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Androgenic Alopecia

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281. Guideline on the management of premature ovarian insufficiency

with POI and endometriosis 123 12.5.d Women with POI and other medical issues 123 12.6. Treatment with androgens 127 12.6.a Indications 128 12.6.b Risks of androgen therapy 129 12.6.c Routes of administration, dose, duration, monitoring 129 13. Puberty induction 138 14. Complementary treatments in POI 144 Appendix 1: Abbreviations 148 Appendix 2: Glossary 150 Appendix 3: Guideline group 152 Appendix 4: Research recommendations 154 Appendix 5: Methodology 156 Appendix 6: Reviewers of the guideline draft (...) this condition be called? The term “premature ovarian insufficiency” should be used to describe this condition in research and clinical practice. GPP How should POI be defined? Premature ovarian insufficiency is a clinical syndrome defined by loss of ovarian activity before the age of 40. POI is characterised by menstrual disturbance (amenorrhea or oligomenorrhea) with raised gonadotropins and low estradiol. What is the prevalence of POI in the general population? The prevalence of POI is approximately 1

2015 European Society of Human Reproduction and Embryology

282. Hypercholesterolaemia - familial

occur in people with FH, but they are less specific. [ ; ; ; ] Secondary hypercholesterolaemia Causes of secondary hypercholesterolaemia The following conditions may cause hypercholesterolaemia (without hypertriglyceridaemia): Hypothyroidism. See the CKS topic on for more information. Cholestatic liver disease (such as primary biliary cirrhosis). Nephrotic syndrome. Cushing's syndrome. Anorexia nervosa. See the CKS topic on for more information. The use of certain drugs, including androgens (...) are needed: Smoking cessation or weight loss advice. See the CKS topics on and . Additional lifestyle advice. Change to lipid-modifying drug. Pregnancy or contraception . Referral to a specialist with expertise in FH. Routinely monitor for adverse effects of statin treatment. If unexplained muscle symptoms (such as pain, tenderness, or weakness) develop: Check creatine kinase (CK) levels. Stop statin treatment immediately if muscle symptoms are intolerable or if CK is five or more times the upper limit

2019 NICE Clinical Knowledge Summaries

283. Macular Abnormalities Associated With 5α-Reductase Inhibitor. (Abstract)

Macular Abnormalities Associated With 5α-Reductase Inhibitor. The neuroprotective action of sex hormones has been described. Data on the association between 5α-reductase inhibitor (5-ARI), a male sex hormone antagonist, and macular abnormalities are lacking to date.To assess the association between the use of 5-ARI for treatment of benign prostate hypertrophy and/or androgenic alopecia in men and macular abnormalities on optical coherence tomography imaging.This retrospective case-control (...) , cross-sectional study included electronic health record data from 31 male patients who showed foveal cavitation on spectral-domain optical coherence tomography imaging from January 1, 2016, to June 30, 2019.Receipt of 5-ARI for at least 2 years as treatment of benign prostate hypertrophy and/or androgenic alopecia.Clinical data and multimodal imaging findings and the proportion of 5-ARI users.Among 31 male patients with foveal cavitation, 5-ARI was used for 10 of 14 patients (71.4%) with macular

2020 JAMA ophthalmology

284. Getting under the skin of hair aging: the impact of the hair follicle environment. Full Text available with Trip Pro

with incidence increasing with age. In men, male pattern-balding (androgenetic alopecia) is driven by androgens and follows a specific pattern of frontotemporal and vertex regression. Women also experience female pattern hair loss (FPHL), presenting as more general, diffuse hair thinning. Hair thinning in women is commonly associated with the menopause, corresponding with other age-related changes in skin. The rapidly growing hair follicle undergoes continued renewal throughout the life span of an individual (...) Getting under the skin of hair aging: the impact of the hair follicle environment. Like the skin, our hair shows striking changes with age, producing hairs with altered diameter, lustre, and texture. The biology of hair aging has focused predominately on various aspects of the hair cycle, follicle size, and the fibre produced, but surprisingly the impact of the aging scalp dermal environment on the hair follicle and fibre has been generally overlooked. Hair loss affects both sexes

2020 Experimental Dermatology

285. Spironolactone use does not increase the risk of female breast cancer recurrence: A retrospective analysis. (Abstract)

