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Androgenic Alopecia

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241. Male Hypogonadism

of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med, 2016. 13: 1787. 10. Kaufman, J.M., et al. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev, 2005. 26: 833. 11. Wu, F.C., et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab, 2008. 93: 2737. 12 (...) . Hall, S.A., et al. Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample. J Clin Endocrinol Metab, 2008. 93: 3870. 13. Nieschlag, E., et al., Testosterone: action, deficiency, substitution. 2004, Cambridge. 14. Parker, K.L., et al. Genes essential for early events in gonadal development. Cell Mol Life Sci, 1999. 55: 831. 15. Brinkmann, A.O. Molecular mechanisms of androgen action--a historical perspective. Methods Mol Biol, 2011. 776: 3. 16. Bentvelsen, F.M

2019 European Association of Urology

242. Male Infertility

Obstet Gynecol, 2009. 21: 223. 57. Baccetti, B., et al. Ultrastructural studies of spermatozoa from infertile males with Robertsonian translocations and 18, X, Y aneuploidies. Hum Reprod, 2005. 20: 2295. 58. Miyagawa, Y., et al. Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study. J Urol, 2005. 173: 2072. 59. Ferlin, A., et al. Male infertility and androgen receptor gene mutations: clinical features (...) and identification of seven novel mutations. Clin Endocrinol (Oxf), 2006. 65: 606. 60. Gottlieb, B., et al. Molecular pathology of the androgen receptor in male (in)fertility. Reprod Biomed Online, 2005. 10: 42. 61. Rajender, S., et al. Phenotypic heterogeneity of mutations in androgen receptor gene. Asian J Androl, 2007. 9: 147. 62. Tincello, D.G., et al. Preliminary investigations on androgen receptor gene mutations in infertile men. Mol Hum Reprod, 1997. 3: 941. 63. Giwercman, A., et al. Preserved male

2019 European Association of Urology

243. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence Full Text available with Trip Pro

therapy, however, may require investigation of androgen excess [ , ]. In a 5-year longitudinal analysis, development of moderate to severe inflammatory acne has been reported to be associated with androgen excess [ ]. Alopecia is rare and not well studied in adolescents [ ]. Isolated acne and alopecia should not be considered to be diagnostic criteria of PCOS in adolescence. Premature adrenarche (PA), defined in girls as the appearance of pubic hair before 8 years of age with Tanner II–III levels (...) Features As in adults, signs of hyperandrogenism in adolescents can be clinical or biochemical. Hirsutism is defined as excessive, coarse, terminal hairs distributed in a male fashion, and PCOS is the most common cause of hirsutism in adolescence [ ]. The severity of hirsutism may not correlate with serum androgen levels; moreover, there are ethnic/genetic differences that may affect the degree of hirsutism [ - ]. Hirsutism must be distinguished from hypertrichosis defined as excessive vellus hair

2019 Pediatric Endocrine Society

244. Diagnosis and Treatment of Early Stage Testicular Cancer

Recommendation; Evidence Level: Grade B) 13a. In patients with GCNIS on testis biopsy or malignant neoplasm after TSS, clinicians should inform patients of the risks/benefits of surveillance, radiation, and orchiectomy. (Moderate Recommendation; Evidence Level: Grade C) 13b. Clinicians should recommend surveillance in patients with GCNIS or malignant neoplasm after TSS who prioritize preservation of fertility and testicular androgen production. (Moderate Recommendation; Evidence Level: Grade C) 13c

2019 American Urological Association

245. 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

2019 American College of Obstetricians and Gynecologists

246. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis

of the skin. General advice for recurrent VVC In patients with recurrent VVC careful review of their daily hygiene routine may identify potential local irritants not perceived as such by the patient for example washing hair in bath water or excessive cleaning. (Grade 2D) No other genital hygiene practices have been definitively linked with recurrent VVC however a number have shown weak associations which may be worth considering in certain patients: • wearing incorrectly fitted clothing made from non (...) in 4 pregnant women was significantly associated with shorter anogenital distance suggesting a potential anti-androgenic effect. 117 • It is important to note that exposure to standard dose fluconazole at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional foetal monitoring. 118 VVC and pregnancy outcome: • Previous studies did not find evidence of an association between Candida colonisation and premature delivery or low birth

