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Androgenic Alopecia

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281. 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

2018 European Association of Urology

282. 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

2018 European Association of Urology

283. Prostate Cancer

, I.M., et al. The influence of finasteride on the development of prostate cancer. N Engl J Med, 2003. 349: 215. 57. Haider, A., et al. Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries. J Urol, 2015. 193: 80. 58. Watts, E.L., et al. Low Free Testosterone and Prostate Cancer Risk: A Collaborative Analysis of 20 Prospective Studies. Eur Urol, 2018. 74: 585. 59. Zhou, C.K., et al. Male Pattern Baldness in Relation

2018 European Association of Urology

284. 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

2018 European Association of Urology

285. Testosterone Replacement Guidelines

aetiology, androgen deficiency secondary to testicular failure (hypergonadotrophic hypogonadism) of various aetiology, and constitutional delay of growth and puberty (CDGP). The aim of testosterone replacement therapy is to mimic the normal pattern of puberty and mimic requirements at different stages of pubertal development 1 . This guideline aims to provide the clinician with testosterone dosing regimens for pubertal induction, progression and post-pubertal maintenance, as well as for penile growth (...) ? Premature epiphyseal closure and stunting of final height (if high doses taken) ? Mood swings, acne, behavioural disturbance ? Worsening of sleep apnoea ? Polycythaemia ? Gynaecomastia ? Weight gain ? Hypertension ? Cholestatic jaundice ? Electrolyte disturbance Future possible issues in adulthood ? Suppression of spermatogenesis - discontinue when seeking fertility ? Acceleration of male pattern balding ? Worsening of benign prostatic hypertrophy, possible prostate cancer Page | 10 ? Possible

2019 British Society for Paediatric Endocrinology and Diabetes

286. Prevention and Management of Dermatological Toxicities Related to Anticancer Agents: ESMO Clinical Practice Guidelines Full Text available with Trip Pro

. Histologically, there is a miniaturisation of hair follicles and a decreased anagen-to-telogen ratio. Endocrine therapies may also cause excessive hair growth in androgen-dependent areas of the body in women (hirsutism). In patients presenting with EIA, differential diagnoses should be ruled out by laboratory testing [thyroid gland function, thyroid-stimulating hormone (TSH) and free T4, iron stores (ferritin), vitamin D, and zinc levels] and examination for female-pattern hair loss, alopecia areata (...) ) is frequently underreported in clinical trials and is inaccurate in observational studies. For CIA, the population-based Dutch Cancer Registry showed that 24% of patients with solid tumours received cytotoxic ChT and 48% of ChTs resulted in grade 2 alopecia (this refers to a hair loss of more than 50% than normal for that individual, that is readily apparent to others) (see supplementary Table S2 available at Annals of Oncology online) [ Paus R. Haslam I.S. Sharov A.A. Botchkarev V.A. Pathobiology

2020 European Society for Medical Oncology

287. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

posterior hairline 40 Broad short-appearing neck 40 Pterygium colli (webbed neck) 25 Thorax Broad chest (shield chest) 30 Inverted nipples 5 Skin, nails, and hair Increased skin ridge count 30 Lymphedema of hands and feet 25 Multiple pigmented naevi 25 Nail hypoplasia/dystrophy 10 Vitiligo 5 Alopecia 5 Skeleton Bone age delay 85 Decreased bone mineral content 50–80 Cubitus valgus 50 Short fourth metacarpal 35 Genu valgum 35 Congenital hip luxation 20 Scoliosis 10 Madelung deformity 5 Heart Bicuspid (...) recommend a formal audiometric evaluation every 5 years regardless of the initial age at diagnosis, initial hearing threshold levels, karyotype and/or presence of a mid-frequency sensorineural hearing loss, to assure early and adequate technical and other rehabilitative measures (⨁⨁◯◯). R 6.2. We recommend aggressive treatment of middle-ear disease and otitis media (OM) with antibiotics and placement of myringotomy tubes as indicated (⨁⨁◯◯). R 6.3. We recommend screening for hypothyroidism at diagnosis

2017 European Society of Endocrinology

288. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Full Text available with Trip Pro

identity, the prevalence of GD/gender incongruence was much greater in this group than in the general population without a DSD. This supports the concept that there is a role for prenatal/postnatal androgens in gender development ( – ), although some studies indicate that prenatal androgens are more likely to affect gender behavior and sexual orientation rather than gender identity per se ( , ). Researchers have made similar observations regarding the potential role of androgens in the development (...) of gender identity in other individuals with DSD. For example, a review of two groups of 46,XY persons, each with androgen synthesis deficiencies and female raised, reported transgender male (female-to-male) gender role changes in 56% to 63% and 39% to 64% of patients, respectively ( ). Also, in 46,XY female-raised individuals with cloacal exstrophy and penile agenesis, the occurrence of transgender male changes was significantly more prevalent than in the general population ( , ). However, the fact