Spironolactone use does not increase the risk of female breast cancer recurrence: A retrospective analysis. Spironolactone is used off-label for androgenic alopecia because of its ability to arrest hair loss progression and long-term safety profile. However, little is known about the safety of spironolactone in breast cancer (BC) survivors. Due to spironolactone's estrogenic effects, there is a theoretical risk for BC recurrence. Given that spironolactone is an important tool in the treatment (...) of alopecia, we investigated whether spironolactone increased risk for BC recurrence.Determine whether spironolactone is associated with increased BC recurrence.A retrospective analysis was conducted using Humana Insurance database. Patients with a history of BC were identified using International Classification of Diseases codes, stratified by spironolactone prescription, and also matched 1:1 using propensity score analysis. Patient characteristics and cancer recurrence rates between both cohorts were

2020 Journal of American Academy of Dermatology

286. Breast Cancer Treatment (PDQ®): Health Professional Version

, Gierach GL, et al.: Mammographic density and breast cancer risk in White and African American Women. Breast Cancer Res Treat 135 (2): 571-80, 2012. [ ] [ ] Key TJ, Appleby PN, Reeves GK, et al.: Circulating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies. Br J Cancer 105 (5): 709-22, 2011. [ ] [ ] Kaaks R, Rinaldi S, Key TJ, et al.: Postmenopausal serum androgens, oestrogens and breast cancer risk: the European prospective investigation into cancer

2018 PDQ - NCI's Comprehensive Cancer Database

287. Childhood Cancer Genomics (PDQ®): Health Professional Version

of H3.3 and H3.1 K27M mutations almost exclusively among pediatric midline high-grade gliomas. The loss of SMARCB1 in rhabdoid tumors. The presence of RELA translocations in supratentorial ependymomas. The presence of specific fusion proteins in different pediatric sarcomas. Another theme across multiple childhood cancers is the contribution of mutations of genes involved in normal development of the tissue of origin of the cancer and the contribution of genes involved in epigenomic regulation (...) to that observed in non-Ph+ high hyperdiploid patients. Certain patients with hyperdiploid ALL may have a hypodiploid clone that has doubled (masked hypodiploidy).[ ] These cases may be interpretable based on the pattern of gains and losses of specific chromosomes (hyperdiploidy with two and four copies of chromosomes rather than three copies). These patients have an unfavorable outcome, similar to those with hypodiploidy.[ ] Near triploidy (68–80 chromosomes) and near tetraploidy (>80 chromosomes) are much

2018 PDQ - NCI's Comprehensive Cancer Database

288. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

incidence of hearing loss increased during this time. Declines in morbidity were not uniform across the diagnosis groups or condition types because of differences in treatment and survival patterns over time (refer to for more information).[ ] Figure 3. Cumulative incidence of grade 3–5 chronic health conditions in 5-year survivors of childhood cancer by diagnosis decade and siblings. (A) Cumulative incidence of a first grade 3–5 condition. (B) Cumulative incidence of two or more grade 3–5 conditions (...) : a report from the Children's Oncology Group. J Clin Oncol 30 (27): 3408-16, 2012. [ ] [ ] Effinger KE, Migliorati CA, Hudson MM, et al.: Oral and dental late effects in survivors of childhood cancer: a Children's Oncology Group report. Support Care Cancer 22 (7): 2009-19, 2014. [ ] [ ] Bass JK, Knight KR, Yock TI, et al.: Evaluation and Management of Hearing Loss in Survivors of Childhood and Adolescent Cancers: A Report From the Children's Oncology Group. Pediatr Blood Cancer 63 (7): 1152-62, 2016

2018 PDQ - NCI's Comprehensive Cancer Database

289. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

shown that it is possible to reduce the radiation dose to 55 Gy to 60 Gy for good responders.[ , ] Surgery. Surgery has a limited role in the management of nasopharyngeal carcinoma; the disease is usually considered unresectable because of extensive local spread. The combination of cisplatin-based chemotherapy and high doses of radiation therapy to the nasopharynx and neck are associated with a high probability of hearing loss, hypothyroidism and panhypopituitarism, trismus, xerostomia, dental