2019 British Association for Sexual Health and HIV

247. Testosterone replacement in menopause

as appropriate female physiological doses are prescribed adverse androgenic effects are not problematic and virilising problems do not occur. Reported adverse effects are shown below; if thought to be linked, the dosage should be reduced or treatment stopped. • Increased body hair at site of application (occasional problem) – spread more thinly, vary site of application, reduce dosage. • Generalised Hirsutism (uncommon) • Alopecia, male pattern hair loss (uncommon) • Acne and greasy skin (uncommon (...) . Testosterone deficiency can also contribute to a reduction in general quality of life, tiredness, depression, headaches, cognitive problems, osteoporosis and sarcopenia. 4 What other effects can testosterone have in the post-menopause? After the menopause, estrogen levels fall to undetectable levels. Consequently, the small amount of remaining testosterone may predispose to androgenic symptoms, especially acne, increased facial hair growth and male pattern baldness. Personal genetics are key

2019 British Menopause Society

248. Screening and Management of the Hyperandrogenic Adolescent

. c Monitoring serum androgens is not recommended. Introduction Although androgen excess can manifest in many ways, the most common and recognizable symptoms are hirsutism and acne. (Alopecia also may be a symptom.) Hirsutism affects 5–10% of reproductive-aged females and is defined as excessive terminal hair growth in a distribution typically seen in adult men (face, sternum, lower abdomen, back, and thighs) (1). Acne vulgaris is a multifactorial skin con (...) with medication that slows or prevents new hair growth. Patients also should be counseled that given the life span of terminal hair, 6 months of medical therapy is required before slower and finer regrowth of hair is noted (15). All patients who present with clinical hyperandro- genism should be counseled on a healthy lifestyle. Weight loss in obese patients with hyperandrogenemia with or without PCOS has been shown to decrease androgen levels, increase sex hormone binding globulin, and reduce clinical

2019 American College of Obstetricians and Gynecologists

249. Screening and Management of the Hyperandrogenic Adolescent

. c Monitoring serum androgens is not recommended. Introduction Although androgen excess can manifest in many ways, the most common and recognizable symptoms are hirsutism and acne. (Alopecia also may be a symptom.) Hirsutism affects 5–10% of reproductive-aged females and is defined as excessive terminal hair growth in a distribution typically seen in adult men (face, sternum, lower abdomen, back, and thighs) (1). Acne vulgaris is a multifactorial skin con (...) with medication that slows or prevents new hair growth. Patients also should be counseled that given the life span of terminal hair, 6 months of medical therapy is required before slower and finer regrowth of hair is noted (15). All patients who present with clinical hyperandro- genism should be counseled on a healthy lifestyle. Weight loss in obese patients with hyperandrogenemia with or without PCOS has been shown to decrease androgen levels, increase sex hormone binding globulin, and reduce clinical

2019 American College of Obstetricians and Gynecologists

250. Testicular Cancer

malignancy. Eur Urol, 2002. 42: 229. 102. Spermon, J.R., et al. Fertility in men with testicular germ cell tumors. Fertil Steril, 2003. 79 Suppl 3: 1543. 103. Nieschlag E, Pharmacology and clinical use of testosterone, In: Testosterone-Action, Deficiency, Substitution., Nieschlag E., Behre HM., Nieschlag S., Eds. 1999, Springer Verlag Berlin-Heidelberg-New York. 104. Skoogh, J., et al. Feelings of loss and uneasiness or shame after removal of a testicle by orchidectomy: a population-based long-term

2019 European Association of Urology

251. Paediatric Urology

therapy with LHRH and HCG in cryptorchid infants. Eur J Pediatr, 1993. 152 Suppl 2: S31. 66. Forest, M.G., et al. Effects of human chorionic gonadotropin, androgens, adrenocorticotropin hormone, dexamethasone and hyperprolactinemia on plasma sex steroid-binding protein. Ann N Y Acad Sci, 1988. 538: 214. 67. Aycan, Z., et al. Evaluation of low-dose hCG treatment for cryptorchidism. Turk J Pediatr, 2006. 48: 228. 68. Hesse, V., et al. Three injections of human chorionic gonadotropin are as effective (...) using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review. J Pediatr Surg, 2014. 49: 1659. 105. Coughlin, M.T., et al. Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood. J Urol, 1999. 162: 986. 106. Tasian, G.E., et al. Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol, 2009