2017 Pediatric Endocrine Society

290. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

. J Appl Behav Anal. 2011 Fall;44(3):523-41. doi: 10.1901/jaba.2011.44-523. PMID: 21941383.X-1 D-66 766. Mrozek-Budzyn D, Majewska R, Kieltyka A, et al. [Lack of association between thimerosal-containing vaccines and autism]. Przegl Epidemiol. 2011;65(3):491- 5. PMID: 22184954.X-1 767. Myck-Wayne J, Robinson S, Henson E. Serving and supporting young children with a dual diagnosis of hearing loss and autism: the stories of four families. Am Ann Deaf. 2011 Fall;156(4):379-90. PMID: 22256539.X-1 768

2017 Effective Health Care Program (AHRQ)

291. CRACKCast E128 – Thyroid and Adrenal Disorders

Cold intolerance Coarse, brittle hair Alopecia Dry skin Lethargy Agitation Mononeuropathy Proximal myopathy Signs of hypothyroidism: Vitals – normal or low and slow Refer to box 120.5 in Rosen’s 9 th edition for the symptoms and signs of hypothyroiditis [7] List 5 lab abnormalities, 2 ECG findings, and 1 CXR finding in hypothyroidism An elevated TSH level with a low T4 level is indicative of primary hypothyroidism. Other laboratory findings may include: Mild anemia, Hypercholesterolemia, Elevated (...) , conjunctival hyperemia, and chemosis. Graves’ ophthalmopathy is also associated with restrictive extraocular myopathy, and exophthalmos . As the disease progresses, patients may experience restriction of their upward gaze from infiltration of the inferior rectus muscle and visual loss from optic nerve involvement (compression by inflamed, enlarged orbital contents). Ophthalmologic findings: Thyroid Stare Proptosis / exophthalmos AP distance from orbital ridge to ant cornea > 20mm Excessive tearing Diplopia

2017 CandiEM

292. 4th ESO?ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)

these regimens as (neo)adju- vant treatment and for whom ChT is ap- propriate. Other options are, however, available and effective, such as capecita- bine and vinorelbine, particularly if avoiding alopecia is a priority for the patient. I/A 71% In patients with taxane-naive and anthracy- cline-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 (...) by an important expression of androgen receptor (AR; luminal AR subtype). The fact that bicalutamide, an anti- androgen approved for the treatment of prostate cancer, is avail- able, has led to some off-label use in advanced TNBC. However, the panel believes that this type of agent should not be used in routine clinical practice, in view of the very limited data that exist [46–48] and until the determination of the AR is optimised and standardised. Unfortunately, the development of enzaluta- mide, another

2018 European Society for Medical Oncology

293. Interventions to Address Sexual Problems in People With Cancer

education may need to be provided on the changes in erection and alternative ways to maintain sexual intimacy. Body image, including such issues as weight changes, disfigurement, scarring, and hair loss, should be discussed and normalized in men. Clinicians should check testosterone levels, even if the patient has a cancer that is not typically associated with hormone changes. Options should be discussed when testosterone levels are within normal range but the patient or clinician feels supplementation (...) be associated with improvement in the domains of the sexual response. To this end, any underlying physical issue contributing to sexual dysfunction should be identified and managed. Sexual Response for Men Recommendations Body image is important to men’s sexual health. Issues such as weight change, increase in breast size, disfigurement, scarring, and hair loss should also be discussed and normalized in men. Normalizing these issues may help men reach a new comfort level with body image and functioning

2017 American Society of Clinical Oncology Guidelines

294. Obesity in Adolescents

, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Obesity in Adolescents ABSTRACT: Rates of obesity among adolescents in the United States have increased at a dramatic rate (...) screen overweight and obese adolescents for depression, bullying, and peer victimization and appropriately refer to school-based and community-based resources as well as psychiatric services. There are currently no evidence-based guidelines for the use of pharmaceutical agents in the management of obesity in adolescents. The obstetrician–gynecologist should caution against the use of weight loss supplements. A multidisciplinary team, including an experienced bariatric surgeon, dietitian

2017 American College of Obstetricians and Gynecologists

295. The 2017 hormone therapy position statement of The North American Menopause Society

is preserved, reduces risk for osteoporosis and relatedfractures,VVA,anddyspareunia,withbenefitseen in observational studies for atherosclerosis and CVD, cognition, and dementia. Younger women may require higher doses for symptom relief or protection against bone loss. Ovarian conservation is recommended, if possible, when hysterectomy for benign indications is performed in pre- menopausal women at average risk for ovarian cancer. SKIN, HAIR, AND SPECIAL SENSES Estrogentherapymay (...) in appropriate candidates. Prevention of bone loss Hormonetherapyhasbeenshownindouble-blindRCTsto prevent bone loss, and in the WHI, to reduce fractures in postmenopausal women. 24,25 Premature hypoestrogenism Hormonetherapyisapprovedforwomenwithhypogonad- ism, POI, or premature surgical menopause without contra- indications, with health benefits for menopause symptoms, prevention of bone loss, cognition and mood issues, and in observational studies, heart disease. 26-31 Genitourinary symptoms Hormone