2018 PDQ - NCI's Comprehensive Cancer Database

290. Breast Cancer Prevention (PDQ®): Health Professional Version

) cancer and ductal carcinoma in situ (DCIS). The reduction in ER-positive invasive breast cancer was maintained at about this level for at least 16 years after starting treatment, 11 years after cessation of tamoxifen. There was no loss of effect between years 10 and 16 after starting tamoxifen (for 5 years) compared with years 0 to 10. There was no effect on breast cancer mortality.[ ] Study Design : RCTs. Internal Validity : Good. Consistency : Good. External Validity : Good. Selective estrogen (...) have an increased risk. Women who develop breast cancer tend to have higher endogenous estrogen and androgen levels.[ - ] Conversely, women who experience premature menopause have a lower risk of breast cancer. Following ovarian ablation, breast cancer risk may be reduced as much as 75% depending on age, weight, and parity, with the greatest reduction for young, thin, nulliparous women.[ - ] The removal of one ovary also reduces the risk of breast cancer but to a lesser degree than does the removal

2018 PDQ - NCI's Comprehensive Cancer Database

291. Breast Cancer Prevention (PDQ®): Health Professional Version

) cancer and ductal carcinoma in situ (DCIS). The reduction in ER-positive invasive breast cancer was maintained at about this level for at least 16 years after starting treatment, 11 years after cessation of tamoxifen. There was no loss of effect between years 10 and 16 after starting tamoxifen (for 5 years) compared with years 0 to 10. There was no effect on breast cancer mortality.[ ] Study Design : RCTs. Internal Validity : Good. Consistency : Good. External Validity : Good. Selective estrogen (...) have an increased risk. Women who develop breast cancer tend to have higher endogenous estrogen and androgen levels.[ - ] Conversely, women who experience premature menopause have a lower risk of breast cancer. Following ovarian ablation, breast cancer risk may be reduced as much as 75% depending on age, weight, and parity, with the greatest reduction for young, thin, nulliparous women.[ - ] The removal of one ovary also reduces the risk of breast cancer but to a lesser degree than does the removal

2018 PDQ - NCI's Comprehensive Cancer Database

292. Acne vulgaris

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 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 (...) Acne vulgaris Acne vulgaris - NICE CKS Share Acne vulgaris: Summary Acne vulgaris is a chronic inflammatory skin condition affecting mainly the face, back and chest - it is characterised by blockage and inflammation of the pilosebaceous unit (the hair follicle, hair shaft and sebaceous gland). It presents with lesions which can be non-inflammatory (comedones), inflammatory (papules, pustules and nodules) or a mixture of both. Up to 95% of adolescents in Western industrialized countries

2018 NICE Clinical Knowledge Summaries

293. Polycystic ovary syndrome

. Oligomenorrhoea or amenorrhoea is present. Symptoms include clitoromegaly, extreme hirsutism, and male pattern alopecia. Acromegaly Normal or mildly raised androgen levels with or without symptoms. Oligomenorrhoea or amenorrhoea is often present. Symptoms include enlargement of the extremities, coarse features, and prognathism. Increased plasma insulin-like growth factor levels. Also consider: Hypogonadotropic hypogonadism (that is central origin of ovarian dysfunction). Hyperandrogenic-insulin resistant (...) is unknown. It is likely to be multifactorial, with both genetic and environmental factors playing a part. Complications include: Metabolic disorders, such as impaired glucose tolerance and type 2 diabetes. Cardiovascular disease. Infertility. Pregnancy complications, such as pre-eclampsia and gestational diabetes. Endometrial cancer. Psychological disorders, such as anxiety and depression. Obstructive sleep apnoea. To help diagnose PCOS: Free androgen index should be calculated to assess the amount

2018 NICE Clinical Knowledge Summaries

294. Amenorrhoea

insufficiency (POI) due to chromosomal irregularities (for example, Turner's syndrome) and hypothalamic-pituitary dysfunction (for example, due to stress, weight loss, and/or excessive exercise [functional hypothalamic amenorrhoea]). Causes of secondary amenorrhoea include: In those with no features of androgen excess — physiological causes (pregnancy, lactation, and menopause), hypothalamic dysfunction (for example, due to chronic systemic illness or stress, weight loss, and/or excessive exercise), and POI (...) of the can also cause primary amenorrhoea, if they occur before the menarche. [ ; ; ; ; ; ] [ ] [ ; ] Causes of secondary amenorrhoea What are the causes of secondary amenorrhoea? Causes of secondary amenorrhoea in those with no features of androgen excess include: Physiological causes: Pregnancy. Lactation. Menopause. Premature ovarian insufficiency, for example, due to: Chemotherapy. Radiotherapy. Autoimmune disease. Hypothalamic dysfunction due to stress, excessive exercise, and/or weight loss