2019 European Association of Urology

252. Renal Transplantation

patients. Eur Urol, 2010. 58: 927. 120. Heylen, L., et al. The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study. Am J Transplant, 2017. 17: 724. 121. Weissenbacher, A., et al. The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation. Transpl Int, 2015. 28: 535. 122. Basu, A., et al. Adult dual kidney transplantation. Curr Opin Organ Transplant, 2007. 12: 379. 123. Haider, H.H., et al. Dual kidney (...) al. Evaluation of the Vascular Surgical Complications of Renal Transplantation. Ann Vasc Surg, 2016. 33: 23. 172. Giustacchini, P., et al. Renal vein thrombosis after renal transplantation: an important cause of graft loss. Transplant Proc, 2002. 34: 2126. 173. Wuthrich, R.P. Factor V Leiden mutation: potential thrombogenic role in renal vein, dialysis graft and transplant vascular thrombosis. Curr Opin Nephrol Hypertens, 2001. 10: 409. 174. Parajuli, S., et al. Hypercoagulability in Kidney

2019 European Association of Urology

253. 5th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 5) Full Text available with Trip Pro

, preferably as single agents, would usually be considered as first-line ChT for HER2-negative ABC in those patients who have not received these regimens as (neo)adjuvant treatment and for whom ChT is appropriate. Other options are, however, available and effective, such as capecitabine and vinorelbine, particularly if avoiding alopecia is a priority for the patient. I/A 71% In patients with taxane-naive and anthracycline-resistant ABC or with anthracycline maximum cumulative dose or toxicity (i.e. cardiac (...) ) who are being considered for further ChT, taxane-based therapy, preferably as single agent, would usually be considered as the treatment of choice. Other options are, however, available and effective, such as capecitabine and vinorelbine, particularly if avoiding alopecia is a priority for the patient. I/A 59% In patients pre-treated (in the adjuvant and/or metastatic setting) with an anthracycline and a taxane , single-agent capecitabine, vinorelbine or eribulin are the preferred choices

2020 European Society for Medical Oncology

254. Amenorrhoea: Scenario: Management of primary amenorrhoea

tract malformation, intracranial tumour (for example prolactinoma), chromosomal anomaly (for example Turner's syndrome or androgen insensitivity), or anorexia nervosa. Puberty lasting 5 years without menarche (for example presenting at 15 years of age when pubic hair and breast development started at 10 years of age). Referral to a gynaecologist (preferably with a special interest in adolescent gynaecology) is appropriate for most people. Referral to an endocrinologist is recommended for those (...) with hyperprolactinaemia, thyroid disease, or features of androgen excess (such as hirsutism, acne, and virilization). Manage amenorrhoea caused by weight loss, excessive exercise, stress, or chronic illness after an endocrinologist has assessed and excluded other hypothalamic or pituitary causes (such as a tumour). For weight-related amenorrhoea, encourage weight gain and refer to a dietician if necessary. If an eating disorder is suspected, consider referral to a psychiatrist. See the CKS topic on for more

2019 NICE Clinical Knowledge Summaries

255. Acne vulgaris: How should I assess a person with suspected acne vulgaris?

or exacerbate acneform rashes including androgens, corticosteroids, isoniazid, ciclosporin and lithium. Hyperandrogenism — may present with irregular periods, androgenic alopecia or hirsutism in women. Examine the person: Look for of acne such as non-inflammatory comedones and inflammatory papules, pustules, nodules and scarring. Comedones must be present for a diagnosis of acne to be made. If not present, consider . Record the type and distribution of lesions and severity. Look for signs of other disorders (...) such as flares with menstruation, contraceptives, cosmetics, face creams or hair pomades. Systemic features — some rare subtypes of acne (acne fulminans) can present with systemic features including fever, arthralgia, and myalgia. Psychosocial impact of acne — ask about psychological problems including anxiety and low mood. Family history including endocrine disorders, polycystic ovarian syndrome, acne and other skin conditions. Possible underlying causes: Drug history — some medications can cause