2017 The North American Menopause Society

296. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline

; decreased frequency of morning erections; decreased performance • Somatic: Increased visceral body fat/obesity; decreased lean muscle mass; decreased strength; fatigue/loss of energy; decreased physical activity/ vitality; low bone mineral density; anemia; flushes; loss of facial, axillary and pubic hair/slow beard growth; decline in general feeling of well-being • Psychological: Depression/depressed mood; mood changes; irritability; inability to concentrate; insomnia/sleep disturbancesGuidelines CMAJ 5 (...) refractory to standard treatment, as well as for men taking glucocorticoid or opioid therapy and men with HIV infection if they have experienced weight loss (weak recommendation; low-quality evidence). 9. In men with erectile dysfunction and no other manifestations of testosterone deficiency syndrome, we suggest investigation only after a trial of phosphodiesterase type 5 (PDE-5) inhibitors has failed (weak recommendation; low-quality evidence). Treatment 10. We recommend that men with documented

2015 CPG Infobase

297. Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations

for efficacy and safety, focusing on ameliorating symptoms, restoring virilisation, avoiding polycythaemia and maintaining or improving bone mineral density. Treatment aims to relieve an individual’s symptoms and signs of androgen deficiency by administering standard doses and maintaining circulating testosterone levels within the reference interval for eugonadal men. Evaluation for cardiovascular disease and prostate cancer risks should be undertaken as appropriate for eugonadal men of similar age (...) . Nevertheless, when there is a reasonable possibility of substantive pre-existing prostate disease, digital rectal examination and prostate-specific antigen testing should be performed before commencing testosterone treatment. Changes in management as result of the position statement: Treatment aims to relieve symptoms and signs of androgen deficiency, using convenient and effective formulations of testosterone. Therapy should be monitored for efficacy and safety. The Endocrine Society of Australia

2016 MJA Clinical Guidelines

298. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting Full Text available with Trip Pro

posterior hairline 40 Broad short-appearing neck 40 Pterygium colli (webbed neck) 25 Thorax Broad chest (shield chest) 30 Inverted nipples 5 Skin, nails, and hair Increased skin ridge count 30 Lymphedema of hands and feet 25 Multiple pigmented naevi 25 Nail hypoplasia/dystrophy 10 Vitiligo 5 Alopecia 5 Skeleton Bone age delay 85 Decreased bone mineral content 50–80 Cubitus valgus 50 Short fourth metacarpal 35 Genu valgum 35 Congenital hip luxation 20 Scoliosis 10 Madelung deformity 5 Heart Bicuspid (...) recommend a formal audiometric evaluation every 5 years regardless of the initial age at diagnosis, initial hearing threshold levels, karyotype and/or presence of a mid-frequency sensorineural hearing loss, to assure early and adequate technical and other rehabilitative measures (⨁⨁◯◯). R 6.2. We recommend aggressive treatment of middle-ear disease and otitis media (OM) with antibiotics and placement of myringotomy tubes as indicated (⨁⨁◯◯). R 6.3. We recommend screening for hypothyroidism at diagnosis

2016 European Society of Human Reproduction and Embryology

299. Palbociclib (Ibrance) - locally advanced or metastatic breast cancer

in identifying patients who may benefit from endocrine therapy. ER-positive tumors make up 65% of tumors in women aged 35 to 65 years and 82% of tumors in women older than 65 years. These cancers are largely estrogen driven in postmenopausal women where the main source of the tumor’s estrogen is from conversion of androgens to estrogens via aromatase enzyme action. 2.1.2. Epidemiology Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012. This cancer (...) or amplification leading to deregulation of CDK4/6, while in triple-negative disease for example, loss of the Rb gene or protein is the main mechanism (Figure xxx). It might therefore be assumed that Rb itself may not be a useful biomarker for screening of patients with ER-positive disease due to the low expected frequency of Rb loss in this population. Nevertheless, in the present pivotal study 1008 (PALOMA-2), immunohistochemical (IHC) analysis of Rb was conducted. The results in this subgroup are presented

2016 European Medicines Agency - EPARs

300. Cochrane team criticises the ECDC experts' draft advice on oseltamivir use

he passed away unexpectedly. In a way, it might have been an ideal departure. We pray his soul may rest in peace. In this issue, we featured a new indication “male pattern baldness” of “dutasteride”, 5- a -reductase inhibitor. We have fundamental questions after reviewing it. Based on the package insert, it is indicated for “androgenic alopecia”. However, is “male pattern baldness” really a disease? Does it really need to be treated? TAMIYA, Jiro, an actor who committed suicide at the age of 43 (...) , was distressed about his sparse hair. Reportedly, he underwent hair implantation every year in Britain, and suffered from its severe complications such as migraine and memory impairment. In those days, another actor advertised wigs on TV and immediately lost his job offers. However, nowadays advertising hair tonics or wigs does not seem to affect actors’ popularity. Male-pattern baldness is also a proof of high sexual function in males. Is alopecia (sparse hair) a “disease” which is more serious than harms

2016 Med Check - The Informed Prescriber

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