2018 NICE Clinical Knowledge Summaries

295. Infertility

that may compromise vascularisation of the testes and lead to testicular atrophy. Idiopathic (unknown aetiology and pathogenesis). Genetic disorders, including: Klinefelter's syndrome with karyotype 47, XXY, which is associated with hypogonadism and disorders of spermatogenesis. This is the most common sex chromosome disorder associated with infertility. Kallmann syndrome, which causes hypogonadotrophic hypogonadism. Small testes. Sterility. Testicular feminization (or androgen insensitivity syndrome (...) ), a condition where there is resistance to the virilising effects of androgens, and a child with an XY karyotype appears as a girl. This can be much less complete, and more limited resistance to androgens can lead to poor development of the testes. Obstructive azoospermia (defined as the absence of both spermatozoa and spermatogenic cells in semen and post-ejaculate urine due to bilateral obstruction of the seminal ducts). Causes include [ ; ]: Ejaculatory duct obstruction: Congenital — prostatic cysts

2018 NICE Clinical Knowledge Summaries

296. Hypothyroidism

fatigue/lethargy, cold intolerance, weight gain, weakness, arthralgia and myalgia, constipation, menstrual irregularities, depression, and cognitive impairment. Signs include hair loss, coarse dry hair and skin, oedema, goitre, bradycardia, diastolic hypertension, and delayed relaxation of deep tendon reflexes. OH should be treated with levothyroxine (LT4) — all people who are stable on LT4 require at least annual measurement of serum TSH levels. Treatment of SCH depends on the specific clinical (...) include: Changes to appearance such as coarse dry hair and skin and hair loss. Oedema, including swelling of the eyelids. Vocal changes such as hoarseness or deepening of the voice. Goitre. Bradycardia and diastolic hypertension. Delayed relaxation of deep tendon reflexes. Paraesthesia — due to carpal tunnel syndrome. Secondary hypothyroidism Symptoms and signs include those of primary hypothyroidism with or without those associated with: An intracranial mass such as headache, diplopia, or reduced

2018 NICE Clinical Knowledge Summaries

297. Acne clinical guideline Full Text available with Trip Pro

, A. Hormonal profiles and prevalence of polycystic ovary syndrome in women with acne. J Dermatol . 1997 ; 24 : 223–229 | | , x 53 Lucky, A.W. Endocrine aspects of acne. Pediatr Clin North Am . 1983 ; 30 : 495–499 | , x 54 Lucky, A.W., McGuire, J., Rosenfield, R.L., Lucky, P.A., and Rich, B.H. Plasma androgens in women with acne vulgaris. J Invest Dermatol . 1983 ; 81 : 70–74 | | | , x 55 Abulnaja, K.O. Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris. Braz J Med (...) : 25–33 | | | | | Spironolactone B II, III x 102 Shaw, J.C. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol . 2000 ; 43 : 498–502 | | | | , x 103 Sato, K., Matsumoto, D., Iizuka, F. et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesthetic Plast Surg . 2006 ; 30 : 689–694 | | | Flutamide C III x 104 Wang, H.S., Wang, T.H., and Soong, Y.K. Low dose flutamide

2016 American Academy of Dermatology

298. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science Full Text available with Trip Pro

, and hair texture) that imposes social concerns. Interestingly, racial/ethnic variations in IHD exist in the United States, and black women have higher prevalence rates (7.0%) of IHD compared with Hispanic (5.9%) and white (4.6%) women. The same trend is noted with myocardial infarction (2.2%, 1.7%, and 1.8%, respectively) and angina (5.0%, 3.8%, and 2.9%). The AHA statistical data for Asian and American Indian/Alaska Native women either are not listed or did not meet the standards of reliability (...) of HRT, the dose of HRT, or the preparation of the HRT itself may play a role in the efficacy. For example, conjugated equine estrogen is a common estrogenic HRT, but because of the source (urine of pregnant mares), there are a significant number of other steroids in the preparation such as androgens. Conjugated equine estrogen was the preparation used in the WHI. Ichikawa and colleagues found that transdermal HRT for 12 and 24 months reduced diastolic and mean BPs in normotensive postmenopausal

2016 American Heart Association

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