menstrual periods, hirsutism may

2019 Oxford COVID-19 Evidence Service

240. The EAU – EANM – ESTRO – ESUR – SIOG Guidelines on Prostate Cancer

receiving testosterone therapy: observations from 5-year median followup of 3 registries. J Urol, 2015. 193: 80. 60. Watts, E.L., et al. Low Free Testosterone and Prostate Cancer Risk: A Collaborative Analysis of 20 Prospective Studies. Eur Urol, 2018. 74: 585. 61. Zhou, C.K., et al. Male Pattern Baldness in Relation to Prostate Cancer-Specific Mortality: A Prospective Analysis in the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol, 2016. 183: 210. 62. Lian, W.Q., et al. Gonorrhea and Prostate

2020 European Association of Nuclear Medicine

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