2019 NICE Clinical Knowledge Summaries

256. Global Vascular Guidelines for patients with chronic limb-threatening ischemia Full Text available with Trip Pro

significant mortality, limb loss, pain, and diminished health-related quality of life (HRQL) among those afflicted. Multiple health care specialists are involved in the management of CLTI, yet lack of public awareness and the frequent failure to make an early diagnosis continue to be major obstacles to effective treatment. Variability in practice patterns is high, contributing to a broad disparity in the use of treatments and clinical outcomes. For example, a study from the United States suggested (...) of disease found in most patients with CLTI. Successful revascularization in CLTI, particularly in patients with tissue loss, nearly always requires restoration of in-line (pulsatile) flow to the foot. Moreover, there is a general lack of understanding of the relationships between patterns of disease, hemodynamic improvement after treatment, anatomic durability, clinical stage, and outcomes that continues to plague the field. With this in mind, a new approach was developed to facilitate clinical decision

2019 Society for Vascular Surgery

257. Risk factors for breast cancer: A review of the evidence 2018

Cancer Australia to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Publications and Copyright contact officer, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012. Disclaimer Cancer Australia does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information. Cancer Australia develops material based on the best available evidence, however it cannot guarantee and assumes no legal liability or responsibility (...) —progestogen only 76 4.6.3 Menopausal hormone therapy—combined 77 4.6.4 Menopausal hormone therapy—oestrogen only 80 4.6.5 Hormonal infertility treatment 82 4.6.6 DES in utero 84 4.6.7 DES maternal exposure 86 4.7 Lifestyle factors 88 4.7.1 Adiposity 88 4.7.2 Adiposity—weight gain 91 4.7.3 Adiposity—weight loss 92 4.7.4 Alcohol consumption 94 4.7.5 Bras 96 4.7.6 Coffee, tea, caffeine 97 4.7.7 Diet—calcium 99 4.7.8 Diet—dairy 101 4.7.9 Diet—dietary fibre 102 4.7.10 Diet—fruit 104 4.7.11 Diet—vegetables 106

2018 Cancer Australia

258. Female Infertility

with and without PCOS [44]. In 2009, the Androgen Excess and PCOS Society proposed the following criteria for diagnosing PCOS: hyperandrogenism and ovarian dysfunction with the exclusion of other androgen excess or related disorders [42]. Hyperandrogenism typically presents as hirsutism, the presence of terminal hairs on the face and/or body in a female in a male-type pattern. Ovarian dysfunction can include ovulatory dysfunction or polycystic ovaries, as defined by ovarian volume greater than 10 cc or 12 (...) not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Infertility Clinical Condition: Infertility Variant 4: Recurrent pregnancy loss. Radiologic Procedure Rating Comments RRL* US saline infusion sonohysterography 8 This procedure may be performed with HyCoSy. Recommend addition of 3-D imaging to assess for Müllerian duct anomalies and Asherman syndrome. O MRI pelvis without and with IV contrast 8 O MRI pelvis without IV contrast 8 O US

2019 American College of Radiology

260. Congenital adrenal hyperplasia

hydroxysteroid dehydrogenase deficiency. History and exam genetic predisposition weight loss failure to thrive vomiting hypotension ambiguous genitalia hyperpigmentation poor feeding irregular menses infertility male-pattern baldness (females) short stature precocious puberty polycystic ovaries hirsutism severe cystic acne genetic predisposition Diagnostic investigations serum 17-hydroxyprogesterone serum 11-deoxycortisol serum chemistry microfilter paper radioimmunoassay for 17-hydroxyprogesterone genetic (...) -wasting crisis in the first 4 weeks of life are likely to be affected with CAH. The diagnosis is confirmed by biochemical findings, such as an unequivocally elevated serum concentration of 17-hydroxyprogesterone. Serum concentrations of delta-androstenedione and progesterone are increased in males and females with 21-hydroxylase-deficient CAH. Serum concentrations of testosterone and adrenal androgen precursors are increased in affected females and prepubertal males. Definition Congenital adrenal

2017 BMJ Best Practice

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